Welcoming in April: Carmen Avendano, MA, LMFT

Carmen has fifteen years of experience as a Mental Health Professional, twenty-five years of experience as a cross-cultural trainer and over thirty years of experience as a teacher, including the past ten years as an assistant professor for Counseling Psychology, Health and Human Services, and Marriage & Family Therapy graduate programs at St. Mary’s University of Minnesota.

Carmen is passionate about helping her clients achieve their goals and finding effective ways to deal with life’s challenges. It is her goal to help clients heal, achieve their fullest potential, have mutually supportive relationships and improve their overall well being. Carmen offers client centered care and understands the power of diversity, equity, and inclusion. 

Spotlight with Brian Borre: Metacognitive Therapy

Before we get into theory, or how this approach might apply to you, let’s take a detour into language. When used as a prefix in the English language, “meta-”, stemming from the Greek for “after” or “beyond”, means something that goes beyond, to be all-encompassing, or become transcendent. When “Meta” and “Cognitive” are put together, the result essentially means “thinking about thinking.” For example, have you ever had an experience where you’re certain you know the name of something--a person, product, or place--but you can’t recall it? This “tip of the tongue” experience is just one example of how metacognitions work to inform our everyday lives--we’re thinking about how we’re thinking. While most of our meta-processes aren’t so conscious, our metacognitions are in the background actively controlling and influencing our conscious experience of the world, 

Metacognitive Therapy (MCT) focuses on targeting and modifying our deeply held beliefs--the thinking about our thinking--that fosters states of perpetual worry, rumination, and/or fixation. For example, if you say to yourself, “worrying about this keeps me safe,” or “I have no control over my thoughts,” you are both observing your own thinkingand having thoughts about thinking. The goal of MCT is simple: identify, challenge, and reduce what they dub, “Cognitive-Attentional Syndrome” (CAS). CAS is an umbrella term that refers to the kinds of beliefs that imply: we need worry, are incapable of stopping worry, and would be better off if we hyperfocus on tackling each individual worry.  

You might be thinking to yourself, “Birch Counseling, this is starting to sound a lot like CBT,” (Cognitive Behavioral Therapy). The truth is, you aren’t exactly wrong. In CBT, we are dealing with our thoughts. For example, if we were to use CBT to challenge our social anxiety, we might ask ourselves, “how likely will this outcome be, and will it be as bad as we’re thinking it will be?” Essentially, we identify an irrational thought and we challenge it with a more realistic lens. 

In comparison, with MCT, we are dealing with how we think about our thinking. We don’t give a lot of attention to the individual thoughts. Instead, we challenge the thinking around the thoughts themselves by asking ourselves, “should I spend my time worrying if the worry doesn’t make it less likely to happen? And if I already worried about it and made a decision, why am I re-worrying about this when I don’t have any new information?” This process, which encourages us to refuse to engage with unhelpful thinking, is called “Detached Mindfulness.” It works because it isn’t avoidance--it challenges people to view their worry and irrational beliefs as something that is outside of their core, observe the thoughts, stay non-reactive to them, and choose to respond without the preoccupation with worry about worried thinking. 

Why does Brian like it? Besides being a philosophical guy interested in all things “meta” (emotions, beliefs, and communication), Brian saw that CBT wasn’t always helpful with anxious, depressed, or addiction-driven thinking. From his perspective, it can be equally harmful to hyper-focus on our worry if we feel utterly incapable of controlling or changing it. He thinks about it like “giving in to a screaming toddler you know is just seeking attention because they want something from you, and you don’t know how to handle the upset anymore. Ultimately, it doesn’t help you, or them, to keep caving in or feeling totally helpless to stop it.” Instead, you can learn how to provide the tantruming child in your brain--the anxiety, depression, or addiction monster’s voice--the reassurance that you know what’s best, have a plan, can essentially “pivot” yourself out of the situation, or rebound if you make a mistake. It deflates the tantrum in your brain. And that’s a powerful tool. 

If you think Brian might be a fit for you, or have any additional questions about metacognitive therapy, please feel free to reach out to our team at BizOffice@birchcounseling.com

References:

  1. https://mct-institute.co.uk/therapy/

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246690/#:~:text=Conclusions%3A%20Our%20findings%20indicate%20that,psychotherapies%2C%20including%20cognitive%20behavioral%20interventions.

