Help us congratulate Jordan Langley, our former intern and recent graduate from the National University MFT program. She is now employed at Healing Reflections Therapy: Diversity, Trauma and Wellness Services and is accepting news clients as she is pursuing her license as a Marriage and Family Therapist. Feel free to send folks her way! Private pay or Aetna insurance. She has afternoon and evening availability, both virtual and in-person in South City St. Louis.
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We hope to see you all join us for a day of therapeutic and relaxation related activities at this year's Tower Grove Pride Festival in St. Louis City. The festival is all weekend, but we are just there on Sunday. Whether you want therapy dog cuddles, need a quiet moment to color, want to learn some new guided relaxation skills, or want to make some fun stress balls or make a packet of coping skills, we are here to help! Sign-up today. Free events all day!

We spoke in an earlier post about the important elements for success in therapy, one of which was finding a therapist that was a good fit.

With the rise of mental health platforms run by tech corporations that have a wide social media presence, there has been a new vogue of treating your therapist like online dating, the minute something is uncomfortable you should get out, swipe left, keep shopping, there’s always another one ready to pop up and take their place.

Wait! Hold on just a minute. 

There may be some valid reasons to terminate your relationship with your therapist, but there may also be some good reasons to stay that you may not have considered.

When to go
As therapists, we frequently hear horror stories of past therapists- be it unethical practices, unorthodox practices, or interventions that did more harm than good. A therapist that crosses boundaries to have sex with a client, or exploits the therapeutic relationship for their own gain, or abuses their power are all serious causes for concern. If a therapist is displaying overtly unethical or illegal behavior, then the relationship needs to end.

Ruptures in rapport: A Forgivable Offense?
Most complaints about a prior therapists usually arise not because the therapist is inherently bad, but because of differing perspectives/worldviews, cultures, generational differences that lead to feeling, hurt, invalidated and misunderstood. For example, a client not liking the words chosen or boundaries set, or feeling uncomfortable with being held accountable in session, the therapist breaching trust by fulfilling their legal obligation to make a hotline report, or recommending medication or hospitalization; or a therapist making a human error in scheduling, missing an email or call, looking sleepy, forgetting something client previously said, being distracted, conflict over a billing error, snacking during session, seeming too casual or not casual enough, or perceiving the therapist as not on their side enough. These slights, however unintentional can hurt, but whether or not it is worth ending the therapeutic relationship over may be complicated.

​Ruptures in rapport are common, especially as the relationship deepens and therapy reaches newer levels of trust and patterns of earlier relationships begin to play out in the therapeutic relationship. While most licensed therapists are well meaning and do their best to serve their clients with the tools they have, they are also human and have their flaws. Some are wounded healers who are still in the middle of their own journeys, others come from a place of privilege or have not sufficiently done their deconstruction and decolonizing work. Both may inadvertently harm the client. Ideally, therapists should spend some time in their own therapy as well as supervision and consultation doing self-of-therapist work prior to seeing clients, if not on an ongoing basis. 

Ruptures as Opportunities for Corrective Emotional Experience 
Therapy is a microcosm of the rest of the world, meaning that problems that play out in the external world often find a way to play themselves out in the therapy room as well. Challenges in the therapeutic relationship are opportunities for a corrective emotional experience that one may not otherwise have had with others in their life. For example, if you are upset with you therapist for something they said or how they handled a situation, your ability to confront them can be the first time you may feel able to use your voice and challenge someone who has hurt you, but in a safe way (hopefully). In this way, addressing conflict and dissatisfaction with your therapist is both courageous and encouraged, and can be an empowering and healing, and deeply transformative process with breaking patterns in the clients’ life. 

Political Betrayal by Your Therapist
There are times when a therapeutic relationship just isn’t the right fit, for example there is a recent discussion about folks leaving their therapist after learning their therapist voted in a way that went against their rights. Essentially, the therapist has violated the clients' trust with their betrayal and failure to protect their rights. Traditionally, therapists are trained to be neutral and not bring their stuff into the room and not share much about themselves personally- but arguably anyone who works with marginalized populations and sexual or religious trauma survivors needs to NOT be neutral about protecting the folks they serve. They have a fiduciary responsibility to care about their clients not just in the therapy room, but who they are as people. In this way, the political is very personal, so sometimes a political/cultural/gender/racial/religious match may be necessary for building trust and eliminating harmful bias.

