Your First Visit

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Your First Visit

Everyone can have difficulty coping with problems. Maybe you have tried everything to solve your concerns and nothing seems to work. You want life to be different, but you feel stuck and unable to move forward. You feel overwhelmed and decide to talk with someone about your concerns. It is a tough decision to call for an appointment. After the call is made, it is common for people to feel nervous and apprehensive about their first visit. These feelings are a normal part of the process. What can you expect during your first visit?

You can expect your therapist to know that this is tough for you. Your therapist will honor and respect you as a unique individual with a story to tell. Your story is personal, and the only person who can tell your story is you. You are the expert on yourself. In order for the therapist to determine the best way to help you, he or she will be interested in your story and what brings you to therapy. You can go about this however you like: starting at the beginning and moving forward, or starting at the end and going backward. Your first visit is the beginning of a special relationship that will help you to make changes in your life. You are the co-creator and of this relationship.

In the first session, you can expect to go over some business and paperwork. Your therapist is bound by ethical standards and law to ensure you understand issues like confidentiality and the Health Insurance Portability and Accountability Act of 1996. You and your therapist will agree on a fee that is determined by a sliding scale.

Don’t hesitate to ask your therapist questions. Your therapist wants to make clear anything that might confuse or trouble you. At the end of the session, your therapist will ask you for some feedback about your first impressions and how good the two of you are connecting. If you feel your therapist does not match your personality or needs, simply say so. We will place you with another therapist. Often, people feel relieved after the first session because they feel understood and have gained a sense of hope.

Ultimately, your first visit begins a journey in a safe and secure relationship to help you discover answers. Research studies have shown that therapy is effective in alleviating many problems ( We consider it an honor to accompany you on this journey.

Recognizing Suicidal Ideation In Others- And How To Help:



Recognizing Suicidal Ideation In Others- And How To Help:

Updated June 2018:

Suicide is one of the toughest issues to talk about. It is quite possibly one of the most devastating choices that one could make, is difficult to understand, and unpleasant to think about. Even the word ‘suicide’ typically causes an emotionally charged reaction, whether in the head, the heart, or in the body.

Because of the traumatic overtones, lack of understanding, unwavering stigma, and feelings of helplessness associated with this issue, it stays hidden in the corner-misunderstood and often ignored.

Even though there are more questions than answers, starting a conversation regarding the harsh reality of suicide is necessary, as suicide rates are rising.

According to the CDC, U.S. suicide rates increased more than 25% since 1999.

While many other causes of death are on the decline due to medical advances and technological breakthroughs, suicide rates keep climbing for every age group under 75, and the suicide rate is now the highest it has been in 30 years.

A distressing trend is beginning to present itself, and it involves the demographic with the largest percentage increase, with suicides tripling over 15 years from .5 to 1.7 per 100,000 people.

Do you wish to take a guess as to which demographic this belongs to? Alarmingly, it belongs to young girls ages 10-14. This is becoming an issue that affects all of us, as this reality is no longer something that exists in the distance- it could be living next door to you.

While all of this information is distressing, there is good news. You don’t have to be an expert in mental health to recognize symptoms of suicidality or self-harm in others, and you have the opportunity to help save a life.

If you notice a change in personality or disruption in normal everyday activities in the life of another, it is helpful to pay attention to the following behaviors referred to as the ‘Six Week Warning Signs’:

  • Extreme psychological turmoil (increase in agitation, irritability, changes in sleep/eating habits, increase in substance use)
  • Verbalized comments of despair/fatalism
  • Anhedonia (finding no pleasure in activities that previously brought enjoyment)
  • Shame-based preoccupation with the past
  • Apathy toward life and anticipation toward death
  • Refusal to seek help
  • No capacity for future-oriented thinking

In addition to the Six Week Warning Signs, it is possible for a person to turn a corner and begin displaying more inconspicuous signs of suicidality. There is a stark shift referred to as ‘the amazing reversal’ that occurs when a person has resigned to this fate.

The following are often considered to be the ‘Six Day Warning Signs.’ They include:

  • A rapid onset of peace and calm
  • A dramatic change from the six-week warning signs
  • Avoids acknowledgment of behavior shift
  • Denies the need for help

If you suspect that your loved one is in crisis by considering the Six Week/Six Day Warning Signs, take them to the nearest emergency room or call 911.

Additionally, the National Suicide Prevention Lifeline (1-800-273-TALK) (8255) offers trained counselors who can connect you with crisis response resources in your area.

