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Online Therapy

Variously dubbed telehealth, telemedicine, teletherapy, distance therapy, e-therapy, internet therapy, or virtual therapy, online therapy is the use of electronic transmission to provide interactive real-time mental health services remotely. Just like in-person counseling, online therapy uses verbal and non-verbal forms of communication. Here at Sanctuary we use a video platform so that we can both see your face and hear your voice during your therapy session. In many cases, online therapy is just as good or even preferred over in-person therapy. We offer online therapy to clients throughout Washington state. 


Having a client in front of me was all I ever considered before March 2020. My training as a counselor, like many grad school programs, assumed that I would only be seeing people in person. I never imagined I would do counseling remotely! As a counselor, I pay close attention to my client’s body language. I notice how they sit on the couch, what they do with their hands, if their foot jiggles nervously, when they take a deep breath, etc. I do this because it gives me valuable information about what is going on in my client’s “internal world”, meaning their emotions and thoughts. I use this information to inform my approach in counseling. Additionally, confidentiality is incredibly important to me as a counselor as well as to my clients. Being able to control the environment of my office is a real benefit to seeing clients in person. My office is very cozy and quiet, and I utilize blinds on the windows and white-noise machines in the hallway to create a feeling of safety and privacy for my clients.


When it comes to online therapy, there are definitely a few obstacles!

Technology challenges can be very disruptive. You can probably imagine what it might be like for a client if they are in the middle of an emotional story and they look up and see their counselor frozen with a strange expression on their face or dropped from the session altogether! Situations like that take repair to the connection, both the call connection and the relationship connection. It’s also somewhat limiting to only see my client’s face, and not see what is going on with the rest of their body. Finally, it can be difficult for some clients to find a place where they feel they have enough privacy to really be open with me. Clients often have their sessions in their cars, as that is sometimes the quietest and most removed setting they have access to while they are at home.


Online therapy has some immense benefits, as well!

One thing that is somewhat unique to counseling (as opposed to a traditional doctor’s office visit) is that the appointments tend to be on a consistent basis at a consistent time. Your counseling appointment might be at 3 pm on Tuesday every week, for example. It may be easy to leave work at 3 pm for a doctor’s appointment a few times a year, but when we’re talking every week it might be significantly harder for many clients. Online therapy is particularly suited to alleviating this difficulty by taking away the travel time on either end of the appointment. Clients can zip out to their car for an hour and have counseling from their front seat, for example, and essentially call it their lunch break. If you’re someone with a private office or if you’re working from home, it’s even more convenient; just shut your door and you’re in your counselor’s office!


Another benefit is that online therapy widens the pool of possible counselors that may be available or specializing in the services you are looking for as a client. For example, if you are looking for a counselor that specializes in perinatal mood disorders and you live in a tiny rural town you may have to either drive a long way to find a good fit in person or settle for more of a generalist local to you that may not help you as fully or quickly as you would like. With telehealth, you can search for all providers in your entire state and find the counselor who will best serve you. I am a huge supporter of anything that lowers the barriers to getting counseling services. If telehealth makes things easier for people to get the help they need, I am all about it.


When beginning online therapy, what should you keep in mind?

Just like I had to upgrade my technology (webcam, lighting, microphone, etc.), I sometimes think that would be helpful for my clients as well. I don’t mean they need a professional setup in order to meet with me, but it might help them to focus more on their issues in counseling rather than having to hold onto their phone or worrying about whether I can hear them clearly.

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Research on what makes a marriage work shows that people in a good marriage have completed these psychological “tasks”:

Nine psychological tasks for a good marriage

  • Separate emotionally from the family you grew up in; not to the point of estrangement, but enough so that your identity is separate from that of your parents and siblings.

  • Build togetherness based on a shared intimacy and identity, while at the same time set boundaries to protect each partner’s autonomy.

  • Establish a rich and pleasurable sexual relationship and protect it from the intrusions of the workplace and family obligations.

  • For couples with children, embrace the daunting roles of parenthood and absorb the impact of a baby’s entrance into the marriage. Learn to continue the work of protecting the privacy of you and your spouse as a couple.

  • Confront and master the inevitable crises of life.

  • Maintain the strength of the marital bond in the face of adversity. The marriage should be a safe haven in which partners are able to express their differences, anger and conflict.

  • Use humor and laughter to keep things in perspective and to avoid boredom and isolation.

  • Nurture and comfort each other, satisfying each partner’s needs for dependency and offering continuing encouragement and support.

  • Keep alive the early romantic, idealized images of falling in love, while facing the sober realities of the changes wrought by time.

(Reprinted with permission from the American Psychological Association with thanks to Judith S. Wallerstein, PhD, co-author of the book The Good Marriage: How and Why Love Lasts)

Image by Tim Mossholder

Helping Teens Cope

Being a teen can feel challenging enough, but sometimes life adds to your stress. There are things you can do to help yourself when something difficult is going on in your life, and psychologists call this resilience. What are some tips that can help you learn to be resilient? As you use these tips, keep in mind that each person’s journey along the road to resilience will be different – what works for you may not work for your friends.

