Ask Doc Snipes Anything LIVE Q&A: Get Your Questions Answered in Real Time!

Foreign. Okay, everybody, we still have a few more minutes before we get started, but, you know, I thought we were close enough that I'd log in, say hi, make sure Everybody's getting their YouTube notification, ETC. I'm gonna have to move this over to the other screen because watching myself on camera is going to be distracting. So anyway, I hope everybody is having an absolutely amazing start to your week and I'd encourage you to take a moment right now to identify three things. There may be a bunch of crap that's not going well, but identify three things that are going well or that did go well today. And that could be you made it to work and didn't get in a car crash, whatever it is. But while we're kind of waiting for people to log in, take a moment to truly reflect on those things that you can be grateful for today. And, and they don't have to be big things. They can be small things. I'm grateful my animals are fine. I am grateful the temperature is going to decline. It didn't rain as much as I wanted to this weekend, so I'm going to have to go out and water my garden. But. But there are worse things in life, you know, at least it's a bright sunny day here, so. Hello. Bless. J. Welcome. And Tiffany, good morning. So I see we have about 30 people in the chat room right now, so I'm going to go ahead and get started. Started. Senorita Aurora asked a question earlier and I wanted to start by answering that. Her question was, what do you do when you've taken action on something and you're waiting for the outcome, which could be positive or negative? How do you manage the uncertainty? People do it in different ways. I will tell you a couple of things that you can do. Number one, write down the probability. You know, write down the facts for and against the belief that it's going to go poorly and write down the facts for and against the belief that it could go well, you know, I could get the job, maybe I won't get the job. What are the facts for and against each of those beliefs? And examine the probability. What is the probability that I am, you know, if you want the job, going to get the job, and a lot of us have a good idea when we walk out of the interview and we're like, yeah, that's 30 chance at best, I kind of blew that interview. Or you may walk out feeling really good. Either way, that gives you a little bit of grounding so you don't start worrying about this, which way it may go, you've looked at the probabilities and you've said, okay, anything can happen. So you still have uncertainty there. And that is unpleasant. Hopefully you know when this is going to resolve. It's going to resolve by the end of next week or, you know, whatever. You have some sort of date. If you don't, that can make it a little bit more difficult. Difficult. I encourage people like for when they're getting tests back from the doctor or when they're applying for jobs, etc, to try to get a end date. When do you think you'll be finished with this process and you'll be able to let me know? So that gives them a time frame that they know they can manage their anxiety. They're not going well, didn't hear anything back. What does that mean? So that can be helpful. Write down all of your concerning beliefs about whatever it is. I'm concerned that this will happen. I am worried that if this happens, that will happen. Whatever your stress thoughts are right now, your worry thoughts, write them down and again, look for the facts for and against those beliefs. If you, for example, will stick with a job if you don't get that job, okay, well, that's unfortunate. Maybe you really wanted it. What can you do then? If this doesn't turn out the way you want to, what are you empowered to do? What can you do? You can't make them hire you, but you can apply for other jobs. So having a plan B, so to speak, if this doesn't work out can help some people feel grounded. I also encourage people to, and I know this sounds weird, schedule worry time if it's, something that's, you know, concerning you or you're, you know, uneasy about or uncertain about. All right, grant yourself 15 minutes a day to think about it. If you feel you need to the rest of the day when you start thinking about it, say, no, there's a time for that. And that is, you know, 5 o' clock this afternoon or something. That can be another way of managing the amount of time you're spending in distress. You can also watch the video on defining your rich and meaningful life. And when you start worrying, when you start getting stressed out about the uncertainty, you can examine the things that are going well in your rich and meaningful life and the things that'll still be going well in your rich and meaningful life even if you don't get this job, even if whatever it is doesn't turn out the way you want. And examine all those things in your rich and meaningful life. And we, when you Start using energy to worry about something that you have no control over. Asking yourself, is this a good use of my energy to move toward my rich and meaningful life? And the answer is going to be no. So how could you use that energy instead? For example, instead of fretting about whether I'm going to get a job I've applied for, I. If I start, you know, getting antsy, getting in my own head about it, I'll go out and play with the dogs, or I'll go out and work in my garden. Those are things that are important to me. I. I'll use my energy to do that and turn my attention