It's ALL Health: A Conversation About Psychological Support for Medical Concerns with Dr. Marni Amsellem

hat do we do when we're up at: 03:30

Welcome. I'm glad you are here today. I'm Dr. Andrea Bonior, and this is Baggage check, mental health talk and advice. With new episodes every Tuesday and Friday. Baggage Check is not a show about luggage or travel. Incidentally, it is also not a show about whether a college has actually ever offered a class in underwater basket weaving. So let's get going. Today, I am particularly excited, and that's because we have on licensed clinical psychologist Dr. Marni Amsellem. She has a specialization in health psychology and consultation, and we've got her on to talk about how all of us are waking up at three in the morning and unable to get back to sleep because we're thinking about whether or not chat GPT can take our jobs. Nope, that's not really true. We do talk about the 3 AM insomnia cycle, but we also are having her on to talk about way more than that. Dr. Amsellem is a licensed clinical psychologist who sees patients in several different states, and she has a ton of expertise in the role of psychological support for physical health conditions. This was a great conversation about everything from meditation apps to back pain to journaling to individual differences, to how to convince someone that therapy can help with health problems and what direction our culture is moving in in terms of wellness. So I'm thrilled you're here for it. You can learn more about Dr. Amsellem at her website, smarthealthpsych.com. Here we go.

Dr. Andrea Bonior: Well, I'm so excited to have you here, Marni. Welcome to baggage check.

Dr. Marni Amsellem: Thank you so much. I am delighted to be here.

Dr. Andrea Bonior: Yes, it's so great to be able to talk about these issues because I find lately that people are really starting to understand that mental health and physical health, it feels like not only even just that they're intertwined, but they're one and the same in so many ways.

Dr. Marni Amsellem: Absolutely.

Dr. Andrea Bonior: Yeah. It's really a pleasure to have you. Why don't we start by hearing a bit about how you got interested in health psychology in the first place.

Dr. Marni Amsellem: So it sort of was a bit, um, by chance, as things often are in life. But when I was looking at graduate school, I wanted to study stress and coping and so I was looking for where I could do that and where I ended up going. The track was within, um, a health psychology, um, concentration. So in so doing in my coursework and of course in some of the research I was doing in grad school, I realized that, um, this was fascinating to me because what I really loved about studying stress and coping was that individuals all approach things uniquely, right? And so if there was a common stress such as a new diagnosis of something, two different people will respond two different ways. So that was something that has always, um, uh, fascinated me and compelled me to want to stay in that space.

Dr. Andrea Bonior: Yeah. And what kind of changes have you noticed over the past couple of decades since we were both in grad school? It's been a little bit of time. We were, I know, very much on the same timeline and uh, as I mentioned, I do feel like people have gotten more understanding in the physical health realm that mental health is right in there. Is that something that you see too? Is that something that you see in the general public?

Dr. Marni Amsellem: I think so, yeah. I think that there's definitely been more openness and acceptance to that. I think with some of the tools that we have accessible to us, um, because in that time, I know we're going back in time to um when we were in grad school, there were no smartphones, there were no apps right? And so things like meditation apps essentially is bringing in the mind and body and that's sort of at the root of what healthy is. So I think with that openness and acceptance to realizing, yeah, the things that we do, the things that how we treat ourselves, um, really has ah, an effect on how we are feeling physically as well.

Dr. Andrea Bonior: Mhm, yeah the sheer volume of changes in advances in terms of the average consumer or the average person seeking mental health services, they have so many more avenues now because of the technology.

Dr. Marni Amsellem: Absolutely.

Dr. Andrea Bonior: Do you find some of that promising? I know I'm oftentimes talking about negative aspects of technology, but certainly there have been so many positive aspects as well. I think especially in health psychology.

Dr. Marni Amsellem: I am a huge fan of mobile health applications that are well vetted and validated to do what they say that they do right. So that there's evidence base behind them. They've been tested in research, um, to show that these tools are effective for so many reasons, but it makes things accessible at our fingertips for everyone, typically in a very cost effective way. And it really helps in terms of mental health with combating the um, access and affordability issues.

Dr. Andrea Bonior: Yes. That makes a big difference, I'm sure. So you mentioned meditation and that's certainly something that I see in a very practical way all the time with my clients, that it's one thing ten years ago for me to have said, hey, here's a script for a meditation and maybe I can give you this recording. It's another one now for me to be able to say, here are 30 different places you can look and see what's out there. And maybe you like this person's voice, or maybe this works best with your phone, or maybe this one is the one that really resonates with you. They have so many choices.