1. Get Together

Talk with your friends and, yes, even with your parents. Understand that your parents may have more life experience than you do, even if it seems they never were your age. They may be afraid for you if you’re going through really tough times and it may be harder for them to talk about it than it is for you! Don’t be afraid to express your opinion, even if your parent or friend takes the opposite view. Ask questions and listen to the answers. Get connected to your community, whether it’s as part of a church group or a high school group.

2. Cut Yourself Some Slack

When something bad happens in your life, the stresses of whatever you’re going through may heighten daily stresses. Your emotions might already be all over the map because of hormones and physical changes; the uncertainty during a tragedy or trauma can make these shifts seem more extreme. Be prepared for this and go a little easy on yourself, and on your friends.

3. Create A Hassle-Free Zone

Make your room or apartment a “hassle-free zone” – not that you keep everyone out, but home should be a haven free from stress and anxieties. But understand that your parents and siblings may have their own stresses if something serious has just happened in your life and may want to spend a little more time than usual with you.

4. Stick To The Program

Spending time in high school or on a college campus means more choices; so let home be your constant. During a time of major stress, map out a routine and stick to it. You may be doing all kinds of new things, but don’t forget the routines that give you comfort, whether it’s the things you do before class, going out to lunch, or have a nightly phone call with a friend.

5. Take Care Of Yourself

Be sure to take care of yourself – physically, mentally and spiritually. And get sleep. If you don’t, you may be more grouchy and nervous at a time when you have to stay sharp. There’s a lot going on, and it’s going to be tough to face if you’re falling asleep on your feet.

6. Take Control

Even in the midst of tragedy, you can move toward goals one small step at a time. During a really hard time, just getting out of bed and going to school may be all you can handle, but even accomplishing that can help. Bad times make us feel out of control – grab some of that control back by taking decisive action.

7. Express Yourself

Tragedy can bring up a bunch of conflicting emotions, but sometimes, it’s just too hard to talk to someone about what you’re feeling. If talking isn’t working, do something else to capture your emotions like start a journal, or create art.

8. Help Somebody

Nothing gets your mind off your own problems like solving someone else’s. Try volunteering in your community or at your school, cleaning-up around the house or apartment, or helping a friend with his or her homework.

9. Put Things In Perspective

The very thing that has you stressed out may be all anyone is talking about now. But eventually, things change and bad times end. If you’re worried about whether you’ve got what it takes to get through this, think back on a time when you faced up to your fears, whether it was asking someone on a date or applying for a job. Learn some relaxation techniques, whether it’s thinking of a particular song in times of stress, or just taking a deep breath to calm down. Think about the important things that have stayed the same, even while the outside world is changing. When you talk about bad times, make sure you talk about good times as well.

10. Turn It Off

You want to stay informed – you may even have homework that requires you to watch the news. But sometimes, the news, with its focus on the sensational, can add to the feeling that nothing is going right. Try to limit the amount of news you take in, whether it’s from television, newspapers or magazines, or the Internet. Watching a news report once informs you; watching it over and over again just adds to the stress and contributes no new knowledge.
(Shared with permission from the American Psychological Association)

Image by Uday Mittal

About Anxiety

Anxiety problems can affect anyone. Anxiety often comes when people hold in their fears until they begin to feel anxious. Symptoms of anxiety can include:

  • Fear of being exposed to the scrutiny of others

  • Checking or rechecking actions

  • Excessive worry about everyday occurrences and activities

  • Fear and anxiety that appear for no apparent reason and that may include physical symptoms such as shortness of breath.


Why is it important to seek treatment for anxiety problems?

If left untreated, anxiety problems can have severe consequences. For example, some people who suffer from recurring panic attacks avoid at all costs putting themselves in a situation that they fear may trigger an attack. Such avoidance behavior may create problems by conflicting with job requirements, family obligations or other basic activities of daily living. Many people who suffer from an untreated anxiety disorder are prone to other psychological problems, such as depression, and they have a greater tendency to abuse alcohol and other drugs. Their relationships with family members, friends and coworkers may become very strained. And their job performance may falter.

By contacting a therapist, those who are struggling with anxiety can take the first step on the road to recovery. According to the National Institutes of Mental Health, 90 percent of people with emotional illnesses will improve or recover if they get treatment.


Are there effective treatments available for anxiety disorders?

Sanctuary staff members are trained in approaches to psychotherapy – including cognitive-behavioral, interpersonal, psycho dynamic and other kinds of ‘talk therapy’ – that can help individuals address problems with anxiety. Psychotherapy offers people the opportunity to identify and learn to manage the factors that contribute to their anxiety. Relaxation exercises can help reduce anxiety and increase resilience.

For some audio resources that will guide you through breathing and other relaxation techniques, visit http://www.allaboutdepression.com/relax/index.html.

Books that may be helpful to people who are experiencing anxiety:

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About Depression

According to the National Institute of Mental Health, an estimated 18.8 million adult Americans suffer from depression during any one-year period. Many do not even recognize that they have a condition that can be treated very effectively. This question-and-answer fact sheet discusses depression with a focus on how psychotherapy can help a depressed person recover.


