Mental Health Articles
|
|
 A Sign to Trust Yourself taken by Megan Garza at Burningman of an art exhibit Many problems in work, school, with roommates, relationships, friendships, and families come down to one issue- Boundaries. Boundaries are the invisible lines that define where you end and another person begins. They protect your physical space, emotional safety, and personal identity. Healthy boundaries allow closeness without losing individuality. Healthy Boundaries can sound like: “I am responsible for my own feelings, needs, and actions. Others are responsible for theirs.” Setting boundaries is an act of self respect, not selfishness. It communicates your worth and protects your peace. This table below provides an outline of what different forms of boundaries look like and how it can be problematic when boundaries in those areas are crossed.  Setting Boundaries with Family Members
Sometimes when folks are struggling with relationships with their family members they have a difficult time setting boundaries. You cannot control other people, you can only control yourself, but you can request that others be considerate of your feelings. Here are some important key point to consider when setting boundaries with Family Members:
Remember- A boundary without a follow-through becomes a wish, not a boundary. Examples: • If they continue yelling → “I’m going to step away now.” • If they push for personal details → “I’m not discussing that. Let’s change the subject.” Consistency teaches people how to treat you. Focus on What You Can Control You can’t control: •Their reactions •Their opinions •Whether they change You can control: •Your boundaries •Your emotional energy •Your responses •How much access they have to you If you are struggling with setting boundaries with someone in your life, consider working with a therapist to help you develop your skills. We have multiple therapists at Healing Reflections Therapy available to meet your needs. Author: Megan Garza, MA, LMFT Therapist & Co-Owner of Healing Reflections Therapy
0 Comments
Revisiting When Rapists Don't Know They are Rapists: Why This Conversation Still Matters in 20264/20/2026  A decade has past since my original post-#metoo era article on when rapists don't believe they are rapists. In 2026, just in time for sexual assault awareness month we are once again confronted with headlines that force us to face the same uncomfortable truth. From the ongoing Epstein sex trafficking investigation (or lacktherof), to the recent sexual assault allegations about Representative Eric Swalwell, Russell Brand's rape trial, and Katy Perry being met with a flurry of Sexual assault allegations after Ruby Rose began speaking out about an encounter decades earlier. All of course, denying the allegations. The major headline this month being the bombshell CNN news investigative report that revealed that 62 million visitors in a single month viewed a website dubbed a "rape academy" where men exchanged tips on how to drug and rape their wives, and even exchanged video content of their crimes. The scale is staggering. People have been rightly horrified at the implications and scale. Women are being forced to question whether they really know and trust their partners. Alongside this, a recently published 2026 study by O'Sullivan and Ronis titled "Isolate, inebriate, intimidate, Repeat: High Rates of Sexual Force Against Women are Reported when Young Men Given Anonymous Surveys." The study of 2,689 US and Canadian men aged 18-34 reported recently using at least one strategy to "force a woman to have sex" i.e. rape them. They reported an average of about 9 strategies being used, mostly being versal coercion or using their peers to manipulate the women. In 8% of the cases, the men explicitly reported drugging women for sex (i.e. drug-facilitated sexual assault) on one or multiple occasions. People have been rightly outraged and ask: How is this possible? Many women indicate they are not shocked. As a sexual trauma therapist, the answer is not abstract. These stories echo of painfully familiar stories I have heard from clients before. And they Point to a deeply unsettling reality: Many Perpetrators do not believe they are perpetrators. Once again, the talk about why women choose the bear re-enters that chat. The Problem isn't just Violence-It's Perception When I was working on my thesis almost 2 decades ago comparing the sequelae of adult vs child onset of child sexual abuse I came across similar findings about sexual coercion. Our original survey packet administered to study participants included several different measures on sexual abuse, and one survey that assessed sexual coercion. Ultimately, we excluded the data from that survey after finding that 100% of the both male and female participants in the study reported experiencing sexual coercion. At the time, we suspected the instrument lack validity, seemingly not being sensitive enough to measure what we were intending it to measure. Now, I believe the opposite was true: Our systems were not prepared to face how widespread the problem actually is. Sexual coercion exists in direct opposition to enthusiastic consent, and it has criminal consequences. But when it is normalized, minimized, joked about, or reframed, it stops being recognized for what it is. The Mental Gymnastics of "Good People" With these new headlines, people are enraged at the numbers. How could this many men be visiting these sites? How could husbands do this to their wives? How could so many people willingly talk about sexually assaulting their partner? The truth is, many men do not know they are rapists. They see themselves as a good person, and good people do not rape, therefore what they are doing cannot be rape. That is when the mental gymnastics start. Pioneering research by Mary Koss demonstrating the mental gymnastic people do, finding that when you ask people about their abuser/abuser experiences without labeling them "Rape" or "abuse", and just using the definitions that make them abuse, people are much more likely to endorse engaging in or having experienced those abuses.... So, now I am going to provide an update to my original article and once again address this theme- what if my rapist does not know he is a rapist. "It has been almost a month since #MeToo flooded social media. Since then, almost a daily parade of new sexual harassment, abuse, or assault allegations are being brought to light about accused perpetrators like Harvey Weinstein, James Toback, Charlie Sheen, Louis C.K., Ed Westwick, Roy Moore, and Kevin Spacey. The responses by the accused have varied from silence, to deflection, to admission, to outright denial. What Survivors Experience Some statements have puzzled people, wondering how could they not know what they were doing was wrong or would upset someone else? Sadly, this relates to a concept frequently found in my therapy practice, in which many victims are astounded when they realize that their rapist doesn't know he is a rapist. After the assault the perpetrator may act casual, inviting them for breakfast, acting affectionate, kiss them, or invite them on another date. They behave as though what had occurred was completely consensual despite the fact that moments or hours before they were holding the victim down, whispering threats in the victim's ear, ignoring the victim's cries of pain or profound lack of interest or engagement, or ignored the fact the victim was intoxicated, passed out, or vomiting and while they pursued sex. The husband that secretly drugs and rapes his wife for years may tell himself that this is his right as a husband. The abusive family member may appear at holiday events and initiate hugs and pretend like nothing ever happened. They may be the charismatic, smiling life of the party. Even worse, family members often rally to protect the accused perpetrator. Sometimes the victim will run into the perpetrator months or years later and be astounded at how "normal" they act. They may approach them like friendly, long lost friends seeking to engage in polite conversation. They may reach out to the victim over social media with casual "hellos" and "how have you beens?" The victims may react in paralysis, fear, or rage and are additionally astounded when they see the look of confusion reflected in their perpetrator's face. The victim/survivor comes into my office begging the question: Is it possible that my rapist does not know he raped me? Sadly, in some instances, the answer may be yes. For those that lack empathy, awareness of