Plan D NOVA, Fairfax, VA (2025)

07/18/2025

Group therapy is a type of psychotherapy in which one to two therapists see multiple clients simultaneously. It can be as effective as individual sessions for many mental health conditions, including anxiety, Attention-Deficit/Hyperactivity Disorder, depression, Post-Traumatic Stress Disorder, substance abuse and trauma. Group therapy provides healing and a sense of belonging and connection, allowing participants to practice active listening and empathy and benefit from the lived experience of other members. Through its multiple perspectives and opportunities for social learning, group therapy has the benefits of a support group with the enhancement of professional guidance.

Groups have specific purposes, such as treatment for a particular diagnosis, learning a set of skills or processing specific traumatic events. New members typically complete an intake process that helps to determine if they are a good fit for the group and vice versa. (A group should have enough similarity between members for it to be cohesive and each participant should readily identify with at least one other attendee.) It is important for prospective members to inquire about attendance policies, confidentiality, costs and how long the group will continue and to understand the group’s function, goals and structure. Groups usually develop their own cultures and norms, which may already exist if you join an open one. (Closed groups begin and end at a set time. Open ones allow individuals to enroll whenever space is available.)

Confidentiality should be expected in a group, yet cannot be guaranteed as it is in individual therapy. (Each member should sign a confidentiality agreement as part of joining.) Groups often range from six to twelve participants and possible focuses include interpersonal process (intended for those trying to build healthier and more secure relationships), psychoeductional (meant to provide information on a specific condition or issue), skill-development and support. Sessions, which can be led by nurse practitioners, psychiatrists, psychologists, social workers or therapists, usually last between 90 minutes and 2 hours.

Types of group therapy range from Cognitive behavioral, which typically is highly structured with a preset number of sessions and significant psychoeducation and examines the relationships between behavior, emotion and thought; to Psychodrama, where group members create performances based on their experiences and learn from both playing themselves and roles in others’ dramatizations; and Psychodynamic, which is based on the belief that all thoughts and behaviors stem from pre or unconscious processes and through which participants gain self-insight.

Therapeutic improvements related to group therapy can result from altruism (helping other members and then developing a better self-image), catharsis (releasing strong emotions), cohesiveness (forming positive emotional connections between group participants), hope (seeing attendees have success and believing you can experience that too), imitation (observing others work through their issues/problems), socialization and interpersonal learning (including gaining effective communication skills and receiving feedback from the group), and universality (realizing that others have similar feelings and problems).

If you are already attending individual therapy, your practitioner may know about groups within his or her own practice or professional network. Mental health organizations, outpatient psychiatric hospitals, university counseling centers and Veterans Affairs facilities also typically offer group therapy. Psychology Today (https://www.psychologytoday.com/us/groups/virginia) has an online list of local groups by state and the American Group Psychotherapy Association allows you to search for Certified Group Psychotherapists (https://portal.agpa.org/certifications/directory?_gl=1*nijwwz*_ga*OTg4ODMyODAyLjE3NTA3OTM4NzU.*_ga_T8P9C6FCEY*czE3NTA3OTM4NzUkbzEkZzAkdDE3NTA3OTM4NzUkajYwJGwwJGgw).

For an individual to be an ideal fit for group therapy, he or she should not be in acute distress or have low motivation for treatment. Being extroverted and conscientious often predicts success as a group member. Group therapy is not only effective, it is efficient with one therapist able to treat multiple patients at once. It is estimated that on average, group therapy costs one-third to one-half less than individual treatment and through it, individuals become members of a supportive community, receiving assistance from both their therapist(s) and peers.

04/03/2025

The Internet can be a one way mirror reflecting ideal images that make adolescents feel like failures. Social media should be used mindfully with set limits on the amount of time that an individual devotes in it. Become aware of how you feel and what you think when you are using social media. For example, rating your mood before and after you look at Instagram or similar apps can help you determine how they influence your mental health. Socializing online lacks personal aspects of communication like body language and facial expressions, which can contribute to hurt feelings and misunderstandings, and ultimately make talking in person seem more intimidating.