Dr. Marni Amsellem: This has been incredible. I love it. That is very much a positive of the space in which we are in right now. I don't know if you remember at any point in your training handing out a cassette or a CD of, um, one person's voice, right?

Dr. Andrea Bonior: Yes. Ah, one person's voice. And now, I mean, I've had conversations with clients just very candidly, like, oh, that person doesn't really resonate with me. But this person's voice is amazing. It's extra soothing. And I think that's so wonderful. It seems like mindfulness meditation is one area where it's really empowering to be able to say, let me try a bunch.

Dr. Marni Amsellem: Yeah, let me try, let me choose what works for me. For sure.

Dr. Andrea Bonior: And I imagine the privacy too, to be able to be alone in your room and have the smartphone and say, I'm going to have this experience right here, just with the device that I have in my pocket. Nobody else has to see, I don't have to check something out of a library. Of course, maybe the privacy settings on your phone mean that in some abstract way somebody else is seeing. But I do think that is not.

Dr. Marni Amsellem: The focus of what we are talking about today. But I would also broaden it beyond to being in your own room with doors closed. This could also happen when you're sitting in your workplace or in a waiting room, waiting for an appointment that you're feeling a bit apprehensive about. So you can use this tool anywhere.

Dr. Andrea Bonior: Yeah. And that's m what makes it so positive. So thinking about waiting rooms and appointments and I know you have a lot of experience working with people who are really transitioning to difficult types of diagnoses in the health realm. What kind of trends have you seen in that in terms of whether or not people recognize that therapy could be helpful? I've got this diagnosis, for instance, it's traditionally thought of as being just physical health related. Have you seen a bigger willingness in maybe the medical health community as well to steer people into mental health treatment over time?

Dr. Marni Amsellem: Absolutely. That has been also a trend in the positive direction. Um, I think that there's a lot of physical complaints, whether we're talking about pain, particularly related to back pain, but it can be in a whole lot of other regions of her body where, as the medical issue is being assessed, it is clear that there are some other life stressors or just approaches to life that are interfering, that are really contributing. Um, whether or not they are the ideology or like the cause of the physical complaint or they are maintaining the complaint. It is clear that, uh, addressing these the mental health aspects are part of the solution.

Dr. Andrea Bonior: Mhm and what would that typically look like? Would it be individual therapy? Are group therapy is particularly helpful in this way? Or self help techniques?

Dr. Marni Amsellem: Really all of the above. It really depends on the problem as well as the person and individual preferences. So if it is kind of going to the example of back pain, um, and it's clear that there's a whole lot of life stress happening, um, kind of feeling like unsolvable problems or not getting enough sleep, you can kind of target some problem solving or addressing if there are underlying mental health diagnoses and targeting the cause of those problems, certainly. And working on some strategies for stress management and for improving sleep.

Dr. Andrea Bonior: Mhm sleep is so huge in so many of you because I think so many health issues disrupt sleep. Obviously mental health issues can disrupt sleep. And then disrupted sleep makes you physically less resilient, makes you emotionally feel worse. And so the cycle starts anew. And it really seems a little problematic that even folks that aren't struggling for M physical health issues, their sleep quality has not been great in recent years. There's some troubling data on that. Yeah.

Dr. Marni Amsellem: So when we are having difficulty sleeping, it can certainly be contributed by many different things. Whether they are environmental things going on in our home or in our lifestyle like crying babies and things like that. Or they are stresses like unresolved things, worries that we have that are staying with us, um, unsolved problems, they can show up. And it becomes a bit of a reinforced cycle where we realize, oh, it's 230, that is the time for me to wake up and start worrying about things. Um, that is a very common experience, actually, for people. But when we do things behaviorally to try to facilitate our sleep, obviously the level of challenge depends on the individual and how deep rooted the sleep issue is. But when we make some changes to help improve our sleep, that of course has carry over effect into how we are feeling the next day, how focused we are feeling, perhaps our patience and how open we are feeling to the challenges of the new day. So very much we all know that a good night of sleep feels amazing. Um, and you're able to approach the date quite differently.

