What is Theraplay?

What is Theraplay?

You’ve heard of therapy, and maybe even play therapy, but what about Theraplay?

Sentier’s child therapists, Bridgett Brye and Lily Ferreira, answered a few questions about what Theraplay is and how it works.

What is theraplay?

Bridgett Brye: Theraplay is a type of child and family therapy that focuses on the parent/guardian and child attachment and interactions. Theraplay aims to help enhance attachment and build the relationship through fun, structured activities that increase a child’s felt sense of safety, connection, sense of worthiness, and need to be cared for.

What is it used for?

Lily Ferreira: Theraplay is helpful for any families who want to build trust, felt safety, and connection. Traditionally, Theraplay has been used with families where there has been a rupture in the attachment relationship- whether due to foster care, adoption, separation, or parental challenges that have impacted their ability to connect with their child.

Who is a good fit for Theraplay?

LF: Theraplay is beneficial for any parent/child relationship. It may be most beneficial for adoptive families, foster families, kids who are having difficulty responding to their parents, or parents who are having difficulty relating to their kids. In my experience, all families can benefit from Theraplay!

BB: Theraplay is a good fit for anyone and everyone! We all need to feel safe, connected, worthy and cared for. Theraplay is often utilized in adoption and foster families where a disruption has occurred within the attachment. However, it has and can be used with teens, elderly populations and others to help model healthy relationships and interactions.

What do you like about it?

LF: Theraplay is interactive, playful, and easy. There is no pressure to say or do the right thing. You just need to be present. I love watching kids and their parents experience shared moments of delight.

BB: It is fun! It takes us back to our innate need for play and the happiness and giggles we get through playing with others. I get to see parents and children learn the power of being with one another, as this can be hard in the stressful day to day lives of families. I also love how it provides families with simple ways of carrying on their work within the home and for years to come.

For more information or to inquire about starting Theraplay services at Sentier, please email our Client Care Coordinator at ellie@sentiertherapy.com

Is This Anxiety?

Is This Anxiety?

First, let’s talk about what anxiety is.

What is Anxiety?

Anxiety is a common human experience most often understood as nervousness, apprehension, and worry. Anxiety is a complex state rooted in fear that presents as a wide range of mental, emotional, and physical symptoms with varying degrees of severity, therefore, understanding anxiety is helpful in appropriately responding to it.

When Your Brain Perceives a Threat

Anxiety is the result of a person’s brain going through a series of changes after it perceives a threat. Whether or not the threat is real, the brain may respond. That is why a genuine threat to safety and simpler things like giving a classroom presentation or getting into an argument can all feel very similar.

It all starts with the amygdala, a tiny but powerful part of the brain that is responsible for triggering the body’s stress response. When the amygdala detects a possible threat, it cues the hypothalamus to activate a network of nerves called the sympathetic nervous system. Then, the endocrine system releases hormones such as cortisol and adrenaline that trigger the body to respond to the perceived threat. That entire process is called the fight or flight response in which the person is highly activated and could potentially fight or flee from the threat. However, when the brain perceives a threat that isn’t really there – or isn’t nearly as severe as the stress response would indicate – it can lead to excess anxiety about commonplace activities.

The Overthinking Part of Anxiety

While the body is preparing to respond to the perceived threat through fight or flight, the prefrontal cortex is also engaged. The prefrontal cortex is responsible for slowing down to take time for rational thought and decision-making. However, when a person experiences too much anxiety too frequently, the prefrontal cortex may become overactive, leading to rumination and automatic negative thoughts. Those thinking patterns can create a cycle of anxiety in which the person becomes stuck in a loop of excess worry. They may feel unable to control their anxious thoughts even if they rationally understand there isn’t a threat.

What Does Age Have to Do With It?

The prefrontal cortex fully develops around age 25, so younger individuals may struggle more to regulate thoughts: “Reduced functional connectivity between the amygdala and the prefrontal cortex indicates a potential pathological factor for anxiety disorders in adolescents” (Xie, et al). In other words,  adolescents and young adults may experience more anxiety because the prefrontal cortex in their brains is not yet able to stop and think rationally.

why are some people affected by anxiety

Why Are Some People More Sensitive to Anxiety?

Along with the amygdala, the rest of the brain’s limbic system also plays a role in the stress response of anxiety. The limbic region of the brain – responsible for memory and processing physical sensations – can become overactive and stuck in a heightened state, particularly for those with a trauma history. Individuals who have experienced time(s) in which their physical or emotional safety was truly at risk also often have memories and associations of being at risk. These individuals may have a heightened perception of threat as well as an increased sensitivity to stress, even if they are not truly at risk in the present moment.

What are Common Symptoms of Anxiety?

Anxiety has mental and emotional effects. The follow psychological symptoms are commonly reported with anxiety:

  • Worry something bad will happen
  • Feeling on edge
  • Racing thoughts
  • Irritability
  • Obsessive thoughts
  • Difficulty concentrating
  • Feeling of dread
  • Panic

The hormones released by the brain following the activation of the sympathetic nervous system also lead to changes in a person’s physical body. The most commonly reported physical symptoms of anxiety include:

  • Increased heart rate
  • Sweating
  • Rapid breathing or difficulty breathing
  • Hyperactivity
  • Physical agitation
  • Dizziness
  • Blood sugar spikes
  • Dilated pupils
  • Churning stomach, nausea, or increased bowel movements
  • Grinding teeth
  • Trouble sleeping
  • Sensitivity to touch

Your Body As An Alert System

Think of your body as a smoke detector. What does a smoke detector do? Although a common response is that it detects fire, it actually just detects smoke. It is important to know the difference between fire and smoke in order to appropriately respond. Fires are threats to bodily safety. Smoke is perceived as a threat that may feel very stressful but does not threaten bodily safety.

Examples of “Fire”Examples of “Smoke”
–         Natural disasters–         Taking tests
–         Sexual assault–         Public speaking
–         Abuse of any kind–         Trying new things, going new places
–         Witnessing violence–         Speaking to new people
–         Accidents–         Arguments

Just as a smoke detector in your home will beep incessantly when you burn the popcorn, your brain and body may respond to perceived threats in the same way. Your alarm (fight or flight response) may go off and signal a problem to you when no actual “fire” exists. Getting to know your early psychological and physical symptoms is helpful so that you can use calming strategies to turn off the alarm before anxiety takes over.