Youth should carefully select who they follow, and parents and guardians should be sure to check and/or change privacy settings after social media accounts are established to ensure that they are not public. When their social media identities do not match their actual emotions, teens can end up feeling even worse. Before posting anything online, stop to think if it is helpful, kind, necessary and, most importantly, true? It is crucial for young people to figure out what makes them happy rather than to simply look at and compare themselves to the ways in which other people live.

According to Psychoanalyst Robin Stern, Associate Director of the Yale Center for Emotional Intelligence, if you are “not feeling good about yourself, it’s likely because you are comparing your insides to someone’s outsides.” Think about what you really know about the internal lives of the individuals you follow on social media. Remember that your own feed likely is a collection of your happiest moments. (The average smart phone user takes thousands of pictures each year in addition to those that are posted on Snapchat, Instagram and Facebook, etc.) A September 2022 study found that what female youth do on social media (rather than simply being on platforms) is predictive of body dissatisfaction. Girls, who consume appearance-focused content by following influencers for fashion or fitness tips or watching beauty tutorials, are more likely to self-objectify and have negative views about their own bodies.

Parents should tell children they understand that peers will post things on private accounts which will be concerning. So they feel comfortable talking to you about it, reassure them that you will not embarrass them or restrict/take away their social media as a result. (Remind adolescents to tell friends, who may have expressed mental health concerns online, that helping them is something they want to do and not a burden.)

In comparison to perfectly curated accounts, viewing ones where individuals deal with similar issues can be helpful, providing useful advice and information and helping adolescents to feel less lonely. Inspiring mental health Instagram accounts include DLCAnxiety (instagram.com/dlcanxiety/), which posts illustrations, Tweets and videos regarding anxiety and other mental health topics; Half the Story (instagram.com/halfthestory/), which features digital wellness tips and has the goal of helping people use social media to “connect rather than disconnect”; and (instagram.com/nedratawwab/account), Therapist Nedra Glover Tawwab’s account that offers concrete suggestions. Rather than mindlessly scrolling social media, use it to connect with friends. If you are simply bored, listen to music, meditate, read or use a coloring book instead.

Social media can be used in a healthy manner. Consider turning off notifications and tracking screen time to learn how much time you actually spend on social media. Maintain balance by engaging in activities and seeing friends in person. Finally, spend time online with accounts and communities that are positive and make you feel supported.

02/28/2025

Anxiety often is a physical experience for youth that appears as irritability, recurring stomachaches (especially if they are brief and accompanied by excessive worry) and/or restlessness. In both children and adults, generalized anxiety disorder has numerous symptoms, including uncommon ones that may not be recognized as such like psychogenic fevers (temperature spikes with a psychological rather than a physical cause, which can be treated by dropping an ice cube down your shirt, removing extra clothing or taking a cold shower.) Habits related to anxiety include apologizing profusely, being indecisive, going to the bathroom frequently, having strange dreams, making lots of to-do lists, picking at one’s skin and excessively twirling or playing with one’s hair.

Because the brain releases histamine in response to anxiety, spontaneous runny noses and/or hives and itching can occur. (The latter can be treated with Benadryl or an ice pack.) Anxiety also frequently leads to digestive system upset (Try staying hydrated and consuming thick, bland foods if this occurs.) and increased sensitivity to environmental stimuli making lights appear brighter, sounds seem louder and more repetitive, and tactile sensations intensify (Respond by closing your eyes or using earbuds or headphones.)

Identify triggers by keeping a diary to track when you feel anxious and what you think caused the episode. When confronting anxiety, try the “File It” technique. Close your eyes and picture a filing cabinet and a stack of folders. Imagine picking up a folder, labeling it with the thought racing through your mind, and then taking a moment to acknowledge it before placing the folder in the cabinet. Repeat the entire visualization until you feel calmer. Blowing bubbles can help control breathing during panic attacks; discovering a new book, form of exercise, food, goal or song/artist provides both distraction and endorphins; and planning something you can look forward to, like seeing a movie or meeting a friend for lunch, coffee or bubble tea, can create positive anticipation for the upcoming week. Make a “dread list” of the things you are avoiding in your life. (Compiling everything can begin to make you feel in control.) Pick an item to tackle first either because you can act on it right away or solving it will have the greatest impact.