Dr. Andrea Bonior: Yeah, I often, uh, talk to audiences about just evolutionarily, how we are bred to be more anxious and negative when we're under slept because it used to keep us alive, right? It used to be a wonderful adaptation that, hey, if we're under slept, we can't run as fast and we're sluggish, we're more in danger. So therefore, our brains are going to adapt by seeing everything as being extra threatening so that we'll be on guard. And nowadays, we don't need to run from predators so much. Now we're just at work and we're super annoyed with our coworker, or we're super fearful of our neighbor, or someone who's different from us just because we're under slept. But it's interesting you mentioned, too, that waking up in the middle of the night, I hear from so many people, especially parents, that even long since the time when they had to wake up for kids, there's almost that, ah, chronic conditioning of, uh, waking up and worrying about something in the middle of the night. I work with so many mothers in particular who say, oh, there it is, it's 330 a. M. And maybe I got up because I had to go to the bathroom or something, but now my brain is cycling and I cannot fall back asleep and it's miserable.

Dr. Marni Amsellem: Absolutely right. Yes. I think that is a human experience to have empathy to that. Because whether or not we, um, have experienced a long standing kind of habitual pattern like you're describing, or we've just had a night or two of rough, uh, non sleeping, right. We can relate to that. But what you are referring to very much has been habituated, where it's set in because of life circumstance. Right. But then there had been this habituation. We are behavioral beings, right. And very much learned, uh, associations. And if there is this, um, the internal clock that we have is set and we learn, okay, well, this is what happens at exactly 331. We think about all of the things that we need to do tomorrow. It doesn't need to be a big worry. It could also be just the everyday things, too. But those are things on the positive. These are things that we can address. These are solvable problems. M?

Dr. Andrea Bonior: Yeah. And so what typically is helpful for folks in that scenario, you know, something that in the light of day, feels manageable. I think, again, we've all had that experience, like you said, where it's 330 and it feels just that much more formidable and terrifying, this thing that we're going over our head because it's dark and we feel more helpless or hopeless about it. So people who are experiencing this cycle and it's really impairing them. What are first steps in terms of trying to break that cycle or even just seek out help for it?

Dr. Marni Amsellem: Yeah. So the approaches that I'm going to share right now are going to be borrowed from a very effective way to treat insomnia. So, um, whether or not we're actually referring to insomnia or just difficulty sleeping, um, there are a lot of behavioral things that we can do, and aspects of our thoughts that are reinforcing this and maybe kind of setting up our expectation of, oh no, I'll never be able to fall back asleep again. My morning tomorrow will be shot. Or these automatic thoughts that we are having. Right. So a very effective way to treat insomnia is a, uh, technique called CBTi, cognitive Behavioral Therapy applied to insomnia, which has a very behavioral component to it as well, in terms of restricting sleep and resetting, really, your wake time to help compress the amount of wakings that happen during the night and improve sleep efficiency. And that is a bit of a mathematical equation of the amount of time that you are asleep compared to the amount of time you are in bed. And you want it to be pretty high, right, where you're not spending a whole lot of time in bed staring at the ceiling or tossing and turning, so to speak. Um, some of the things you can do are, um, when you notice you are tossing and turning, getting up out of bed and going to a different location. Because, again, you want to pair your bed with successful sleep. So this can help reset you in your night of sleep. So going maybe to the couch, turning on a low light. And notice I have not yet mentioned the smartphone. It now to say that would not be recommended by any means. What I would do is maybe even have something, if this is a repeated pattern, have something nearby that you can access. You're not even thinking so much about it. Maybe a boring book. I often tell people that something maybe you've picked up so many times can never get into, that would be a thing to pull out at that time. Um, because once you start looking at it, you will probably notice physiological signs of fatigue. Like, yawn, that is a sign that your body is saying, yeah, I am tired, and this can be the reset that you need. So, mhm, that would be, um, a go to there. But tossing can very much reinforce, uh, that frustration with not sleeping.

