Please note I cannot directly endorse or vouch for the quality or competence of any of these organizations.

• Use your health insurance out of network benefits to reimburse a portion of private therapy costs. Most companies reimburse 40-80% of out of network therapy costs, with some reimbursing the full session fee.

• Try group therapy practices who have interns. Interns are graduate students learning to be therapists who practice under the supervision of seasoned practitioners; therapy with interns is typically offered at a steeply discounted rate. Examples of WA practices with graduate student interns:

  • River Bank Therapy

  • Self Space Seattle

  • Alliant Therapy Group

  • Bastyr Counseling Services

  • CityU Counseling Center

  • Antioch University Community Counseling and Psychology Clinic

  • MEND Seattle

• Try a nonprofit, low-cost directory service such as Open Path Collective

• Try community mental health centers, particularly if you are insured through the state (e.g. Medicare, Medicaid). Most community mental health programs offer many services beyond therapy, too, including wraparound care, psychiatric medication management, case management, substance use treatment, family therapy, and more. 

  • Asian Counseling and Referral Services - focuses on AAPI community

  • Compass Health

  • Consejo Counseling and Referral Services - focuses on Latinx community

  • Center for Human Services

  • International Community Health Services

  • Kitsap Mental Health Resources

  • Mental Health and Addiction Services at Harborview 

  • Navos

  • Sound Health

  • Therapeutic Health Services

  • UV Cares

  • Youth Eastside Services - serves people from birth to age 22

  • Need more options? Try calling a regional or state crisis line to be connected to an organization that suits your needs

• If you have state insurance/Apple Health, consider contacting your health plan provider for an in-network referral 

• Ever wonder why therapy is so expensive? What about why it's so hard to find a therapist you like? Here are a few resources which I feel accurately explain the problems which keep therapy inequitable and difficult to access

  • South Seattle Emerald: "Ask a Therapist: Why is Therapy So Expensive?"

  • Harvard Medical School Primary Care Review: "Here's Why Mental Healthcare is So Unaffordable & How COVID-19 Might Help Change This"

  • Mind Wellness Center: "Why is Therapy So Expensive?"

  • Center for American Progress: "The Behavioral Healthcare Affordability Problem"

• Crisis lines:

  • For a life threatening emergency, call 911

  • Call or text 988 for the national suicide and crisis lifeline

  • Call 711 for the 24/7 Washington state crisis line relay for King, Pierce, Clark, Skamania, Klickitat, Grant, Okanogan, Chelan, and Douglas counties; this crisis line can help you determine appropriate emergency mental health services

• Crisis lines for specific populations and specific challenges:

  • For teens: Call Washington Teen Link at 866-833-6546

    • To speak with a peer (another teen), call the line above from 6-10pm or chat and text from 6-9:30pm

    • To speak with an adult, call the line above from 3-6pm

    • To speak with a substance use clinician, call the line above from 3-6pm and press "2"

  • LGBTQ-specific support: Call, text or chat The Trevor Project for free, 24/7

    • Text "START" to 678-678, or call 1-866-488-7368. You can also chat with them online via the link above

  • Trans-specific support: Call the Trans Lifeline 24/7 at (877) 565-8860

  • For substance use, gambling, and mental health concerns: Call Washington Recovery Hotline 24/7 at 866-789-1511

  • Additional details including other regionally specific crisis resources 

• DBT Skills Training: Handouts and Worksheets- nothing beats the OG! There are open PDFs of this online (just Google it!) though I recommend getting a hard copy so you can fill it out yourself

  • Note: Please make sure you get the skills book, not the training manual, which is geared toward clinicians (you can get that too, if you like, but it's supplemental/far beyond what most clients want)

• The Skillful Podcast- solid podcast covering DBT skills application, great for those who prefer to consume information in this format

• DBT Skills List- a useful reference, and worth having easily accessible or saved to your phone photos or notes. Google "DBT Skills List printable" for a variety of additional options

If I had to pick the DBT skills I reference the most, they would be:

• • Mindfulness: basic definition and principles (HOW and WHAT skills)

  • Mindfulness of current thoughts and emotions (building meta-awareness of self)

  • Radical acceptance (including dialectics)- beware of common radical acceptance mistakes:

    • • Radical acceptance does not mean you have to approve or be ok with facts about reality- just that you need to fully acknowledge those facts for what they are

      • You do not have to radically accept something that isn't a fact or a reasonable limitation on the future

      • Having radically accepted something does not mean you feel "at peace" with it (not at all!)

