Winter landscape branches form a heart-shaped pattern
Clients at my practice have shown an increase in depressive symptoms in the past month. This is typical for this time of year. The decrease in sunlight causes the Winter Blues, or technically, Seasonal Affective Disorder (SAD).
Our brains are dependent on chemicals from sunlight to create the happy chemicals. You may have noticed you are feeling more: sad, irritable, grumpy, touchy, or frustrated this month. If this is you, make an effort to get more sunlight. Sit outside during lunch. Go for a short walk before work. Anywhere you can get an extra 20-40 minutes of sunlight will be an improvement.
Is My Child Suicidal?
Child sitting alone, curled up
If you are worried about your child, whatever their age, it is good that you are paying attention. Let's talk about warning signs and give you the tools to act appropriately.
Warning signs of depression in children:
Irritability
Aggression
Crying spells
Isolation - not wanting to talk, not wanting to be around their friends
Lack of pleasure in things - do not want to play with their toys, their pets, their friends
Talking about suicide is okay. Talking about or asking about suicidal thoughts does not increase them, so ask. "Are you thinking of suicide at all?" An open-ended question like this invites the child to talk about what they have been thinking, so you know what is on their mind, if they choose to share.
If your child says they have been thinking about suicide, or thinking "it would be better if I were not alive" or "sometimes I think about being dead" or "it would be easier if I were just gone", this does not mean they are suicidal. These are normal thoughts that many people have, no matter their age. Therapy would be a good intervention at this point. Your child is saying they are in pain and need relief.
Probe to the next level "Do you have a plan to kill yourself? Do you want to kill yourself?" Use plain language like this and be direct. You need to know the information and asking like this will get you what you need. If your child has a plan and a desire to attempt suicide, intervene immediately. Google "mobile crisis team [your county]" to find the number for who to call. A mobile crisis team will come to your home, interview you and your child, and make a determination as to the severity of the suicidality. If warranted, they will take your child (or refer you) to the nearest psychiatric admitting hospital. If not warranted, meaning there is not immediate danger, they will encourage you to seek therapy for your child, which you should start as soon as possible. To find a therapist, you can search Psychology Today for your city and insurance, but be aware that many therapists (like myself) use telebehavioral health and you can see them from anywhere in the state, so you have additional options if you open your search to include telehealth.
If your child is cutting, that is, you see marks on their arms, legs, or torso, ask about it. "Why do you cut yourself? How often do you do so? What is the benefit you get from that? When was the last time that you did it? Are you taking care of the wound so they heal properly and don't get infected?" Cutting is not suicide. Please take cutting for what it is: a way to release emotion, or a way to feel something when numbness is all that they are feeling. Cutting behavior should always be accompanied by therapy because either cause is a sign of deep sadness.
If you have a child that is hurting, having your own therapy is a benefit to you and to the family. You can learn how to support your child, have an outlet to express your frustration or sadness, and get support as you go through this tough time for your family.
Multiple State Licenses
Autumn Hahn, Licensed Mental Health Counselor, Licensed Professional Counselor, Certified Clinical Hypnotherapist
There is a lot of confusion when it comes to getting licensed in multiple states. How do I begin? What is it called? What's the benefit? I'll demystify some of that here. I am licensed in Florida, my primary state, and state of residence, since 2010. I got licensed in Georgia in 2021, and have licenses pending in Washington DC and New York.
Why get licensed in multiple states?
The more states I am able to see clients in, the more business I stand to get. I accept insurance, and utilize a number of referral sources to get clients (if you are interested in information on those, please email me and I'll refer you).
Having a wider base allows me to see the clients who are the most appropriate fit for my specialty. I specialize in trauma, and typically work with only those clients, so I don't see everyone who needs therapy, only those who seek me out.
Working in multiple states allows me to serve a wider population. Being in telebehavioral health (seeing clients by video) allows me to serve clients in underserved areas, across the entire state.
The American Counseling Association is working on an Interstate Compact that will allow us to practice across state lines for those states participating in the compact, provided you are licensed in one of those states. The American Psychiatric Association has something similar for psychiatrists. You can learn more about the Compact here.
What are the types of license across states?
License by reciprocity - This is outdated. I have heard rumors that some states used to let you practice across state lines simply because you held a license in your state of origin. This is not true now, with the exception of some ability to do so during the pandemic. Do not pursue this. Even if you find it is true for some pandemic-related rules, it will go away at some point soon, if it hasn't already. This is not a modern law or rule.
License by endorsement - This is your search criteria. If you want to become licensed in another state, search "License by endorsement counselor [state]" and follow the rules on their webpage. You may find that you need to have been licensed for a certain amount of years in your state of origin to qualify (in New York, for example, you have to be licensed for 5 years to qualify), or there may be other rules related to how many practicum hours you need to have completed, certain coursework your school needed to provide you, etc. You may also have to take an additional continuing education course to qualify; New York has a 2 hour child abuse awareness and reporting course everyone has to take. Complete the paperwork and send in your fee. Be aware that you will need access to: your unofficial transcript, your employment and education history, your existing license(s), professional references, and will likely have to send official transcripts, may have to get finger prints done, and more. The process varies by state. The verification and licensing process also varies by state. Georgia, for example, took less than 6 weeks to process all of my information and approve my license. DC, however, has had my paperwork for over 3 months and it is still "pending" with no reason given.
Your title may change as you apply across state lines. I am a Licensed Mental Health Counselor in Florida, but my title in Georgia is Licensed Professional Counselor. It is the same information, same degree, same everything, but certain states have different titles. It does not functionally mean or change anything.
Now what?
Once your secondary (or more) license has been approved, do a couple of things:
Update your referral sources to reflect the new status so you can begin advertising to those states. This includes your Psychology Today profile, website, email signature (mine says I am accepting clients in Florida and Georgia), and any paid referral sites that send you clients where you have a profile.
Go to your CE tracker and enter the new information so you can log all your appropriate CEUs and be certain you don't miss any renewal dates. Make a note in your calendar to take a course that you need, as appropriate. I use CEBroker for Florida and CEWindow for Georgia.
