Envision Therapies - The Game

Featured as an easter egg at envisiontherapies.net, it might have been overlooked. Enjoy Envision Therapies - Cloud Clearer. Blast those dark clouds from the Seattle skyline in order to let in some sun! Happy Spring!

Inurance Update

Envision Therapies is now in network with Premera Blue Cross

Happy Equinox! (A day of balance)

Isn't that just "Pros of Positive Psychology: A Look"...?

Happy 10!!!

This year marks the 10 year anniversary of Envision Therapies. I've been asked several times recently why I do what I do, or how I ended up as a counselor. I feel incredibly blessed to be a part of essential and meaningful work in the community for well over a decade.

As far back as 1998, I started the practical steps toward being a psychotherapist. Originally, I planned to complete medical school to work as a psychiatrist. I skipped ahead by completing the AP psychology test (even without having had the AP class.) Each college course in psychology reconfirmed my passion in psychology and behavioral health. The material that illustrated the ever-present human capacity to change and adapt, but not always in healthy, helpful, or (on the outside) rational ways always piqued my interest and intrigue. I completed my bachelor's degree (a year early) with all the premed required courses. Without that extra year to plan my transition to medical school, I started my career as a case manager inside a homeless shelter. I saw first hand psychiatrists' roles in the world of mental health. Put off, I honed in on a path toward being a counselor and psychotherapist.

In 2003, Lewis & Clark Graduate School warmly accepted me as a student. I have been grateful of the education and experience Lewis & Clark afforded me. I'm not sure I would have the same appreciation for how the experience of body, movement, and sensation plays vital roles in mental health if I had completed coursework elsewhere.

Working in community mental health after graduate school provided a solid balance of experience as a therapist, witnessing the value of community, and (sometimes painful) sense of reality.

It was one of my proudest moments, earning my counseling license. Prouder still, when I could officially hang a shingle and offer the experience, interest, and realism to my community under my own flag. 'Envision Therapies' expressed a emphasis in work that looks forward, mindfully, healthfully with a plan. I wanted my practice to instill hope. I envisioned a model that guided client's aspirations from this present moment to something better. In January 2008, Envision Therapies was a legal entity.

By April 2008, it had a physical address. (Like many buildings on Capitol Hill - it no longer stands.)

It fills me with gratitude to recognize the colleagues who have provided support and guidance. I've been blessed with clients and a community that value my work. Envision Therapies shares my mission in providing psychotherapy to people who need and want services, to be realistic about how that can actually be achieved, and to ultimately work myself out of a job.

Happy Birthday Envision Therapies!!!

Break for a Joke

Pavlov walks into a bar. The phone rings, and he curses, "Damn! I forgot to feed the dog."

The Chemical Balance Myth

I recently read the August 7, 2017 Time cover story "The Anti Antidepressant." It talks of possible "new" innovations in psychopharmacology. It's hardly new Ketamine, MDMA, and other medications have been researched in the past. Often street (ab)use, led to discontinuing the research in medications like this.
This latest article does a fine job of describing the (Western) understanding of depression. It also does a poor job of updating the understanding that's come in the last 40 years. The brain in "chemical imbalance" model of understanding and treating depression was outdated by the time it was used to help portray to clients the usefulness of SSRI in treatment. It's not that it's totally incorrect -- it's incomplete. The latest Time article does at least note that the latest understanding acknowledges the likelihood that depression is perhaps a dozen plus conditions. It still, however, perpetuates the perspective that depression lives solely in the brain.

Depression may be demonstrated through low serotonin, dopamine, or other neurotransmitters. Recent researchers, though, see a multidimensional, physiological syndromes that explain the depressive experience. There is a shift in how the anatomical areas of the brain metabolize and send impulses (a neurological and circuit based disease.) Not only do certain genes show links to depression, but whether those genes have been turned on or off in a person's lifetime (a genetic and epigenetic disease.) The genes con
trol how hormones are replicated and how sensitive our body is to these hormones (an endocrine disease.) These hormonal interactions inflame our tissues - a disease of inflammation. These are all parts of depression - it is not only seen in the brain, not only felt in the brain.
Depression impacts our sleep, appetite and metabolism, our sense of energy, our ability to concentrate. It impacts relationships in the family and in the community - a person's participation in the call and response of human connection.
I hope that clinicians find one more effective treatment of depression. I regularly tell my clients and colleagues (with a touch of facetiousness) "No business is good business." My sense of this comes with the belief that counseling is only one vehicle to address depression. Often, it's the job of therapist to connect people to more meaningful interventions, more resolute solutions to managing mood: Healthy relationships, healthy lifestyles, communities, friends, exercise, greater sense of connection to the world and to people, a sense of meaning, a remembrance of one's fortitude and internal resources. Because depression does not simply live in the brain. Treatment can start in the brain, in relationships, and in physiology. It does not end there.

You Can Always Ask, They Can Always Say 'No'

There's a list of recommended exercises I pull from when working on assertiveness with clients. It comes from Dr. Linehan's DBT Manual - the Interpersonal Effectiveness chapter. It's a whole list of ways to make requests of people in settings that are generally safe. For some (including myself), a portion of the exercises can feel like a real challenge. 



