[BLUEPRINT] Providing great therapy day after day can be challenging even for the best of us. At Blueprint, they believe that nothing should get in the way of you doing your best work, which is why they created a platform that provides therapists with an array of clinical tools, things like therapy worksheets, intervention ideas, and digital assessments that are designed to help you and your clients stay connected and confident throughout the care journey. Even better, Blueprint helps streamline your documentation so you can spend less time on your notes and more time on the things that matter. To learn more and request a 30-day free trial, visit blueprint-health.com. Again, that’s www.blueprint-health.com. [JOE SANOK] This is the Practice of the Practice Podcast with Joe Sanok, episode number 870. I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast. We are doing specialty months in April and May. We’ve been covering all sorts of clinical specialties that a lot of people in our membership community listeners, people that reached out. We’ve been diving into so many great issues, Things like redefining trauma, talking about EMDR, grief and trauma healing, toxic families, LGBTQ care, Gottman Level Three, couples work and infidelity, attention span, so many awesome things that we have been covering. So we’re super excited to have you hanging out with us around the clinical things that people that we just think are amazing are doing. Today I’m so excited to have Cordelia Miller Mohammad with me. Cordelia is the owner of a virtual behavioral health practice that serves older adolescents and adults who struggle with anxiety. Cordelia is a wife, a mom, a sister, a friend, and a lover of live music, especially jazz, dancing, and very good food. Cordelia, welcome to the Practice of the Practice Podcast. [CORDELIA MILLER MUHAMMAD] Thank you. Glad to be here, glad to participate, glad to share my wisdom. [JOE] Absolutely. Well, actually, when this episode drops, I will just be flying back today, when this drops from Jazz Fest in New Orleans. So I will have soaked up a bunch of live jazz down there. [CORDELIA] Okay, so I’m jealous, but enjoy, enjoy. I look forward to one day being able to actually visit quite a few of the jazz events that’s going on across the country. [JOE] It’s amazing, at Jazz Fest, they have like tents, like a jazz tent, a blues tent, a gospel tent. It’s amazing. I went in 2022 for the first time. There’s a whole group of people from Traverse City that fly down. It’s definitely worth putting on the calendar for 2024. Maybe we’ll have to meet up in New Orleans. [CORDELIA] Yeah, I like that plan. [JOE] Let’s do it. So Cordelia, I would love to hear how did you get into the work of anxiety? [CORDELIA] So, I’ve been in practice, what, over 30 years now and when I first started doing therapy, working in a agency, you really don’t have a lot of control over who you will work with. So I worked with people who had anxiety, depression, bipolar disorder personality, disorders, some of the other serious mentally ill disorders and what I found was that my anxiety was getting in the way of me being able to help clients at times. So I started getting help myself to deal with my own anxiety and my nervousness of being a therapist and from that I had such a good experience, it helped me to be a much better therapist and then by the time I started working part-time in private practice, the clients that tended to find me were the ones who were struggling with anxiety. So, I don’t know, I guess the universe just put it in my lap and so from there I would go to more trainings to be more skilled in dressing generalized anxiety disorder or social anxiety disorder. I found that as I worked more with adolescents, most of them were challenged with social anxiety disorder and then after 9/11 more older people were challenged with social anxiety disorder. So that’s what led me to even go even further in specialization to now I focused more on those who have social anxiety disorder. [JOE] Now, when you were realizing that your preference was to work with that population or your skillset, what were some things that were helpful to build your confidence as a clinician? What were either, whether it was trainings or mindsets or tools that for you was helpful to work with that population? [CORDELIA] Yeah, I think probably the biggest leap for me or the biggest aha moment was when I realized how my anxiety was getting in the way of me being able to recognize some of the things that were happening in the room. I’ll never forget that I was being taught that I need to be in a relaxed body to be more available. So I think what’s huge is when you’re getting ready to work with someone else, if you’re not scanning and paying attention to what’s going on inside of you, then you’re not necessarily going to be available to be there for the client. So it helped me to orchestrate our sessions to, a lot of times I start my sessions doing something to relax both of us, because I know that if we are in a relaxed body, we’re going to do better work. A also know that if my client is in a relaxed body, they can notice their anxiety better than if we don’t even try to have a baseline. They’ll come in tense and anxious