others boundaries or feelings may not exist. The default is: if this benefits me, my actions are ok. Lack of empathy can be the bi-product of someone in a status of power or privilege, "Just boys being boys," "locker room talk," or "old school." For other sexual violence perpetrators, they may have a sense, if not clearly know what they did was wrong, but use elements of denial, minimization, deflecting blame, or manipulation to escape any form of personal accountability to seep into their conscious awareness. Power, Privilege and Normalization Is it possible that some of these celebrities really did not know that what they were doing was wrong? Well, since they kept the secret and did not exhibit those behaviors in public, then probably on some level they did know. I would argue that they probably were in a position that did not serve them well to think it was wrong. "He/she really wants this," "They deserve this," "I deserve this," "They like how it feels," "Everybody does it" are all arguments used to justify sexual violence. Think of it this way: if you were about to step on an ant and crush it, you would probably tell yourself that have good reason to do so, that it won't matter, that they cannot feel anything, that you are really being helpful...but you can do this because essentially you see the ant as significantly less powerful and less important than yourself. By contrast, if you think about killing a shark you may still justify the kill, but you will still probably worry about the consequences to yourself because the shark is inherently more powerful. Power, control, status, privilege, and lack of empathy play important roles in supporting rape culture. When we are so inundated in rape culture, like a lobster in pot slowly brought to a boil, we may not even realize we are in danger of becoming the next meal because the environment around us was already so unhealthy in the first place." So what can we do about it? I challenge men to embody the coveted protector role and to challenge other men. It is your job to start calling out the bad behavior of your peers instead of silently standing by or bearing witness in what translates into tacit complicity. Report website like the rape academy. Stand up to your friend that it trying to hit on the drunk girl at the club. Call out when you hear adults making sexual comments about teenagers. Don't laugh at the "locker room talk", make the other person visibly uncomfortable by having them repeat it until it loses its power. It may not be all men, but most violent crimes are committed by men, and all men have a responsibility to do better. References https://www.hopehealreflect.com/mental-health-articles/when-rapists-dont-know-they-are-rapists O'Sullivan & Ronis (2026) https://journals.sagepub.com/doi/10.1177/08862605261432630#tab-contributors https://www.cnn.com/interactive/2026/03/world/expose-rape-assault-online-vis-intl/index.html Conley & Garza (2011). https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1559-1816.2011.00828.x Koss M. P., Gidycz C. A., Wisniewski N. (1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55(2), 162–170. https://doi.org/10.1037/0022-006X.55.2.162 Author: Megan Garza, MA, LMFT Sexual Trauma Specialist and Co-Owner at Healing Reflections Therapy April is Sexual Assault Awareness Month: How to Access Support that Many People Don't Know Exists4/13/2026  April is Sexual Assault awareness month. We are seemingly inundated with news about sexual violence in the headlines lately. So, let's talk about some resources that many people don't know about for seeking help with domestic or sexual violence. These resources are primarily for Missouri, but there are national resources available as well.
Victim Advocates Did you you know that you can get an advocate to accompany you to to the hospital or make a police report? You can pre-arrange this with them to ensure you have the safest experience where they can even schedule the meeting with a detective and give you follow-up updates on your case. Places like the YWCA Metro St. Louis and Crime Victims Advocacy Center, and Children's Advocacy Center are great for this kind of work Safe at Home Program Sometimes after folks have been in an abusive relationship or have experienced an interpersonal violence episode, they struggle with feeling safe at home. Survivors may worry about their perpetrator having access to them, or stalking them. Did you know that that you can sign up for the Safe at Home Address confidentiality program to keep your address out of public record, to ensure your privacy where you live. You can sign-up here for free https://www.sos.mo.gov/business/safeathome Offender research tools Another tool people have in Missouri to help keep themselves safe is using Casenet to research individuals name to see if they have criminal or civil cases of public record in the state. Sometimes knowing someone's history can be a great tool for personal advocacy and protection, especially when dating. Case update Tools If you experienced a crime where your offender has been adjudicated and want to know the release date status of your offender, you can use MOVANS to get automatic updates on them. This is designed to help victims stay notified of their case and when their future safety may potentially be threatened. Crime Victims Compensation Many people don't know this, but if you experienced certain types of crimes and filed a police report and are actively participating with the police in the investigation, you may be eligible for have any expenses incurred by you as a result of the crime, reimbursed to you. This may include medications, medical visits, therapy costs, funeral expenses, and lost wages. There are stipulations involved, but filing a claim is relatively simple, though the re-imbursement process may take some time. If you think you or a family member are eligible, you can seek info here https://dps.mo.gov/dir/programs/cvc/crime-victims-compensation.phpdps.mo.gov/dir/programs/cvc/crime-victims-compensation.php Therapy Support An extraordinarily valuable tool in the healing process from trauma is getting therapy. Our therapists at Healing Reflections Therapy: Diversity, Trauma, and Wellness Services are experts at understanding the complexity of trauma and treating the resulting wounds. We utilize evidence-based approaches to help clients address their acute traumas from recent events as well as addressing chronic concerns from traumas that occurred decades ago. Reach out to us today, and we can help you find the help you need https://www.hopehealreflect.com/contact-us.html . For those not local to St. Louis, you can use Rainn.org to lookup a sexual assault near you. Group Therapy Support Another valuable tool is group therapy. I often recommend individual therapy paired with group therapy as a part of the healing journey. It is a wonderful opportunity to share your story with other survivors and see that you are not alone. Places like Safe Connections and YWCA Metro St. Louis are known to offer this for free. Survivors.org also offers a virtual support group. Healing Your Body As many people are now aware due to education on ACES and the popularity of Bessel van der Kolk's "The Body Keeps the Score," the body is often impacted by trauma and carries a health cumulative impact. Resources like trauma-informed yoga have come about to help this process. This month, Survivors.org is offering free virtual trauma informed yoga workshops as well as art therapy workshops. Joining the survivor community can be a transformative experience. It can help reframe your relationship with your victimized self, help release you from the bonds of secrecy with your perpetrator, and empower you to find a community of others that understand and empathize with your experience. You don't have to go through this alone. It's never too late. For more resources and information, you can check out our trauma resources information page and our sexual trauma resources page. Author: Megan Garza, MA, LMFT Megan is a Co-owner of Healing Reflections Therapy and Sexual Trauma specialist. You can schedule an appointment with her today here.  Photo by Engin Akyurt: https://www.pexels.com/photo/red-couch-on-the-floor-4177669/ We recently shared an article addressing therapists ghosting clients, and I wanted to touch on the occasions where clients ghost their therapists. There are lots of reasons that a client might stop responding to their therapist or scheduling sessions: most of which are centered around avoiding discomfort and fear.