  • 54321 - for grounding, mindfulness, dissociation, and/or crisis

  • PLEASE - take care of the overall wellbeing to increase resiliency

  • Identifying and labelling emotions - I highly recommend posting an emotion wheel on your bathroom mirror or somewhere easily accessible!

  • Check the facts and cognitive distortions (overlapping skills from DBT and CBT, respectively)

  • Opposite action - beware common pitfalls and misinterpretations of this skill-

    • • Opposite action isn't for making yourself do things you don't want to do. Instead, the goal of opposite action is to change your current emotional experience

      • For opposite action to work, we need to do it all the way. No half-assing it!

  • Clarifying priorities in interpersonal situations (then using skills accordingly)

A few words of caution: Consider this a "taster" or a place to start from. Trying these skills may help some AND doing all of the skills properly in group typically takes 6-12mo with a lot of trial, error, and feedback from a trained therapist. There's no replacement for learning the skills in their entirety, then picking and choosing what elements work best for you. 

• Books

  • The Happiness Trap by Russ Harris (here's a complete set of worksheets from Harris' books)

  • The Anxious Perfectionist by Clarissa Ong and Michael Twohig

• Fundamental skills and ideas

  • Dropping the anchor (ACE)

  • Cognitive defusion - increase awareness of thoughts, decrease attachment to their believability

    • Unhooking strategies

  • Willingness to experience discomfort (aka Acceptance- not the same thing as resignation or submission)

  • Mindfulness - contact with the present moment and self

  • Values; taking committed action toward values

  • Psychological flexibility: opening up, being present, and doing what matters

• Great OCD treatment often starts with a ton of education about what OCD is and how it works. It takes the average person ~7 years from the beginning of symptoms to get an accurate diagnosis (some research suggests even longer). It's worth spending time understanding OCD a bit more. It can also be validating to discover others with shared experience. Here are some resources:

  • International OCD foundation (IOCDF) and a page with fact sheets and handouts

  • Learn about Exposure Response/Ritual Prevention, the gold-standard treatment for OCD

    • More detail about ERP for OCD using Acceptance and Commitment Therapy (the approach I use)

  • For learning about others' lived experiences, The OCD Stories podcast by Stuart Ralph

• Treatment resources:

  • My favorite workbook (which is grounded in Exposure and Response/Ritual Prevention) is The ACT Workbook for OCD: Mindfulness, Acceptance, and Exposure Skills to Live Well with Obsessive-Compulsive Disorder by Marissa T. Mazza

• Research suggests that diagnosis is even more delayed for racial and ethnic minorities than white people; it's hypothesized that this is due to cultural barriers, social stigma, and general barriers to mental healthcare including difficulty finding culturally competent providers.

Bright light therapy has been shown to be an effective treatment for seasonal depression, unipolar depression, perinatal depression, and for the depressive phase of bipolar disorder (in the latter, please be especially careful to not use this intervention when there is risk of hypomania or mania, and consult with your mental health care provider). This can be an adjunctive treatment to therapy and/or medication and is sometimes recommended to those who can't or don't want to use medication.