The Good Parts of Anxiety

When there truly is a threat, the fight or flight response of anxiety is like having a superpower. The process taking place in the brain and body can keep us safe and alive in situations of acute danger. However, we are not usually at risk most times we feel anxiety start to creep in. So how can we recognize that and use anxiety to help us in day to day life instead of being hijacked by it?

In the right dose, the stressors that lead to anxiety can actually improve our performance. The Yerkes-Dodson Law is the theory that “performance increases with physiological or mental arousal, but only up to a point.  When levels of arousal become too high, performance decreases.” This theory  is commonly represented by a curve with a steep, mountain-like peak. The shape of the curve demonstrates that, to a point, stress and performance are positively correlated because without any stress, the person does not care to perform well. On the other side of the curve, we see that when stress becomes too great and anxiety takes over, performance suffers. Learning how to manage your anxiety response so that performance reaches and stays around the optimal level makes anxiety work for you.

anxiety effects

image from https://courses.lumenlearning.com/suny-monroecc-hed110/chapter/yerkes-dodson-law/

You Are Not Alone

According to the Anxiety & Depression Association of America, “Anxiety disorders are the most common mental health disorder in the United States, affecting approximately 40 million adults aged 18 or older.” Anxiety is a common experience that becomes a problem when it causes significant distress and interferes with daily activities, relationships, and quality of life. Clinically significant anxiety may be categorized according to symptoms and diagnosed as a variety of mood disorders. Anxiety is also very treatable and, in some cases, can even be beneficial. Understanding the process of anxiety and mental, emotional, and physical symptoms can help you respond appropriately, seek help when needed, and prevent anxiety from interfering with your life.

Blog written by Sentier therapist, Sarah Souder Johnson, M.Ed., LPCC







Meet the Therapist – Becky Lawyer

We are thrilled to welcome Becky Lawyer, LPCC to our team! Becky has 17 years of therapy experience primarily in college settings. We asked Becky a few questions so that our community can get to know her:

Sentier: How did you decide to become a therapist?

Becky: My earliest memory of wanting to be a therapist was during high school after taking a class in psychology. Something about the information I was learning just connected with who I was and am as a person. Since that time, I’ve had no doubts that this would be my career path.

S: Who do you love working with, and what excites you about working with your chosen populations?

B: I love working with teens and college aged clients! As a previous college counselor, I really enjoy working with these clients as they are on a path of discovery of who they are and what they truly want out of life.

S: How would you spend a free day?

B: I enjoy spending time outside and being active. So when I have a free day to myself, you will often find me hiking and sometimes geocaching on the local trails in MN and WI.

S: You’re getting takeout. What’s your meal of choice?

B: This is a hard one with so many great local restaurants to choose from! My first choice would be the roast eggplant pizza from Broders’ Cucina Italiana in Minneapolis. After that option, it would be Thai food, specifically anything with peanut sauce, from one of the great restaurants in Saint Paul!

S: What is your favorite method of self care?

B: I love doing different arts and crafts as part of my self care. As a stained glass artist, you will often find me cutting and breaking glass, or soldering glass together as part of my nightly self care.

S: What are your professional goals for the next year?

B: After leaving a long career working as a therapist in a college counseling center, one of my professional goals for the coming year is getting to know myself as a therapist in private practice. I view myself as a lifelong learner, so I will also be deepening my knowledge of trauma based therapies such as ART.

Read more about Becky here!

Becky currently has openings for individual therapy, EMDR therapy, and workshops for teens and adults. Email ellie@sentiertherapy.com to learn more.

What is play therapy?

Plus a tour of Sentier’s playroom!

Stepping into Sentier Psychotherapy’s playroom is like stepping into a treasure trove of fun. A rack of costumes sits next to a floating shelf filled with dolls which hangs across from a play kitchen set. There’s a bookshelf in the corner with a beanbag chair beside it, shelves holding baskets of legos, building blocks, and yes, a fart sound machine. There’s a tent to crawl in and a velcro dartboard. There are shelves stocked with colored pencils, paintbrushes, coloring books, and board games.

While it has some of the same elements as what you may find in a playroom at school or someone’s home, Sentier’s playroom is set up a little differently. So, what is play therapy? And what are the secrets of the playroom that make it such a fantastic space for children to safely explore their feelings?

What is Play Therapy?

Play therapy is similar to adolescent or adult therapy in that it is an opportunity to process, express, and release thoughts, feelings, or emotions. Kids, though, don’t have as extensive of a vocabulary to express themselves. In play therapy, they can express themselves in a language that they understand–through play! According to the Association for Play Therapy (APT), “play therapy builds on the natural way that children learn about themselves and their relationships in the world around them.”

Why might a child go to Play Therapy?

There are many reasons a child might try child therapy. One of the most common things that brings children to play therapy is difficulties with emotion regulation that keeps them from functioning at school or other environments. Other reasons may include trauma, transition due to divorce or uncoupling, affirmative gender exploration, sibling issues and more.

Bridgett Brye, Sentier’s child therapist, has noticed a trend in her caseload–kids who are adjusting to in-person learning. “I’ve seen a lot of issues with managing big emotions or behaviors in a classroom setting after being at home and missing out on so much of that social development time” she notes.

How does Play Therapy work? The Four Stages of Play Therapy

The first stage of play therapy is to build connection and trust with the child. At the beginning of her clients’ time in play therapy, Brye’s role is almost entirely passive. She lets them explore the playroom without any suggestions or instructions. In allowing the child to guide the play, trust is built and the client can begin to feel comfortable and safe in the space.

Once that trust is built, Bridgett moves on to the second stage, which is to assess the child’s functioning. By observing their play, Brye can begin to understand where the gaps are in a child’s functioning and pick up on themes of play that she may want to address more directly in the therapy. These themes can include power/aggression, control/safety, and family relationships/nurturance.