Dr. Andrea Bonior: Right. And what you said about those automatic thoughts becoming almost a self fulfilling prophecy. I think it's so true in insomnia, more than even most things, which is, uhoh, uh, now tomorrow is going to stink and I'm just going to be a mess. And that's a fundamentally, inherently unrelaxing thought. Which is why some of those paradoxical techniques sometimes are helpful. Like, okay, well, let me assume that I am going to be a mess tomorrow, then whatever extra sleep I get right now is just a bonus. Exactly. I remember telling my kids that early on when they'd be like, well, I can't fall asleep. I can't fall asleep and say, that's fine, just enjoy the fact that your body is able to rest right now. And that's shifting perspective in and of itself. Yes, exactly. Thinking about all of these issues. I think they're so intertwined. And I think one thing that I notice a lot of is that health problems sometimes start to creep up. For some people, it's a very gradual thing. It's not, okay, I got this diagnosis yesterday, but it's HM, my back has kind of been bothering me and over the course of a few months, it's affecting how I sleep. Or hey, maybe some autoimmune conditions are like that. It's not like one day out of nowhere it hits you, but hey, I've been struggling with dizziness or rashes that itch at night. And it sort of gradually starts to seep in. In your experience, when people are adjusting to new diagnoses or new symptoms, what kind of emotional stuff goes along with that? What kind of things do you see that could be helpful for them to work through?

Dr. Marni Amsellem: Yeah, it's so individual. Kind of getting back to one of the things that I find so fascinating and really powerful, um, about facing that stress of something's going on, right. Two different people can interpret the same news or same experience in different ways, of course. So, um, really getting a sense for the individual what this means and what this might mean for them in the context of their, um, overall life experience. For example, was this an expected turn of events, right? That they are prediabetic, for example, they get that news right? Mhm, and they have a long family history of diabetes, so there may be an expectation there that this was going to happen to them versus someone who did not and feels like they are on top of their health and making, um, generally speaking, making healthy decisions. So what is the meaning of that? And then also sort of individuals kind of like predisposition to worry and anxiety and maybe conclusions there. So now I very much see that there can be a bit of a difference. Health issues can kind of live in their own sphere, where they can be huge triggers for anxiety for some people, whereas other stressors may not affect them quite as much. So this is, again, how some individuals, uh, were all different. And that's pretty cool, right? So really getting a sense of what this means for them and helping them really address their thinking around it, as well as certainly any related behaviors either to the medical issue or just their overall health and wellness. Such as addressing how they are sleeping, uh, how they are managing their stress in general, um, what outlets, um, where they are going for, um, support and how they're eating, how they're taking care of themselves, et cetera.

Dr. Andrea Bonior: Mhm, and health anxiety being its own sphere, I see definitely an increase in health related anxiety since the pandemic. I think we were all kind of thrust into this world where realistically, we did have to worry about it, and we did have to worry about it for a really long time.

Dr. Marni Amsellem: I mean, anxiety is most often rooted in something real. Right.

Dr. Andrea Bonior: Exactly.

Dr. Marni Amsellem: Doesn't mean our brains then take it and um, kind of map out the future to some catastrophic level. Right. They very much can do that. But yeah, we've been living in definitely a lot of periods of uncertainty that have been shifting and we've had to kind of roll with it and various points. There were different hurdles that we were all kind of collectively facing and trying to make sense of and make decisions about. And um, this has been an area where you really are seeing, again, the role of individual differences, both in terms of how this health information and risk assessment is being interpreted, but also how decisions are being made. Any gatherings that you may have had at peak moments in the pandemic.

xiety. Well, in the middle of: 2020

Dr. Marni Amsellem: And that same behavior put in the context of, say, a later period m, where we are living with the virus. Right. But the world has certainly opened up, uh right. Mhm that can be seen differently depending on the context.

Dr. Andrea Bonior: Yes.

Dr. Marni Amsellem: And the information we have and the tools we have to protect our health, certainly. Right.

Dr. Andrea Bonior: And our own needs to protect ourselves. Whether we are highly vulnerable.

Dr. Marni Amsellem: Correct.

Dr. Andrea Bonior: For instance, someone who needs to protect themselves with extra measures because of an autoimmune condition or cancer diagnosis or something like that.

Dr. Marni Amsellem: And I think just hitting a pause there, I think recognizing that there are many who are currently living and I'll say that knowing that there is no endpoint for this, that we know of, um, with these realities that are still at heightened risk. Right. And despite having used some of the tools, or maybe not because they're not eligible for the tools of vaccines, um, that they are perhaps realistic concerns that they are dealing with and have had to integrate into their life and are making decisions differently than others as the world has moved on a bit.

Dr. Andrea Bonior: Yeah.