There's two suggestions that didn't make the list, but other clients and group members have recommended. (I have since found them in other material.) One of those suggestions is asking a sales associate to open a display case for you without buying an item. I regularly picture the scene from Wayne's World in which the sales person in the guitar shop reluctantly obliges. BUT the salesperson draws the line at the first few notes of "Stairway." And, he ultimately asks Wayne to put the guitar back in the case. (Yes, I realize Wayne then purchases said guitar.) When building assertiveness, it helps to recognize that other people we make requests of have some responsibility in setting their own limits and refusing or rebuffing. If they don't want to hold resentment, it's their responsibility to keep to a line or say "No." Most people let us know gently and politely that we're putting them out or crossing a line.

Another suggestion brought up has been sending food back when dining at a restaurant (even if it is exactly what you asked for.) This tends to get a debate going in DBT skills groups I've led. In session, it often gets a strong pushback, as well. I'm all for the "social experiment" for a good cause -- restoring a person's voice and recognition of one's own worth. It excited me to read this article. "Why sending something back at a restaurant is perfectly fine — and how to do it right" Seattle Times Yes, it still does not bring up the issues of the legitimacy of the "social experiment"/exposure therapy in a restaurant setting. It does, however, show that a dish may still be sent back while by all measure it's a fine plate -- it comes down to personal taste.

Happy Fall!

 Today marks a day of balance - half light, half dark. In honor, you can get out one of those Thought Records I often hand out and log the balanced thought - the world's not simply black and white!

New Phone System

A friendly headsup - Envision Therapies will no longer be able to receive SMS/texts. It's a new phone system for the New Year. It may seem a step back -- overall, though, it's a step forward. As always, it's more secure to call and leave a message. (I'm still taking emails, if you would like: envisiontherapies@gmail.com)

Darkest Days

Winter solstice - the darkness is a time for reflection, communion, and rest. ...It only gets brighter from here!

Veteran's Day 2015

Today and everyday -- Thank you, Veterans. Your service and dedication is admired and appreciated.

Out of the Darkness Community Walk

I'm glad to have the opportunity to participated in the Out of the Darkness Community Walk today at Seattle Center. The local AFPS chapter is dedicated to providing a community for family members, friends, and people who are struggling with Suicidality. Over 1200 people participated and over $130,000 was raised. What a great effort.

In Network - Cigna

Now glad to announce that Michael Sibrava's an in-network provider for Cigna!

Fall's Here -- Couple's Return Home

As we slide on into October, Seattleites also begin their preparations to transition much of their time back to indoor activities. Much of that time ends up being time at home. We see a lot more of our loved ones and partners as the clouds start hanging in The Sound. When relationships are working well, the time at home can be just as enriching. If there are tensions, pains, and frustrations that can be avoided while outside and active -- the discord is much harder to avoid when fall and winter bring you face to face with your partner.
Disagreements are a given. If the disagreements are confronted and discussed, a couple has an opportunity for deeper understanding and a chance to work together as a team. Your intuition can gauge how productive your arguments unfold and resolve. Believe it or not, having the same arguments and differences of opinions do not mean the relationship is doomed. People in lasting relationships disagree about more things than they do agree. The ways in which arguments are approached are more telling of a relationship's resiliency.  Arguments where respect is lost, a person feels insecure, shut down, or like they're walking on eggshells -- these are feelings that signal deeper issues are influencing interactions with a partner.
Some helpful advice in soundbite form:

Build opportunities for teamwork: Find some chores and projects to take on together. Cook some meals together. Recognize those moments that you do agree about solutions.
Make time for quality time: Set a date night. Eat meals together.
Stoke warmth and intimacy: Massages, Cuddling, Day at the spa, adventures, and, yes, of course, sex.
Stay curious: Have an authentic interest in your partner, their growth, their feelings. You need not interrogate, but show that you simply are curious to know about their day, what was enjoyed, what was difficult, and what was noteworthy.

Staying Current

Taking the National Clinical Mental Health Counseling Examination (NCMHCE) in order to continue providing independent services for Service Members and their family. It's been study, study, study... now the moment of Aletheia.

Group Health PPO

Very excited to announce that Michael Sibrava will be accepting Group Health PPO starting September 1st.

And as always, still in network for:

• AllOne Health EAP

• Aetna

• First Choice PPO

• Lifesynch/Humana

• MHN

• MHNet

• Tricare

• Regence Blue Shield

• United Behavioral Health/Optum

• United Healthcare

• Value Options PPO
• Washington Crime Victim Compensation

Kids Have the Scoop on Coping Skills

I love the neurophysiology lesson about the neocortex. I'm taking an extra easy breath right now.

SHORT FILM ‘JUST BREATHE’ HELPS KIDS DEAL WITH EMOTIONS

EMDR Survey

A graduate student at Smith College​ is asking recipients of EMDR therapy to participate in a survey regarding substance use/abuse and behavioral addictions (i.e. process addictions) and the impact of EMDR. If interested, the survey is located at: https://www.surveymonkey.com/s/N962MW7

New Trauma Credential -- CCTP

Officially a Certified Clinical Trauma Professional... with even greater knowledge in promoting growth after trauma.

Now In-Network for Regence Customers

As of February, 2015, I'm please to announce, that I will now be able to bill services to Regence Blue Shield and BridgeSpan Health as an in-network provider.