As the days grow shorter and that familiar crispness returns to the air, life in the Ithaca area begins to shift. College students flood back into town—some for the first time, some returning after summer break—and the rhythm of the community changes almost overnight.
For therapists in Ithaca and environs, this time of year always marks an uptick in calls and emails. Whether it’s a college student navigating the transition to campus life or a longtime resident facing new challenges, many people start thinking: Maybe it’s time to talk to someone.
IRTG is a network for therapists and mental health professionals in Ithaca and the Finger Lakes Region to connect and share resources. We have now launched a new website at www.irtg.org, designed to connect people in the Ithaca area with trusted local mental health professionals.
The website is a one-stop resource for finding support whether you’re in a moment of crisis or simply ready to prioritize your mental well-being.
What started back in 2005 as a small circle of local therapists gathering in each other’s living rooms has grown into a robust, collaborative network.
Over the years, our group steadily evolved to better meet the needs of the community. Our internal therapist listserv now boasts nearly 600 members, averaging around 150 posts per month and serving as a valuable resource for the therapy community.
With the creation of the new website, our group has expanded its vision and reach—reflected in a name change from the Ithaca Therapist Group to the Ithaca Region Therapist Group.
The website offers:
—A searchable therapist directory to find local private practice therapists by specialty, treatment approach, and availability. The search can be filtered to show therapists who are accepting new clients.
—A Spotlight series featuring local therapists discussing their personal backgrounds and approaches to supporting clients.
—Curated listings of national, state, and local crisis hotline and other support resources; including separate pages for Tompkins, Cayuga, Chemung, Cortland, Seneca, Schuyler, and Tioga counties.
—An Upcoming Events calendar featuring support groups, wellness workshops, and educational offerings.
—A portal for the network’s therapists to stay connected with each other and informed through shared resources and updates.
—By Tamie Pushlar
Tamie Pushlar is a Licensed Clinical Social Worker in Ithaca and a member of the Ithaca Region Therapist Group Leadership Team
People and dogs. Living together for some 40,000 years. Inextricably linked. “Man’s best friend.”
Dogs are a part of our daily lives, of human joy. We now know that dogs can also effectively combat mental illness. They are known as emotional support animals and therapy animals. Research confirms how well dogs operate in this sense. I concur. I grew up with dogs, first Charlotte, then after she passed, Rose. And while my mother provided most of the quotidian maintenance, I enjoyed having them around, taking a quick break here and there to pet them, an effective means to de-stress.
Jazzy
When I visited the SPCA for my very own emotional support animal, I was in for a surprise. It had been my mother’s idea, a means of mitigating my isolation. Dealing with mental illness by oneself promises a cruel existence. Thus, I accepted. I saw and walked two dogs before I met Jazzy. The SPCA worker pinpointed the match as my future husky and hound dog mix waltzed into the enclosure. Meeting her at first, she strolled up and rubbed against me. Cue loving smile, cue the worker pointing at me: “There!”
What does the research say about dogs assisting mental illness recovery? One meta-analysis found reductions in heart rate, anxiety, and stress. Other research determined that canine-assisted therapy attenuates anxiety, but also improves a wide range of internalizing and externalizing disorders and global function. Another study supported findings on wellbeing, emotional function, self-esteem, and vitality.
Other varieties of pets, such as cats, may also give their owners greater social support, life satisfaction, happiness, mood, and self-regulation, along with less loneliness. One study considered all manner of companion animals, and though dogs were paramount, positive effects were noted on acceptance, stigma management, social interactions, and emotional sustenance. Researchers have found that even farm animals and horses may aid many emotional conditions.
Emotional support animals (ESAs) are normal pets, not trained for a specific task, that provide comfort, calm, and composure to people with mental disorders. Service animals, by contrast, have a specific task that directly assists their owner with the owner’s disability; a service dog may remind its owner to take their medication or kiss them when they’re having a panic attack. Therapy animals are specifically trained to provide emotional support to others in an institutional setting.
Therapy dogs can assist the elderly. A study found them to improve quality of life and symptoms of dementia, with lesser, but clear, benefits on depression and anxiety; this was partly mediated by increased exercise. A meta-analysis discovered benefits in dementia symptoms, mostly regarding mood and agitation. Another study found reduction in depression caused by dementia. Finally, in those with severe cognitive disorders, researchers found improvements in health, well-being, depression, and quality of life.
Every year, the Tompkins County SPCA facilitates 1,400 animal adoptions, 100 of which are for prospective emotional support animals, according to SPCA adoptions manager Doug Scott. Furthermore, he said 90 percent of the animals adopted as emotional support animals are cats, and 10 percent are dogs.