away from the thing that's stressing me out that I have no control over. Those are the strategies I would use. I encourage other people to share in the discussion what strategies you might use, but that would be kind of where I would start. But great question, because there's uncertainty in a lot of things. There's uncertainty about politics, there's uncertainty about geopolitical issues, there's uncertainty about finances, your job, your health. You know, there's a lot of uncertainty about different things. We're dealing with it on a daily basis. Another thing I'm going to add to that that's not exactly applicable to your question is to eliminate sources of uncertainty that don't have a direct impact on you. If you find yourself getting overwhelmed by the uncertainty, stay off Twitter, stay off social media. Because there are a lot of things that are uncertain right, right now. And being bombarded by people telling you, you've got to worry about this, you've got to worry about this, you've got to worry about this can cause you to worry. And again, it doesn't do any good. Anxiety is an emotion that we have that we're hardwired for that tells us that there may be a threat and we need to either fight or flee. And feeling anxious, dwelling on anxiety doesn't do any good, but burn up a lot of energy. We need to figure out how can I use that energy to either address the issue or to change gears and focus on something that's important in my rich and meaningful life. And for me, quite a while ago, I swore off a lot of news and various social media platforms and everything that were just too toxic and too overwhelming. They weren't producing happiness and joy in my life. And I was like, you know, I don't really need that right now. So again, that's not directly related to your question, but in general, reducing the amount of things that you are uncertain and Stressing about is going to be helpful and healthy for for your autonomic nervous system, your HPA axis and the rest of your mind and body. All righty. Bless. Jay, I'm not really sure I understand your question. They say I'm going through the emotional disturbances as I get major trauma from my husband's end. Need a little bit more information to be able to address that. Cheryl says asks how do I best study to pass my MFT clinical exam? I've never taken the MFT exam, so I can't speak directly to that. One of the things I would suggest is to go into, and I know you may groan when I say it, Facebook, because I have found that that there are a lot of groups for licensed clinical social workers and licensed professional counselors on Facebook that are actually still active and can be very helpful at providing you information about their experiences of taking the test and the materials they used to study for their test. So that can be really helpful. I haven't found the same thing on LinkedIn. Another thing you can consider doing is going to oh gosh, what Quizlet Quizlet people have often created flashcards that you can use to study. Oftentimes I found the flashcards aren't really good quality and so they it can be more frustrating. Go to your board's website and see what sort of recommendations they have for for topics you need to study. You can also go to like for counselors, you go to the NBCC website or the Mental Health American Mental Health counseling website and they will provide you information. Ask colleagues who've recently gone through it what materials they use to study and if they still have those materials. If they used print materials, they may actually still have them. I've heard really good things about Linton's counseling exam.com My guess is he has a MFT version. I don't know that to be a fact. Hopefully you've got some time and what I find most helpful and and again, we all learn differently. What I find most helpful is to take a full practice test and identify the areas that I'm still weak in and then I can focus on those for studying in preparation for the exam. There are, if you Google, you know, free practice test, MFT exam. You can also find places like mometrix that have some questions that are available to help you study. It's not going to do everything. They're not the exact questions off the test, but all of those things can give you more information. I know it was really helpful for me for one of my licensure Exams that I studied for when people told me ahead of time, you need to really focus in on the assessment measures because they hit that hard. And it did seem like they hit that particular topic in assessment inordinately hard in that particular test. But I was prepared for it. So ask. I wish I could give you more specific things, but those would be where I would start. Tiffany asks how can I find information regarding information on self help addiction videos? I know. Okay, if you've gone to allce.com you can log in there and get continuing education or get training. But you can also go and Adriana, if you would put this in the chat, you can go to allce.comaskdoc snipes and that takes you to my AI which will help you search through my videos. Whoops, it jumped on me. Hang on a second here. Do narcissistic and ADHD traits overlap? That's a great question. I've never really thought about it. ADHD and narcissism or narcissistic traits often overlap the traits of PTSD and cptsd. So I guess I would be interested in what traits you're really thinking about. The lack of empathy. That isn't necessarily true in adhd. It may be some people with ADHD may have a hard time