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Today, we’re excited to announce that Breakthrough has been acquired by MDLIVE, a leading innovator of telehealth services and software. This acquisition will further enhance/springboard MDLIVE’s position in the telehealth market as the nation’s leading provider of medical and behavioral health solutions.

MDLIVE, a leader in telehealth, provides patients with access via video, phone, and secure email to board certified doctors and licensed therapists to receive treatment for non-emergency medical issues. The company is headquartered in Sunrise, Florida and operates in all 50 U.S. states.

To learn more about the acquisition, view the press release and a letter from our President, Julian Cohen click here. To learn more about MDLIVE please visit their website at

Stay tuned over the next few months for updates on how we’ll be rolling out exciting new opportunities to the Breakthrough community.

Thank you for being part of the Breakthrough family and for your continued support.

The Breakthrough Team

by Ann Williams, LPC

After a traumatic experience, it is normal to feel frightened, sad, anxious, and disconnected from the people and world around you. If the upset feelings do not dissipate, you may feel ‘stuck’ with a continuous sense of danger and painful memories. It can even begin to feel as though you will never ‘get over’ what happened and feel ‘normal’ again. By reaching out and seeking treatment to learn and implement new coping skills, you can conquer PTSD and move forward with your life.

Post-traumatic stress disorder (PTSD) can develop following a traumatic event that threatens your safety or makes you feel helpless. Most people associate PTSD with soldiers who have been in battle, as military combat is the most common cause in men, but any overwhelming life experience can trigger PTSD, especially if the event feels unpredictable and uncontrollable. PTSD can affect those who personally experience the catastrophe, those who witness it, and those who are involved afterwards, including emergency workers and law enforcement officers. It can even occur in the friends and/or family members of those who went through the actual trauma.

PTSD develops differently from one person to the next, and while the symptoms of PTSD most commonly develop in the hours or days following the traumatic event, it can sometimes take weeks, months, or even years before they appear. The traumatic events that lead to post-traumatic stress disorder are usually overwhelming and very frightening. Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. When your sense of safety and trust are compromised, it is normal to feel as though you are going ‘crazy’, disconnected, or numb. Oftentimes an individual will experience bad dreams, feelings of fear, and have difficulty stopping thoughts about the traumatic event.

PTSD includes frequent re-experiencing of the traumatic event, avoiding reminders of the trauma and increased anxiety and emotional arousal. You may find yourself avoiding activities, places, thoughts, or feelings that remind you of the trauma; being unable to remember important aspects of the trauma; losing interest in activities and life in general; feeling detached from others or emotionally numb; and perhaps experiencing a sense of doom and gloom about the future (“my life will never turn out like I planned”). Increased anxiety and emotional arousal can result in difficulty falling or staying asleep; irritability or outbursts of anger; difficulty concentrating; hypervigilance (on constant alert for threat); and feeling jumpy and easily startled. These symptoms make it very difficult to live your life.

Why should you seek help? The traumatic event or events you experienced are not your fault. You do not have to ‘hide’ from the world you once thrived in. And most importantly, you are not alone. The earlier you begin treatment, the better. Symptoms of PTSD may get worse and dealing with them now will likely help stop them from getting worse in the future.

Telehealth is very helpful when leaving your home or trying to juggle family life, appointments, and other tasks is difficult. From the comfort and ‘safety’ of your home, you can receive the help you need to reclaim your life and live it on your terms. Through the confidential website, you can meet with a therapist who will help you learn how to cope with and rid yourself of the symptoms you are experiencing. You can be assured that your sessions will remain confidential, be scheduled at times most convenient for you, and are covered by many insurance plans.

Getting the help you need in the privacy of your own home will allow you to begin to learn and utilize skills that will help you feel safer about going out and interacting with others and the world you remember. Through Breakthrough, you can find a therapist who specializes in trauma and will be fully with you as your wounds heal and you rejoin life. You do not have to be afraid any longer. Help is out there!




Ann Williams is a Licensed Professional Counselor and Drug & Alcohol Counselor in the state of Nebraska. She graduated Bellevue University with an M.S. in Human Services/Clinical Counseling in 2002.