Fear of Embarrassment Whether it is a misunderstanding about session times, location, or cost, sometimes a client gets upset with their therapist and then realizes they made a mistake. As a result, they feel embarrassed enough that they don’t want to face the therapist. If anyone is going to understand making a mistake, it is a therapist! I know I will certainly make my own fair share and embarrass myself regularly, but I would hate to let that embarrassment get in the way of all the good work we can do together. Fear of Confrontation Our therapists are human and make mistakes; therefore, from time to time, they may do or say something that upsets us. Maybe they made a comment you didn’t appreciate or rubbed you the wrong way, maybe they seemed upset with you or like they weren’t paying attention, maybe you didn’t feel heard or understood, or maybe they guided a session in a way that didn’t feel helpful to you. Speak up! It’s scary to confront anyone, really, but people also put therapists on a pedestal that makes it all the more intimidating. As a therapist, I am here to work alongside you, not dictate how you live your life or lord over you with my great and powerful wisdom. As therapists, we strive to be very aware and informed for the safety and comfort of all of our clients, but we still have blind spots. If I said or did something unhelpful, I want to know. Fear of Shame Let’s say you didn’t finish, or even start, the assignment your therapist gave you in the last session, and it feels like it would be easier or more comfortable to cancel the session or not show up. After all, who wants to hear, “That is so disappointing, it’s a shame you didn’t do the work between sessions. What are we even doing here?” I’m not going to shame you for not doing “the homework.” There are no grades in therapy, and if something I asked you to do was difficult, then let’s talk about it. If doing things that are good for you were easy, then you probably wouldn’t be in therapy to begin with. When something is difficult, it is the perfect place to dive deeper. Avoiding Responsibility With that said, there will be times when I will challenge something you said or push back against a core belief, and that can trigger feelings of shame and blame as a gut reaction. This is especially relevant in couples therapy since there is likely already an established pattern of blame. Often, someone coming to therapy falls into one of three categories: the visitor, the complainant, or the customer. The Visitor: This person doesn’t feel ownership over what brought them to therapy, and they are likely there because someone else has asked them to be, either a loved one requested they go, or they are court-mandated to be there. They are just visiting therapy and passing through with no real intention of using the time to their advantage. The Complainant: This person can identify a problem and is upset by it, but they see it as mainly external.
The Customer: This person is willing to acknowledge their role in the problem and ready to work and take action to create change. They are aware of the investment they are putting into this process and are motivated to make the most out of it. Individuals who fall into the visitor or complainant category may ghost their therapists as soon as they can. Oftentimes, the ghosting comes when they have grown tired of being asked to take accountability before they are ready to do so. Going to therapy in one of these mindsets isn’t wrong and is a great first step towards becoming ready for the work. Down the road, you may find yourself more motivated or self-aware and want to try again. Do it! We’re ready when you are and will meet you where you’re at, no matter your level of readiness. Fear of Judgement You might have done something you’re not proud of between sessions. Maybe you got into an argument with your partner or engaged in self-injurious behaviors. Maybe you’re afraid to bring up a taboo subject with your therapist because they might be offended or judge you. My job as a therapist is to make sure you feel welcome and safe, but even with those efforts, doubt might creep in. Allow me to provide reassurance - I’m not here to judge you. I’m here to support you. I hope you feel comfortable coming to me about anything, but tell me if you’re feeling uncertain, and we can work through it. Fear of Discomfort Therapy is not a comfortable process. Often, the things that brought you to therapy in the first place are painful, and frankly, healing is too. Sometimes we confuse discomfort and pain with being dangerous or harmful. However, discomfort does not equal danger. Sometimes our nervous system has a hard time telling the difference, and that discomfort can send us into fight, flight, freeze, or fawn mode. A big part of therapy is learning how to cope with that nervous system activation and teach your body and mind the difference between discomfort and danger. Financial Distress The economy is TOUGH, and money is TIGHT, which often means that people drop therapy in order to afford other, more pressing bills. What if you are in a crisis? If the economy is trash, your life is likely on fire, and your mental health is suffering. Let’s be real, we’re all going through it. If you are not able to afford therapy, REACH OUT. I may have ways to help with the cost, such as a sliding scale, payment plans, and resources for low-cost or free therapy services elsewhere. It’s not ideal to have to change therapists, but getting you the help you need is my top priority, even if that is with someone else. Feeling “Too Bad” You wake up and are having a rough day. Therapy sounds like a chore and not a relief. You don’t want to just cry while your therapist watches. Hear me out… The days we WANT therapy the LEAST are the days we NEED therapy the MOST. I know that has been true for me, and I’ve heard it from clients, too. When we’re low on energy and motivation, our mask tends to drop, and we can see through to some of the issues we may be hiding from. There is valuable insight behind that feeling of resistance. People Pleasing When you’ve worked with a therapist for a long time or when you have just met a new therapist, you may be tempted to be the “model client.” You might feel bad about having a bad day, especially when you’ve been working with a therapist for a long time and have seen a lot of progress. Healing isn’t linear! Having a bad day, having trauma resurface, or having symptoms return does not mean you have lost all of your progress. Our journeys have hills and valleys, and as a therapist, I’m there for them all. You don’t have to impress your therapist. Rupture in Rapport Something happened, and you’re really mad at your therapist even though you generally really like them. Whatever the injury, you’d rather run for the hills than risk hurting your therapist’s feelings, but you’re still upset enough that you don’t want to go back for sessions. Maybe if I just avoid the problem, it’ll go away? Avoidance is a tempting coping skill, and one that usually shows up in all areas of our lives, not just therapy. However, avoidance only puts us in our own way and keeps us from progressing. Challenge the avoidance; you might be surprised by what happens. Running away from your feelings and to a new therapist may provide some temporary relief, and it can reinforce previously established patterns of avoidance. It may be worth the effort to try to address discomfort, work through the issue, practice using your voice, and work towards repair in a safe environment. Questionable Practitioners In some cases, moving on to a new therapist is unavoidable. Naturally, it is within your prerogative to leave a therapist who crossed your boundaries, did something legally or ethically questionable, or is just plain offensive. The field of psychology can attract people who are in it for the wrong reasons and use their position for personal gain. That kind of behavior should not be tolerated, and you have the option to report them. In this case, “ghosting” is actually self-advocating and necessary. Good job! Ethical and compassionate therapists will be here when you’re ready to try again. Ask friends, family members, coworkers, and other people in your community who they see or recommend. Word of mouth is an amazing way to find the therapists who are here for the right reasons and will prioritize your best interests. Outgrowing your Therapist Sometimes folks make progress with a therapist, but reach a plateau. You might need a new perspective, or a new therapeutic orientation to shake things up a bit. If you like your therapist enough, you might not know hot to tell them that it's just not a good fit anymore because you don't want to hurt their feelings, so you avoid it and ghost or gradually fade away. Your therapist may be sad to see you go, buy often we love these closing conversations and seeing you self-advocate. We can be great at helping to guide you to the next person on your healing journey. It all boils down to fear and discomfort. Don’t let temporary discomfort and fear keep you from pursuing the things that are going to help you and better your life long term. It’s so tempting to run and hide, but if that worked, you’d have already solved all of your problems. Sit with the discomfort. Push back against the urge to flee- recognize that as your learning edge and lean into it. See what happens. It might be something wonderful. Author: McKayla Kagie Robinson, MS, PLMFT McKayla is Therapist at Healing Reflections Therapy. Contact her here to setup an appointment https://www.hopehealreflect.com/mckayla-kagie-robinson-plmft.html  As therapy enters the main stream more and more comedians, actors, influencers, and layfolk are talking openly about their experiences. It’s wonderful to see the stigma breaking down and people accessing the mental health care they need, yet at the same time when I read comments sections, I see so many people who had negative experiences with their therapist. Many folks report believing that their therapist ghosted them, while others fear that they have hurt their therapist or that their therapist couldn’t handle them, or worse yet, fears that their therapist left the field entirely because of them. Having worked with many mental health professionals over the span of my 25+ year career, I wanted to take a few moments to pull back the curtain and help people understand what is happening on the other side and provide insights into what the therapists may be going through and what are some of the other reasons why they may be responding or not responding in the way that way that is most helpful to you, the client.