Dr. Marni Amsellem: To honor those differences.

Dr. Andrea Bonior: Yeah. To really honor them and to allow them to be seen. Because I think I have heard from a lot of folks who feel invisible in that. Whether I think more generally with chronic illness or disability. And then also too, in the context of COVID and needing extra protection and feeling like they've been left behind. And I think maybe this is a larger question about folks that are suffering from chronic pain, um, or folks that are suffering from an illness that maybe isn't automatically seen as they are at the grocery store, but they're suffering with symptoms that are almost debilitating, even though they're not obvious. Correct. What can we do as a culture to help empower these people to feel less invisible? Because I think a lot of them feel silenced, I think a lot of them feel ignored even in the medical community sometimes. And we've seen some studies where, for instance, people with disabilities, there's a lot of maybe discrimination that even goes on in health care and folks not being able to even get the care they need, which is ironic. You would hope that the health care field would be better about this. And again, we all have culpability here. I'm not trying to point fingers, but where do we go from here? I'm especially imagining that with long COVID, we are maybe anticipating even more folks dealing with sort of silent types of symptoms and, um, there are increase in people with debilitating types of conditions. What can we do to recognize this more, to empower people more, and to not make them feel so silenced and invisible?

Dr. Marni Amsellem: Yeah, I think back to your earlier question of what I've noticed in the field of health psychology generally over the time that I've been in it, is the greater awareness of this being an issue and openness to bring this to light. And I think some of the facilitators have been, generally speaking, a more open place to talk about differences and bring feelings of invisibility to public discourse. Mhm, there's been that I've seen within healthcare, within professionals, there being a, ah, whole lot more topics that are being, um, discussed in professional forums on topics such as recognizing discrimination toward overweight patients. And in terms of bringing voice to this, I'm about to once again talk, um, about some of the positives of social media, but where everyone has a platform, right. So a lot of people have brought their experience, uh, feeling not seen or, um, kind of sharing what it is like when they park in a handicap spot because they have their handicap, um, designation in their car and get out of the car, they look to the outside world as a healthy person. Right. And so there is a place to share that voice. HM. And certainly there's a place to share the voice of those struggling with mental health conditions which, as we know very much might be invisible, um, to the outside world.

Dr. Andrea Bonior: Yeah, it's so true. I mean, most mental health conditions have at least a layer of being masked, at least in superficial interactions. I mean, not all some symptomology is pretty overt, but I think in our culture, sometimes we put that sheen on it because somebody says, well, I didn't know they were struggling because they seemed happy when I saw them at work or whatever. And I think you're right in that social media has allowed people a forum maybe to speak out more and to.

Dr. Marni Amsellem: Find other people, to find correct, to connect with others. And um, it's certainly been beneficial that a lot of influencers, right. Celebrities, so to speak, have come out about whatever their struggles were, that, to your point, are being masked by the public persona and saying, if I share my story, maybe this will help others. Right. And finding that this really is something that people can connect with and can be inspiring for them to both bring awareness to what they're experiencing is worthy of paying attention to or getting treatment for or sharing with others in their lives. Mhm, basically taking action on right.

Dr. Andrea Bonior: And helping people get into treatment, I know often is the goal if there is a mental health concern, or if they just need the support because they are struggling with something really challenging, like chronic pain or something. What would you say to a skeptic about that? Somebody who's really been struggling, they've got a new diagnosis. They certainly are showing signs of anxiety or depression, but they just don't think that mental health support, whether it be in the form of individual therapy or group therapy, or even seeking out sort of a, uh, connection with others with this illness. They don't think that it would be helpful or they think that it is just beside the point where they don't see it as being connected to their overall health. What would you say to somebody like that? Right?

Dr. Marni Amsellem: I mean, typically those are not the people that we see coming into the office when we are in, um, outpatient settings where people are coming involuntarily. Right? Um, what I do hear a lot more of are those in the lives of people with whom I am working that are not recognizing the role of their mental health and how they are their interpersonal relationships, how they are showing up to work, how they are uh, making decisions and getting through their day. So it is very challenging to reach people that don't want to be reached. Right? And that has historically been an issue. Um, and the positive I can say is that overall, the trends are moving in the direction of greater awareness and recognition of there being tools that can effectively help people manage healthy. Tools that people can effectively use to manage, um, challenges. And whether or not it's framed in the context of a diagnostic label, or if it's framed in the context of here are some tools that you can use to help deal right. That getting that word out and uh, certainly reducing the stigma around that we can all use tools.