Scott estimates that 95 percent of people who adopt emotional support animals are under age 30, 66 percent of them students from Cornell University and Ithaca College. Neither school was able to provide a number of support animals on their campuses.
Having a dog is like gazing into a campfire, smores on demand, having a mano-a-mano with someone who’s so alien from you and so similar to you in all the best ways. Jazzy and I complete each other. It’s a bit like having a child rather than a roommate (aka a cat). I am first in Jazzy’s world. My deep paternal affection for her, without effort—it is intoxicating to this day and moment.
By Ben Komor
Ben Komor has been a certified peer specialist for over eight years and, among other functions in the mental health realm, served as an advisor to the Tompkins County Crisis Negotiation Team. He is a graduate of Ithaca High School, and holds a BA in Human Development and an MS in Health.
Sunday May 12 is National Mental Health Provider Appreciation Day! The Sophie Fund joins the Tompkins County Suicide Prevention Coalition in saluting and celebrating our local mental health workforce.
“Thank You” poster @ East Seneca & North Tioga bus shelter
In a small token of appreciation, the coalition has placed “Thank You” posters at two bus shelters in Ithaca—at East Seneca Street & North Tioga Street, and at Cayuga Medical Center. The coalition has also placed public service announcement messages on two Ithaca radio stations throughout the month of May—Lite Rock 97.3 and Rewind 107.7.
“Appreciation” poster @ Cayuga Medical Center bus shelter
We show our appreciation for mental health providers who toil to help us address our mental health issues and enable us to lead happier and healthier lives.
At times, the clinicians, social workers, peer specialists, and others in the field sacrifice their own mental well-being in the service of our community’s health and wellness.
If you know a mental health provider, or are personally supported by one, consider reaching out to them on National Mental Health Provider Appreciation Day (and other times, too!) to express your appreciation. Even better, bake them some cookies or cupcakes, or invite them to share a meal. Small acts of kindness go a long way!
Cornell University, like other colleges, recognizes that some students are addicted to alcohol and other drugs and is exploring the development of a collegiate recovery program. Some elements for a comprehensive program already exist on campus; others are yet to be created. A successful program, however, will embed a firm understanding of addiction and recovery into Cornell Health’s public health approach to mental health.
Addiction is characterized by the psychodynamics of denial, and collegiate recovery programs must confront those psychodynamics within the framework of a comprehensive public health approach. Anyone who has attempted to talk with a loved one about his or her addiction knows that their first reaction is to deny that there is anything wrong with their drinking. “I am not an alcoholic. I drink like everyone else.” “Alcoholic” and “addict” are highly stigmatized labels, heavily freighted with accusations of moral failing. In American culture, nobody wants to be seen as out of control, especially unable to exercise control over one’s alcohol or drug use. Denial makes helping addicted individuals difficult; nevertheless, it is possible to overcome their denial and set them on the pathway to recovery.
One in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page
Employee Assistance Programs use the constructive confrontation strategy to break through denial and motivate employees to accept help. Supervisors, for example, focus on job performance. When they see an employee’s performance deteriorate, they use progressive discipline and offers of help to motivate the employee to seek assistance from the program. When supervisors implement this strategy, employees are most likely to accept help and recover from their addiction. The constructive confrontation strategy can be used in a variety of settings, including schools and hospitals. The crucial balance—disciple and assistance—motivates addicts to accept treatment and recover.
Collegiate recovery programs can embed the crucial balance in the comprehensive public health approach—education/prevention, intervention, and treatment—used by colleges to address student mental health. Within each approach, it is important to highlight that addiction is a real phenomenon on college campuses, that addiction is characterized by denial, and that students can be motivated to accept help by focusing on their performance (e.g. grades, personal relations, campus code) and offering them assistance in correcting the problems. It is most important to emphasize that addiction is a medical problem and not a moral one, that recovery is possible, and that many students and alumni have recovered and are living sober, rewarding lives.
Education: Colleges already educate students about alcohol, responsible drinking, and the consequences associated with excessive use, but they can do more to educate the campus—students, faculty, and staff—about addiction and recovery. Campus alcohol and drug policies should state clearly that addiction is a medical problem and that the college is committed to providing students with the support required to recover and live sober and successful lives. College presidents and other campus leaders can amplify this message across campuses.
Likewise, addiction and recovery can be included as part of education efforts such AlcoholEdu, the Alcohol Literacy Challenge, or eCHECKUP TO GO and social norming campaigns. Cornell Health, for example, is incorporating a segment on addiction and recovery into its online alcohol and drug program required of all freshmen and transfer students. It is crucial that everyone understand that students’ use of alcohol lies along a continuum: many students choose abstinence; most students consume alcohol responsibly; some students get into trouble with alcohol and can learn to moderate their drinking; some students get into trouble because they are addicted to alcohol and they can recover and live sober lives.