Ghosting I often see people posting that their therapist has ghosted them, which is never something that we want to hear about. There are ethical obligations that therapist should be fulfilling regarding maintaining contact with clients and being responsive. It’s important to understand reasons why a perceived ghosting may happen. Sometimes therapists have their own mental health crisis and are just not functioning well. I have known clinicians who have at times been unable to return phone calls or messages because their own anxiety levels have become debilitating. This is obviously something for which they need to be receiving their own treatment. Sometimes therapists ghost because of severe medical issues where they are sick, ill, injured, and just physically not able to communicate, and in rare cases the therapist has passed away. More commonly, sometimes therapist ghost because of basic communication misunderstandings or errors. Sometimes they just didn’t see a client's message in their inbox. Has that ever happened to you? You scrolled past a message or accidentally put it in the trash and didn't even know you missed it or discovered it months later? Yeah, unfortunately it can happened in overwhelmed mental health care too. Or maybe they were expecting the client to message them back (but the client was awaiting an initiation from the therapist). The communication break down comes when the therapist was expecting the client to return the call and follow up to say when they wanted their next session. When the therapist doesn't think the client has responded, they assume the client is taking a break and they give the client autonomy and respect for choice, putting the ball in their court by leaving it up to the client to reach out when they want services. Like any good novel, the misunderstanding on each side can pave the way for a lot of confusion, hurt feelings, and ultimately missed connections. Some clients though, especially those that have attachment needs, they feel abandoned by their therapist when the therapist is not maintaining consistent connection and keeping them in their thoughts, and so a miscommunication error can feel like an activation of a rejection wound, and thus the client stops reaching out. Sometimes there’s just a missed connection because a message has just disappeared and did not reach its intended destination- you know, like in the interwebs when something has gotten caught in a spam box or was chunked into massive google thread that was missed, and so there was just a moment where someone thought they had returned a message and they didn’t. Just human and technical errors that naturally occur or are normal things that happen to most people at some point. There is tremendous value in assuming positive intent, and not assuming the worst. Therapists have a responsibility to be consistent in checking back with their clients and clients have a responsibility to reach out and connect with their therapist about what their wants and needs are regarding therapy. Another reason a therapist may stop communicating may have to do with their relationship with the organization they worked for. I have seen examples of therapists being dismissed from positions at their workplace and have been removed from computer access, client files, and call lists, resulting in them being unable to contact their clients any further, nor provide a termination session, which may be no fault of their own. Most of these dismissals usually come because of problems on an administrative vs client level. If they have been dismissed under those circumstances, the agency has a responsibility to contact and follow up with those clients. Unfortunately, that doesn’t mean that it has always been done and clients can fall through the cracks leaving them hurt with unanswered questions. In private practice, I also see a lot more clinicians put the onus fully on the client to reach out for services and automatically close files after a month or two of no-contact or no sessions. And yes, there are those folks that just don't return messages. That do just disappear from clients and drop them with no other reason than their poor organizational skills or desire not to work, or to avoid working with someone. Therapists do have legal and ethical duties to not abandon our clients, so clients who feel there has been a violation have the right to seek remuneration. A note should also be said about when clients ghost therapists. Unfortunately this does happen and it often haunts us. We worry about you. We wonder what happened? Are you safe? Did we do something wrong? We replay every moment of our last few sessions scouring for evidence of ruptures in rapport. Sometimes we check obituaries. We go to our supervisors or therapists to discuss our fear and worries. We try to think of what we could have done better. Therapy is a unique type of relationship, often a microcosm of relationships in the outside world. Clients often repeat the same patterns with therapists as they do with others in their life, and we are not immune to being hurt by it. Although there are some sucky therapists out there, most therapists I have known are genuinely well meaning and deeply concerned about their clients. “I Broke My Therapist” On more than a few occasions clients have relayed that they feel that their past therapist had experienced a crisis or a mental health breakdown and had left the field because of them. Therapists are human and can be vulnerable to their own mental health crises, which may prompt them to leave the field. It is not usually because of the client. Most of the time those therapists have already been experiencing a multitude of things in their life that have culminated in significant levels of distress and their ability to fully be there for a client has been limited. There are rare instances where a client has directly traumatized the therapist- usually through physical violence or some other boundary crossing, which has led to significant levels of distress that may prompt them to re-examine their commitment to the field. Sometimes when therapists get burnt out, they want to do something that involves the least amount of emotional investment, like fantasizing about folding towels at a salon. Trust me when I tell you, if anything is going to drive a therapist out of the field, it is more than likely their relationship with their workplace leadership than any of the clients. Sometimes clients relay that their therapist cried during session, which made them feel like the clinician could not handle their concerns. In psychotherapy there are different schools of thoughts on this, some will argue that therapists should never emote, because it conveys to the client that we cannot hold space for them, that it brings the focus on us, that "people pleasing" clients will feel the need to take care of us. Conversely, others will argue that crying in front of a client in response to their story can convey empathy, model appropriate affect expression, and be a display of authenticity and humanity that may build rapport. Occasionally, I will hear stories about therapists who were unable to keep the focus on the client’s needs, were triggered and became dysregulated. This is exactly why therapists are recommended to get their own therapy before become therapists as well as getting good clinical supervision training that focuses on countertransference and self-of-the-therapist concerns. Therapy is an experiential process and we may not know how our body is going to react to a client’s disclosure, but most therapists do their best to try to meet their client’s needs. While one client may feel touched that the therapist teared up and feel closer to them, another may feel triggered and unsafe and promptly drop out of therapy. You should know, that your therapist is likely stewing over this and beating themself up over not being a “good enough” therapist. I’ve seem many clinicians express distress over their own reactions in sessions. It is never the clients job to take care of the therapist. Clinicians should be trained to use their resources to take care of themselves. “You Don’t Really Care About Me and Are Only in it For the Money” Clients with abandonment, trauma, attachment, and trust issues may sling this arrow of words at us as a defense mechanism. We know this, it still hurts all the same. Some clinicians have over $100k in student loan debt and only make $38k a year. I’ve had clients without college educations getting free therapy at non-profits from me that were making more money than me. If we wanted a job for the money, we would have gone into finance. I don’t think I have ever met a clinician who was in it just for the money. Most of us tie ourselves in knots, expose ourselves to vicarious trauma, wear ourselves thin, have sleepless, anxious nights worrying about clients, battle it out with difficult employers