being empathetic and focusing. The need to be revered that we see in narcissistic traits may or may not come out in adhd. I'm really kind of stretching here because a lot of people with ADHD have extreme rejection sensitivity and because they've experienced a lot of rejection, they up until, you know, whenever now is as a result of being neuro atypical. So some people may develop a compensatory mechanism of needing to be the best and focusing on that at the expense of focusing on relationships. So without knowing which specific traits of narcissism and ADHD you're talking about, I'm just kind of spitballing it here. I would encourage you to examine the behavior, whatever the symptom or the behavior is and what function that behavior is serving for that person and what it's communicating for that person. And then you can kind of start figuring out whether you're talking about underlying trauma protective mechanisms or narcissistic personality or adhd. Jemima asks how to handle a paranoid ideation of a son who's becoming aggressive towards people he thinks are hurting him and putting microphones around his room to listen to him. The first thing obviously would be to try to get him engaged with a mental health provider that can help him with those delusions right now. Encouraging him to tell you what you can do in order to help him feel safe is also going to be important. I'm not sure how far his delusions have gone, whether he's thinking that you are also hurting him, spying on him, etc. There's only so much that someone who is in an actively psychotic episode or delusional period will be able to contact with actual what we know to be with our reality. Their reality is, is different and it's real to them. So trying to get them to understand the difference may not be super helpful. Now, there is a fair amount of research that indicates that some cognitive behavioral therapy interventions can be helpful with people who are, who have schizophrenia or delusional disorder. In, in that it can give them tools to evaluate the facts in the current context. If your son thinks that there are microphones in his room, okay, let's see if we can find them or what can we do to block them. Figure out how you can help that your son, in this case stay safe or feel like he's safe in that environment. Helping people who are, especially when they're in a remission stage, helping people use cognitive behavioral tools to address their beliefs, again has been found to be helpful in the research with a lot of people who have schizophrenia and other psychotic features. But, but again, we can't say that any one thing is going to work for any one person. My concern about trying to use cognitive behavioral techniques with him and help him see that, that there are no microphones in his room, for example, is that he's already feeling the paranoia and that might actually cause him to lash out at you because you're contradicting his firmly held belief. So again, the aggression tells me that he really needs to get connected with a licensed mental health professional asap. Okay, Cheryl, one thing I, well, I would encourage you to do is examine whether 170 questions is difficult. And I would examine your test taking strategies to see if taking the test, if there are ways that you can speed, speed up how quickly you take the test. Okay, so that's one. But I would also encourage you to examine whether you have a disability for which you can receive reasonable accommodations, I. E. A time extension. My daughter has pots. Postural orthostatic tachycardia syndrome. And for people with pots, when they are sitting for any length of time, their cognitive functions start to decline. Their blood starts pooling in their feet and not in their brain where it needs to be. So she really struggled and she wasn't diagnosed when she was taking the act. But she really struggled getting through the ACT because about an hour into it, she would notice that she was having problems thinking clearly and she would slow way down. And you could see even in her test taking, her scores for what she started with were much better. Being screened. And I have videos on what POTS is being screened for. Pots. If you think you might have that, you can also just Google it and it'll pop up everywhere being screened. If you have adhd, that might also be an issue. And it's possible that if you have a diagnosis of clinical depression, you also might be able to receive a reasonable accommodation, because we know that in depression our cognitive abilities are slowed down to an extent. So that reasonable accommodation thing area in the Americans with Disabilities act could end up being your friend again. I don't know how many practice tests are out there, but it's possible if you have a full length practice test that you could take it and have somebody observe you while, while you're taking it. And kind of note if you hang up on particular questions. Working with a testing coach can also be helpful. They can help you figure out how do I narrow down the options here? I recognize how frustrating it is to have gone through all the years of graduate school that you went through and be stuck with this one test keeping you from doing what you've been trained to do. We had that same problem with the NCMHCE in, in counseling, and they finally recently changed that test. I haven't heard anybody talk about it quite as much sense, so I'm hoping that it got a lot better. Can I recommend a counselor in the Texas area to help a young