To reduce the stigma associated with addiction, colleges can bring successful recovering alumni back to campus to talk with students about their college experience, addiction, and recovery. At Cornell, for example, the Panhellenic Society and Interfraternity Council have sponsored alumni talks, which enable students to distinguish between normal drinking and addiction. From the talks, students learn that help is available for themselves or friends and that sobriety and success are realities for addicted students.
Intervention: Intervention means taking direct action to help someone. On campus, many individuals are well situated to identify students with a potential problem and intervene. Among those well situated to intervene are faculty, peers, student advisors, health care professionals, campus police, and judicial administrators. Unfortunately, intervention often receives short shrift in mental health programs, whether they occur in the community, workplace, or campus because clinicians are uncomfortable with the constructive confrontation strategy and prefer that clients recognize their own problems and choose to come to the program on their own. At the same time, Americans are reluctant to intervene because we prize self-control, expecting others to behave responsibly and seek help on their own. Unfortunately, individuals suffering from addiction do not seek help on their own and require external motivation to accept assistance. The good news is that programs can train individuals such as peers, faculty, and advisors to identify students with problems, to intervene constructively, and to motivate them to seek help.
Many colleges are developing bystander intervention programs, which train students to identify problematic situations and intervene. For example, the NCAA’s program, Step UP!, is an excellent bystander intervention program that trains students to take action in a variety of situations—alcohol and drugs, sexual assault, cheating. It has been adopted by many colleges. Cornell has an award-winning video and workshop, Intervene, which depicts students intervening constructively in a variety of situations. While bystander intervention training increases students’ openness to intervention, the training efforts have yet to create a norm for intervention so that it is embedded in the campus culture and that students take it for granted and feel a duty to intervene.
Comprehensive recovery programs can do more to teach intervention strategies to intervene and ensure that students who have substance use and mental health disorders receive help. This means creating a web of support for individuals to intervene so that intervention is taken-for-granted as part of their role, whether one is an advisor, professor, doctor, or police officer. It also means teaching that college students can be addicted to alcohol and other drugs, that they can motivate students to change their behavior by using the constructive confrontation strategy, and that students can recover from their addiction, live sober lives, and have successful academic and professional careers.
Creating this web of support requires commitment from the top, making it a priority so that individuals feel a duty to intervene when they see students in need of help for addiction and other serious mental health disorders. It also requires some creativity. For example, at Cornell, some fraternities and sororities are implementing peer-based health and safety committees to educate chapter members about health related issues. These committees, like successful peer-based Member Assistance Programs, could train fraternity and sorority members to intervene, refer students for help, and support them in recovery. Similar programs could be developed for faculty, advisors, and health practitioners to create a web of support and duty to intervene and make a referral to the college’s student health center.
Treatment: Treatment refers to health practitioners accurately diagnosing a student’s medical condition, providing appropriate treatment, and following up to make sure that the treatment was effective and the student has recovered. It is important that clinicians are cross-trained in mental health and substance use disorder. That capability is crucial for differentiating between students who are abusing alcohol and other drugs and those who are dependent upon substances. Like Cornell, many colleges have two programs that can help students who are abusing alcohol to control their drinking. BASICS is a harm reduction strategy, which teaches students responsible drinking by highlighting campus norms and encouraging future compliance. Research finds that most students learn their lesson and drink responsibly. Some have difficulty learning, continue to abuse alcohol, and are candidates for Moderation Management, which is typically a group program. Students agree to abstain from drinking for 30 days and are taught techniques for moderating their alcohol use. Students who are abusing alcohol will learn to control their consumption. Students who are addicted to alcohol will not be able to implement the techniques and control their drinking. These students are candidates for addiction treatment.
Sixty years ago, addiction treatment was limited to a few in-patient programs, often 30 days in length, and Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) to support one’s long term sobriety. Today, there are many treatment options. However, abstinence still remains the goal for addicted individuals and long-term support by attending self-help, mutual aid groups still works for maintaining sobriety. Some people are able to utilize out-patient programs, which teach them about addiction, abstinence, and managing their sobriety. Individuals attend individual and group sessions multiple times a week, often daily. They allow patients to maintain some involvement in their normal lives (e.g. working and attending classes) while requiring them to avoid activities that can trigger a return to drinking such as hanging out with drinking buddies and attending parties and to attend AA or NA meetings. In-patient programs remove individuals from their normal lives, put them in a congregate living situation with other addicts, and immerse them in an intensive education experience about their addiction, abstinence, and long-term sobriety.