Rather than helping children avoid anxiety provoking situations, parents should point out similar circumstances they have successfully handled in the past. If a youth’s anxiety is the result of a traumatic situation or interferes with eating, sleeping, school or activities he or she used to enjoy, professional help, including therapy and/or medication, may be required. In fact, working with teachers, school counselors and mental health practitioners (who know specialized techniques) will provide the most comprehensive support system. Whether dealing with anxiety in yourself or others, it is crucial to be flexible and patient, adapting different strategies as necessary.

10/28/2024

In 2021, it was estimated that over 46 million Americans aged 12 and older had at least one substance use disorder. Ma*****na remains the leading cause of adolescents entering substance use/abuse treatment, accounting for 63 percent of admissions for those aged 12 to 14 and nearly 70 percent of individuals aged 15 to 17 in 2011. In addition to being illegal, it is dangerous for youth to use substances. Drinking can impair teens’ judgment; affect their lives at school, preventing them from playing sports or participating in other activities; and impact college applications. Drugs and alcohol also can interfere with treatment for mental health disorders and worsen the long-term prognosis for those who experience them.

If you have used drugs in the past, it should not prevent you from having discussions with your children about the dangers of their using substances. Be specific and explain your reasoning when talking about family rules regarding substance use and the consequences for breaking them. During the discussion try to keep an open mind and remain calm and objective. Youth should be able to express their concerns and feelings.

If you are concerned that someone may be an alcoholic, talk to him/her when he/she is sober and not hungover. Having the conversation remain factual and neutral (i.e., unemotional) also is helpful since addicts often experience guilt and shame. Quitting drinking can be frightening. Consuming alcohol may be a significant part of an individual’s daily routine and/or social life and serve as a coping mechanism for difficult emotions or stress.

Teens have a much higher risk of alcohol poisoning than adults because they metabolize alcohol less efficiently, get drunk faster, and stay intoxicated longer on less alcohol. In addition, drinking after using any kind of drug, whether prescribed or illegal, can increase the risk of alcohol poisoning. Warning signs include: being unresponsive to physical contact (such as pinching, poking or shaking), shouting or talking; an inability to stand up or remain standing without assistance; skin that is clammy, cool, or appears bluish to purplish and/or very flushed; slow irregular breathing and a pulse that is uneven or less than 40 beats per minute; unconsciousness; and vomiting while being passed out and not waking up.

Calling 911 and remaining with the individual until medical assistance has arrived is the only solution to alcohol poisoning; and waiting until someone is unresponsive or unconscious may be too late. Parents should tell children that while they are expected not to drink, everyone’s safety is the most important thing. Adolescents should always call when they are in a risky situation and, if someone needs help, they should dial 911 or phone a trusted adult rather than worrying about possible punishment. To avoid using substances, youth can volunteer to be the designated driver or tell friends that they are allergic to alcohol or their parents test them for drugs. If there is a history of substance abuse in their family, they also can share that, saying they prefer not to drink as a result.

Participating in and saying something at self-help group meetings, even if it is only one or two sentences, reinforces the likelihood of continuing recovery and makes it easier to connect with other participants. Dual Diagnosis Anonymous (DDA; https://ddainc.org/about/) is a self-help group intended for individuals who have been diagnosed with both a chemical addiction and a psychiatric disorder. Unlike some traditional self-help groups, DDA can provide a safe forum to discuss prescribed medications. In addition to adapting Alcoholics Anonymous’ (AA) 12-steps, DDA has 5 additional ones that address mental illness and its treatment. Another alternative is Self-Management and Recovery Training (SMART Recovery; https://smartrecovery.org/), which focuses on clinical evidence and science; incorporates cognitive behavioral therapy and motivational psychology; and has meetings led by trained facilitators, who are not required to be in recovery. Many individuals chose to attend both SMART Recovery and AA meetings.