man with abandonment issues? Actually, the link at the top that I pinned is a link to the Psychology Today database. And you can search by area, by treatment approach, by disorder or symptoms, and by insurance carrier. So you can really narrow it down to what you're looking for and you can read their profiles to see if it sounds like somebody that would be a good fit for you. You're very sweet, senorita. California is different. We aren't. We actually don't even provide CEU in California. So I can't. You. I'm just not familiar with whether if California has their own state test or if they use a national test. How do you differentiate between different disorders? Well, the first thing is to. In my opinion. In my opinion. Well, let me, let me back up. What I would do is start with cptsd. Now, unfortunately, and I've gotten on the soapbox a bunch of times in the past. The American Psychiatric association has no intention of recognizing CPTSD as a legit diagnosis. So if you're having to bill, that's different. And you may want to start with PTSD and, or the trauma related disorder unspecified to see. And, and that's kind of where I would put CPTSD if they didn't meet the PTSD criteria. So that being said, I start with with CPTSD because the criteria in CPTSD clearly says if this diagnosis, if these symptoms clearly explain everything that's going on with the person, then no other diagnosis is necessary or appropriate. It says that in the ID ICD11. So I start there. And a lot of times what I'm seeing the ICD 11 or the criteria for CPTSD does cover if I have to diagnose for billing purposes in the U.S. bPD is what I look at as well because a lot of times the symptoms of CPTSD and BPD are almost indiscernible and that at least is billable. However, personality disorders carry with them a lot of stigma in American culture still and can actually block people from being able to get into certain residential programs. So we. I try to be aware of that and make sure if I'm going to assign a personality disorder diagnosis that this person for certain has a personality disorder. Dissociative identity disorder is going to often co occur with ptsd. It often co co occurs with trauma. But dissociative episodes are not necessary in cptsd. So you can have a PTSD or a CPTSD diagnosis. Dissociative Identity disorder. Oopsies. Oh, Megan, thank you so much for your support. I appreciate that. Bless J asks and I'll get down to your question in just a second, Megan. Bless J asks how to be emotionally strong while someone puts you down constantly. Even at times. My own parents drain my energy and want to adjust my ocean emotional feelings like when I'm say I'm not okay. They don't understand if they're not willing to empathize, you can only give them the information. If they're not willing to empathize, if they invalidate your feelings, which is, you know, violating that emotional boundary, then you need to decide what strategies you're going to take in order to help yourself feel safe and stay safe. Emotional abuse is abuse. It is no less harmful than physical abuse. It leaves wounds. It programs really awful tapes in our head. So it's important to recognize that emotional abuse is abuse and take steps accordingly in order to get yourself safe. Nobody can continue to hear put downs and criticisms and hateful things said to them repeatedly without it having a negative impact on who they are and and how they feel about themselves. Obviously, it's important to communicate with those people in a healthy way and family therapy can be a great way to do this. So you have somebody that can help you navigate this discussion, communicate with people in a healthy way about what your needs are and what you're feeling when they say that and how it's hurtful to you. And so you can ask them to quit doing it and if they have a concern or a criticism or whatever, to focus on the behavior that they don't like and not you as a person. Okay, Megan asks, I recently had to leave a man because of his attachment style and if he returns and is willing to address it and get help, what is the best therapist to address this? Marriage and family therapists obviously work a lot with attachment styles and power dynamics in families. However, the cause of his attachment issues may also be able to be addressed by a professional counselor. So either one I would probably tend to lead more towards a marriage and family therapist. But there are licensed professional counselors who specialize in addressing attachment issues that could also probably do the same thing. So that's a great question. We have a lot of letters out there after our names and it's like, well, what do they do? They do. Professional counselors are trained in large part to help the individual resolve issues that are causing them symptoms right now and move toward their rich and meaningful life. We encourage them to develop a support system. We can work with family members, but it's not the focus of what we do. And the way we interpret issues is more from an individual standpoint than from a family standpoint. Marriage and family therapists look at family dynamics and how the behavior of one person impacts the other person and how your identified patient getting better, so to speak, addressing their issues is going to impact the family and what resistance they may get, etc. Family systems theory really helps marriage and family therapists conceptualize problems from the perspective of the environment and the family, not just the