This article gives a great review of the research. If you do this intervention, it's recommended you follow these particular specifications, which substantially increase the likelihood of treatment effectiveness:

• It’s best to choose a commercially available unit designed specifically to treat SAD because home units may not have the right brightness or UV filtration

• The light should have ~10,000 lux and minimal UV light

• Exposure should happen for 20-30mins daily

• The unit should be placed 16-24in from one's face. It's ok to defer to the manufacturer’s directions

• Early morning treatment has been shown to be most effective, ideally in the first hour after waking up

• The light needs to come in through the eye, though it is not necessary and not encouraged to look straight at the light

• It's ok (and encouraged) to do other activities while doing bright light therapy e.g. eating breakfast, looking at phone or reading, working, etc

• Treatment needs to be done on a daily basis, including weekends

• An effect is typically seen within several days of treatment

• Portable options are available; some clients do treatment at work

• Some insurance plans or HSAs/FSAs will cover or reduce the cost of an object like this

• Values card sort - I highly recommend doing a values sort every couple of years. Valuable questions you can ask yourself to further the process include:

  • • Is the way I currently live my life in line with my values?

    • What could I change to live more congruently with my values?

    • What do my values say about me?

• When is the last time you tried journalling? Journalling (by most any method, including the notes app on your phone, audio/voice notes, or typing and handwriting) helps us achieve many things:

  • • Externalizing thoughts/cognitive defusion

    • Increasing awareness of self through observing thoughts, emotions, and patterns of behavior

    • Opportunity to overtly practice changing how we speak to ourselves

    • If you're research-minded, check out this meta-analysis of randomized controlled trials on the effectiveness of journalling on mental illness

• Basic self-awareness requires knowledge of our present emotional state. Psychological research consistently shows us that those people who identify and label their emotions are better emotion regulators. Try practicing emotion identification and labelling. Many people find the following tools to be helpful:

  • Emotion wheel - pick one you like the best! I encourage clients to put this somewhere they can reference it easily (e.g. taped to the bathroom mirror, saved to your "liked" photos on your phone, etc)

  • Mood tracking - don't knock it until you've tried it!

    • Apps for mood tracking and journalling:

      • Moodnotes

      • Daylio

      • Finch

      • Daily Bean

    • Pen and paper methods:

      • Mood journalling (including bullet journalling)

      • Google "mood tracker printable" for online options- choose whatever suits you best

      • DBT diary card

• Mindfulness - if we're not fully experiencing the present moment, we're probably not experiencing ourselves fully, either. Mindfulness strategies of all kinds can help us feel more connected to and knowledgeable about who we are. See Mindfulness section for more details and ideas.

  • Self-compassion mindfulness practices

• Books:

  • Self Compassion by Kristen Neff

  • The Anxious Perfectionist by Clarissa Ong and Michael Twohig

• Health at Every Size (HAES)

  • Additional HAES-aligned resources

  • HAES information for kids (5-12th grade) via National Geographic

  • HAES fact sheet about weight cycling

• Debunking fatphobia and bogus science:

  • Maintenance Phase, an evidence-based podcast that's fun and scientific

  • A seminal literature review explaining the move away from weight-centered health, and the science that supports HAES

  • BMI (Body Mass Index) - why it sucks and isn't an accurate measure of a person's health

    • From FiveThirtyEight

    • From the Harvard T.H. Chan School of Public Health

    • From the CDC (targeted at practitioners, but useful for all)

  • The health consequences of weight/size discrimination- I highly recommend this article for an in-depth summary of major fatphobia issues in medicine, via the University of Illinois - Chicago School of Public Health

• How to find providers who don't suck at talking about size, shape, and the realities of living in a human body:

  • Rule-out and rule-in providers by looking for important keywords in their bios and descriptions (e.g. rule-in HAES, all foods fit, body neutrality; rule-out weight loss, dieting, broad recommendations for restriction or exclusion of foods)

• Managing weight and size conversations at the doctor's office

• Book recommendations:

  • Fearing the Black Body: The Racial Origins of Fat Phobia by Sabrina Strings

  • The Body is Not An Apology by Sonia Renee Taylor

  • Sick Enough: A Guide to the Medical Complications of Eating Disorders by Jennifer L. Gaudiani