When To Pause before a break-up-When Attachment Wounds Run the Show
The "swipe left" method for choosing/leaving a therapist is particularly problematic if the client has concerns with attachment. What do we mean by that? Healthy attachment develops from our early caregivers. When we feel safe and our needs lovingly cared for, we develop a secure attachment, which enables us to have healthy, secure trusting relationships in adulthood. When our needs are not met, or we grow up in unsafe/traumatic, unpredictable, or chaotic environments we may develop anxious, avoidant, disorganized or insecure attachment styles that hinder our brain development and adult relationships. In children, they may be given a diagnosis known as RAD, Reactive Attachment Disorder, commonly seen among foster and adopted kids where there is a disruption to the early attachment relationships. This article talks more in-depth about the disastrous consequences of early attachment wounds and the impact it has on one's ability to attach to future care-givers. 
https://www.theatlantic.com/magazine/archive/2020/07/can-an-unloved-child-learn-to-love/612253/ .  Mary Ainsworth, Margaret Mahler, Harry Harlow, and John Bowlby were among the early pioneers of attachment theory and more modern books by Dr. Bruce Perry have talked about this concept. At the end of this article there are some videos that talk about these foundational attachment studies and why early attachment relationships are so fundamental to development. 

Carl Rogers, famous for developing the Humanistic client-centered psychotherapy treatment method commonly seen as the foundation of most clinical practices wrote about his theory of change in “On Becoming a Person” where he compared the role of the therapist to that of a healthy soil for a tree to grow. In order for someone to grow and flourish, there needs to be a healthy, nurturing soil. Although the home/family environment might not have been provided enough sustenance for early growth, healing/growth in the therapeutic realm can be made through a secure attachment with the therapist by way of empathy, genuineness, and unconditional positive regard.   

So while for some people the task may be to find the “right fit” with the therapist, for others their challenge is deeper- to work through their attachment wound and allow themself to connect/share intimately in a therapeutic relationship, to not run away as the relationship deepens as a form of self-sabotage (i.e., I will leave them before then can leave me, So I won’t be hurt again), and to be able to appropriately address and work through conflict in order to make repairs to be able to have enduring relationships. This process of challenging patterns helps build new neural networks in the brain, to make repairs from earlier setbacks.

Trust and Attachment Takes Time
For some folks, the real work in therapy may not begin for 6 months to a year until they have worked with the therapist long enough to “test them” to ensure the therapist will not reject or abandon them, only then do they start to show their therapist their deeper wounds, pain, insecurities and problematic behaviors. Not surprisingly, this same pattern can emerge in romantic relationships, where the partnership seems like bliss, so they rush to marry or move-in together quickly. Once the partner has them on the hook, suddenly their personality and behavior shift. One begins to see an entirely different side of the person than they did before, and in some cases it may seem like a Dr. Jekyll/Mr. Hyde situation. The other partner often feels confused and betrayed. 

A Note About The Impact of Sexual Trauma on Attachment Wounds
One common scenario where attachment wounds play out with women in romantic relationships is when there is a history of sexual trauma. In the wake of the trauma she may experience distorted beliefs in which she believes it is her fault, is damages, unloveable, unwanted, or not good enough. This leaves her feeling hurt, sad, lonely, and isolated. As a result she may end up hooking up with various people in a serial fashion combo of trauma re-enactment, maladaptive coping, attempts to reclaim power, and self-fulfilling prophecy. Eventually she ends up with a hook-up that turns into a situationship that turns into a relationship. It starts out hot, but once the relationship gets to a point of stability and safety, the sex life turns cold and avoidant. The couple starts fighting more as he is frustrated and hurt from the rejection and she is feeling pressured and coersed into unwanted and painful sexual activity which cause her to further lose interest and avoid any attempts at intimacy, for fear it will lead to demands/pressure for sex. This pressure is a trauma trigger that feeds back into her original negative beliefs about herself that she is damaged/unloveable/only good for sex. The antidote is recognizing those patterns, and encouraging the partner to create a safer space while the she works to challenge her distorted beliefs and anxiety about triggers. If the couple can work through this together, they can have a deeply satisfying, intimate relationship. If they cannot address it together, there is the risk that the pattern will be repeated with the next partner, and the next. The same can be said about the therapist, if conflicts in therapy room are not addressed, there is a risk that pattern will present with the next therapist and so on.