because we are passionate about serving our clients. Seeing what's going on behind the curtain in therapy really just means that your therapist is likely just doing their best. They are human, with human emotions, triggers, and flaws. It is an art that requires constant learning and refinement. We do our best to be there for clients, but sometimes we mess up. Most are well meaning, some are inexperienced, some have experience that works against them, and sometimes you have a therapist that just plain sucks. Even the best ones can make big mistakes. If they suck so bad to where they breach legal and ethical codes, then you have options to report them. Most frustrations in therapy are interpersonal - they do not breach any regulations, but they cause harm. Recognizing that therapy is a fluid, relational process built on trust, communication, and making repairs, extending grace, and forgiveness, and perspective taking can go a long way in learning how to make changes in patterns of relationship injuries outside the therapy room. -And to any clients with whom I've ever made one of these mistakes. Please accept my humble apology. I would love to hear from you. Author: Megan Garza, MA, LMFT Are you in a relationship with AI?: When a therapeutic tool becomes the third person in the room2/24/2026  More and more people are using AI to assist with their mental health needs, and new tools and platforms are being built to expand on this. Clients are using AI to keep them accountable, to locate therapists, to learn coping skills and emotion regulation skills, to track their sobriety, to create mood logs, and to help them recognize patterns in their behavior and symptoms. Some clients are using AI to create healthy meal plans. Others are using it to identify red flags in dating conversations or to help them figure out signs if someone is into them. But as AI gains familiarity, some folks are turning to AI for much more than resources; they are using it to fill gaps in their emotional intimacy needs. They are using AI as a pocket therapist, an in-home life coach, as a friend, and sometimes as a romantic or sexual companion. How did we get to where AI filled such a void within us? In 2023, the surgeon general declared loneliness an epidemic negatively impacting mental health. Between political values dividing the dating scene, the disappearance of traditional third spaces like churches for meetups, and decreasing alcohol usage, the fuel and kindling that historically gave rise to so many relational fires, albeit disastrous ones, many folks today just don’t know where or how to authentically connect. Now add the economic crisis and rising costs of insurance, making mental healthcare difficult to access, and you have the perfect condition for relationship problems and isolation. Enter AI. The AI Affair AI chatbots are being used as tools for social connection, a friend, a helper, a nonjudgmental encourager, with some people stating their family members think they are directly talking to a human friend at-the-ready. Some are crossing the dimensions into developing intimate relationships with AI, where they substitute human companionship. As so many sci-fi movies have predicted, the future is here, and of course, humans being humans, people have also started using AI for sexting with chatbots. Arguably, a more ethical arm of the porn industry, due to not requiring the exploitation of vulnerable women and other individuals, but not without its own problems. AI porn is built by stealing the art and original imagery of real humans, some of whom may have consented, others may not have to their original use, reproduction, or misrepresentation. For those in relationships, finding out your partner is in a sexual relationship with a chatbot without your knowledge or consent can lead to problems with trust, anger, resentment, betrayal trauma, breakups, and divorce. And those folks are already showing up in therapy rooms and divorce courts. The AI Substitute Therapist Over the past year, I’ve encountered more and more people using AI to assist in their therapy between sessions. Indeed, I rarely go a day anymore without hearing clients talking about their collaborative use of AI to aid the therapeutic healing, most of which they find very effective. The AI Couple Therapist Some folks are turning to AI to determine whether or not they are in domestic violence relationships and how to communicate with their emotionally abusive partner. We have heard multiple women report putting their partner’s words into the chat and then using the chat’s response to send back to their partners in an effort to de-escalate or set clear boundaries. The AI Family Therapist Similarly, we have heard multiple family members report trying to resolve family conflicts through AI chat. One family member will hurt another family member, then turn to AI to write an apology letter for them. Sometimes, the AI-assisted apology letter is a considerably better attempt at repair than anything the other person has historically offered verbally. Sometimes, family recognizes the AI assist, sometimes they don’t and are seemingly content with the attempt at repair. But what happens when both people are using chat to write their responses? It comes down to a question of whether any true skills are being developed, or whether people are outsourcing their relationships and avoiding conflict, and how to learn conflict resolution skills. AI should be a tool, not a replacement; otherwise, we would be left with a modern-day dystopian Cyrano De Bergerac where two AI machines are transferring messages back and forth to one another, masquerading as their human puppets who show up with placid smiles after the conflict, ready to hug and make up. The AI Psychologist Some are using AI to try to diagnose their mental health concerns. The problem, of course being that AI results are largely based on the information you give it, and frankly, it can be a bit of a brown-noser in trying to get your approval. More often than not, it tells you what you want to hear. It cannot tell you what you do not know or understand about yourself, which is especially problematic for folks who lack insight or are poor reporters. Nor can it observe your body language, tone, and micro-expressions that are key to understanding human behavior. Recently, in 2025, an AI mental health software firm, Yara AI, closed after the developers determined that further development of their product was “too dangerous” for users in crisis and would cause more harm than good. It was preceded by similar closures from Woebot, Tessa, and Clarigent Health. One AI company has already come under fire for contributing to psychosis and suicide. In one recent case, a 16-year-old who died by suicide was discouraged by AI from seeking help and was offered assistance in writing a suicide note. There have been reports from psych hospitals receiving an increase in AI-related psychosis. Adding onto the problem, recently OpenAI came under fire after it was discovered that the shooter in a mass killing event in Tumbler Ridge Canada had been using their service and was detected for “furtherance of violent activities” and was kicked off the platform months prior, but the failure of the developers to report the issue to authorities has created a question of liability and whether or not the crisis could have been averted. Multiple states have started to initiate legislation to rein in the expanse of AI in mental health spheres as recognition of the problems and limitations grows. Certainly, as a clinician, there has already been growing fear of jobs being encroached on by the tech and venture capitalist sector, but more important is the larger human risk. As therapists, we know that the research has been clear that the biggest indicator of successful outcomes in therapy are not about what tools are used, what certifications someone has, the type of modality or intervention applied that could be replicated by an algorithm, but by the therapeutic relationship itself. The healing art of dynamic human connection. The unquantifiable algorithmic element. Much like the development of the printing press, the automobile, the assembly line, the computer, and the internet, AI is not going away, nor is the human demand for it. The question remains, how do we best use the tools to our benefit? And perhaps the larger question remains for both users and developers exists in the bioethics realm, similar to that of growing the Jurassic Park dinosaurs: Are we so focused on what we could do with AI to meet our intimacy needs, that we are forgetting to stop and ask ourselves if we should? So, in conclusion, this is just your friendly neighborhood therapist reminding you o remember to stay connected to real people and use AI only a tool/resource, not a replacement for human connection. This article was written by a human without the aid of AI.