Dr. Andrea Bonior: And I like the tools metaphor. I've. Seen it be so helpful for people who maybe otherwise assume that therapy is sitting around and talking about yourself all the time with your feelings. I think there's really an element of needing to help folks understand that really, you're going in there to increase your ability to have these tools so that you can cope outside of the therapy room.

Dr. Marni Amsellem: Too. Absolutely. That's the strengthening of it. Right.

Dr. Andrea Bonior: Yeah.

Dr. Marni Amsellem: Uh, it's one thing to reserve 45 minutes and talk about things. Right. There's some utility in that. But the real work happens when you leave and you apply it to your life.

Dr. Andrea Bonior: Yes, exactly. And we've seen therapy and the ability to get these tools, I think, become more accessible with telehealth. That's certainly something that you are in the throes of. I know you're licensed in multiple states, so you see people from all over. Um, can you talk a little bit about what people should expect when seeing a therapist online versus in person? And how to sort of weigh that in their decision making and some of the ways that you've seen it be helpful, but some things that maybe people should keep in mind, too.

Dr. Marni Amsellem: Absolutely. Well, talking, um, generally speaking, about what can be extremely helpful about telehealth. The accessibility. Right. You can be in your own living room or private space anywhere in your residence. Right. Really emphasizing the private space. Um, you want to be able to say things that you need to say with the privacy, but you can be there. And regardless of where your provider is, as long as they are a licensed provider in the state in which you live, it opens up the possibilities of who you can work with. And certainly, if you are looking for a provider who specialize in a particular area, and there's not that many who are licensed, who are in your physical area, that it's easy for you to get to or who have availability right. Who are open and accepting new patients at this time. So it opens up the potential to reach people and to have access, um, from the comfort of your own home. And certainly for those with any mobility or, um, kind of practical logistic concerns of, gosh, my job is so demanding to go somewhere, that's another factor in another at least 45 minutes, back and forth, at least. Right. Um, and that you don't need to do that when it's telehealth. Right. And if there are certainly, again, like, mobility issues or you're a caregiver, you have limited bandwidth, and carving out this time for yourself is a big thing. Um, it allows for greater flexibility and reduced, again, like logistic demands on you.

Dr. Andrea Bonior: Yeah.

Dr. Marni Amsellem: And as far as flexibility, may also allow, uh, for greater flexibility with scheduling, with your provider as well.

Dr. Andrea Bonior: Right. And those are the things that can make or break. Sometimes, I think. Sometimes we think of those as being superficial things, like, oh, I don't have to commute to the therapy appointment anymore. But in a way, sometimes that can be what helps somebody go in or not. That's a role especially when you think of all of the constraints on people's time.

Dr. Marni Amsellem: Yeah, absolutely. And I would say the flip side to your question. The downsides are, uh, actually pretty minimal, but are real, which is that it may not be the appropriate form of treatment for certain mental health conditions, and it may not be appropriate for those who are not feeling comfortable, certainly either with technology or, um, with having relationships over video. But the overwhelming evidence, because there has been a whole lot of evidence on this, are that the effectiveness of telehealth via video therapy sessions is just as effective in the vast majority of cases because relationships can be a rapport can be established, and, um, addressing whatever the needs are that you're coming into therapy can certainly be addressed that way. It fundamentally, at that point, comes down to preference. Would you rather be in a room with someone or are you okay with not being right?

Dr. Andrea Bonior: And so the caveats are important, but for most people, they really don't outweigh the benefits. And I find that sometimes awkward things come up. Like, sometimes there are some clients, for instance, where it's distracting for them to see themselves. So we have to figure out a way for them to not be looking at themselves.

Dr. Marni Amsellem: Most of the technology does allow you to hide your window if you don't want to see yourself.

Dr. Andrea Bonior: Exactly. Or sometimes the sort of very high achieving, busy person, hey, maybe I'll have another window up, as I'm talking about therapy.

Dr. Marni Amsellem: Ah.