Once she has a better sense of what the child is needing from therapy, Brye moves on to stage three, which is the introduction of directed play in order to help the child develop coping mechanisms. In most cases she comes to sessions with unique and stimulating activities that engage the client and help them learn about what they’re feeling.

The final stage is termination. From an adult perspective, a child reaching a point where they are stable enough not to be in therapy may seem like a great thing. For the child, though, leaving a setting where they feel safe and comfortable once they start feeling generally more well might feel hurtful. Patience with a child as they transition out of services is key and “with everyone’s efforts, the end of therapy can truly be a celebration of your child’s gains and a genuinely happy and playful event” (APT).

What does Play Therapy look like?

Brye uses both directive and non-directive methods to help children feel, express, and process their emotions.

Non-directive Play Therapy

Non-directive play could look like letting the child know that they are welcome to do what they would like with their time in the playroom. If they venture to the dollhouse, Brye lets the child choose which dolls they want to play with and which doll they want to “be”. This non-directive approach helps children play out things that may have happened or be happening in their worlds. Children tend to reveal their inner turmoil through their play, and child therapists are trained to understand their play.

While she does not instruct the child to do anything, Brye may make clarifying observations about the play to give language to what the child is feeling. Brye remembers a client who was fascinated by the lava lamp and would watch it frequently. Brye verbally observed that it seemed like the client seemed relaxed. The client was pleased to have a new word to label how they were feeling and continued to use the word in different contexts throughout the session. “He knew [the lava lamp] made him feel good but he didn’t know other words that he could use to describe that,” Brye explains. “Reflecting back to them makes them feel understood and expands their emotional awareness, and playing it out helps them feel seen.”

By allowing space for the child to make their own decisions, they can create worlds that both reflect their own and help them imagine what is possible. Maybe the child’s doll family has two moms, or they can explore what feels good to them by dressing up in clothing that may not be typically associated with their sex assigned at birth. Non-directive play helps children build worlds that can clue a child therapist into their strengths, struggles, and areas of growth.

 Directive Play
A non-directive approach doesn’t work for all clients and that is when directive play is more beneficial. Directive activities are introduced by Brye to the child and they work on the activities together during session. For example, incorporating activities that are difficult for the child and working together to complete them can engage and challenge their frustration tolerance. If a child has trouble taking turns, Brye might organize the sessions into 15 minute chunks and alternate between an activity that she chooses and one that the child chooses in order to model patience. For a child who has trouble staying calm, Brye might use part of the session to introduce a method of play that requires slowing down, like building a maze with play doh and using a straw and cotton ball to guide the cotton ball through the maze. How fun, right!?

Brye takes time between sessions to come up with directive activities tailored to each individual client’s developmental level and emotional needs.

 So what’s in the playroom, and why?

“The playroom is filled with intention,” Brye emphasizes. Rather than buying toys of all kinds to stock it with, there are certain staples of child therapy playrooms and they all have specific reasons for being there.

Child Therapy playrooms include both realistic toys (dollhouse, cash register, dolls) and abstract toys (legos, fidgets, play doh). Realistic toys like dolls allow the direct expression of emotions as kids can play out scenes. Toy cars, trucks, and cash registers are also staples of a playroom as they can encourage anxious or cautious children to play “in noncommittal ways without revealing any feelings” (Landreth, 2012, p.161). Moving cars back and forth or organizing play money allow the child to play and move without any pressure to complete a task or play out a specific scenario.

While there are a variety of toys to explore, the playroom isn’t so overwhelmingly crowded that it becomes stressful for clients. A few toy cars to choose from is just as effective if not more than a whole box of them to rummage through. Children who are timid might not have the confidence to dig through a box of stuffed animals or move things around and they should feel like there are less overwhelming options for them to explore as well.

Toys that may appeal more to younger kids are placed lower on the shelves and toys that are more developmentally appropriate for older children are at their eye level. Things like puzzles don’t do as well in playrooms–when one piece goes missing, which is inevitable when it comes to puzzles, it may cause unnecessary frustration (Landreth, 2012, p.170).

One crucial characteristic of the playroom is that it looks exactly the same every time a client comes in for a session. Brye “resets” the playroom after each client, returning toys and materials to their designated spot. The resetting of the playroom provides consistency to kids in a way that they might not experience in other settings. When they enter the playroom, the dollhouses are empty and the dolls are on their shelves, the costumes are hung up, and all toys are back on the shelf. They enter the room as a blank slate that children can build onto.

Another way that a Child Therapy playroom may operate differently than other playrooms is that kiddos don’t need to clean up from their play therapy session. They can if they want to, says Brye, but “this is a different space than home or school and we don’t need to clean up or put away our feelings.”

Brye regularly sends requests for materials to Sentier’s team that may not seem like they belong at a therapy clinic but in fact are valuable tools in a playroom. “Does anyone have extra egg cartons?” for example, is a recent text message she sent our team. Egg cartons are great for ripping apart (and many other things!) and bubble wrap, which colleagues save and bring into the office, is a sensory treat for a lot of kids.

When in the playroom, kids are encouraged to be themselves rather than be careful (Landreth, 2012, p.151). The playroom is meant to feel well worn rather than sterile and new.

 Why is play therapy important?

Children play all the time, so what makes play therapy different? Children can’t begin to learn how to function unless they have trust, and a play therapist can be a stable attachment figure that helps facilitate a child’s emotional, social, and mental growth. It allows them to express themselves creatively in a way that makes sense to them. At the end of the day, it helps a child feel seen.

Play therapy may look like just playing, and sometimes it is! But in engaging with a child in their play, a therapist can help foster safety for the child to be themselves. Brye remembers a session where she and the client played hide and seek the whole time. “That is so powerful,” Brye says, “because you are constantly showing that kid that no matter what, you are always showing back up.”

What does Brye like about play therapy? “It’s amazing when you truly let the kid decide what they will do with their hour. The things they absorb in their day to day life that come out in their play and what they say and the questions they ask…it is so powerful and makes me pause,” Brye reflects. “And it’s fun!”

Blog written by Sentier Client Care Coordinator, Ellie Struewing.

The Benefits of Using RPGs for Mental Health

What are RPGs?