So, before you fire off that email to break-up with your therapist, really sit and be curious. Ask yourself:
Is this about them, or is this about Me? 
Is this similar to a pattern in your life with other providers, family members, friends, or romantic partners?  
Am I leaving to avoid conflict? 
Am I leaving to avoid connection? 
Have I done the work to give them the opportunity to change or demystify their process or apologize?  
Are they safe?
Do they respect my dignity and autonomy?
Is this therapeutic relationship doing more harm than good?
Were they having an off day when something happened that hurt your feelings or do you feel hurt more often than not when meeting with them? 
Am I expecting perfection?
Did they tell me something I did not want to hear, but maybe needed to hear?
If I don’t trust them, do I feel I can trust anyone?
Am I ready to make changes to myself and the patterns I am in?

Barriers to Change, Lack of Readiness and Low Motivation 
While we are talking about reasons people stop therapy, sometimes it's because of the therapist, sometimes it's because of client attachment concerns, but sometimes it's lack of readiness or willingness to change.  When people are at the pre-contemplative or contemplative stages of change, the might throw up all kinds of barriers to attending services, like needing things to be "perfect", requiring just the right time slot, location, proximity or services; or just the right therapist demographics of race, gender, religion, level of experience/certification/degree, or lived experience; minimal cost, and just the right modality. While all these things certainly can help as previously discussed, when folks are creating barriers that sometimes set it up to where no one can fulfill their needs, and they thus get to avoid the therapy process by escaping it but claiming no responsibility. They may also create further barriers to change by not thinking about their therapy after/between sessions, not doing homework, etc. We find that when people are really desperate and motivated for change, most those barriers fall away and all people are really left with is “Can you help me?” And “How Soon can I get in?” Research is clear that the number one predictor of positive outcomes in therapy is not the therapeutic modality, it is the alliance with the therapist. Attachment matters. Readiness to change matters. Attachment to your therapist matters. Take time to see if they are trustworthy. Decide if you are really ready. If they are trustworthy, and you are ready for change, take time to consider before you leave. 

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Author: Megan Garza, MA, LMFT

A common misunderstanding in the therapy realm has to do with all those confusing alphabet soup of letters after the providers name- LMFT, PsyD, PhD, MS, MSW, MD, NP, MFT, LPC, PLPC, LCSW... and so on. Even as someone who went through years of school, multiple graduations, and career highlights, admittedly my family still mislabel my title and don't understand the work I do.

So what do all these letters mean and why does it matter to you as a person seeking mental health services? Many people frequently get confused about whether they were seeing a psychologist or a psychiatrist, which can lead to a lot of frustration and disappointment when they are expecting an hour long psychotherapy session, but instead get a doctor's appointment that lasts 5 minutes and are given a prescription for antidepressants, or vice vera.

Well, for starters these letters are basically indicators of their years of education, specific degree, specialization. They may even tell you about the philosophy and values of that profession.

Your Medication Prescribers
MD- Your psychiatrist is usually and MD. They went to medical school and specialized in studying the brain and its impact on mental health. Visits with a Psychiatrist are usually 5-15 minutes once a month or every few months for adjusting medications based on symptoms. Occasionally you will find old school psychiatrists (think Fraser Crane, Dr. Freud, or the dad in Growing Pains) that still do psychotherapy on top of prescribing meds, but that is far less common these days.

GP -or general practitioner also has an MD and also frequently prescribes basic medications for anxiety for depression or anxiety in cases that are less complicated.

NP - Your nurse practitioner is a nurse  (RN) with specialized clinical training that can often prescribe meds for mental health and usually works in conjunction with an MD.

Your Testers, Forensic Evaluators, High level Administrators, Psychotherapists
PhD- This is where you typically find Psychologists. These individuals have doctoral degrees usually in clinical psychology, Marriage and Family Therapy, Education, Social Work or a related field. They have typically 10+ years in academia after high school completing their education with  scientific research components, teaching, and writing/publication. Clinical Psychologists may provide psychotherapy, but often you find them doing a host of other jobs. They are highly trained in diagnosis, testing, and various forms of evaluation. There also other Cognitive Psychologists and Industrial/Organizational Psychologists who specialize in other areas of psychology, but do not usually provide therapy.