Author: Megan Garza, MA, LMFT Sources https://www.ama-assn.org/public-health/population-health/loneliness-public-health-crisis-learn-how-screen-it https://www.theguardian.com/world/2026/feb/21/tumbler-ridge-shooter-chatgpt-openai https://stateline.org/2026/01/15/ai-therapy-chatbots-draw-new-oversight-as-suicides-raise-alarm/ https://www.npr.org/sections/shots-health-news/2025/09/19/nx-s1-5545749/ai-chatbots-safety-openai-meta-characterai-teens-suicide https://www.pbs.org/newshour/amp/show/what-to-know-about-ai-psychosis-and-the-effect-of-ai-chatbots-on-mental-health https://fortune.com/2025/11/28/yara-ai-therapy-app-founder-shut-down-startup-decided-too-dangerous-serious-mental-health-issues/ The Working Alliance (1994) Horvath & Greenberg. John Wiley & Sons: NY Jurassic Park (1993)  Therapy has become increasingly accepted as a norm for health treatment, especially since covid. As historical barriers of stigma and shame fall away, more and more people are embracing hope and change and looking for therapists to help them facilitate healing, but sometimes struggle with where to start.
One option for finding a good therapist or mental health treatment center is to ask your family, friends, or colleagues for recommendations. High praise from someone you know can go a long way in building trust with your provider. Another option is to check with your insurance company. If you check the back of your insurance card, there is usually a number you can call and they can help with referrals for providers in your network. Better yet, go to the insurance companies Doc Find on their website, which usually allows you to add in filters for your selection and find providers nearest you. A third recommended option is using Psychology Today's search field at www.psychologytoday.com Many reputable clinicians use this for their marketing. You can read about each clinician in detail, view their fees, insurances taken, and specialty areas, and even watch video snapshots of them. Of course Google can also locate someone near you, but that may be driven more by sponsoring ads than who is the best fitting provider near you. Alternatively, crisis lines like BHR can also help link you to social service organizations, psychiatrists, and mental health facilities. There are low-fee sliding scale therapists available through memberships at Open Path Collective. What about the venture capital backed companies (VC) that you see the ads for a lot? These are usually the first 3-5 companies that pop on any any search result for a therapist now. There are many options for therapists available through them as well, but the controversy surrounding them is increasingly mounting, with more and more pressure to push back against the Walmart effect and risk of healthcare monopolies with conflicts of interest and how they impact your healthcare and your local community. You can read more about that here. You don't have to go through this alone. Many people are available to help. A word to the wise, be patient, sometimes places may have long wait lists or be slow to return calls, if at all. It may be beneficial to reach out to multiple providers initially and see who is most responsive to your needs. How to know if the therapist is a good fit? An important quality is competence, does the therapist have specialized training or certifications in the area, symptom, or diagnosis that you need help with? Do they primarily do individual or couple or family counseling? How long have they been working in that area to develop a solid set of skills for complicated needs? Do they do in-person, virtual, or a combination of both that may make them more accessible or easier for you connect with or be vulnerable. Does the therapist specialize in Christian counseling or are they general, non-religiously focused? Choosing a therapist that works within a framework you are comfortable with can be helpful. If you are a member of a marginalized population, does the therapist understand those complexities or needs so that you feel safe? A therapist doesn't have to be a member of that population to be helpful, but they do need to have culturally competency or willingness to approach with openness and non-judgement. Are you wanting only wanting validation or change? Therapy can feel really good if you are supported and the therapy gives lots of validation, but that doesn't always result in change. One major difference between a friend and a therapist is a therapist is specifically there to help you work on your goals to change, which may mean they tell you things that can be hard to hear and encourage you to do things you are uncomfortable with, for the sake of your recovery. If the therapist only validates you, it may feel good, but might not always result in the change you are seeking. And lastly, what is the general vibe of the therapist? How do you feel about their demographics and personality? Look over their website, their psychology today profiles and videos, do they seem like someone you could jive with? Tempering your Expectations Sometimes we hear about folks that therapist hop, looking for the "perfect fit," much like dating, it's not likely you will find the "perfect therapist". They are humans and can make mistakes, but are they open to learning and making change to meet your needs, or are you willing to accept that maybe they are telling you something you need to hear instead of what you want to hear? Therapists also encourage the client to do the hard work, not them. So if you are expecting them to do all the work, you may feel frustrated with long silences and delayed in progress. The more you modulate your expectations, the happier you may be about the result. Sometimes when folks are not ready for therapy, they easily find barriers. It is a good idea to think about whether you are screening out providers who would otherwise be a fit for this reason. When people strongly desire change and are ready to do the work, they may not overemphasize what certifications the therapist has, or how far away they are, or what times they offer, or what the cost is. They will be willing to do anything to access the service they need at the moment and are also willing to do the hard work in the process. Conversely, if a therapist makes you feel unsafe or judged, it makes sense to listen to your gut and move on. Hopefully this helps and you can find your way to a clinician that helps you meet your needs. Good luck, and good health! Authors, Megan Garza, MA, LMFT & Chris Scarberry, MA, LPC  When you search for “therapy near me,” chances are the first results you see come from big corporate platforms like BetterHelp, Alma, Headway or similar entities. These companies spend millions on advertising and search engine optimization (SEO) to dominate the internet.