In addition, it is helpful to know what to say in times of crisis. Remember these simple questions in assessing whether or not a person is thinking of harming themselves:

  • Are you thinking of taking your own life?
  • Have you thought of how you might do it?
  • Do you have access to carry it out?
  • Have you considered when you might do it?

If the answers to any of these questions are ‘yes’, assistance is required. Ideation begins with thoughts to harm the self with no intention to carry it out. At this stage, counseling is recommended in order to get to the root of those thoughts and feelings. As the above questions progress and details of self-harm or suicidality emerge, this warrants a more critical response. Again, take them to the nearest emergency room or call 911.

If you or someone you knows is searching for answers, consider calling The Refuge Center at 615-591-5262 to begin counseling. There is always hope, and we are here to help.

**The National Suicide Prevention Lifeline (1-800-273-TALK) (8255) is also available at any time, even if you are unsure of what to do.

Bichelle, R. E. (2016, April 22). Suicide Rates Climb In U.S., Especially Among Adolescent Girls. Retrieved April 28, 2016, from

Communication and Expression Using the Visual Arts

As I think about the many ways we are able to express ourselves in this digital age, I realize that the options for communication are so vast. Email, social media, letter writing, and the good old telephone are just a few of the ways that we can express our needs, wants, and desires with those around us. Often, a simple look is enough to communicate with others. We can also communicate with our body language. But what about those moments when words, gestures, or expressions fail? When life seems so complicated, and situations so unexplainable that there are no words to express what we are feeling or thinking- no avenue to alleviate our emotional burdens? This leaves us not only unable to express our needs and wants to others, but it can also render us blind to our own feelings and desires.

Using the fine arts as an expressive tool is one of the most unique and limitless forms of communication. It has the potential to help express ideas, feelings, and thoughts that would otherwise be very difficult to reveal. Pablo Picasso once said, “Art washes away from the soul the dust of everyday life.” Using the fine arts as a therapeutic tool can be a cathartic and meaningful avenue of expression and communication with the self, and if you choose- with those around you. Instead of facial expressions, movements, or words, we have the opportunity to open our psyche using colors, textures, shapes, and concepts.

You might be thinking, “I am not an artist, this doesn’t apply to me.” If you are able to put pen or brush to paper, then this can certainly apply to you! You don’t have to have a great deal of skill or creativity to use this technique of expression- you only need a willingness to try, and to nurture a non-judgmental attitude toward your process and finished product. Even better, you don’t need a lot of art supplies to tap into your expressive self. You may have many useful materials lying around your house- items such as pencils, paper, crayons or markers, and even newspaper or magazine clippings to use in a collage. Using photographs and other meaningful images can be a great way to open the door to your heart’s voice, moving you to uncharted territory within. If this task feels daunting to you, start out simple. Create a self-portrait in the media of your choosing. Or, simply ask yourself, “What do I need?” Or, “What am I feeling?” This can be represented by simple lines and shapes- no Mona Lisa required! Writing can also be a helpful expressive tool. Beginning or ending your day with a “mind dump” can help alleviate stressors and thoughts that will not go quietly. Simply grab a piece of paper and pencil, and begin writing any random word, phrase, sensation, or sentence that comes to mind- “dump” it out!

Remember- the process is yours. Deciding what to do with your creation could be the most beneficial part of your experience. You might want to frame your work and hang it on a wall, or you could even find closure to an experience and opt to destroy your work depending on its significance to you and your process. This is possibly the greatest aspect of expression using the visual arts- there are no rules!

Expressing your inner voice using the visual arts has many benefits and can be used by virtually anyone. If you would like to explore more of your situation through therapy, we would love to serve you. The Refuge Center for Counseling can be reached at 615-591-5262.

unsplash-logoKelli Tungay

The Science Behind Meditation


The Science Behind Meditation

The benefits of daily meditation practice are endless, however, less than 10% of Americans engage in the practice.  Why aren’t more people motivated to meditate?  Meditation may sometimes seem too elusive, as if it is something that only monks would do for hours on end every day.  There’s often not enough talk about the substantial impact meditation can have on well-being and too much focus on stereotypical connotations associated with the practice.

While mindfulness or meditation may seem like a hippy activity with no real purpose, there is actually an abundance of science to prove that changes actually happen in the brain when a person adopts a daily meditative or mindfulness practice.  In 2011, neuroscientists at Harvard conducted an experiment that examined the brains of 16 people before and after undergoing an eight-week mindfulness course.  The results of the brain scans showed that participation in a meditative practice is associated with changes in the concentration of gray matter in areas of the brain involved in learning and memory, regulating emotion, sense of self, and overall perspective.  This ability to scan the brain and create tangible evidence of the positive changes that daily meditation can have allows skeptics to understand the truly scientific side of a mindfulness practice.  Science shows that people who meditate regularly experience reduced anxiety and depression, improved sleep, increased compassion, longer attention span, reduced pain, less reactivity, and an overall happier mood.  These benefits begin almost immediately, and accumulate over time, allowing a consistent meditator to experience positive effects continuously.