PsyD or EdD- These individuals also have a doctorate in either psychology or education, or counseling usually, but their programs were more clinical and less research focused. They have 10+ years in education, but their training was highly specialized to working with clients or students in the field rather than the research lab.

Your Master's level Therapists/Psychotherapists/Counselors
These folks make up the bulk of who is providing therapy today

MA means they have a Master of Arts degree
MS means they have a Master of Science degree

MSW- These folks have a Master's degree in Social Work- They have a 4 yr Bachelor's degree + 2-3 year Master's degree with a strong social justice component.
LCSW- These folks are Licensed Clinical Social Workers- They have a  4 yr Bachelor's degree + 2-3 year master's degree with a strong social justice component but they also have added clinical training and experience to work with clients and have passed their licensing exam. They usually are opposed to diagnosis, but in practice diagnosis is often required to billing purposes.


LMFT ( or MFT of FT in some states)- These folks are Licensed Marriage and Family Therapists. They have a a 4 yr Bachelor's degree + a 3 year Master's degree in therapy interventions with a specialization in relational and family system therapies. They have specialized clinical training and passed their licensing exam.
PLMFT- These folks are provisionally Licensed Marriage and Family Therapists. They have a 4 yr Bachelor's degree + a 3 year Master's degree with a specialization in relational and family system therapies. They have passed their licensing exam, but have not yet completed their required 2+ years of clinical training prior to being fully licensed. They work under the license of a supervisor.
SMFT- These folks are working toward their provisional License as a Marriage and Family Therapist. They have a 4 yr Bachelor's degree +a 3 year Master's degree with a specialization in relational and family system therapies. They have not taken/passed their licensing exam yet, and have yet to complete their required 2+ years of clinical training prior to being fully licensed. They work under the license of a supervisor.

LPC- These individuals are Licensed Professional Counselors with a 4 yr Bachelor's degree + 2-3 year Master's degrees in Counseling or a related field. They have very similar education requirements to MFTs, but they tend to focus more on the individual, so they don't usually have the additional specialized training for working with kids/couples and families unless they sought that out separately.
PLPC- is a Provisionally Licensed Professional counselor who has completed their Master's degree and have passed their licensing exam, but are working on completing their 2+ years of post-degree clinical experience.

Bachelor Level support workers
BA Bachelor of Arts- 4 year degree
BS Bachelor of Science- 4 year degree

Your Case Worker or Support worker or Tech usually will fall into this category. They don't have a license or any specialized clinical training beyond education and work experience. These are the "trench workers" who usually work very hard, for little pay, and see high volumes of clients.

Certificate holders
A Lifecoach is a person that helps direct a person to make important decisions in their life. They have no specialized education/degree requirements, no exams, nor is their a governing regulatory body that gives that a license or oversees them to guarantee ethical practice. They typically receive a certificate as a life coach and often train under another life coach. This area is often controversial because the lack of oversight and lack of public knowledge about the professional competencies of the lifecoach. There is a concern that people may be taken advantage of by individuals that label themselves lifecoaches, but may in fact be doing their clients harm due to their lack of training, skills, or boundaries outside of what that they believe themselves to have. Conversely, many licensed therapists also double over as lifecoaches and offer coaching as a separate part of their practice. Some people who find mental  health stigmatizing may shy away from "therapists" but may proudly seek out a "lifecoach." Lifecoaches should avoid diagnosis and attempting to provide therapy. Their work is usually skills and decision based (e.g. a career coach) and should not involve diagnosis, or attempts at therapy. 

Hopefully after reading this you have a better sense of the kind of provider you are seeking or seeing (and maybe what label you should actually call your family member).  Sidenote, though it may seem like these words are interchangeable, it's actually illegal/unethical for these professionals to call themselves by a title that does not belong to them so as not to misrepresent themself. A psychologist cannot call themself a psychiatrist and a lifecoach cannot call themselves a therapist unless they have a Master's degree and clinical license. As you become a savvier consumer, the more likely you will ensure you have the satisfactory treatment experience you are expecting.

by Megan Garza, MA, LMFT

We want to take a moment to welcome aboard our new intern Jordan Langley, BA, BS onto the Healing Reflections Therapy Team. She is completing her Master's degree in Marriage and Family Therapy and is ready to see clients. She is currently accepting spots for individuals, couples, and families virtually. A little down the road she will be able to see kids in-office. She is a great option for folks need lower fee accessible services. Feel free to send folks her way!