But just because they appear first doesn’t mean they’re the best choice for your mental health care. In fact, working with a small, independent therapy practice may offer better care, stronger privacy protections, a healthier long-term future for mental health access, and build a stronger community in the future. Here’s why choosing a small practice could make all the difference. 1. Personal Care, Not Corporate Protocol Therapy works best when it’s about you—not algorithms or quotas. Large platforms often emphasize quick intake and high-volume scheduling, leaving little room for deeper connection. Therapists may be pressured to see too many clients, too fast. We often hear complaints from clients who tried out these platforms only to be ghosted by their therapists. At a small practice, your therapist sets their own caseload-which often starts at the first point of contact when you are seeking therapy, tailors treatment to your needs, and builds a genuine therapeutic relationship. It’s care that prioritizes quality over quantity. 2. Protecting Your Privacy and Data Big platforms are not just therapy providers—they’re tech companies. And like many tech companies, their business models raise concerns about how personal data is stored, analyzed, or even monetized. What happens when that business gets bought out by another corporation who wants that data? Small practices, on the other hand, are directly accountable to state licensing boards and ethical standards. Your records are kept private, secure, and never shared for corporate gain. 3. Insurance and Affordability: The Hidden Costs of Marketplace Domination While companies like Alma or Headway market themselves as making therapy “easier to access with insurance,” the reality is more complicated. These platforms negotiate contracts with insurance networks to benefit the company first—not always the client or therapist. There is also a specific advantage that these corporations have over small practices- small practices run by therapists are responsible to their licensing boards and must be licensed in and/or have a base company in the state they are billing the insurance company from. This usually means that they can only bill the insurance company where their business is primarily based/has a formal US postal address. Insurance reimbursement varies widely from state to state. A therapist in Washington may get an insurance reimbursement rate of $175/session but a therapist in Missouri may only get $57/ 45 minute session. Big corporations can set up corporate offices anywhere where they can get maximal profits from insurance and use that as the state from which they are billing and corner insurance markets. They get to bill where they can the biggest payday, but independent practices cannot do that. Essentially, they distort the market. BIG payday for them. They also get to offer more money to the clinicians that work for them (while still taking a huge cut for themselves), which makes other clinicians wonder why they cannot get paid that same rate from their local business and they demand raises that independent practices and non-profits cannot compete with, drying up eligible employees and clients from local businesses. The end risk is Market Domination: Just as Walmart’s scale pushed small businesses out of towns, venture-capital-backed therapy platforms flood the internet with paid advertising and SEO dominance. This leaves smaller practices buried in search results, regardless of the quality of their care. This is followed by Price Pressure: Once corporations dominate a market, prices often rise. While BetterHelp may initially seem cheaper, consolidation creates leverage to set rates higher once competition disappears. Private equity firms have already started buying up private practices, eliminating competition. By contrast, Independent practices often offer more flexible options, like sliding-scale fees, out-of-network reimbursement support, and transparent billing. You work directly with your therapist—not a corporate middleman. 4. Ethical Oversight and Accountability If something goes wrong with your care on a corporate platform, responsibility can get blurry. Many of these companies call themselves “tech platforms,” distancing themselves from ethical oversight. At a small practice, your therapist is directly accountable to professional boards (such as AAMFT, APA, or state boards) that enforce strict codes of ethics. This means a higher standard of care and accountability. 5. Supporting Diversity in Therapy Just as Walmart pushed many local stores out of business, corporate therapy platforms risk creating a monopoly in mental health care. When fewer companies control access, prices eventually go up and services become less personalized. Small practices protect diversity in the field. They offer specialized services for trauma, family systems, LGBTQ+ care, BIPOC communities, and other areas that might get overlooked in a one-size-fits-all corporate model that is subject the winds of change with DEI initiatives. 6. SEO and Visibility: Why You May Not See Small Practices First The reason BetterHelp or Alma appear at the top of Google isn’t because they’re the only or best option—it’s because they spend heavily on SEO and ads. Independent practices don't usually have those resources to keep up with the big dogs, which means these independent or non-profit practices may be harder to find online. Most clinicians we know used to use Psychology Today as their main source of referrals, but over the past couple years have found that Psychology Today's marketing budget is no match for larger corporations, and our referrals from there are down 65% from 2020-2023. In fact, I recently found that when searching specifically for referrals for a client on Psychology Today, my google search re-routed me to another website that initially looked like Psychology Today's search index, but it turned out to be another site entirely. Going back and researching again, I had to scroll down several items before I actually reached Psychology Today's real website. Things like this have become a real problem as well trained, licensed clinicians have repeatedly found thein information stolen from other databases and placed on their platforms to make it seem like we work for them. The client finds us and selects us, but they are then re-routed to another clinician. The potential client is told we have been notified of the referral, but we are not. It is a scam to route them into their corporation, using more reputable clinicians in a bate and switch scheme. Clinicians end up having to fight and threaten litigation to get their names removed from these databases. When you choose a small practice, you’re choosing to look beyond the first page of search results and invest in care that’s personal, ethical, and community-focused. Conclusion: Your Choice Shapes the Future of Mental Health Care Every time you choose where to get therapy, you’re making more than a personal decision—you’re shaping the future of the field. By supporting small practices, you help protect affordable, ethical, diverse, and client-centered mental health care. At Healing Reflections Therapy: Diversity, Trauma, and Wellness Services, we believe therapy should always be about human connection, community building, accountability, and trust—not corporate profit. If you’re ready to explore therapy that puts you first, contact us today.  A question that I often hear brought up in therapy is when is it appropriate to cut off my family members? This has become a popular topic these days as generational differences, awareness of trauma, and politics divides family.
As systemic marriage and family therapists, we are trained to study family ancestral trees called genograms and look for patterns of connection, attachment, abuse, substance abuse, and cutoffs. Whenever cutoffs show up in a genogram, it tells us something important about the family dynamic and signs of dysfunction. Generally, we discourage folks from immediately considering cutoffs vs exploring alternate options. What are the alternatives to cutoffs Rather than black and white thinking, that things have to be "all this way" or "all that way" or we are a family unit or we have no connection, as family therapists we often encourage people to explore they gray areas. What about decreasing length of visits or frequency of contacts? Instead of going over every holiday, maybe only go to one, and don’t stay with them, limit your time there and stay at a hotel. Maybe instead of taking all their calls, you choose selectively when to respond or you just send them cards. There are many times as people explore their development and really individuate from their parents and begin to develop their own sense of identity and beliefs, that they suddenly see problems in their relationship with their family members that were not fully realized prior. Or perhaps the parent is struggling with adapting to the new role of having an independent, adult child where they have less control. At that point, as growing awareness blooms into anger and contempt, sometimes prompted by an outsiders’ view of your family such as partner, teacher, friend, or therapist that the drive to cut-off a family member or make big changes in boundaries with family comes about. When is a cutoff appropriate? Sometimes folks have decided that the only way they can have some peace is to cut off their family members. This is especially true when family members have displayed long patterns of egregious, toxic, abusive, manipulative, or selfish behavior and are unlikely or unwilling to change, nor take accountability for their actions.