How does depression differ from occasional sadness?

Everyone feels sad or “blue” on occasion. Most people grieve over upsetting life experiences such as a major illness, loss of a job, a death in the family, or a divorce. These feelings of grief tend to become less intense on their own as time goes on. Depression occurs when feelings of extreme sadness or despair last for at least two weeks or longer and when they interfere with activities of daily living such as working or even eating and sleeping. Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. Some may have thoughts of death or suicide. People who are depressed may become overwhelmed and exhausted and stop participating in certain everyday activities altogether. They may withdraw from family and friends.


What causes depression?

Changes in the body’s chemistry influence mood and thought processes, and biological factors contribute to some cases of depression. In addition, chronic and serious illnesses such as heart disease or cancer may be accompanied by depression. For many individuals, however, depression signals first and foremost that certain mental and emotional aspects of life are out of balance. Significant transitions and major life stressors such as the death of a loved one or the loss of a job can help bring about depression. Other more subtle factors that lead to a loss of identity or self-esteem may also contribute. The causes of depression are not always immediately apparent, so the disorder requires careful evaluation and diagnosis by a trained mental health care professional. Sometimes the circumstances involved in depression are ones over which an individual has little or no control. At other times, however, depression occurs when people are unable to see that they actually have choices and can bring about change in their lives.


Can depression be treated successfully?

Absolutely. Depression is highly treatable when an individual receives competent care. Mental health professionals have years of experience studying depression and helping patients recover from it. There is still some stigma, or reluctance, associated with seeking help for emotional and mental problems, including depression. Unfortunately, feelings of depression often are viewed as a sign of weakness rather than as a signal that something is out of balance. The fact is that people with depression cannot simply “snap out of it” and feel better spontaneously.

Persons with depression who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen a depression. The importance of obtaining quality professional health care cannot be overemphasized.


How does psychotherapy help people recover from depression?

There are several approaches to psychotherapy – including cognitive-behavioral, interpersonal, psycho-dynamic and other kinds of “talk therapy” – that help depressed individuals recover. Psychotherapy offers people the opportunity to identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal and situational causes.

Skilled therapists can work with depressed individuals to:

  • Pinpoint the life problems that contribute to their depression, and help them understand which aspects of those problems they may be able to solve or improve. A trained therapist can help depressed patients identify options for the future and set realistic goals that enable these individuals to enhance their mental and emotional well-being. Therapists also help individuals identify how they have successfully dealt with similar feelings, if they have been depressed in the past.

  • Identify negative or distorted thinking patterns that contribute to feelings of hopelessness and helplessness that accompany depression. For example, depressed individuals may tend to overgeneralize, that is, to think of circumstances in terms of “always” or “never.” They may also take events personally. A trained and competent therapist can help nurture a more positive outlook on life.

  • Explore other learned thoughts and behaviors that create problems and contribute to depression. For example, therapists can help depressed individuals understand and improve patterns of interacting with other people that contribute to their depression.
    Help people regain a sense of control and pleasure in life. Psychotherapy helps people see choices as well as gradually incorporate enjoyable, fulfilling activities back into their lives.


Having one episode of depression greatly increases the risk of having another episode. There is some evidence that ongoing psychotherapy may lessen the chance of future episodes or reduce their intensity. Through therapy, people can learn skills to avoid unnecessary suffering from later bouts of depression.


In what other ways do therapists help depressed individuals and their loved ones?

The support and involvement of family and friends can play a crucial role in helping someone who is depressed. Individuals in the “support system” can help by encouraging a depressed loved one to stick with treatment and to practice the coping techniques and problem-solving skills he or she is learning through psychotherapy. Living with a depressed person can be very difficult and stressful for family members and friends. The pain of watching a loved one suffer from depression can bring about feelings of helplessness and loss. Family or marital therapy may be beneficial in bringing together all the individuals affected by depression and helping them learn effective ways to cope together. This type of psychotherapy can also provide a good opportunity for individuals who have never experienced depression themselves to learn more about it and to identify constructive ways of supporting a loved one who is suffering from depression.


Are medications useful for treating depression?

Medications can be very helpful for reducing the symptoms of depression in some people, particularly for cases of moderate to severe depression. Some health care providers treating depression may favor using a combination of psychotherapy and medications. Given the side effects, any use of medication requires close monitoring by the physician who prescribes the drugs. Some depressed individuals may prefer psychotherapy to the use of medications, especially if their depression is not severe. By conducting a thorough assessment, a licensed and trained mental health professional can help make recommendations about an effective course of treatment for an individual’s depression.

Depression can seriously impair a person’s ability to function in everyday situations. But the prospects for recovery for depressed individuals who seek appropriate professional care are very good. By working with qualified and experienced therapists, those suffering from depression can help regain control of their lives.


(reprinted with permission from The American Psychological Association Practice Directorate which gratefully acknowledges the assistance of Daniel J. Abrahamson, Ph.D., Lynne M. Hornyak, Ph.D., and Lynn P. Rehm, Ph.D., in developing this fact sheet on depression)