Treatment for college students is not easy. Colleges located in urban settings may have many options, both in-patient and out-patient, where students can be referred for treatment. Colleges in rural settings may have few or no local options, especially for out-patient treatment. Indeed, local options may be limited to a single program designed for a wide range of adults and, therefore, less able to focus on the special needs of students and the demands of college life. Fortunately, there are excellent in-patient programs for college students, but they do require students to take a leave from campus life and focus on treatment and recovery. Typically, this means taking a semester off, completing the program, and finishing up at home with one’s parents and attending AA or NA meetings.
The congregate college life with its parties is not the ideal environment for students learning to abstain from alcohol and embrace a sober lifestyle. Imagine trying to adopt a sober lifestyle while living in a fraternity, apartment, or dorm with one’s drinking buddies. In this context, in-patient treatment offers a refuge where students can focus on their recovery and enjoy the support of others.
Whether one opts for out-patient or in-patient treatment, long-term recovery requires the support of others such as fellow students, faculty, and advisors. Colleges can do a great deal to support addicted students in their recovery. They can begin by telling everyone that addiction is a medical problem and that students who recover from their addictions have excellent GPAs, graduate, and have successful careers. They can provide group support through local AA and NA meetings and create campus self-help, mutual aid groups such as Sober@Cornell. Student health services can provide counseling to help students with adjustments to campus life and prevent relapse. They can also provide safe spaces such as sober dormitories and club rooms, where students can hang out and enjoy the company of other students in recovery. Colleges can connect students with alumni in recovery, who are able to share their stories of recovery.
Addiction to alcohol and other drugs is a serious problem on college campuses. Nevertheless, recovery is possible and students can live sober and rewarding lives. Cornell Health’s effort to develop a collegiate recovery program can achieve success by embedding it into its public health approach to mental health.
—By William J. Sonnenstuhl
William J. Sonnenstuhl is an emeritus professor in the School of Industrial and Labor Relations (ILR) at Cornell University. His primary research examines alcohol and drug problems in the workplace and on college campuses. He is the faculty advisor for Sober@Cornell, President of Cornell Collegiate Recovery, Inc., board member of Cayuga’s Watchers, and member of the Fraternity, Sorority, and Alumni Council.
Mental health services in Tompkins County have been stretched to the limit for years. Demand for crisis support at local mental health clinics, as well as calls to Ithaca’s crisis hotline, spiked after the Covid-19 pandemic disrupted normal life in 2020. The number of people seeking non-crisis counseling in the county has also increased steadily since then.
MindWell Center Co-Founders Sarah Markowitz and Aaron Rakow
Into this breach last October stepped a new service provider promising cutting-edge approaches to mental health care: Mindwell Center LLP, located in the South Hill Business Campus.
MindWell is the brainchild of Aaron Rakow, a clinical psychiatry professor at Georgetown University who returned to his native Ithaca with a mission to upgrade the availability of services and standard of care in rural upstate New York. In short order, Rakow and co-founder Sarah Markowitz have hired 25 therapists and are adding another one-to-two a month; they plan to open a second clinic with 10 clinicians in September in Albany. MindWell is currently supporting 350 patients and counting.
“Across our society, we have more demand for mental health services than we have providers able to support that demand,” Rakow said. “In particular, within a category of the mental health field that we refer to as evidence-based care, or psychological intervention that is based on science, to be as effective as possible in treating a host of mental health challenges amongst individuals, there are even fewer practitioners that practice in that space. My hope is that through opening MindWell Center we will be able to address some of those needs.”
The Tompkins County Chamber of Commerce honored MindWell at its 2021 Annual Meeting and Celebration on May 20 with its Distinguished Business of the Year Award. Announcing the award, the Chamber said: “In response to a specific and substantial community need—access to effective, quality mental health care, and removing stigma regarding mental health concerns—MindWell founders Aaron Rakow and Sarah Markowitz have introduced a new model of treatment to our community and expanded their staff and services considerably in a short period of time.”
MindWell strives to provide the highest quality evidence-based mental health care to children, families, and adults for a spectrum of mental health conditions, including depression, anxiety, eating disorders, sleep disorders, substance use disorders, Post-Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and Attention-Deficit/Hyperactivity Disorder (ADHD).
Besides supporting individual patients, MindWell is ramping up population-level initiatives—for example, it offers contracted services for companies where clinicians implement programs fostering healthy workplaces through leadership training, wellness seminars, stress reduction classes, support groups, and individualized care for employees. MindWell is offering similar services to schools in the region, both K-12 and colleges. Rakow believes that the Ithaca community is aware of the need to address the “mental health pandemic” many experts believe accompanied the Covid crisis.