Are you convinced of the benefits and ready to start?  Just find a quiet place and sit in a comfortable chair with both feet on the ground and close your eyes.  Focus on your breath and clear your mind.  If a thought comes, acknowledge it and gently bring your focus back to your breath (this may happen almost constantly in the beginning, but don’t worry, it’s part of the process).  When you are finished, gently open your eyes and slowly ease back into daily activities.  Start with a five minute session, and increase it as you feel comfortable.  If you feel more comfortable with guided meditation, try meditation apps for smartphones like Headspace, One Giant Mind, and Insight.

Need more motivation or scientific proof?  Watch the TED talks by

Light Watkins and Sara Lazar.



Goyal, M., Singh, S., Sibinga, E., Gould, N., Rowland-Seymour, A., Sharma, R., .Haythornthwaite, A. (2014). Meditation Programs for Psychological Stress and Well-being. JAMA Internal Medicine JAMA Intern Med, 174(3), 357.

Hölzel, B., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S., Gard, T., & Lazar, S. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36-43.

Lazar, S., Kerr, C., Wasserman, R., Gray, J., Greve, D., Treadway, M.,  Fischl, B. (2005). Meditation experience is associated with increased cortical thickness. NeuroReport, 16(17), 1893-1897.

Band-aid on a Bullet Wound


Band-aid on a Bullet Wound

Do you know someone that is experiencing a difficult time in their life? It may be a friend going through a heartbreaking divorce, a family member dealing with a frightening diagnosis, or someone grieving the loss of a loved one. Most of us do know at least one person, and it can often hurt to watch someone that we care for suffer so much. Our first impulse is often to want to rush in to ‘make things better’ or ‘fix’ the pain that they are experiencing, and we often do that by expressing the only sentiments that we can think of when words truly fail. Many quick and common clichés come to mind- “Don’t worry!” “It’s going to be ok.” “This must be God’s will.” “It could be worse.” “You should try (fill in the blank).” Do these phrases sound familiar? Perhaps you have shared them- or even heard them. Though these sentiments often come from a compassionate and sympathetic heart, there are more powerful and constructive ways to show support to others during times of need.

Studies show that three of the most beneficial types of support that can be offered to others who are enduring difficult times are emotional support, informational support (caution!), and instrumental support. Emotional support is by far the most helpful and beneficial type of support that we can give. This is reflected in verbal and nonverbal communication, and includes listening, empathizing, comforting, and a general availability of ‘being there’ for someone. There is great power in silence and simply being present in your loved one’s time of need. This type of support can reinforce a person’s self-esteem, feelings of adequacy, and general feelings of love and acceptance during their difficult season.

Informational support includes the delivery of information regarding the loved one’s experience, however this should be used with caution and only at the request of the loved one. When the crisis is health related, this type of guidance has found to be most helpful coming from healthcare providers, but harmful when coming from friends and family. Proper informational support that is delivered in an appropriate manner enhances a person’s feeling of control, coping skills, and management of day to day life while enduring hardship.

Instrumental support includes practical applications of service to your loved one. This includes the execution of daily routine activities, such as making meals and helping with various tasks. This can also include a thoughtful gift, such as cards and words of encouragement that show support and love.

While these options provide us with many ways to help loved ones in their time of need, it is notable to mention that some well-intentioned actions have in fact been shown to be detrimental when used. Displaying unrelenting optimism, minimizing the problem, forced cheerfulness, making insensitive comments, avoiding the situation or person, and being told not to worry has been found to be the most harmful. If you have found yourself making these blunders, don’t beat yourself up! Many of us have resorted to these approaches in an attempt to help when we feel truly helpless. However, remember that there are many ways that we can help those who are suffering that will benefit them in the long run, while strengthening the relationship that you have with them. You can’t put a band-aid on a bullet wound, but you can sit with your loved one in their time of need, show support and love, and in turn become a catalyst for healing.

The Refuge Center for Counseling is here to provide you with the additional support that you or your loved one needs while navigating through difficult times. You don’t have to walk this road alone! Call us at 615-591-5262 to schedule an appointment.

Helgeson, V., & Cohen, S. (1996). Social support and adjustment to cancer: Reconciling descriptive, correlational, and intervention research. Health Psychology, 15(2), 135-148.