Role-Playing Games (RPGs) have been around for over 50 years. In essence, they are games in which each player takes on the role of a character. The group of players then work together to tell a story with their characters. Many RPGs also include a Game Master (GM) or Dungeon Master (DM). This is a person who serves as the narrator, moves the story along, and plays all other characters including the monsters and villains. There are many different systems that have their own set of rules. One of the most recognized systems is Dungeons and Dragons.

Due to the potential for fighting and violence, RPGs can be controversial regarding their psychological effect on children. However, research has not been able to show any causal relationship between RPGs and poor mental health or delinquency. We will keep you posted as this research continues. The past decade, however, has started to produce research that shows several positive effects of playing RPGs both in and outside of therapy.

Role-Playing Games as Group Therapy

The most common way that RPGs are used therapeutically is through group therapy. Therapists who facilitate therapeutic RPG groups believe that there is an inherent opportunity in games to allow for skill building and positive social interaction. Skills that are gained can include emotional regulation, frustration tolerance, decision making, and cooperation. The therapist oftentimes takes on the role of the GM, guiding the players into situations that naturally allow them to interact socially and practice different skills.

The therapist also works to ensure safety for all players. The use of safety tools is an important part of therapeutic gaming. Common safety tools include lines, veils, and the X card. Lines are subjects that the player does not want included in the game. For example, racism is oftentimes a line that will not be a part of the game. Veils are subjects that the player doesn’t want included in detail, but can be mentioned or a part of a character’s backstory. For example, a player might not be comfortable with in depth descriptions of head injuries. This means that a character can have a head injury occur, but it will not be described in detail.

The therapist will ask each player if they have any lines or veils before the game starts, but they are free to add them throughout game play as needed. Players do not need to explain their lines and veils in front of the group, although many process these topics with their individual therapist outside of the game play setting.

Can role-playing games really help boost mental health?

The short answer is yes! Here are some of the ways in which RPGs can have a positive impact on mental health:

  • Screen time alternatives- You may have seen the acronym TTRPG. This stands for Table-Top Role Playing Games. TTRPGs allow for interactive game play that doesn’t include staring at a screen!
  • Character distance- When creating a character, people oftentimes put parts of themselves into their character. Even when this is consciously done, it can feel easier to work through these issues and characteristics when we aren’t talking about our real life situations. We can “talk about it” without directly talking about it.
  • Connecting with peers- RPGs can be fun to play with friends AND family! For people who have difficulty making friends, a therapeutic RPG group can give them a safe space to build friendships.
  • Connecting with family- RPGs can also be played as a family, allowing family members to interact in a fun space with less pressure. Many RPGs can be played online, which has been especially important during the pandemic. Online RPGs can also allow people to play with loved ones who they can’t be with in person.
  • Skill building- The skills that can be obtained through playing RPGs are endless! They can include educational skills such as practice in reading or math. They can also include skills in creativity, flexible thinking, social skills, emotional regulation, frustration tolerance, and more.

Where can I find more information?

Non-profit organizations such as The Bodhana Group and Game to Grow have put an extensive amount of time into developing therapeutic gaming techniques and collecting research that has studied the connection between RPGs and mental health. Other organizations like Geek Therapy and CASTT Gamers offer community and resources for therapists, spiritual directors, educators, and other professionals who are interested in the intentional and therapeutic use of RPGs. If you are interested, please check out these great resources!

What could you and your loved ones gain from gaming?

Find information about the Teen Gaming Groups that I facilitate in St. Paul, MN on the Sentier Therapy website.

Blog written by Sentier therapist, Mary Devorak, MS, LMFT.

Are My Thoughts Facts?

Thoughts play a very powerful role in our self concept and the way we feel. Cognitive distortions – or thinking errors – can occur when the thoughts we have about ourselves, other people, or situations do not match reality. Thinking errors usually first develop out of adverse situations that feel threatening and then often stick around to become automatic thoughts. These faulty patterns of thinking easily become repetitive and can get us caught in thinking loops or ruminations.

When automatic thoughts are also negative, they cause high anxiety, low sef esteem, difficulty trusting others, trouble in relationships, and under-performance in our work. Therefore, it is important to challenge automatic negative thoughts and irrational thinking errors in order to have a healthier mentality and feel better about ourselves and various situations.

Please note: It is normal and healthy to have some negative thoughts. The goal is not to eliminate cognitive discomfort. The goal is to be fair and rational so that you can acknowledge when a situation is not ok but avoid exaggerating it in your mind or slipping into a state of aimless rumination.

Cognitive restructuring is the umbrella term for identifying and then challenging automatic negative thoughts. Here are a few strategies from Cognitive Behavioral Therapy (CBT) that may be helpful in this process.

  1. Record Your Thoughts. Automatic thoughts occur almost as reflexes and can be hard to even notice until we feel awful in our emotions and bodies. That is why it’s helpful to talk about it with another person and/or write thoughts down in order to sort through what is really going on in your mind. A thought record is a simple way to identify and then move toward challenging thinking errors.
    1. Parse through your thoughts by writing down everything you are thinking, one thought per line. (It might be a lot.)
    2. Put a star next to the thought(s) you believe are automatic negative thoughts or thinking errors.
    3. Note the date, time of day, and situation/place
    4. Note any physical sensations, emotions, and behavioral changes taking place when the thought occurs.
  2. Socratic Questioning. Once a thinking error has been identified, the distortion can be called into question.
    1. Ask yourself the following questions about the distressing thought:
      1. Do I have evidence for this thought?
      2. Do I have evidence against this thought?
      3. Would a rational person believe this thought to be true?
      4. Would I say this out loud to another person about myself?
      5. Would I say this to another person about them?
    2. Rewrite the thought..
      1. Rewrite the thought using words that are rational and evidence-based.
  3. Decatastrophizing. This one is pretty simple and especially effective for worry-based thoughts. Simply ask and answer this question: “What is the worst thing that could happen?” over and over until you get to the end of your worry. You will likely notice the fact that even the worst-case scenario is a. Unlikely, and b. Manageable, even if it is scary or uncomfortable. Then you can use step “b” from above to rewrite the thought based on rationale and evidence instead of a worst-case scenario worry.
  4. Adopt Flexible Thinking. Thinking errors occur when we adopt a rigid way of thinking. The flipside is to stretch ourselves to see things from a different – or opposite – point of view. One way to reduce anxiety is to stop looking at the thought in a black and white way and, instead, to consider the entire spectrum of options and possibilities. In order to be cognitively flexible, avoid using words like “always”, “never”, “should”, and “must” to describe yourself, situations, or people in your mind.