and not able to be as aware of the shifts that’s going on inside of their body. [JOE] Now when you think about after that first beginning of the session, I think that’s such a great thing to start with some way to decompress, are there, first, are there specific things you do to help folks reduce that anxiety right from the get go of the session? Like what does that look like? [CORDELIA] So, yeah, so we’ll do a relaxation activity a lot of time. I’ll do a check-in a lot of times to see how they’re feeling. But what’s huge is to also teach self-compassion. So there is a lot of vulnerability that shows up when you are trying to feel confident. The whole nature of anxiety is fear. You’re anticipating things to go wrong. You’re anticipating that you’re going to be judged, you’re anticipating that you might be embarrassed. So there’s the tension right there. Well, in any course of treatment you have to learn how to function differently or how to think differently and especially with anxiety, learn how to notice what’s going on with your body. And whenever you’re coming from not knowing the learning curve in itself can be a very anxiety provoking experience. So the self compassion is what helps the client to be able to give themselves a break and give themselves the benefit of the doubt. So I spend a lot of time in the beginnings of my work with clients, creating this safe space where they can practice being courageous and they can practice bring being brave. And from that corrective experience of ooh, I was courageous, ooh, I was brave and I didn’t quite get it right, it’s okay, I’ll try it again and I’ll tweak this and I’ll tweak that. So from that, they’re able to see themselves learning, see themselves growing and give themselves the grace to learn the way they’re going to best learn. So that’s key and important I think. [JOE] What ancillary things do you typically recommend for people dealing with anxiety, so I’m thinking exercise, diet, meditation, those sorts of things? What are some of those menu items that you would say when someone’s dealing with anxiety are essential for them to at least have a working knowledge around? [CORDELIA] I do start a lot with body work, meaning a lot of people with anxiety are tenses and been tense for a long time so they’re not necessarily aware that their body is tense. So I will talk to them about getting massages, doing the progressive relaxation, yoga so that they can consciously pay attention to what a relaxed body is actually feeling like. Another go-to is the Insight Timer app. There are a ton of meditation music, sound healing music, the different hertz, 482 for positive hertz to raise frequencies and vibration as well as — [JOE] I use, just a quick side note, I have one that I listen to. I mean, it’s just on Spotify, but it’s the hertz for concentration. It’s what I always listen to when I’m working on email. [CORDELIA] Yes, yes. So Insight Timer has so many, so much free content that they can use. It also helps them learn how to meditate. So you can start with a two-minute meditation on there, five minutes, 15, 20 minutes. It has meditations to help people sleep. It has meditations where you have guided meditations to help with building confidence, actually a whole bunch on there to deal with anxiety. So I will a lot of times work with my clients to work with the Insight Timer app and I will specifically ask them to work with more of the guided meditations because a lot of times when you are struggling with anxiety, slowing down your mind is super, super, super hard. But if you can pay attention to someone else talking, that’s a break from you paying attention to your racing thoughts. So that’s the beginning of them learning how to slow down their mind and their thinking and getting more present in what’s going on inside their body. [THERAPY NOTES] Is managing your practice stressing you out? Try Therapy Notes. It makes notes, billing, scheduling, and tele-health a whole lot easier. Check it out and you will quickly see why it’s the highest rated EHR on Trustpilot with over 1000 verified customer views and an average customer rating of 4.9 out of 5 stars. You’ll notice the difference from the first day you sign up for a trial. They offer live phone support seven days a week so when you have questions, you can quickly reach out to someone who can help. You are never wasting your time looking for answers. If you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your clients’ demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE], J-O-E to get the first three free months totally free to try it out, no strings attached. Remember telehealth is included with every subscription free. Make 2022, the best year yet with Therapy Notes. Again, use promo code [JOE] to get three months totally free. [JOE SANOK] So when people start to focus more on what’s happening in their body, what do you see happen with their anxiety? Like what are the natural ups and downs that happen? [CORDELIA] So what typically happens is once they start relaxing and feeling what relaxing feels like, remembering what relaxing feels like, then they want more of the relaxed state of the body. So once people become more aware that they’re tensing up, then they start using their