  3. https://mental-health-matters.com/what-is-metacognitive-therapy-and-how-can-it-help-anxiety/

  4. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00031/full

Going Out On A Limb With Brian Borre, MA, LMFT, LADC

In another life, Brian would have been any college student’s dream Philosophy or Creative Writing professor because he makes you think without feeling judged. He doesn’t pepper you with questions, or reflexively challenge your answers for the sake of being contrarian. And while you can tell that there is always something percolating just beneath the surface, it never feels like he’s holding something back from you, creating a power imbalance, or checked-out in the moment. He’s just effortlessly curious, compassionate, and clear about his boundaries: he won’t work harder than you do. 

 Perhaps part of what makes Brian a refreshing therapist to Minnesotans is that he’s not from here; being a Chicago native, he can observe the “Minnesota Nice” practices of passivity, but he’s not limited to them. He’s not afraid to sit in silence, push on a button, or meet clients where they are at--it all just depends on what the client’s needs are. While he identifies as more of a “generalist,” or someone who sees a variety of client populations, Brian likes to work with blended families, young professionals, and couples because of his own personal experiences. When it’s appropriate, Brian has found it can really help to have someone who has been through some of those experiences help validate your feelings, normalize what’s happening, and help figure out what comes next. 

 One thing you might find surprising about Brian: His first professional venture had nothing to do with therapy! While he always felt a calling towards private practice, and his undergraduate major focused on Psychology and Sociology, Brian took a several-year detour into the Culinary Arts! Brian worked in professional kitchens near Yosemite National Park and “really loved it.” What’s really surprising about this tidbit isn’t even the professional pivot, it’s the fact that he identifies as a “professional chef who now doesn’t cook.” He’s clear he’s diplomatic about shared household labor, but in terms of creative expression and self-care, he’d rather spend his time watching or reading Science Fiction, having adventures with his kids, or playing guitar. 

On coping with the pandemic: Brian admits that his coping with the pandemic has shifted as the world starts to open up again. Early on, his coping came from fitness, work, reading, and nature; things that would help him to ground or find some semblance of normalcy. Now that we’re able to explore more, he finds himself coping with the uncertainty by noticing the “absolute, purest joy” that his children are experiencing. Even if vicarious, the “wonder they have and excitement for everything they’re doing, it’s like watching them discover it all for the first time,” which helps him hold on to gratitude, wonder, and simplicity, even in the most uncertain or ambiguous of times. 

 Walk-Up Song: Brian’s ideal walk-up song, “would be something like a mash-up between The Sex Pistols and Beethoven,” which we think is pretty indicative of his style: a balance between classical approaches and total anarchy. Since that song doesn’t technically exist yet (and Brian’s musical skills are limited to the guitar), the closest thing he could think of was London Punkharmonic Orchestra’s cover of “Pretty Vacant” (originally by The Sex Pistols). While we were skeptical at first, we might be able to add this to our waiting room playlist…

Professional pet-peeve: Brian is “other professionals who stop learning or continue to learn in a singular way.” From Brian’s perspective, having an interest as a clinician in anything ranging from music to Mythology, Stoicism to sports, nature or technology, literally whatever you choose to learn about, can inform how we experience our lives and others. Brian believes that a narrow focus or general lack of curiosity can contribute to the greatest of professional offenses: shaming and invalidating clients.

Favorite tool in the Therapist Toolbox: By this point in the blog, you’re probably not going to be surprised that Brian is anti-assessment and scales. To be fair, he does believe in referring to psych testing, understands the value of tracking relevant data, and ongoing anecdotal assessments. He just doesn’t believe in universal measures of unique situations, or snapshots in time meant to reflect something grander. In his experience, some of the most standardized tools can bring about shame for clients because they “didn’t make progress fast enough, or felt like they had a better week but their depression assessment is high today,” and it can cause undue harm. Instead, Brian often uses an ecological approach to help clients reflect on what is going on in their life at any given moment, on a bunch of different levels. If you’ve never had one, it can sort of look like a target with each ring reflecting a different domain of our life. This way, “we’re checking the health of their system as it is today--not just focusing on all the bad at work or home, it’s bringing it back into a larger context and perspective so there’s more balance and insight.” 

 If you have any questions about Brian, his approach, or think he might be a fit for you, please reach out to us at bizoffice@birchcounseling.com or get in touch through the “Contact Us” tab on our website. Otherwise, stay tuned for our next blog post where we put the spotlight on how Brian’s “Meta” thinking translates into Metacognitive Therapy with clients!