Sometimes, the mere awareness of a thinking error or automatic negative thought is enough to eliminate it. Other distortions are more deeply ingrained, requiring extra work. Keep at it – it’s worth the work to dig out from under thinking errors and find a more rational, truthful version of the way you talk to and think about yourself.

Simply put: Don’t trust everything you think.

Blog written by Sentier therapist, Sarah Souder Johnson, MEd, LPCC

DBT Therapy – What Is It? (Part 2)

See our first blog about DBT: “DBT Therapy: What is it?” to learn about types of concerns that DBT can help relieve. 

So, what else is there to know about DBT?

DBT has four modules: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. 

DBT Mindfulness

Mindfulness skills teach people how to live in the present moment. Wouldn’t it be so great to spend time with friends and fully enjoy that time together, rather than thinking about all the chores you have to do once you get home? You may be thinking, “What if doing chores is awful? I don’t want to do that!” Even when your present moment is unpleasant, it is beneficial to be present in it because if you are aware of what is going on, you are better able to decide how to proceed.

DBT Distress Tolerance

Distress tolerance skills help you avoid acting on impulses. A lot of times, impulses that people have might feel good in the short term, but end up having negative consequences in the long term. These can include drug or alcohol use, self harm, and disordered eating. Distress tolerance skills help you find effective ways to manage negative emotions in the moment  in a way that doesn’t leave you feeling worse later. 

DBT Emotion Regulation

Emotion regulation skills help individuals have more control over their emotions. This module includes tips for improving your emotions in the short term by doing activities you enjoy, but it also helps you have more stable moods over time by helping you examine your sleeping habits, eating habits, and other factors. 

DBT Interpersonal Effectiveness

The Interpersonal Effectiveness module includes skills for everything relationships. People often struggle with assertiveness skills and communicating effectively (especially in the Midwest). Have you ever avoided a hard conversation? Do you find yourself saying yes to favor after favor when you really don’t have the capacity to take something else on? Or do you struggle with getting your own needs met because you are too afraid to ask for what you need? Skills in this module help you ask for what you want and need in such a way that makes the other person more likely to say yes and without getting defensive as well as respect your “no”. With these skills, you can ask for something and say no to something all while maintaining your relationships and your own self respect. Sounds pretty good, right?

Why DBT Is Useful

As you can see, DBT skills can be useful for just about anybody! At Sentier, we offer a Teen DBT Skills Group and a Young Adult DBT Skills group. Each of these groups is 10 weeks long and teaches some of the skills from each of the modules. I like to say we go through the “Greatest Hits” of the skills. New groups are offered quarterly. 

What module sounds most helpful to you?


What Does Grief Look Like?

The Parts of Grief We Do Not Expect and Do Not Talk About

I am a Covid Widow. I lost my partner of nineteen years at the very beginning of the pandemic before we knew what Covid was, and before it was being diagnosed. We do not have an official diagnosis of Covid as the cause of death for my partner, however, all of the signs and symptoms and her cause of death point to Covid as the cause.

Since losing my late wife, I have become a non-consensual expert on Grief. Not only do I sit in and process my own grief, but I now have a collection of widow friends (we call ourselves “the weeping”) that I have formed a deep and intimate relationship with over these past eighteen months. Having a community of people who know what it is like to be a griever is a game-changer in being able to sit with and process grief. My weeping and baking bread are probably the two things that have made it possible to continue to exist in space with folks.

This blog isn’t necessarily about me and my experience with grief and it’s not about all of the usual mainstream conversations around grief, either. This blog is about the unspoken pieces of grief and the things that crept up or surprised us Weeping Widows while going through our Journeys.

grief is normal

First off…

Grief is not a horizontal line, and it’s not even a circle. Grief is like an ocean. Some days you have giant capsize your boat waves, and sometimes you just have little laps on the shore.

Grief has a starting point but never an end point. I think this is one of the hardest things to learn when going through the process. So many folks ask me when grief will end. I am the forever optimist and I want to say that it will end soon or someday, but the realist in me (and the griever) has to say unfortunately, never. Grief stays with you. At first it’s really intense and ever-present. As it continues to flow through you (and as you continue to process along your journey) it evolves. It still can be intense and ever-present, but hopefully those days get further apart and don’t linger as long as they did in the beginning.

Grieving is unpredictable and pops up in strange ways during the most inconvenient times. It can be a song or a smell, a bird or a flower, or something you didn’t know was going to bring on strong feelings. When talking with my widow friends, we all agree that those “surprise griefs” are the worst. Surprise griefs are the moments that show up when you least expect them; you have no idea where they came from. These are moments in grief that you can’t prepare for.

I asked my widow friends what were the things that surprised them the most after they lost their person, and here are their responses:

The build-up is always worse than the day…

The buildups to the big anniversary milestones (birthdays, hospitalizations, etc.) are hard and painful. We spend so much time and brainpower thinking about all the things that are, were, or what could be. We are also just anxious about how it’s going to be on the actual day. I have had 18 months worth of anniversaries and this statement is always true: The build-up has always been worse than the actual day. When the day comes, it might be sad, but it is never as tragically sad as we prepared for.

Those who you thought would stick around don’t, and those you didn’t think would stick around, will.

Is very interesting to see who stays after a significant loss. Everyone shows up obviously for the first two weeks to a month after the death, and then the world tapers off and gets back doing their thing. At this point, we as grievers are left feeling very lonely. Many of the people that I thought would hang around and be supportive did not support me, and I was constantly surprised by who was able to lean in and stay present even after that first month.

Grief math or “Widow Math” as I call it.