We are playing with building blocks, my four-year-old daughter, two-year-old son, and I.  The atmosphere is calm and purposeful.  We are each building our own little structures.  My son suddenly picks up his creation.  My daughter and I both glance at him quizzically as he attempts to balance it on his head, as if to wear it like a hat.  He watches us with a smile as it falls off.  My daughter laughs delightfully, in turn causing my son to giggle.  I pick up my blocks and attempt to put them on my head.  As they come cascading down, we are all laughing now.  I subtly sense that I am no longer trapped in an isolated self—that all of us are floating together in an in-between space that has been opened up spontaneously.  We are connecting with each other by virtue of surrendering to a process greater than ourselves.

Moments like this are indicative of genuine bonding.  I would argue that the more we connect with our kids on this level, the more we ensure their future emotional stability.  It might be that simple.

And it might be more complex.   Many parents will attest that these moments are elusive and difficult to attain.  Speaking from experience you would think that, since I am a therapist and get paid to connect with people in a deep and meaningful way on an hourly basis, that I would be exquisitely attuned to making these moments a priority with my own children.  Yet I must confess that there have been entire weeks when I became so preoccupied with my own world that, not only was I not having these kinds of connections with my kids, I forgot to be concerned about having them in the first place.  Many times what jolted me back to prioritizing these moments of connection was listening to my patients’ vivid stories of how wounded they were by their parents’ narcissism.   What about all the other parents who aren’t faced with such stark reminders?

For the problem does lie in our narcissism.  It’s an illusion to suppose we can ever outgrow our first and fondest delusion that the world revolves around us.  So when the external world, following its own inscrutable circuit, doesn’t orbit within our wishes, our cherished routines get disrupted.  Since on this level of our emotional functioning other human beings (read: kids) get included in the “external world” bucket, I can think of no other task that challenges this delusion in such a visceral manner as parenting does.

One of the dangers we risk as parents is responding to this challenge with rigidity instead of release.  We can overcompensate by trying to control the external world even more, hoping this extra effort really will finally keep us in the center and the world at bay.  Thus we are less able to have moments when we truly let go of ourselves.  At best this effort at control results in us being emotionally absent from our children for a time.  At worst, for a person whose sense of self is shaky or unstable (i.e. a person who experienced too many external-world-intrusions in early life), this results in outright abuse.

Ironically the only cure for our narcissism is… to focus more on ourselves!  What I mean is: to practice being emotionally attuned with ourselves such that we know when we must take the time to replenish our capacity for giving.  Again, it’s really that simple.  Just go to the gym, engage in your favorite hobby, meditate, read a good book while sipping on a cappuccino, etc.

Right?  We parents smile at the naiveté of such advice.  Time is our most precious commodity.  If we are lucky enough to be able to pay for the childcare while we engage in such indulgences, not to mention having the energy to be so self-motivated, these things of course would help.  But what about financially strapped parents without a lot of family support, or single parents?  Or parents who are divorcing?  Or what if we engage in these activities but they don’t help much?

The most powerful way I know of to practice emotional attunement to ourselves is to be in psychotherapy.  In therapy we are allowed space to express ourselves openly, without judgment.  It’s an incredible relief just to speak what is on our minds and be heard by another caring adult.  Even more powerful, we can learn about the deeper sources of our worries and the patterns that keep us stuck.  Or (apropos to the topic of this blog post) we can understand how our parents’ care-giving subtly influences our own ability to parent.

Luckily for parents, with the advent of telehealth and, getting to a quality psychotherapist is as easy as walking in to the spare bedroom with your laptop and closing the door.  Having gotten the external world to bed first, of course.  Indulging ourselves so that we may forget ourselves:  our kids notice the difference and are ready to jump with us into the space beyond.



Matthew Morrissey is a licensed psychotherapist in the state of California. He holds an M.A. in Counseling Psychology from The California Institute of Integral Studies.



By Marion Barnett, MA MFT

Imagine you are feeling overwhelmed, you’ve been unable to sleep and you have been tossing and turning almost every night.  As you lay in bed you can’t turn off your thoughts.  You finally get to sleep, but when you wake your heart is beating quickly for no reason and you are feeling a bit scared about all of this.  You may feel sad and a bit hopeless about how you are feeling.

You are frustrated that you can’t feel better.  You want to take care of this yourself, but at some point you realize you can’t.