tools to help them relax. So I will hear them tell me about relax, excuse me, not relaxing, but going and get massages, frequency, going to get massage. I will, they will start telling me about mindfulness things they’re doing, walking in nature, also being outside and feeling the warmth of the sun. They will start telling me what they’re noticing more in their environment and then they’ll actually start finding themselves feeling more fulfilled in their lives, feeling happier in their lives and feeling less scary. [JOE] Now I’m wondering if you could have just the average clinician have a working understanding of anxiety, like what would you say are things that are essential for the average therapist to know, maybe things that they would ask in their intakes that oftentimes therapists don’t think to ask or things that they could be doing because so many people deal with anxiety? What would you wish that more therapists were doing in their sessions? Some just like basic clinical knowledge that you think the average clinician needs to have around anxiety. [CORDELIA] Well, we have good screening tools out there. The GAD-7 is a good screening tool. There’s also a tool that I like the DASS, which is depression, anxiety, and stress screen. A think it’s important to do those but then go back and ask the client to tell you more about why they scored themselves the way they scored themselves. That right there will help the clinician have a better idea of what is actually happening within the client, what thoughts are they having. You can pick up whether they’re distorted thoughts, you can pick up on some of the beliefs that they have. As well as you can pick up on some of the themes. By me using the screening tools, that was how I was better able to recognize that people were experiencing more social anxiety than just general anxiety. So then our, I was, you’re more able to pinpoint the type of challenges that the client is having and address those and then the client is experiencing progress quicker because you, from the beginning is addressing the challenges that they are rating as the higher symptoms that they’re challenged with opposed to just assuming that we may know what we need to focus on with the client. [JOE] Now for those of us who have been out of grad school for a while what would you want us to know about differences between social anxiety and general anxiety? [CORDELIA] Well, I think it’s important to understand how paralyzing the social situation can be for a person who’s struggling with social anxiety. I also think it’s important to understand social anxiety through a cultural context. So most people who are having a hard time with social anxiety is avoiding social situations for the most part and depending on who you’re talking to, they could be avoiding those situations because one, they don’t want to feel embarrassed because they feel like they look a certain way or they feel like they sound a certain way, talk a certain way. So there’s a lot of self-criticism and from that space they avoid social situations. But then we have people, when you’re like taking things in a cultural context that will avoid a social situation because they’re trying to avoid being criticized or being treated differently. So I think an example is, I had one client who was a person of color and they hesitated to be vulnerable in group settings where they may be the only person of color because the experiences that they had is when they would speak up in these situations where they might be the only person of color. There was a lack of understanding of their particular experience and so it would be sometimes misjudged or sometimes there was a lack of patience or understanding with my client. So there’s this hesitancy to show up and to express self when they’re feeling like they are in a setting where they fear or this anticipatory fear or the anticipatory threat that I’m going to be humiliated or I’m going to be judged, or I’m going to be called out in some way that makes me feel less than or makes me feel like I don’t deserve to be here or makes me feel like I don’t deserve to have help and support. I hope that wasn’t too confusing. [JOE] No, I think that’s really helpful. And part of it, like if I had a client that was saying, I’m fearful of these things, like, I mean, I live in northern Michigan and we are not a very diverse area and so I would be apt to say, I feel like a lot of that is is justified in the sense that to have some of that fear in today’s day and age is unfortunate. So like how do you parse through normalizing what you know, I mean, I would love to say we’re at a point where people don’t experience that racism, they don’t experience that exclusion but the reality is that oftentimes people of color have. So like how do you pull out maybe an anxiety that is founded from a social anxiety that’s clinical and needs to have some help? Or do you see them both as having similar treatment goals either way? [CORDELIA] What I tend to do is I spend a lot of time talking about being courageous and being brave. What I teach the client is we can’t do anything about institutionalized racism. There are circles that people of color will go be in and they will be treated differently and they