This is the subconscious need to countdown until the next significant event. How many days until the next anniversary? how many days has it been since the first anniversary? how many days until I’m older than they were ever going to be again? That constant counting of time is our brains trying to keep us connected to the human we lost, and also breaking down forever into measurable moments. It is not an anxiety easing process or technique. In fact, grief math is incredibly difficult and intrusive for most folx.

It’s really hard to be around people who don’t also experience grief.

This one surprised me. I am a people person and I love to be with people. I now find it hard to be around people who don’t know what it’s like to experience grief on a cellular level the way I have. I’ve asked a lot of widows about this, and this is something that they feel as well. It is a common theme. We tend to lean into each other and into our network because it’s a lot easier to be around people who get it than it is to explain it.
You see grief and death everywhere.

Until becoming a widow, I never realized every show has a character who deals with some sort of significant loss. Many shows have widowers or widdudes as we call them in the Widow’s Club. You can’t help but see those characters differently after joining the Widow Club/Grief Club. Or maybe you didn’t even notice that character at first, and then that’s all you can see.

The body remembers before your brain will.

There is something to be said about the body keeping score. We hold trauma in our bodies, and our body then reacts in somatic ways. My body told me an anniversary was coming up before the calendar did. It was shocking to make the connection between the physical pain and the proximity of the anniversary. Grief does not just hurt emotionally, it hurts physically, as well.

minnesota counseling can help

What is the takeaway from all of this?

If you are a griever:

Find a community. Find people who know what it’s like to experience what you have experienced. A community will give you common language, and most importantly connection. Grief is such an isolating experience that creates such big internal and external spaces of loneliness. Most people need to have people around them in order to get through, and out to the other side of those dark spaces. Remember that you’re not alone. There are so many of us out there. Just come find us.

If you’re not a griever:

Don’t forget about your friends who have lost humans. Be patient with them, as they may not be the same person they were before the loss. Allow people to grow into their new selves as they work on figuring out who they are becoming after their loss.

Don’t take silence personally. If your grieving friend withdraws, it is not about you. It is most likely because they needed to go inward and do some work.

Be there for them when they return with open arms, and not with judgment. Remember, they are different now.

Trust your grieving friend when they share things with you about their experiences. If you don’t understand why they are doing a certain thing or you don’t agree with the choices they are making, ask them about it. They may be doing things a certain way because they have to protect themselves or because they may be dealing with other people’s grief. They have to be a certain way in the world right now in order to keep themselves safe.

Do your best not to put your own grief onto the person who is grieving. If your friend loses a parent or a partner, going to your friend and talking about how sad you are and leaning into them to help you process your feelings of grief and loss may be incredibly overwhelming to that individual. If you’re able to take your feelings and process them with somebody else who is not as close to the loss, that is going to be more beneficial to your grieving friend. Grievers do not have the emotional space to hold grief for other grievers the way that other grievers need. This is not Universal for everybody but in general it’s very hard for those who are in it to be there for others.

One important thing to remember is that we will all be Grievers one day.

Unfortunately, death and loss are inevitable and every person will experience some sort of significant loss. As a culture (in North America), we are generally not great about talking about death. Death is scary, so it is avoided. But it is a thing that happens. The more we can all remember that we will all be grievers one day, the easier it will be for us to lean into that experience and to feel what we need to feel and process what we need to process.

You cannot bypass grief, you cannot avoid the loss, and grief can never be outrun. The only thing you can do is go through, feel it, process it, and even eventually embrace it. It is not scary, it is just beautifully sad.

What has helped you in your grief?

Blog written by Sentier therapist, Ashley Groshek, LMFT

Coming to Terms With the Psychological Effects of the Pandemic

The COVID-19 pandemic upended much of life as we knew it and people are now trying to make sense of what just happened to us. The existential weight of it is almost too much to comprehend, especially because it is still going on around the world. However, in the United States and here in our home state of Minnesota, we see rising numbers of vaccinated individuals and plummeting numbers of positive cases of COVID-19. We are receiving permission and even encouragement to resume “normal” activities. As we begin to see the restrictions of the pandemic in the rearview mirror, it can feel exciting and upsetting all at the same time.

understanding the psychological effects of covid

So exciting: Friends! Hugs! Live events!

So upsetting: Anxiety. Stress. 600,000+ deaths.

In therapy, we call this the dialectic: when two seemingly conflicting truths exist at the same time.

For example, I have heard clients talk about all of these dialectics throughout the pandemic and also experienced some of them myself:

  • Quarantine was both terrifying and relieving. Some people described an exciting pandemic “honeymoon” period while at once knowing that others were sick and dying – and that it could also happen to them.
  • The pandemic brought job loss and financial devastation to many while also presenting the chance for important professional reflection and growth that may have never happened without the forced slow down.
  • Some people decided to make important changes in their lives that will bring them closer to peace and happiness while also being forced to reckon with painful changes in other areas of life.

And now we are facing another dialectic: It is very hard to act or feel like everything is fine even when the experts say it is safe to get back out there. So why is that?

Simply put, we have experienced trauma. The COVID-19 pandemic has combined the threat of physical harm (“I could get sick and die.”) with heightened psychological vigilance (the 24-hour news cycle, constant changes to the rules and recommendations, worry about getting others sick, missed events, lack of closure, grief). Taking precautions like social distancing, masking, and immunization helped keep us safe, but it also meant being on guard all of the time. In addition to the pandemic, we also collectively felt stress from natural disasters, racial injustice and human rights violations, political turmoil, and police and community violence.

If you don’t quite feel like yourself, rest assured there is a good reason for that. Brain fog is a common symptom of chronic stress, and “chronically stressful” is an apt description for the circumstances of the past year. Under threatening conditions, the brain gets hijacked by stress. Then hormones like adrenaline flood the body and the nervous system goes into what is commonly known as fight, flight, or freeze to help keep the body safe. It becomes difficult to concentrate, reason, and have a clear sense of time and perspective when we are on high alert at all times waiting for something bad to happen. This is brain fog. Another common symptom is disorientation, especially under ambiguous circumstances. Although the virus is receding, there will be no hard and clear end to it, and that type of uncertainty increases anxiety even more.