While addiction is a chronic disease, it is treatable. The substance use disorder continuum of care includes four levels of treatment: outpatient, intensive outpatient, residential and inpatient hospitalization. Attention to any co-occurring disorders, education, exercise, healthy relationships, medication (as needed), peer support and psychotherapy (which can reinforce motivation to remain sober) all benefit recovery. Support groups for families of addicts can reduce isolation; help individuals share tips and tricks they have found helpful; and provide education about how the disease of addiction progresses, treatment and recovery. For individuals with a substance use disorder, long-term encouragement from family members and self-help and support groups can result in a greater likelihood of sustained sobriety.

07/11/2024

It can be difficult to obtain mental health help for teenagers. They may deny anything is wrong, believe therapy is embarrassing or feel so hopeless that they doubt anything will work. One option is to liken therapy to having a coach, who will teach new skills, strategies and ways to succeed. Another possibility is to find several practitioners and allow your adolescent to interview them. Selecting the one he/she will see can provide a sense of control and a greater likelihood of therapeutic success. A third alternative is Motivational interviewing (MI), a type of therapy intended to create a non-judgmental, safe environment for youth to establish personal goals and values and discover how altering unhealthy behaviors will benefit them. By having the patient play an active role, MI can explore and confront any ambivalence or resistance he/she has to treatment and increase motivation for change.

MI was created in the 1980s by psychiatrists William R. Miller and Stephen Rollnick. It is employed with adolescents (rather than children, who are not as emotionally developed and have less control over their environment) and is often used to treat self-harm and substance abuse. MI is collaborative, compassionate, confidence-building, non-confrontational, positive and respectful; and views clinicians and clients as equal partners. Its core principles include Open-ended questions (to determine an individual’s values and goals for treatment), Affirmations (to build the confidence to change), Reflections and Summarization (so the patient will feel heard during the process). In MI, therapists avoid providing unsolicited advice or direction.

There are multiple phases to MI. The initial one is Engagement where a therapist creates a judgment-free space for a youth to share his/her feelings and any reservations he/she has about change. Next is Focusing where the specific behaviors the client is willing to alter (“change targets”) are identified. Evoking then examines the disadvantages of retaining unhealthy behaviors in order to reveal the benefits of modifying them. Finally, Planning is an optional phase. It is intended to help patients establish manageable goals, consider any potential barriers and develop skills, including combating all-or-nothing thinking, expressing self-compassion to practice acceptance and maintaining goal-oriented behavior.

Not simply a standalone process, MI can be combined with other forms of treatment, such as cognitive-behavioral therapy. It can be particularly beneficial for youth, who often prefer clinicians who actively participate in conversation rather than being passive listeners. Adolescents with mental health issues need to want to get better and be willing to work with a practitioner for that to occur. MI can be a valuable tool for reducing resistance to therapy and provide the internal motivation necessary for altering self-destructive behaviors (while acknowledging how difficult that change can be.)

03/01/2024

A person’s mental health affects how he/she perceives his/her surroundings and can impact his/her ability to both identify and respond to potentially threatening situations. According to the Substance Abuse and Mental Health Services Administration, individuals with severe mental illnesses are over 10 times more likely to be the victims of violent crime than members of the general population.

If others make you feel insecure or unsafe, there are ways to strengthen your conflict resolution abilities, personal boundaries and overall self-defense. Using your voice and saying “No!” is your first tool. (Yell “Get away from me.” even if an attacker tries to intimidate you by telling you to remain silent or he/she will hurt you.) Your volume level should be the same as or slightly louder than the other person and should increase if he/she comes closer to you. Stand up straight and make eye contact so your body language matches your voice.

Always be aware of your surroundings. Walking confidently, with your head up and your shoulders back and relaxed makes you less likely to be perceived as an easy target. Trust your instincts and listen to the messages your body gives you. Recognizing when you are in an unsafe situation and leaving is the best option. Try to stay calm and breathe, which will help you to think clearer and respond more quickly. If you feel safe to do so, take a picture of a license plate or the scene, etc. It can help you to report an incident.

Let family members or friends know where you are going and when you should be back. When driving, be sure to park in a well lit area and lock your car. Keep your keys handy so you can enter your vehicle faster and use the panic button (if you have one) as necessary. If you are walking alone and feel uncomfortable, return to where you came from and ask someone to accompany you, if possible. Otherwise, try to maintain as much distance as possible from the suspicious individual(s) and keep objects (like cars) between you and him/her before dialing 911.