When we are depressed and/or anxious our brains are simply not working optimally.  The shifting of the vital neurotransmitters in our brains, in addition to hormonal dysfunction can really throw us off center and can cause a steady stream of negative and painful thoughts. This is part of the human condition and can happen to anyone. There are thousands of very high functioning people who are suddenly faced with a crisis or set of losses or disappointments that cause the brain to shift out of sync. In fact, according to USA Today article from 2/7/2013, up to 39% of young adults reported increased stress and many had been subsequently diagnosed with either depression or anxiety (the top stressors reported were money, work and relationships).

When you realize you need to find a therapist, it can be feel like a daunting task- to find a person who you can feel comfortable with and who will actually help you.  Maybe you saw a therapist in the past and she/he did not help you, maybe they helped a little but you were disappointed, maybe they were nice but did not give you the feedback you hoped for.

Finding a mental health professional you really connect with is hard enough; most of us end up looking for one when we are at our most vulnerable. Add to that the scheduling, finding a babysitter and commuting to their office, and the process can seem daunting. Telehealth is most useful in those times when, for so many reasons, we cannot get to a therapist’s office or there is no good therapist around who has the hours we need.

When I meet with someone online through the confidential website, I am with you 100%, helping you to clarify what is going on in your life that is causing you distress. My goal is to foster an honest collaborative conversation in a trusting and safe environment.

If you have experienced stress, sadness, depression or anxiety and have some of above symptoms remember you are experiencing the human condition! It happens to most of us in our lives- times we are feeling so overwhelmed that we can’t think straight. We can feel angry, sad, frustrated, hopeless, and anxious and we think we can’t be helped.  But this is not true

Our brains are marvelous things! We create ideas, beliefs, meaning of everything we do and see in our brain.  Our brains are always trying to make sense of the world around us.  Most times our brains function wonderfully, but sometimes it goes “off track” and get into a “negative groove” whereby everything we think is negative.  But we can change the way we think about things absolutely.  As we reframe how we see things, we can come to understand we have the POWER to look at our concerns in ways that are useful rather than destructive.

I help each client week by week understand themselves and reframe their circumstances so they can see what I already know – They are resilient, courageous and stronger than they think they are.  It is a glorious journey to find your authentic self.



After working in the private sector for several years, Barnett received a Masters Degree in Integral Counseling Psychology at the Institute of Integral Studies in San Francisco. She has been successfully working with individuals, families and couples for 14 years.

by Erin Alexander, LPC

Stress is the way our bodies react physically, emotionally, cognitively, and behaviorally to any change from what is expected. We usually think of stress as negative, but it can also be positive: from an evolutionary, standpoint, for instance, we need it for survival in our “fight or flight” response.

Stress often has a negative impact on our bodies physically; for example, we may have decreased immune system efficiency, poor digestion, problems with metabolism, and issues with blood sugars. Cognitively, we can become forgetful, lose concentration, and even become confused – sometimes when I’m stressed, I even forget sections of the day! Behaviorally, we may become less productive, withdraw from others, or feel negative. From an emotional perspective, stress can cause us to feel anxious, irritable, resentful, and depressed, leading us to snap at our coworkers or spouse. Or, we start making negative comments about our jobs when we really love what we do. Many of the stress warning signs actually mimic Depression and/or Anxiety, like panic attacks, difficulty concentrating, loss of appetite, heart palpitations, digestive problems, and body aches. Often, doctors will recognize these symptoms as Acute Stress and refer patients to mental health professionals.

What triggers stress? The list seems endless! Marital conflict,, moving, job loss or change in work conditions, vacations and holidays, pregnancy, children leaving home, retirement,  legal issues, family reunions, deployment and reintegration-related issues in the military, Financial problems, school, personal injury or major illness, death, care-giving (elderly parent or mentally ill family member), and physiological changes (like menopause and aging). Some of these seem like they would be “happy” events, like retirement and vacations; however, many clients in my practice say otherwise: retirement is a complete life transition from what one has known for 20-30 years, vacations are typically rushed, etc.