patient. I'm glad that you are able to watch our videos in Romania. Adriana is actually based in Romania, so she may be a good resource for you to identify any particular issues or to tailor it to meet your cultural needs. Because obviously I'm speaking from the perspective of American culture, but I am really glad it's helpful. Is it possible to fully recover from addiction? I'm not sure how you're defining fully recover. There Is in all of us, whether you've been addicted before or not, in all of us, there is the propensity to develop an addiction. In people who've had addictions, there is a propensity to go back to those behaviors when the current behaviors are ineffective or insufficient or even problematic. For example, if you go back to staying up all night and burning the candle at both ends and engaging in high stress activities and things that you did either prior to your addiction that led you to your addiction or when you were in your addiction, then those behaviors, those are relapse traps. Those are things that are probably going to lead you back to coping through addictive behaviors. Is it possible for the nervous system to heal after addiction? Is a slightly different question. And the answer is in large part yes. I can't say it'll heal a hundred percent for every person, but we do see neurogenesis in the brain as people's autonomic nervous system, their HPA axis, etc. Starts to heal. Remember addiction, whether you're using and flooding your system with an excess of chemicals or withdrawing and your system is going insufficient input, you know, both states trigger the stress response. Both states trigger that autonomic nervous system and cause damage to it. So as you get away from that place where you're regularly triggering that stress response, your body will be able to start heal and remodeling, rewiring. They say that neurons that fire together wire together. And if you're having mainly stressful experiences, then your stressful nervous system pathways are going to become a lot stronger than your relaxation and recovery pathways. You want them to be about equal. You want them to be able to balance each other out. You need to address the issues, not just the physical issues, but all of the issues that developed prior to or as a result of your addiction. And those are your physical issues, your interpersonal, your emotional, your cognitive and your environmental issues. Any of those areas that were damaged relationships both with yourself and with others, the stability of your environment, your reputation at work, etc, all of those things are going to need to be addressed and healed, if you will, in the recovery process in order to get to that point where you're not experiencing as much, what I'll call residual stress from the addiction. You're not experiencing resentment from others, you're not experiencing bosses that are going not sure if you're going to show up. Once those things are eliminated and people are seeing you for who you are as a person, then a lot of that stress is going to be reduced and your nervous system can Heal even more and you'll start feeling better. Yes, it is possible to recover from compulsive sexual behavior as well as any other addiction. It is a matter of addressing, as I just said, all of the pieces, your physical health. Help your nervous system rewire. Get your gut microbiome back in whack. Get your circadian rhythms realigned to where they're supposed to be. Heal the body. Heal your relationships. Identify the problems that led to the use or or the risky behaviors and address those. And identify the problems that developed as a result of the use or risky behaviors and address those in the recovery process. Bless j I'm not sure what bpad is, And again, Cheryl, I would really encourage you to advocate for yourself for reasonable accommodations because it sounds like you qualify for them. Can trauma cause skin issues on the face, like lesions that have formed into what looks like scars? I'm not sure that would be something that you would really need to ask a dermatologist or a medical doctor. That's a great question, Mimi. How do I stop collecting educational mental health videos on YouTube and actually start applying the information? I find? I think a lot of us are guilty of that. Now, I don't do the videos as much, but I have well over 200 articles that I've downloaded from PubMed that I still haven't read. And I keep getting more information, but at a certain point I got to read it and be able to create classes out of it. So I hear what you're saying there. What I would encourage you to do is define your rich and meaningful life. What where you want to be, what life looks like when you're what's important to you in your rich and meaningful life. So that'll help you have a goal out there and then look at where you're at right now and what is not quite fitting that vision of your rich and meaningful life. Pick one thing that is either not fitting the vision or keeping you from achieving that vision, and then identify the videos that will help you work on that one thing and focus on that one thing for, I don't know, a week, a month, however long you need to, and then move on to the next one. The beauty of YouTube videos is kind of like everything else on the Internet, they are there in perpetuity. So I have videos on trauma, for example. Well, if you are working on healing your inner child or interpersonal relationships or something, you're not working on trauma yet, that's fine. The videos