De-escalate. If someone is trying to pick a fight, do not engage, even if he/she is insulting or rude. Take all threats seriously, attempt to get away from the individual and call for help if necessary. In personal relationships, abusive individuals often cross smaller lines before committing overt violence so pay attention to how others react when you communicate boundaries and say what you do and do not want. If they do not listen or pressure you to change your mind, it can be a warning sign.

Anxiety and depression can cause higher levels of stress and fear, along with a greater sensitivity to one’s environment and possible threats, making it more difficult to accurately assess situations and make safe decisions. Learning self-defense may reduce those challenges and help to establish protective boundaries by beginning to heal past traumas and lessening feelings of powerlessness.

01/29/2024

Self-care involves a change in mindset rather than specific activities. By choosing yourself and prioritizing your needs, you can improve both your mental and physical health. To guide yourself in practicing self-care, think about what you loved about your day and what irritated you or try to remember when you were smiling and/or upset.

Make a list of things that feel restorative to you and relieve stress, which could include baking, going outside to look at the clouds, listening to a podcast, meditating, organizing your closet or petting your dog. Other forms of self-care range from establishing a routine and adhering to it to making your bed; focusing on what you have accomplished at the end of the day rather than on the things you were unable to do; and not saying maybe when you want to answer no. Prioritize your time by making a list of what needs to be done and when.

Since small amounts of physical activity add up, do not be discouraged if you cannot find 30 continuous minutes to exercise. Go roller skating or take a “Rainbow Walk” and try to pick up or photograph objects that are Red, Orange, Yellow, Green, Blue, Indigo and Violet. (When you return home, arrange the seven things or photographs into a rainbow using their natural order [ROYGBIV].) Visit a local nursery or garden to view and smell plants and flowers. Sit outside and people watch or enjoy a sunset. Attend an outdoor performance, go fruit or vegetable picking, or start a collection of rocks or shells. All will encourage you to spend more time in nature.

Have a good, long cry and/or yell, pound pillows or tear up paper to release your emotions. Examine the facts of a situation to see if your emotions match what is actually occurring. If you are making things worse, do the opposite of whatever you feel you should (for example, if you want to isolate, spend time with others). Lay down on the ground and feel the floor or Earth holding you. Take a hot or cold shower or bath and put on clothes that make you feel good. Inhale a scent you love. Distract yourself by doing a puzzle, holding ice or making a list of things (favorite dog breeds or songs, etc.)

Keep your hands busy and relax with repetitive motion by crocheting, cross stitching or knitting; playing with therapy putty; or putting together model kits. Make kindness stones to leave outside for people to find, follow a Bob Ross tutorial or try Diamond Painting. Complete a crossword puzzle or Connect the Dots or play a game. Reread your favorite picture or chapter books from childhood.

Invite a friend to the Dollar Store, Target or Walmart; set a $10 limit and spend 10 minutes assembling gift baskets for one another. Hang some Christmas lights in your room. Get cozy with a heated or weighted blanket and/or take a timed nap. Escape by watching a reality television show without guilt, doing some online “window shopping” or streaming the latest buzzworthy movie. Go to bed early with fresh sheets and a magazine or a good book so you can savor the first chapter. (Try to read for pleasure 30 minutes every day, perhaps by dividing the time into three 10 minute sessions.)

Even small acts of self-care can have a large impact, reducing anxiety, depression and stress and increasing feelings of contentment and happiness. Self-care not only helps individuals maintain their mental health, it also alleviates symptoms and supports treatment and recovery for those with mental illnesses. Having a regular self-care routine that includes activities you enjoy doing will improve your ability to adapt to changes, build and maintain strong relationships, and recover from setbacks. Expect that your self-care will grow and change as you yourself do.

10/03/2023

The more you share with your therapist, the better he/she can understand you and help you reach your goals. Omitting facts or distorting the truth can make your treatment less effective. While being honest may not become easier, the process will grow more familiar. Arriving 5 to 10 minutes before your appointment can allow you to relax and get settled, permitting you to better focus on what you want to talk about that day. To increase your peace of mind, you can request that your therapist review his/her confidentiality policy with you and/or specifically ask what information he/she would have to report to an outsider. Disclosing smaller events or issues first can let you see how it feels and the way that your therapist handles them. You also can write your therapist a letter and give it to him/her during your session. It is likely that he/she has heard something similar from other clients.