Here are some of the best self-care techniques to make sure that you have a good resiliency foundation to deal effectively with stress? Many of the suggestions listed have been recommended by professionals on numerous occasions; some things you may not have considered:

  1. First of all, eating a healthy diet and consuming enough water is important to help make sure that you have the appropriate nutrients in the body, and that you are hydrated. I consume between 24 and 32 ounces of water in the morning before I have any caffeine. I also use the MyFitnessPal app on my phone to enter everything that I consume so that I have a nutritional food diary.
  2. Exercising daily is also important…not necessarily for weight loss but to help boost the “feel good” chemicals in the body. I do a 10 minute workout in the mornings while my coffee is brewing. I do something intense, like a few sets of squats, burpees, and oblique planks; that way I have a short full body workout in a short amount of time and I feel good.
  3. Getting 8 hours of sleep is important but easier said than done. To help with this, I do things to wind down in the evening in preparation for sleep, like taking a hot bath, drinking herbal teas, and doing yoga. I do not watch anything on TV that is going to be emotionally disturbing. I have also gotten into the habit of keeping electronics out of my bedroom unless it is soft music. I do not have a TV there.
  4. Enjoying quality time with friends/family is essential, as well as making time for your hobbies. I enjoy music, yoga, hiking, and just having lunch and conversation with friends.
  5. Many people do not know how to set boundaries, or know how to say NO. Learning this skill definitely decreases the stressors that you would ordinarily have.
  6. Learning to utilize all resources that are available to you is essential for stress management. For example, if others have skills sets that you don’t have, ask for help when you need it! Along these same lines, learn to delegate tasks to others when it is appropriate.
  7. Another way to utilize resources is to take advantage of your employee assistance program; for example, there are resources to help out with financial planning, elder care, counseling, career, legal assistance, and other issues. Now mental health has expanded to telehealth, to reach people who are not available for more traditional types of counseling. Breakthrough Behavioral provides secure online services to people wherever it is most convenient.
  8. Learning to set realistic, measurable goals is important for stress management. This helps you to feel accomplished and as if you are managing your time well.

And finally: try to see life through the eyes of a child…laugh more, let things go, have fun, don’t take everything so seriously, and appreciate the beauty in the world.

These things take practice so that they become habits, but once they do, you’ll be feeling lighter and so much more carefree.


Screen Shot 2014-04-17 at 2.16.47 PMErin Alexander is a Professional Counselor in the state of Texas. She holds an M.A. in Counseling/Educational Psychology from UTSA.


Schedule a video session with Erin today!


Ann Williams cropped

Congratulations to Ann Williams, LIMHP, LADC, SAP for completing Breakthrough’s first online session in Nebraska! Ann has been in practice for 12 years and is a member of the American Mental Health Counselors Association and National Association of Alcoholism and Drug Abuse Counselors. We are excited to have Ann in the Breakthrough network.


In my last post, I introduced the root psychological cause of many physical ailments, and shared how equally physical interventions don’t help. So, what does?

An important first step is asking a medical doctor, “do you have any evidence that the pain I feel in my back/neck/etc. is the result of physical activity?” Once physical issues are ruled out, educating oneself about the mind/body relationship can supply the tools to cure the pain. Acknowledging that the pain is not actually rooted in the physical is the entrée to overcoming it.

To use Carol as an example: In handling her daily responsibilities without complaint, she may be repressing an enormous amount of rage and resentment at caring for everyone else’s needs instead of her own.  By denying those negative emotions, she is condemning them to overflow.  If Carol doesn’t express these feelings through words or tears, she may develop physical symptoms (Clarke 2011).

Seeing the influence of the mind over the body can be a powerful realization, but if finding the etiology of the pain doesn’t get rid of it, the patient is urged to first look at any imbalance in their lives.  A tool to identify this is the Eco-map, which diagrams people or activities that create or sap energy from the patient. Visualizing the input and output can clarify a possible imbalance: is the patient giving more than they are receiving?  The answer is usually, “yes.”

The next step would be using problem-solving to break things down so they are more manageable: Can Carole delegate some of her duties to other family members, or reconsider her role in creating the problem? Asking herself, “why am I valuing the needs of others over my own?” can help her gain a different perspective.  Learning that it’s ok to say “no,” and setting other boundaries and limits, will enable her to feel more in control and less stressed.

Identifying cognitive distortions (irrational thoughts) and reframing them will also help Carol be more accepting of prioritizing her own needs.  Challenging cognitive distortions like “I must be perfect or no one will like me” or “If I don’t take care of everyone, I am a bad person” will help her see that taking care of herself is not being selfish.  Utilizing “want to/could” instead of “have to/should” and telling herself “this is disappointing” instead of “this is terrible,” can help moderate her response to daily stressors.