will still be there whenever you're ready to work on them. One thing we find is because we are, all the pieces of our life are intertwined, when we start improving in one area, then a lot of the other areas start improving as well. As we start reducing our stress in one area, it starts benefiting us in other areas. So you'll see exponential growth focusing. And this is something that people often do, young counselors often do in their first practicums and early in their career. They often give people too many treatment plan goals. And you can't focus on 15 things at once. So again, go back to the beginning. Keep it simple. Simple. Focus on one thing. What is one thing that you want to work on right now? Find the videos related to that and maybe even, you know, I don't know how far down into the weeds we need to go. Watch. Set a goal of watching one video each night on that topic, taking notes and figuring out how to apply it. And then you can do the same thing the next day and the next day until you've gone through that particular playlist and obviously monitor how you're pro, how you're progressing with those strategies that you're using. So that is, that's a common problem. We are in information overload pretty much constantly. So your frustration is, you know, understood by a lot of people. It was a great question. What to look for for advice on deciding on practicum sites as I enter my last year of grad school. Great question. You say practicum, so I'm assuming you haven't had any field placements yet. And the nice thing about practica is just like doctors have residents, different residencies. Your practicum allows you to explore different treatment settings and different types of treatment, whether you want to work with children or adults or the geriatric population, whether you want to work with mental health or addiction, whether you want to be in residential or outpatient type settings. Those are the big ones that you can start looking at. I would encourage you to visit some of the facilities, call up the facility, whoever you would be working with, and see if you can come in and talk to them about what it's like to, you know, what's a day in the life of a PRAC student here, and get an idea of what that's like. By visiting the facility, you can also get a feeling, and I wish I had something that was more concrete to give you, more scientific to give you. But we all been there. You walk into a facility and you, you feel warm, fuzzies, you know, it feels like people want to be there, people want to be Working there, people are happy to come into work in the morning. And then other times you walk in and it's like, how fast can I get out of here? Nobody's happy. Nobody wants to be here. And that can be a great barometer for choosing your practicum placements. If you've got a lot of choices because there are places on each side, what other things would I suggest? I would suggest talking to people in your cohort or people who are doing their practicum right now or their internships right now and get feedback from them, you know, sort of on the DL about what their experiences were like. There are some things that a clinical advisor is not going to tell you. You know, let's. It's just like interviewing for a job. You're not going to interview for a job and have the supervisor go, well, let me tell you, most of our people get burned out in two months because our EHR sucks and the caseload is just incredible. They're not going to say that if they want to hire you, but a person who's done their practicum or worked at that facility before will be able to kind of give you the skinny on it. And, and that can be super helpful. And I will point out too, that there also is some variation between supervisors. Some people may be really awesome supervisors that love working with students like I do. And I just. I loved when I had practicum and intern students. It was just amazing. And then there were other people who had to supervise prac and intern students who just made it a. It was almost like a hazing ritual. And I felt bad for them. So if you walk into the facility, if you walk into the agency and it feels like people, you know, kind of like being there, Then, you know, do a little bit more due diligence. You can also go on another trick. Go on their. The company website and look at their career offerings, their job openings. If they have like 15 pages of open positions, that's not a good sign. Okay, that's a really bad sign. If they have. Glassdoor is a place where you can look at employee reviews. And if they have, you know, an employee review rating of 2.1, that tells you it's probably not a really happy place. Now, obviously you want to make sure that, you know, if they have a rating of 2.1, you're looking at how many people have rated them. If it's two people, then that was two people with a grudge. But if it's 202 people, that's what we call a Clue and so you can look at it that way. So go there, look at Glassdoor, look at how many open positions you have. Talk to people who've either worked there or done their practica there. Obviously decide the types of settings that you would like to be in. And another thing that may be a deciding factor for you or not, I don't know, is talking to the practicum coordinator about whether there is, what the likelihood is that if you do your practicum there, you will be able to get hired for a full time position at the, at the completion of your practicum. There are a lot of places I think most, but