An effective therapist should challenge you, allowing you to see things from a different perspective, even if that is difficult, and he/she may assign homework that you do not like in order for you to understand yourself better, communicate more healthily with individuals in your life and/or learn skills (like practicing acceptance and navigating difficult emotions or stressful situations, etc.) Likewise, he/she should regularly ask how you think therapy is going and adjust treatment based on your feedback. When the patient is a minor, parents need to feel comfortable sharing their concerns and observations with the clinician, who should take both seriously. Therapists also should treat patients as their equals and exhibit cultural competence, tailoring sessions to an individual’s specific background.

For children who worry that seeing a therapist means there is something wrong with them or is a form of punishment, parents can emphasize that mental health professionals are like coaches, who will help them build skills that will make them feel better. A diagnosis should precede treatment. As part of an evaluation, the clinician should interview the patient (and his/her parents if he/she is a minor). If medication is prescribed, the dosage should be carefully established by starting with a very low amount that is gradually increased to reach an effective level while also looking for potential side effects. Youth taking psychiatric medications need to be closely monitored as they grow and develop, with checks occurring at least every 6 months.

Problem signs for therapists include: your feeling inferior, judged or that you are not being listened to during a session; he/she does not respond actively, pushes you too hard or talks over you; there is romantic attraction on either side or he/she tries to be your friend; and he/she habitually cancels, is late to or misses appointments. A therapist should guide you toward your goals, not set them or make guarantees about how or when you will reach them. Any improvement should take place at your own pace. Likewise, he/she can demonstrate concern or recommend against certain behaviors, however, a therapist should never make you feel ashamed.

You do not have to remain with the first therapist you find. If you decide to see a new one, be sure to cancel your existing appointments with appropriate notice and consider sending a message that says something like, “I have decided I want to try a different approach with another therapist, however, I appreciate your time and thoughts.” The most effective ones show understanding by approaching clients with compassion, empathy and kindness and making them feel accepted and validated; and children do best when their mental health care providers share information with the other professionals in their lives, including pediatricians and teachers.

09/01/2023

Qualities associated with creativity, including awareness, curiosity, engagement, focus, presence and self-expression, all contribute to overall life satisfaction. Being creative involves an openess to change and a willingness to risk failure. It can reduce the symptoms of depression and anxiety, increase positive emotions and lessen anger and shame, improve immune system functioning and relieve stress. Creative activities also provide a sense of control, purpose and accomplishment; and art therapy has been used as a treatment for addiction, anxiety, depression, grief, phobias and Post-traumatic stress disorder.

Rather than being goal oriented, creativity causes an individual to be present in the moment. Creativity requires concentration, does not allow multitasking and is a process rather than a result. It blocks external stimuli and provides the same calm and peace that result from meditation, mindfulness and yoga. Ways to be creative vary from painting to singing and playing or listening to music, dancing, writing, cooking and even gardening.

Think about something you genuinely enjoy doing. Actions as simple as noticing how blue the sky is, the smell of coffee or the softness of your pet’s fur are creative practices. Photograph the view out of the same window for a week. Find and listen to three different versions of the same song. Let your mind wander. Take yourself on a weekly “Artist Date” to do something fun and frivolous, browsing at a bookstore; seeing a movie in the theater; trying a new bakery, cafe or coffee shop; or visiting animals at a pet store, etc. Draw your stress through literal or abstract representations. Leave your phone at home and go on a 20 minute walk by yourself, looking for all of the colors of the rainbow in nature. Buy a “Paint by Sticker” or “Sticker by Number” book. Start a dream journal by keeping a notebook and pen beside your bed and writing the first words and sketching the first images, and symbols that come to mind when you wake up.

Creativity does not require talent. It can help you express emotions that may be difficult to put into words and communicate, process and release your feelings, improving your overall mental health.

Plan D NOVA

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