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                    Acacia Counseling
           Gene Douglas, M.Ed. LPC LMFT


To treat a problem using TAT, follow these instructions:
1.) Rate the strength of your feeling you are experiencing right now, on a scale of 1-10, when you think of the problem.
That number is the SUD (Subjective Units of Discomfort.)
2.) Put your thumb against the inside corner of one eye. Place the ring finger against the inside corner of the other eye.
3.) Place the middle two fingers against your forehead, about a quarter inch above a line between the eyebrows so the
two fingers are lined up with the upper part of the eyebrow.
4.) Cup the other hand, and place it behind your head, with the thumb against your neck, right where it meets the base of the skull.
The little finger will be pressed against your head where it rests. Don't lay your hand flat against your head.
5.) Close your eyes and think of the feeling or event or person that bothers you. Continue for one minute, or until you feel a "shift"
in your body before that. This may be a reflexive sigh.
6.) Keep your pose, and repeat a statement reminding you of the problem in your mind. It may be a person's name,
a phrase about what happened, or the name of the feeling. Continue repeating for one minute, or until you feel a shift.
7.) Keep the pose, and repeat in your mind a statement which is opposite of the problem -- even if you don't believe it.
This might be "I will feel comfortable when I do that," or "I will feel calm and relaxed," whatever is opposite to what has been the case.
Continue repeating for one minute, or until a shift occurs.
8.) Keep the pose, and concentrate your attention on the part of your body where you feel your feelings. That will be different for different people.
Continue for one minute, or until a shift occurs.
9.) Rate your SUD again.

TAT Links:
Learning and Using TAT
How To Do TAT

Recommended Reading


21 Tips for Clients in Therapy (click here)

What if I see a friend or acquaintance in the waiting room?

So you finally get to your first counseling appointment and you are suddenly faced with an unexpected challenge - a full waiting room. Thoughts go through your mind about who you might see there and what they may think of you. This week we give our ultimate guide to surviving waiting room stress.

Congratulations!  You’ve taken a step to improve your well-being, but while there, you encounter an unforeseen source of stress – the waiting room.

The chaos can be overwhelming as you may be surrounded by people from all walks of life, but don’t let the discomfort of the waiting room stand between you and the competent mental health treatment you deserve. Here’s how to navigate the waiting room like a seasoned pro:

Do not arrive until shortly before you appointment time.  Possibly you could ask your therapist if there is a single room you could wait in.  You may even want to park your car a block away.  You may want to ask if there is a back door you can use to enter or leave.  

In a larger town, that may not even be a problem.  Also remember, if your acquaintance comes in and sits down, they are there for a reason also.  They understand the reasonableness of mental health care themselves.

Assess your Stress

Some find the waiting room experience a welcome opportunity to prepare for their coming session. Others find the entire process uncomfortable and unnecessary.

They might feel high levels of shame and embarrassment for being in a waiting room, or they feel waiting rooms increase only the anxiety they are hoping to reduce with treatment. Whatever the source, take a long look to understand your stress.

Challenge the Stigma

If you struggle with embarrassment, you will do well to address mental health stigma. Stigmas are biased views towards a whole group of people. It may seem surprising, but people with mental health conditions often unreasonably stigmatize themselves, resulting in unrealistic shame. Accept your state and know that sitting in the waiting will help meet your goals. There is nothing wrong with seeking mental health treatment. The only shame is ignoring the issue.

Shrink the Fear

People from all walks of life sit in mental health waiting rooms. At any given time, you could see children waiting to see a psychiatrist for their ADHD medication, a person with bipolar disorder restlessly pacing during a manic period, or someone with a psychosis actively hallucinating. It can be overwhelming, intimidating, and scary, but it doesn’t have to be.

These people may look, act, and think differently than you, but they are sitting in that waiting room looking for the same help as you.

Talk it Over

Since, your waiting room stress could come from many sources, talk about it with your therapist. S/he can help you understand what sparks your discomfort and investigate possible solutions. Perhaps, you can schedule your appointments for days or times that are less busy, or your therapist can teach you how to use the stress of the waiting room to extend the treatment goals.

For example, if you are seeing a therapist for social anxiety or agoraphobia, dealing with the waiting room stress, rather than avoiding it, can actually improve your symptoms.  (It's a technique called "flooding."  Repeatedly doing a thing and suffering no harm from it can make you less affected by it.)

Practice Relaxation

The waiting room in a community mental health agency can be a stressful place, but what place is not stressful? Identifying ways to turn stress into tranquility is always a useful coping skill.  Explore and experiment with techniques like deep breathing, muscle relaxation, and positive self-talk to calm your mind and relax your body. These strategies can offer the peace you seek.

Create a Plan

Entering a stressful situation without a strategy is like starting a football game without a playbook. Work through a few situations mentally and decide how you would like to respond. Ask yourself:

  • What if my neighbor walks in?

  • What if someone asks me why I’m there?  ("Personal reasons" would be a good enough answer.)

  • What if I get emotional before or after the appointment?

  • Should you rush out of the building screaming, or should you avoid all acquaintances and stare at your phone?

When answering these questions, imagine how you would like to be treated to guide your process.

In the end, the waiting room might seem like a foreign land when you first enter, but with a few modifications, you’ll feel at home in no time.

Why do I not do home based counseling?  

It’s because I did that for years, simply because the people I worked for required that, and I think it is inferior.  If you do wish for somebody to come to your home (other than me) please observe the following:

Do not schedule anything else at the same time as your appointment.  If you need to do that, then please call the therapist’s office and re-schedule your appointment.

Please turn off the TV.  If you make an appointment, do not make it at the same time you expect to be watching TV.  The therapist’s time is valuable, and there is no reason s/he should wait a half hour for you to finish your show and be ready to see him or her.

Do not invite visitors at your appointment time.  If you or your children have a friend there at the time of the appointment, please ask them to leave.

If the telephone rings, do not carry on a conversation.  Please let the caller know you are in a meeting, and ask them to call back later.  Please do not text or allow your children to text or play video games during the session.

If somebody comes to the door, handle it in the same way as with the telephone caller.

Please do not do housework at the same time as the scheduled appointment.

Do not go shopping at the same time as the scheduled appointment.  If you will not be there, please call the counselor’s office and re-schedule.  It does not help for the counselor to call ahead, because s/he does not know if you do not answer, if you plan to be home later.

If your children are up and down, please discourage them from going to the refrigerator or to the door to visit a friend who arrives.  If they are engaged in family therapy, keep them in the room, and discourage them from wrestling or otherwise playing.

If they are involved in family therapy, please be sure they come home in time to keep the appointment.

If you do all these things every time, the chance that the therapy will succeed is greatly enhanced.