will not necessarily have access to the type of support that other people in the room will have. They will be judged and so forth and so on. But if you can be courageous and be brave, you can push through the fear where if you have a focus of why you’re there, why you want to participate and what you want to gain, then that is your focus and that’s what you do. So when I’m working with my client, a lot of times we will process experiences and we will look for what was the game for them and if, and we can always usually find a gain. And even if you had to be brave to get that gain or if you had to do extra work to get that gain, it’s okay because it was a gain that you keep and that you get to use and that propels you forward. So I think what I’m saying is I spend more time looking at how we grow, what are the challenges out there that cause us to be stronger, but also adds to where we’re trying to go in our life? So it’s important to have some goals for yourself, have a reason why you’re doing what you’re doing, and then when you run upon these challenging moments, you pull in, out your tool belt, you be courageous or you breathe brave, and then you walk away intact; not expecting other people to necessarily see or understand where you’re coming from because that can just spoil it for you, but you feeling connected to your sense of wellbeing, you feeling connected to your sense of value and worth, even if other people around you can’t see it. [JOE] Such wise words. I love that. Now, when would you say that a general clinician or someone that doesn’t specialize in anxiety should refer a client out? [CORDELIA] Well, that is a very good question. I don’t even think I’ve even thought of that. That’s because I’m always working with the people with anxiety. I would say that first of all I would love for clinicians to pay attention to how they show up with a client, to work with a client who has anxiety. And if they find themselves leaving that session tense, anxious, if they find themselves leaving feeling, oh, I don’t know what to do and just worried, that’s probably a good sign to refer that client out because it’s sounding like the therapist is having a hard time staying in a relaxed body and helping the client to learn how to be in a relaxed body. So that would be one of the indicators to be like, okay, let me refer this person out. I also feel like if you show up and it’s very draining for the clinician, that might be another indicator to, hmm, let me refer this person out to someone who more so specialize in helping those who are challenged with anxiety. [JOE] Well, the last question that I have is if every private practitioner in the world were listening right now, what would you want them to know? [CORDELIA] Pay attention to what’s important to you. That’s how you find out what your niche is. Then don’t hesitate to get the extra training, the guidance, the mentorship, the support to grow your skills in that area to be more effective. I find that by focusing on social anxiety, I am more of an effective clinician and as well as I enjoy my work so much, much better because I’m truly just working with those, or should I say I’m truly working within my zone of genius. There are so many other clinicians that are specializing in other areas that there’s plenty for all of us to be able to have a niche and I think it if we just pull us all together, the effect that we could have in the mental health world could be so much more powerful. So yes, specialize, specialize, specialize. [JOE] So awesome Cordelia. And if people want to connect with you, if they want to follow your work where’s the best place to send them? [CORDELIA] Yeah, they can just go to my website and leave me a message. That would be at www.s-h-i-f-a-l-i-v-i-n-g.com, shifaliving.com and just leave a message and I will respond. [JOE] Awesome. We’ll have a link to that in the show notes. Cordelia, thank you so much for being on the Practice of the Practice Podcast. [CORDELIA] Thank you. Glad I could be here. [JOE] I am just loving doing these shows and hearing about people’s clinical work, their passions, how they got into it, techniques. Having covered so much business over the years, it’s good to go back to also these basics around just working with people with social anxiety and things like that. We have tons of resources on Practice of the Practice, whether it’s clinical resources, business resources. You’re going to want to check that out. As well we could not do the show without our amazing sponsors like Therapy Notes. Therapy Notes is the premier electronic health records out there. They make it so easy and they have teletherapy as part of it so you don’t have to worry about getting a business associates agreement with Zoom or things like that, or even having the business version of Zoom. Instead, you can have it be all within Therapy Notes and make your billing easy and make your bookkeeper and your biller have an easier life as well so you’re not paying for all that. Try therapy notes over at therapynotes.com, use promo code [JOE] at checkout and you will get two free months. Also thanks so much for letting me into your ears and into your brain. Have an amazing day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.