Dr. Andrea Bonior: And so I guard against that type of thing. Like, no, you wouldn't check email if you were in the middle of a therapy session in my office. So let's try to find a way to raise that urge this time. The other main caveat I see, and most of the time, this is not an issue. I think sometimes you brought up the privacy, the private space concept, because that's so crucial. And if somebody is talking about their family or their roommate or their partner, or especially if somebody is in a relationship that might have a controlling aspect to it, I think it's very important that we find a way to protect them when talking and to create a truly safe and private space. Uh, I've had some clients in cars go out to their cars. Yes. And not driving, let's be clear. But even if it's something minor, like, you know what, I'm going to talk about my teenage daughter today, and I want to make sure that she's not in the next room, or something more serious, which is I'm thinking of leaving my partner, and I need to make sure that I can talk freely about this.

Dr. Marni Amsellem: Right.

Dr. Andrea Bonior: But yeah, it speaks, if anything, to the importance of, uh, at the beginning of the therapy relationship really being clear about all this and being honest about it. And here are some of the drawbacks. How do we think that we would handle these? Because there is such a world of benefit to potentially come. We just need to make sure that we're doing it in the right ways. And I'll tell certain clients right off the bat that maybe it's not the best fit for online, um, just do the nature of what they're struggling with. Right. But I think, as you said, for most people, it can really be a beneficial arrangement. Just really positive.

Dr. Marni Amsellem: Yeah. I would echo everything that you just said in there. All, um, consideration.

Dr. Andrea Bonior: Yeah. One thing that we haven't talked about. You've done a lot with helping people learn how to journal in a way that can be mentally and emotionally beneficial. Could you speak to that a little bit? Because I think that's one of those concepts that some people do it naturally and then other people kind of roll their eyes, like, oh, are you going to tell me that I need to journal about my feelings? But what I love about some of the work that you've done with it is that really helps people realize ways that it can truly be actionable and truly make a difference. It's not just kind of this general idea, oh, journaling is good, but if you do it in a targeted way, it has a lot of positive benefits.

Dr. Marni Amsellem: There are so many ways in which you can do it. And certainly it can be that tool to help with those thoughts, get them out of your head, that do serve as at 330 in the morning, whether it is, again, kind of like working through a, uh, big issue or really just kind of getting those more like a to do list.

Dr. Andrea Bonior: Right.

Dr. Marni Amsellem: Kind of getting those activities, uh, and actions that you need to do, um, out of your head and putting them down. So there is that very practical purpose of it and the emotional catharsis of getting out whatever it is that you are carrying with you. It can be part of a very we were talking about tools before. A very, um, important tool for part of a routine. And routine feel good. Right. So a lot of people do find, um, some comfort and regularity in knowing that, yeah, this is something I can do to help ground myself and starting a day. Or I can get out those things that I've been thinking during the day. If I do this at the end of the day, or whenever it works for you, or however frequently, again, it's, uh, accessible to you to do. Right. Not have to be thinking about it as a chore. That's not the most useful way, and there's no need. Right. It's a tool. It's something that you can use for many purposes. Whether it is sort of like an emotional catharsis, um, helping organize your thoughts and figure out what is so distressing to you about the challenge that you're facing? Like, why is this getting you so much? And when you sit down and kind of start somewhere, right? It doesn't have to be and we can talk about that in a second, but starting somewhere, you might find that it's taking you somewhere else. And that in so doing something's, jumping out at you like you are realizing, okay, this is the aspect of this that is really getting at me. Mhm as a place to start, that is often a barrier that people do have in journaling. Like, staring at a blank page just feels stressful, like, I don't know what to do. And it can be like another reinforcer for them or another bit, um, of evidence that to them is saying, you don't know what you're doing, right? And that's not true. However, there are lots of ways that you can get around that by, um, using some journal prompts. You can go online and find some journal prompts that speak to you. You can go purchase a journal that has some prompts that are already, um, provided for you and use them as starting places. And one of my favorite things and some of the things that I've written, um, has been to also leave some blank pages at the very end where you can take those same prompts that you use maybe two months ago and replicate them again later when you realize, okay, I am now approaching this. How am I approaching this right now? Let me see. Let me just use this, and maybe after doing this, I'll compare this to what I have written previously.