As part of the National Partnership for Ending Interpersonal Violence (NPEIV), I have committed myself to the cause of ending violence across the lifespan. Along with my colleagues Dr. Pearl Berman, Joyce Thomas, Dr. Karen Rich, Susan Omilian and I recently worked in collaboration to present a webinar series on addressing the impact of violence in Pennsylvania communities, with emphasis on trauma-informed care related interventions.

​You can watch the video here https://www.youtube.com/watch?v=bafhxI6PIlc&t=6s  to learn more or tune into NPEIV's youtube channel to watch the video series that follows up on resilience. 

If you want to collaborate and help end interpersonal violence, consider joining NPEIV and attending this year's Think Tank in San Diego, CA on August 27, 2022  ​https://www.npeiv.org/think-tank

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Healing Reflections Therapy is excited to announce the addition of our new Intern, Mckayla Kagie. She is completing her graduate program at Capella University in Marriage and Family Therapy. 

She has immediate availability to see individuals, teens, and adults for $40 per hour, or  couples or families for $50 per hour.

She has afternoon and evening availability for virtual sessions.

She specializes in Marriage and Family Therapy, depression, and Trauma and will be working under the supervision of Megan Garza, MA, LMFT 2011011850 MO.

If you are interested in working with McKayla, contact us at [email protected]

I am pleased to announce the publication of the book chapter I co-authored with Dr. Karen Rich on Trauma-Informed Systems of Care in the new resource Handbook of Interpersonal Violence Across the Lifespan. 

Rich K., Garza M.R. (2020) Trauma-Informed Systems of Care. In: Geffner R., White J.W., Hamberger L.K., Rosenbaum A., Vaughan-Eden V., Vieth V.I. (eds) Handbook of Interpersonal Violence and Abuse Across the Lifespan. Springer, Cham. https://doi.org/10.1007/978-3-319-62122-7_293-1

"Survivors of interpersonal trauma are vulnerable to risk of re-victimization when seeking help from community agencies such as welfare offices, substance abuse clinics, schools, homeless shelters, medical facilities and criminal justice agencies. Re-victimization of trauma survivors can lead to client dropout, “resistant” behavior, and treatment failure. It can also lead to stress, conflict, burnout, and frequent turnover among staff. Trauma-informed care is a community’s best approach to supporting survivors of interpersonal violence, but many agencies under-estimate its value or lack a comprehensive approach to its implementation. Budgetary concerns, resistance to change, turf issues, hierarchical power structures, lack of training, fears of trauma contagion and negative attitudes towards service recipients contribute to the problems. Interdisciplinary collaboration, investment in prevention, concern for employee wellness and top-down commitment are essential features of trauma-informed agencies. This chapter will present an overview of trauma-informed care, the benefits to clients and providers, obstacles to implementation of best practices, and research initiatives in the field."

This handbook is a project of The National Partnership for Ending Interpersonal Violence (NPEIV), an organization I have been a part of several years dedicated to ending interpersonal violence. The chapters in this handbook are comprehensive in covering the most up-to date research on various forms of interpersonal violence. Over 200 authors, clinicians, and researchers contributed to the handbook, with all proceeds benefitting NPEIV. 

​Introduction:  The Handbook of Interpersonal Violence Across the Lifespan is a comprehensive state-of-the-science reference work for researchers, practitioners, and policy makers. It is written from a trauma-informed perspective, and utilizes adverse childhood experiences research as its basic developmental framework along with the traumatic effects all forms of interpersonal violence tend to produce. With public health and social justice in mind, this human-rights based handbook also focuses on the overlap and continuum of the various types of interpersonal violence. It integrates all forms of interpersonal violence while dealing with key issues of intersectionality and systems responses.


This two-volume handbook is published in collaboration with the National Partnership to End Interpersonal Violence Across the Lifespan, which aims to:

• Acknowledge and understand the impact interpersonal violence has on individuals and society
• Recognize the mental, physical, legal, social, and economic burden of interpersonal violence
• Respect an individual's basic right to live without violence; value human dignity
• Promote consensus-based practices while maintaining cultural sensitivity
• Consider and address the unique needs of vulnerable populations

I encourage anyone with an interest in ending interpersonal violence to make a pledge to NPEIV today at ​www.npeiv.org/donate-2