These are all examples of family dynamics that are difficult, if not impossible to manage. Sometimes, for one’s own safety or sanity, there is no recourse but to put distance from the harmful family member. Note, a person is not put into these categories simply because you do not approve of them, or they are not who you want them to be or what you believe, they meet these criteria when they are actively inflicting harm on others through their behavior, the pattern is chronic, and there is a demonstrable unwillingness or inability to change. Consequences of cutoffs Sometimes I encounter clients who, at the advise of younger clinicians, have decided to cut-off their family members with formal letters, over more minor and typical family conflicts. Rather than attempting to work through the issue in family therapy, the family member unceremoniously receives a letter that that have been disowned or a list of their infractions and have been informed they are going no-contact. They problem with formally making these statements in a letter is 1) it gives the other person no opportunity to respond, clarify, ask questions, or make amends. And since many issues come down to problems with communication and understanding, this can only exacerbate the problem. 2) You cannot take back the harm inflicted by a formal pronunciation that you are cutting off a family member, thus creating or exacerbating a rejection wound. Although many people experience family cut-offs for a time, rarely are they permanent. Most people end up reunifying with their family members within a few years. This is true for even the abusive, toxic family members, or the religiously based cut-offs. Writing letters to harmful family members are very powerful tools in therapy for clarifying your hurt, exploring boundaries, and finding cathartic release. As a trauma counselor I have been witness to thousands of these letters over the years. However, a therapeutic exercise for the self is not the same thing as sending one of those letters to a family member and should be taken with great care and consideration. Sometimes folks who struggle with assertiveness or have fears/challenges with being communication/being heard by their family member may feel letter writing is the only option necessary, which may be true, but it’s also important to know that what is formally written may be hard to take back or make repairs from as well. There is also no guarantee they will read it. Cautions of cut offs If your attempt at a cut off is to get the person comply, to punish, to be more the way you want them to be, then you could be abusing the situation and using the cut-off as a tool for emotional manipulation. If, by contrast, you are using the cut-off as a tool for safety when all methods of communication, family therapy, consultation with faith leaders, and boundary setting have failed, this is totally appropriate. This is especially true when there are no signs of positive change or willingness to change or willingness to take responsibility for the harm that has been caused, and they are in-fact doubling down on their behavior and blaming you for it. Red flags. As a family therapist, I have witnessed the devastating impact of trauma and clients struggling to set limits with narcissistic parents who continue to ignore and cross boundaries. I have also seen the tragic result of when clients are unceremoniously cut-off by their family members and the pain, sadness, and confusion that results. Many times the person being cut-off genuinely does not recall the events they are being accused of and are shocked at the variation in perspectives. There is no easy path and the decisions you make today may impact generations to come. It's important to remember that small, consistent shifts in your behavior can change the larger family system functioning over time. A note for parents: Sometimes parents feel blamed a lot in the therapy process, and the fear of being blamed or judged can keep them away from participating in family therapy. This is a fair concern as parents do take a brunt of the impact when their is family dysfunction. It's important to remember that there are no perfect parents. And even the best parents are going to say or do something at some point that harms their child directly or indirectly. In family therapy we really stress the idea of a "good enough parent". In order for children to develop well, you just need a good enough parent. Most parents do many more good things than bad things. A bad choice does not automatically equate with a bad person/parent/child. Sometimes the positive contributions and the way the parent shows love is not readily recognized. For example, a child may say they did not feel love because dad did not hug them or say "I love you" or was overly strict or critical or said things that made them feel bad about themselves, but that same dad may have shown love through showing up all their sporting events, making sure to always have a job and steady income to support the family, by fixing things around the house to create a safe environment for them, by making sure they had a car to get to their job or college. How a person receives love may not be the same as how another expresses love. Parents do however have the responsibility, as the older person with more power and authority in the relational dynamics, of being the one to reach out to their children and initiate contact occasionally. It cannot be left just up to the child/adult child. The child also has a responsibility of returning the calls and checking back in occasionally as well if they both wish to maintain a relationship. Parents do have the burden of being the bigger person, because of child's need for unconditional love from the parent. If you are considering a cut-off, try these steps first
Author: Megan Garza, MA, LMFT is a licensed Marriage and Family Therapist and Supervisor at Healing Reflections Therapy  In doing counseling with clients who have substance abuse concerns and disorders, I often draw from the world of 12-Step recovery. One of the concepts that comes out of the wisdom of AA is the idea of People, Places, and Things. In order for someone who abuses substances or things like food or sex to change their behavior and maintain their progress, it is usually necessary to change the people with whom they associate, the places they frequent, and items with which they regularly come in contact. The world that someone in that situation has created is often filled with other people who abuse substances, places the person goes to use those substances, and items that are components of their use pattern. The comedian Bill Hicks once said that the only things a man needs in order to be come someone who has an alcohol use disorder are, “the right bar, the right girl, and the right friends.” I have always liked that quote because it acknowledges that anyone can become someone who abuses something or other given a few circumstances. While I appreciate the wisdom of the disease model of addiction and also see people who abuse substances as having a likely chemical imbalance and a genetic predisposition to addictive behavior, there is also a role that habit, modeling, and circumstances play in substance abuse and life in general. I have always felt that in the “nature versus nurture” debate, the answer is both. As such, people who abuse substances tend to think in such a way as to maintain the addiction and the circumstances that give rise to it. Changing people may be the hardest of the three. It may mean cutting off contact with family or close friends temporarily or indefinitely. Sometimes new ways of interacting with them can be negotiated, but sometimes not. When I quit smoking cigarettes many years ago, having a romantic partner who believed I could and should do and did not smoke herself was a huge factor in the longevity of my ability to cease and desist from using tobacco. If someone has a problem with methamphetamine and chooses to stay with their partner who abuses meth also, one can imagine all of the temptation and other challenges that will continue to bring into their life while they try to pretend that they are quitting in a vacuum. I have seen some of the places people should consider avoiding be the route to the liquor store they normally go to, places that are trauma triggers that may make them want to use to self-medicate, childhood homes, their drug dealer’s house and so forth. Sometimes if avoiding those things is not suggested by a peer or professional, it does not occur to the user. I have seen numerous people with alcohol problems believe they can/should work in a bar and have encouraged them to consider other options. There are countless rituals and routines around using that the person will benefit from breaking or at least interrupting. “Things,” can be paraphernalia, numbers in ones phone, the actual substance they use. I have seen people hold onto a stash of tobacco, drugs, or alcohol because they say they feel more comfortable still having it if they need it. While this may work as a form of harm-reduction at first, it is likely not sustainable long-term. Initially keeping alcohol around with hopes to one day drink in moderation also seems premature in my experience. In short, every person who abuses substances or struggles with other compulsive behavior has a list of people, places and things that they need to evaluate and possibly partially or completely liquidate in order to best prevent relapses into old behavior. These are always unique to each person. Once someone is far enough along the stages of change to take action, they are more likely to take this recommendation or see that this work needs to be done without guidance. Sponsorship within AA/NA, counseling, or just some serious conversations with concerned loved ones can also wake a substance abuser up to a lot of their patterns of behavior and once they have this solid information, it is up to them to personalize it and choose to take it from there. Avoidance can cause prolonged grief, traumatic reactions and the like and, as such, therapists typically advise clients to face their fears, explore underlying emotional responses and the like. By contrast, avoiding people, places, and things is an adaptive tool for people to use in recovery because they have likely already identified the underlying emotion, have no sound reason to be around their substance of choice given the corresponding cravings that may ensue, and are or will become aware that trying to master regularly being tempted just isn’t worth it. Author: Chris Scarberry, LPC
Chris is Therapist and CO-founder of Healing Reflections Therapy and is available to see clients in recovery. |
AuthorSMegan Garza, MA, LMFT is a certified Specialist in Treating Trauma at a Supervisory level and is Licensed as a Marriage and Family Therapist. She specializes in work with complex trauma, sexual abuse survivors, and relational therapy. Archives
July 2026
Categories
All
|
RSS Feed