Dr. Andrea Bonior: Mhm I love the idea of just kind of letting yourself start without it having to be a certain way, without it having to be a chore, without it having to be something that you do, right or wrong. Right. It is right if you try it. And that's as simple as could be. Uh, you mentioned the idea of a blank page. Is there something really important about I personally, when I think about writing stuff or collecting my thoughts or even just writing, hey, I need to remember to send that thing into the car insurance or whatever. I do find that writing with a utensil by actual writing is somewhat more helpful for me than, oh, I'm entering this in on my phone. But in, um, this day and age, I imagine there's a lot of people who say, well, I'll journal, but I'm going to just type it in somewhere. Does that still have benefits, too? I imagine so.

Dr. Marni Amsellem: You're not going to be shocked to hear me answer it this way, but we're all different, right?

Dr. Andrea Bonior: Yeah.

Dr. Marni Amsellem: So whatever works, like, whatever is accessible for you, um, and feels, right. So there is sort of like cursive writing when you write and those of us that still know how to write incursive words, you might feel like you are more in tune with your thoughts when you are having that appropriate section and the physical touch of the pen on paper or pencil or whatever it is, if that works for you. Fantastic. And what's nice about that is that you can then keep all of your entries in one place in a journal. However, if what is most accessible is having your um, computer with you at all time, or your smartphone, um, there are a whole lot of journaling apps that you can go to, or um, you can just start some sort of document where you are recording and bringing it on your computer there. I would recommend that that is uh, somewhere that you again feel like is a safe space.

Dr. Andrea Bonior: Right. That's a really important point.

Dr. Marni Amsellem: Like password protected or something like that, if that is what you're feeling like you're dating.

Dr. Andrea Bonior: Yeah. No, absolutely.

Dr. Marni Amsellem: Yeah.

Dr. Andrea Bonior: And I have a lot of clients that come in, even if it's not journaling, per se. I mean, I have clients doing all sorts of things that work for them. And a lot of times it's even just record keeping for hey, I noticed my society this day and what triggered it. Right. And they'll pull up their phone and it's right there.

Dr. Marni Amsellem: Again, speaking as a therapist, that's evidence. Right. It's also information that you are using to help you better understand what you're experiencing connections of. Oh, right. When this is going on, this is typically my emotional response, or what are the similarities, or what are the patterns that have persisted over time. There's so much learning that can come from recording all of this.

Dr. Andrea Bonior: Yes. The noticing, I find that's been a theme in several shows so far. Just the power. And of course, that's something that speaks to the efficacy of therapy and part of why therapy helps. The gaining insight that comes from noticing instead of, hey, I've been on autopilot doing this thing this way for five years, and I can't really notice the way that it hurts me or helps me instead. It's actually the observation. Of course, that's the heart of mindfulness too.

Dr. Marni Amsellem: Right.

Dr. Andrea Bonior: It's that uh, gentle, curious, non judgmental observation. But I think there's such power in the noticing. And it seems like journaling is such a great conduit to that, because now I'm looking, and this happened yesterday, too, and every day, mid afternoon, I start to feel really irritable. And I didn't put that together until I charted it for two weeks. Right.

Dr. Marni Amsellem: Absolutely.

Dr. Andrea Bonior: Well, there's so much here. I know we can talk for hours on this stuff. And I just think that it's so important that people realize that they're not alone. That when they're struggling with a uh, physical health diagnosis, especially, it might feel like they're the only one. And yet there is always hope to connect with other people. There's always hope to really get some space with mental health treatment, where it's m your space alone. And it's your space to be safe and to explore all of these feelings about it. I know this, unfortunately, is something that I do think it's going to become more of a concern over time as more people struggle with various diagnoses and mental health and physical health. It's taken a hit these past few years.

Dr. Marni Amsellem: All speaks to the importance for ourselves of recognizing that when we are experiencing something physical, that we should also check in on ourselves emotionally as well. Well as those around us.

Dr. Andrea Bonior: Yes. To help take care of each other. So I really thank you for providing a ray of hope for folks today. Thank you, Marni.

Dr. Marni Amsellem: Very welcome. I really enjoyed our chat.

Dr. Andrea Bonior: Likewise. Thanks for joining me today.

Once again, I'm Dr. Andrea Bonior, and this has been Baggage Check. With new episodes every Tuesday and Friday. Join us on Instagram @baggagecheckpodcast. Give us your take and opinions on topics and guests. And you know you've got that friend who listens to like, 17 podcasts. We'd love it if you told them where to find us. Our original music is by Jordan Cooper, covered art by Daniel Merity and my studio security, it's Buster the Dog. Until next time, take good care.