Remember that you have lived through a series of rapid changes following a very abrupt shutdown. If you are feeling more upset than excited and struggling to return to “normal,” gently consider the following tips for recovery:

  1. Get organized. Show yourself compassion by using a calendar to track plans and tasks and set reminder alarms. Carving out a little more time than usual for daily tasks will increase the effectiveness of your work and give you a sense of accomplishment.
  2. Leave your home. You may be isolating yourself after following recommendations to physically distance. Question any notion that you are better off alone as that is likely anxiety speaking and not a rational thought. Start by establishing a simple routine for going outside, make eye contact, run errands, and be around other people with increasing frequency.
  3. Move your body. Movement creates new neural pathways that can help your brain get through mental blocks and also helps rid the body of stress hormones. This is particularly true with movement that engages both sides of the body in an alternating, repetitive motion. Take a walk, hop on a bike, or row a boat to help you process the big emotions of this new reality.
  4. Humans recover best together. Your relationships may have changed over the past year, and that is ok. Conversations with just one trusted person about the highs and lows of your experience can help calm your nervous system, reintroduce a sense of lightness and safety, and move you toward feeling and functioning better.

If you are struggling more now than earlier in the pandemic, you are not alone. This is trauma, and it takes time to get back into your body, calm the nerves, and make sense of it. Accepting the dialectic of the present moment – that it is indeed both exciting and upsetting at once – can get you feeling more like yourself again.

Sarah Souder Johnson, M.Ed., LPCC is a therapist at Sentier Psychotherapy in St. Paul, Minnesota

Gratitude During COVID Pandemic

Historically, as the calendar year comes to an end, I take time to reflect on the past year. I ask myself: What did I learn? How did I grow? What ways did I struggle? I create a mental Top Ten list of my favorite memories I long to hold forever.

I pause to honor the difficult memories, too, and consider what’s left to heal. Then, I take those reflections and allow them to help me consider goals for the new year.

As 2020 neared its end, I found myself avoiding that tradition. This past year felt like too much to process properly. I felt stuck. Then, as the great prophet Oprah Winfrey says, I had…

This tradition involves practicing GRATITUDE!!!


Yes. It’s true.  My gratitude practice struggled in 2020.

This year brought heavy grief on a global, national, state, local, and personal level. There was no manual on how to be a mom, partner, friend, daughter, sister, teacher (not self-inflicted), or therapist during a pandemic.

Gratitude is high on my personal values list and typically feels second nature to practice. However, sometimes the things that once felt  easy can feel almost impossible in times of crisis.

As the dumpster fire of 2020 continued to spread, this value was challenged for me. I could always force myself to find something to be grateful for, but the key word here is FORCE. What once felt familiar, was now a struggle. I wasn’t feeling grateful for this pandemic year.  So how can I practice it, if I don’t feel it?

As I processed these thoughts with my best friend, he said, “Thankfulness is a feeling, gratitude is an action.” This brought my second ah-ha moment.  My ACTIONS of gratitude were lacking because I didn’t always FEEL it.  With this revelation, I researched ways to jump start my gratitude actions in 2021:

“Thankfulness is the beginning of gratitude. Gratitude is the completion of thankfulness. Thankfulness may consist merely of words. Gratitude is shown in acts.”
Henri Frederic Amiel

  1. Keep a gratitude journal.
  2. Consider the small things; they add up.
  3. Complete a random act of kindness.
  4. Take 2 min to think about someone who inspires you.
  5. Say it out loud: Tell someone you love something you are grateful for. Tell them you love them while you’re at it too.
  6. Write a thank you note to someone.
  7. Volunteer your time for a cause you are passionate about.
  8. Create a gratitude jar.  Write the items you’re thankful for and place them in a jar, read as needed.
  9. Create a piece of art to represent something you are thankful for.
  10. Build routine: pick one consistent time of the day to practice.

If you have also struggled to feel thankful this year in the midst of grief and loss, consider trying one of these action steps to increase your gratefulness. What other ways do you practice gratitude?

Blog written by Sentier therapist, Alyssa Haggerty

Home for the Holidays… Still.

santa with face mask

It was great to see how creative families were in making Halloween an exciting holiday, even with COVID-19 restrictions. There were candy chutes, scavenger hunts, and small get-togethers with safe “pods” of people.

With winter holidays approaching, feelings of disappointment might be coming up because you can’t see family or do certain traditions.

Many of you have also been home for the past nine months, which means coming home for the holidays just isn’t the same. It is important to acknowledge that loss and feelings of disappointment. It is also important to try and embrace the current situation.

Just because the holiday season looks different this year, doesn’t mean it can’t have the usual holiday cheer! And hey, you might even create a new tradition!

things to do for christmas

I have 14 ideas for you on how to have a safe and fun holiday this season:

  1. Have a virtual ugly sweater party. You can make DIY ugly sweaters or if crafting is not up your alley, there are many available for purchase online. At your virtual party you can vote on who is the “ugliest.”
  2. Do a Secret Santa gift exchange. You can draw names virtually using a website such as drawnames.com. Deliver gifts secretly and follow social distancing by dropping them off on the giftee’s doorstep or mail the gift anonymously.
  3. Have a virtual family dinner. The holidays are often a time to get together and enjoy a big meal. Before the holiday dinner share recipes or do driveway drop offs so the family favorite dishes can be enjoyed. Share the meal or dessert together via Zoom.
  4. Watch your favorite holiday movies. You can still watch your favorite holiday movies! If you want you can discuss them with your friends and family while you watch using Teleparty.
  5. Bake cookies. Baking cookies is always a classic. Families often have their own traditions around baking cookies for the holidays. This year you could bake them together virtually and deliver them to friends and family.
  6. Go to the St. Paul Winter Carnival. The Saint Paul Winter Carnival is happening this year with COVID-19 restrictions.
  7. Go to the GLOW Holiday Festival. The Minnesota State Fairgrounds is having a drive-thru event that will include a light display, State Fair food court, and more.
  8. Go to a drive-thru light display. Severs Holiday Lights (Shakopee, MN), Christmas in Color (Shakopee, MN), Bentlyville (Duluth, MN), Sleepy Eye in Motion (Sleepy Eye, MN), Sam’s Christmas Village (Somerset, WI) and Christmas Village (Chippewa Falls, WI) are having drive-thru light displays this year. Get everyone a warm beverage, load up the car, put on holiday music, and enjoy a cozy ride in the car.
  9. Look at light displays in residential neighborhoods. Many houses in the Twin Cities have impressive light displays. Here is a 2020 light display guide.
  10. Attend an outdoor/virtual Holiday Market. Holiday markets are great ways to check out goods from local vendors. You can get gifts for everyone on your list. If visiting in person, don’t forget to wear your mask.
  11. Attend a virtual event. Holidazzle has gone virtual this year. Check out the link for more information: https://www.holidazzle.com/
  12. Check out Gingerbread Wonderland at the Norway House. This exhibit of elaborate gingerbread houses is available to see in-person by appointment from November 6-January 2 or virtually beginning December 6.
  13. See a play. The Ordway and the Guthrie are having virtual performances this year.
  14. Embrace Hygge. Hygge is a defining characteristic of Danish culture that means: a quality of coziness that results in feelings of contentment and well-being. Read more to capture this feeling in your life: https://www.countryliving.com/life/a41187/what-is-hygge-things-to-know-about-the-danish-lifestyle-trend/