Rakow said that another key part of MindWell’s mission is to support the training and retention of high-quality evidence-based clinicians in upstate New York. To that end, MindWell has formed partnerships with the University at Albany and Binghamton University to provide training through externships for graduate programs in clinical psychology.
WATCH: Promotional video about the MindWell Center
Evidence-Based Care (EBC) is an evolving standard of care involving a variety of treatments endorsed by leading mental health associations. According to experts, it emphasizes integrating the best available research with clinical expertise in the context of a patient’s culture, individual characteristics, and personal preferences. Nonetheless, as a 2013 New York Times article pointed out, “surprisingly few patients actually get these kinds of evidence-based treatments” despite numerous trials demonstrating their effectiveness.
MindWell clinicians are trained to provide Cognitive Behavioral Therapy (CBT) and Measurement-Based Care (MBC) to carry out its evidence-based approach. According to the American Psychological Association, CBT encourages patients to recognize distortions in their thinking that are creating problems, and learn problem-solving skills to cope with difficult situations.
Any good therapist will utilize treatment elements such as reflective listening, validation, and empathy. As Rakow describes it, evidence-based treatment adds a roadmap for the client and the therapist to most efficiently decrease the symptoms of disorders through specific strategies and techniques that have been proven through science. In treating a patient with depression, Rakow explained, the therapist will assess the factors behind the patient’s negative thinking patterns. Then the treatment will focus on teaching coping skills that can change the patient’s cognitive narrative.
“The client gets a workbook to help their guidance and help their process at home,” said Rakow. “The clinician has a workbook to help guide the sessions. That is an evidence-based intervention in practice.”
Furthermore, MBC bases clinical care on data collected from patients throughout their treatment; experts say that MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes.
“We are looking at every single session for the individual on how they are improving, if they are improving,” Rakow explained. “And if they are not, what can we be doing differently on an interventional level?”
To use an example, Rakow said that a clinician treating anxiety will have patients fill out screen tests during every therapy session to measure increases or decreases in symptoms. “So they can say, ‘It looks like you’ve had a difficult week. We’re seeing your anxiety go up. Let’s see how we can calibrate the treatment effectively to bring that level back down. Because we know you have that potential.’ If we are not practicing measurement-based care, we’re not practicing evidence-based care. Those two things must always go together,” Rakow said.
Some team members at MindWell are equipped to prescribe medications. That said, Rakow points out that many of the most evidence-based strategies involve the combination of psychotherapy and medication management, as opposed to a treatment regimen that involves medication management alone. Thus, MindWell’s team of multidisciplinary providers collaborate closely on cases to ensure that the treatments are optimally calibrated to each patient’s individual needs.
Population-level initiatives provide easier access to mental health treatment, Rakow explained. “There are far too many barriers to accessing high quality mental health care in our country,” Rakow said. “We will partner with hospitals, with school systems, with institutions of higher education, with businesses big and large, to provide integrated mental health solutions for their employees, for their pupils, for their staff, for their patients, to make the process of accessing mental health care that much easier.”
Rakow said that businesses are receptive to upstream mental health support for their employees, especially amid the Covid-19 pandemic, in part because they realize that decreased wellness can impact productivity and profits. He said that MindWell services for K-12 schools can focus on administrators, teachers, and staff as well as students and their parents.
School-integrated support helps parents avoid what can be a difficult challenge in navigating mental health services for their children on their own, Rakow said. “If you are a mom or dad, and your child needs mental health care, you have to locate a provider, wait for that provider to have an opening, take time off to drive across town and take that child to that appointment, wait while the child is seen, and follow up with the clinician,” Rakow said. “That could take weeks or months to treat, in the best-case circumstances.”
MindWell’s model for higher education similarly supports faculty and staff members while seeking to relieve the increasing burden on student counseling services.
“College student mental health is right now an extremely high need for our field,” said Rakow. “The institutions of higher ed in our region are taking this issue extremely seriously and have put an incredible amount of thought and commitment and resources towards it. But our need in our society from a mental health perspective continues to grow and the demand for it continues to increase. We need to really think innovatively about how we can provide support and access points for undergraduate and graduate populations of learners in our community to be able to effectively meet that demand.”
UPDATE: MindWell is working with regional insurance carriers to become in-network as soon as possible to increase access to its care model. In the meantime, MindWell offers a generous sliding scale for clients in need. MindWell also offers what it calls courtesy billing whereby the MindWell team submits the claim on the behalf of the client so they can focus on their care rather than dealing with paperwork.
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