Knowing that stress, tension and/or repressed emotions are causing the pain, and accepting this both consciously and unconsciously, may bring an end to it. Once the charade is exposed, the brain will no longer be able to use the pain as a distraction from emotional issues, and it will disappear.  The patient is taught to think psychologically instead of solely physically, and to be aware of what is happening below the surface (Sarno, 1991).

Tools like the Eco-map, problem-solving and interrupting cognitive distortions may not be enough to get rid of the pain. In this case, the patient may need psychotherapy to help identify deeper repressed negative emotions that are at the root of their discomfort. If chronic pain sufferers don’t think they can accommodate one more thing in their life, video counseling is a great way to get help.

Next time, I’ll be sharing a real-life example of a client I work with via video.

Barbara KlineBarbara Kline is a licensed, certified, clinical social worker (LCSW-C) in the state of Maryland. She holds a bachelor’s degree in psychology from Shepherd University and a master’s of social work degree from University of Maryland, Baltimore. Barbara has participated in several national training seminars on mind/body therapies, and utilize an eclectic approach including cognitive-behavioral therapy, as well as relational, behavioral, psychodynamic, and insight-oriented therapies. She has a strong interest in mind/body medicine and specialize in working with clients suffering from chronic (non-cancerous) pain syndromes including back, neck, & shoulder pain; fibromyalgia, and other musculoskeletal disorders. In addition to chronic pain, she also treats anxiety, depression, and other mental health problems.

Schedule a video session with Barbara today!

Part 1: It’s Not About Pain Management

Picture this: Carol bends over to pick up the bag of groceries she is taking to her mother.  She feels a sharp twinge in her lower back. She straightens with difficulty. She has too much to do to pay attention to the pain. After working at the office all day, she stops at the supermarket for the groceries, picks up the kids from soccer practice, drops them off at home and makes her way to her Mom’s. Later that evening she will fix dinner for the family, go over homework assignments, pay some bills, balance the checkbook, fold the clothes she left in the dryer that morning, and fall into bed exhausted but unable to sleep.  The pain in her back that began as a twinge has now escalated to near-agony.  She takes some over the counter pain pills and makes a mental note to call the doctor.

What Carol doesn’t realize, is that she may be having a physiological reaction to emotional distress. Although it is more readily accepted that stress can cause ulcers and other gastrointestinal ills, it is less accepted by patients and doctors alike, that chronic back pain often shares the same etiology. Our bodies are not immune to stress, and often times diagnoses such as degenerative disk disease, stenosis, carpal tunnel syndrome, rotator cuff tears, plantar fascitis, GERD, irritable bowel syndrome (IBS), tinnitis, dizziness, fibromyalgia, and temporal mandibular jaw malfunction (TMJ) exhibit physical symptoms of stress.

Dr. John Sarno, author of Healing Back Pain:  The Mind Body Connection, suggests that 98% of the people in the United States who have chronic back and neck pain actually have Tension Myositis Syndrome (TMS), also commonly referred to a psychophysiological disorder (PPD). Symptoms of PPD are caused by psychological stress. He believes that physical pain, along with other symptoms, can be the mind’s way of distracting us from emotional pain that is too difficult to express.

Don’t miss our next post, when we’ll explore the role video counseling plays in addressing physical pain.


Barbara KlineBarbara Kline is a licensed, certified, clinical social worker (LCSW-C) in the state of Maryland. She holds a bachelor’s degree in psychology from Shepherd University and a master’s of social work degree from University of Maryland, Baltimore. Barbara has participated in several national training seminars on mind/body therapies, and utilize an eclectic approach including cognitive-behavioral therapy, as well as relational, behavioral, psychodynamic, and insight-oriented therapies. She has a strong interest in mind/body medicine and specialize in working with clients suffering from chronic (non-cancerous) pain syndromes including back, neck, & shoulder pain; fibromyalgia, and other musculoskeletal disorders. In addition to chronic pain, she also treats anxiety, depression, and other mental health problems.

Schedule a video session with Barbara today!

20% of new moms will experience postpartum depression or anxiety and these moms aren’t being diagnosed and treated.

LEARN MORE about how Breakthrough can connect you to a provider today!