there are a lot of places that really want you to stay on. So even if you're doing a volunteer practicum, they will, they've put energy and effort into training you so they're going to want to bring you on board. Yeah, those are, those are the things that I would, I would look for. Oh, finally. Sorry, this is not a question. I get a lot, so I have, don't have it as concise as the others. If you're planning on doing your postmaster supervision there, make sure that they are going to be able to provide you a clinical supervisor and be very wary of contracts that they may make you sign. There are some agencies that have gotten kind of hinky with contracts where if you sign a contract to be there and they provide your postmaster supervision and you, then you're required after you get your license to stay there for an additional two or three years. Otherwise you have to pay back the cost for supervision at the quote going rate. Which right now the last contract I saw for somebody was they'd have to pay it back at $140 an hour. So be really careful about signing those contracts in which you're sort of an indentured servant. Great question though. Awesome. How can I know I have perfectionist issues? I feel like I have some problems related to perfectionism and I also procrastinate too much when I finish the work. When I finish work perfectly, then I do that particular other work. I mean, it sounds like there are some perfectionistic tendencies and procrastination, but it sounds like all of those are sort of tools or strategies you developed to deal with fear of failure, fear of rejection. So what I would encourage you to do is evaluate what is the benefit to your perfectionistic behaviors and how are they helping you move toward your rich and meaningful life. If they're not, which my guess is they're not, or not totally, then what issues? What which of your perspective, perfectionistic tendencies and procrastination behaviors do you want to start to address? And then start addressing each of those behaviors individually. Again remembering that behaviors communication. If we are procrastinating, handing something in, it may be because we fear the results coming back. If we feel that it needs to be perfect, then we may again fear rejection and feel like if our behavior, if our work product is not perfect, then it means we as a human being are imperfect and somehow therefore unlovable. So, you know, really working backwards to examine what your thoughts are that are promoting that behavior. Ficus. I would really encourage you to talk with your doctor about issues regarding weight management and your medication regimen. Programming guru. I really don't have an answer to that because in general we cannot measure serotonin in your brain. We can measure it in your body. But to the best of my knowledge, there is no test to measure it in your brain. We can measure the activity of neurons in your brain and we can measure the activity of the areas where there are a lot of serotonin or dopamine receptors. But in terms of measuring the amount of neurotransmitters, to the best of my knowledge, we can't do that yet. So I'm not sure how you would assess the outcomes. Is it possible and common to trigger bipolar if someone with brief anger symptoms and impulsive traits takes Lexapro to treat agoraphobia? Meaning would the SSRI trigger trigger a potentially hidden bipolar? The short answer to that is SSRIs, if they're not taken with mood stabilizers, can very easily trigger a manic or hypomanic episode in someone with bipolar. Does it mean it will? Not necessarily, but there is a great likelihood and that's even on the prescribing information from the doctor that the doctor gets. You are quite welcome. Nkariuki. Which courses I've done that have been valuable for my growth and practice? I really think in graduate school we were taught a lot about person centered therapy. We weren't taught a lot about motivational interviewing, trauma, informed care or and definitely not about neuroscience and how the nervous system and the hormones and neurotransmitters all work together and why it's so important to address the mind and body, Complicated grief and cumulative grief. And it sounds like cumulative trauma for you, hero. Take a while to go through and it's going to be important to work with a therapist who can help you, number one, start feeling safe in the current situation and empowered in the current situation and develop tools to tolerate distress and anxiety. So again you feel safe and empowered in the present. Once all of those are solidified, then a therapist, especially a therapist who specializes in emdr, for example, may be able to help you integrate those past traumas. Are there other questions? Alrighty. Well, I thank you all for being here and being so interactive and asking such wonderful questions. We really fielded a lot of questions that are different from the ones we typically get, so that was really awesome. Providing some new information, some new resources out there. I do encourage you, if you are a student, to share the channel with your colleagues. I am always happy to provide mentorship as well as I can. Obviously not being in your particular state, but having been both a student, a line clinician as well as a clinical supervisor and an just regular old administrative supervisor, I've kind of been in all of the roles and hopefully I can give you a little bit of insight into what may be going on in our minds. Everybody have a wonderful day. It.