christmas lights st paul

There are many creative ways to make the best of the holidays this year. What ideas do you have?

Blog was written by therapist, Andrea Schroeder, MS, LPCC

College Students and COVID-19

covid-19 memeTo say that it is a weird year for college students is an understatement.

When I think of college, I think of it being a time to meet new people and “find yourself.” I think of busy cafeterias and full lecture halls. This year schools look a lot different.

Some schools are fully online, while others are doing in-person classes with restrictions, and others are doing a hybrid model. Some students are choosing to defer their enrollment altogether because none of these options seem desirable.

College students know they won’t get the typical college experience because of the pandemic and want to wait to attend school until they can.

I remember my first night of college. My wing had a “wing event” where all my hallmates went to get ice cream at Sonic together. Around October there was an event in which all organizations on campus set up booths and you could walk around and see what interested you. I signed up for Psychology Club. Events such as these are online or cancelled this year, which makes it more difficult to try new things and meet new people.

how to deal with covid-19 in college

Whether your classes are virtual, in-person, or you decided to defer a year, you are undoubtedly experiencing grief. Grief does not just occur when there is a loss of a loved one.

People have feelings of grief when life goes differently than they envisioned or there is a loss of any kind. There are so many losses when it comes to COVID. School is different, sports are cancelled, events have been called off, we can’t see friends, etc.

Fortunately, something that helps with grief is gratitude. Since it’s November, expressing gratitude often happens if not personally, at a family holiday or tradition.  Sometimes it can be hard to think of something that you are grateful for, so here are some tips to start your gratitude practice.

Gratitude Tips:

  1. Write down three things that you are grateful for each day
  2. Let people in your life know what you appreciate about them
  3. Make a collage of things you are grateful for; engage someone in your bubble to clip magazines together!
  4. Try to think of the positives in negative situations (eg. being able to stay connected with friends and family through virtual get-togethers)
  5. Make a gratitude practice part of your routine by thinking about what you are grateful for at the same time every day (such as meal time or before bed)
  6. Post what you are grateful for on social media
  7. Expressing gratitude is not intended to minimize your feelings of anxiety, sadness, etc. You can feel your feelings AND be grateful for something.

COVID is hard and it has taken and will take a lot away from us. Despite this, what is something you can find to be grateful for?

Also see Preventing Social Isolation to Protect Our Mental Health

Blog written by Andrea Schroeder, MS, LPCC, therapist at Sentier Psychotherapy

Will Seasonal Affective Disorder Arrive Early During COVID?

Winter… ready or not, here it comes!

With winter comes beautiful snow falls, cozy sweaters, and warm cups of cocoa around the fireplace. But let’s be real, winters can also be long, dark, and take a toll on our mental health.

People often describe getting “winter blues,” also known as Seasonal Affective Disorder, and experiencing feelings of sadness, changes in mood, low energy, and difficulty sleeping. In addition to the change in season, the uncertainty that comes with the Coronavirus pandemic might add stress and have negative impacts on our health, schooling, work-life balance, and ability to get a good night’s sleep.

sunshine and your health

With this in mind, now is the time to begin preparing ourselves for the effects of these seasonal changes and continued social isolation related to Covid-19 in the winter months. Ways to fight against symptoms of Seasonal Affective Disorder:

  • Get as much outdoor time and sunlight as possible
  • Find creative ways to stay connected with loved ones
  • Exercise
  • Practice good sleep hygiene

Another way to help manage “winter blues” and increased stressors, is taking the right vitamins and supplements. Vitamin D is sometimes known as “the sunshine vitamin” due to its production in the body in response to sunlight. Vitamin D helps our immune system fight off disease and builds healthy bones. But did you know, vitamin D is also linked to improved mood and reducing symptoms related to depression?

hello sunshine

Vitamin D and Depression

Researchers have found links between vitamin D deficiencies and increased levels of anxiety and depression. Studies show that individuals taking vitamin D reported a decrease in their depression. Because increasing your sun exposure during the winter months is difficult, taking a vitamin D supplement may be a healthy alternative to getting that needed dose of sunshine. Vitamin D can also be found in foods such as:

  • fatty fish, such as salmon, mackerel, and tuna
  • egg yolks
  • cheese
  • beef liver
  • mushrooms
  • fortified milk
  • fortified cereals and juices


vitamin d supplements

Can Vitamin D Supplements Help Fight Depression?

Health professionals recommend taking magnesium along with your vitamin D to help support your body in absorbing the vitamin and receiving its full benefits. Taking vitamin D and magnesium supplements are best paired with other practices, such as those listed above, to help treat depression.

When considering taking vitamin D and magnesium, be sure to consult with your doctor to ensure you take the correct amount and consider all potential effects to your individual health.

How do you plan to combat winter blues? Do you take any vitamins or supplements that are helpful for your mood and overall health?

This blog was written by Sentier therapist, Tana Welter, MSW

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