Is Telehealth really effective?

May 4, 2020

written by Tiffany Merchant, MS, NCC, LPC

It started as something half a world away from the United States in December 2019. In January 2020 the World Health Organization (WHO) declared the novel coronavirus, COVID-19, a public health emergency of international concern. As the number of positive tests for COVID-19 grew exponentially in the United States the President of the United States declared a national emergency and Wisconsin Governor, Tony Evers, declared a public health emergency. On March 24, 2020 our definition of “normal” changed severely when Governor Evers enacted a Safer-At-Home order. 

This order has left many places of employment scrambling to understand what is considered “essential” and how they could continue to support their employees and customers. Doctors began cancelling “non-essential” appointments. Schools closed. Parents and guardians were now left questioning what they needed to do to educate their children and teachers began a journey of transforming the way they teach and inventing new ways of teaching. And many citizens were left with the question of how they would access the mental health services they have come to depend on. 

“Is it effective?”

Absolutely! Jonathan G. Perle and Barry Nierenberg completed a literature review (1) that found telehealth to be an effective mode of therapeutic treatment for people who are unable to access face-to-face mental health services. 

“Is it safe and secure?” “Will it be just us?”  

SCCS uses the safe and secure platform of Google Hangout Meet for telehealth ensuring HIPPA is followed even in these changing times.. Providers are diligent in protecting the rights of clients. Providers are alone in their office or home and use headphones if needed in order to ensure that client information is kept confidential.  

“Is it legal?”   

Telehealth is legal in the state of Wisconsin. Under the Emergency Order 16 and 2019 Act 185, mental health providers in the state of Wisconsin are authorized to provide telehealth services so long as the services provided are within the scope of practice of that provider, and the client is in the state of Wisconsin. Telehealth services were legal before COVID-19, however, under the Emergency Order 16 and 2019 Act 185 the provider does not need to be credentialed specifically for telehealth. There is no test to pass or further education required to obtain that credential. 

“What can you do with my elementary aged child on video?”  

SCCS providers that work with children are skilled in finding creative ways to connect with their younger clients. They will use numerous ways to connect including games, coloring, drawing, conversation about interests, and lego blocks.  

“There is no way that we can connect over video! I will feel so awkward!”

This is a common fear of telehealth. However, this fear should not keep you from seeking mental health care. In the times of COVID-19 and social distancing, it can become easier to connect in ways previously more difficult. SCCS providers will gauge the conversation and adjust as needed to find a way to connect with you. We are also continuing to provide counseling at the office in person.

“Will insurance cover it?”

Many insurance companies have shifted to cover telehealth, however it’s important to note, every insurance is different. If you are uncertain if your insurance will cover telehealth for mental health services, call the SCCS office and contact your insurance company to verify benefits. 

While transitions are difficult for many of us, most mental health clinics, including SCCS, have been providing telehealth options since the “Safer at Home” order. Hopefully, the answers above have helped you feel comfortable with the option of telehealth. SCCS providers and support staff are here to answer any other questions that you might have. And, again, we continue to provide services in person at both the Onalaska and Black River Falls locations.

To continue your mental health journey, or if you have discovered that you need someone to talk to and process just how upside down your world has turned in the last 6 weeks, call Stein Counseling at (608)-785-7000. We’re here to help!

(1) Jonathan G. Perle & Barry Nierenberg (2013) How Psychological Telehealth Can Alleviate Society’s Mental Health Burden: A Literature Review, Journal of Technology in Human Services, 31:1, 22-41, DOI: 10.1080/15228835.2012.760332

Trauma Informed Information

March 9, 2018

SMART Recovery Meetings

October 4, 2017

LaCrosse SMART Recovery Meeting Schedule

We have grown!

SMART Recovery is an abstinence based program

SMART = Self Management And Recovery Training

We offer Tools, Strategies and Exercises to help you in recovery

SMART is based on science and 4 principles:

1-  Building and maintaining motivation

2- Coping with urges

3- Managing Thoughts, Feelings and Behaviors

4- Living a Balanced Life

Mondays 5:30 – 7 pm       401 West Avenue

Unitarian Universalist Fellowship Building

Wednesdays 5:30-7 pm   921 West Avenue

Coulee Council on Addictions

Fridays 5:30-7 pm            921 West Avenue

Coulee Council on Addiction

Women’s SMART meeting

Saturdays 1:00-2:00 pm

Coulee Council on Addiction

Handling Conflict

June 14, 2017

Handling Conflict in Your Life


Let’s face it.  Conflict is going to happen in your life – possibly even daily.  It will occur at work, home, and in the community.  How you handle it will have a large impact on the quality of your life.

Some people thrive on conflict.  If it doesn’t exist, they will create it simply for the thrill of the drama.  They tend to be very loud and use explosive, if not obscene, language to draw attention to themselves.  They believe that the loudest person will win the argument.  And, as we become embarrassed by their display, they ramp up the volume.

Others find conflict so distasteful that they give in automatically to the person they are having a disagreement with.  They are even willing to give up their rights if they can avoid those ugly scenes.

An effective way to respond to conflict is to manage it. Here are a few steps to take to handle conflict without losing your cool or your rights:

  1. The first step is to speak with the person(s) you have a conflict with and state the truth:  “We don’t agree on this.”  Simply make clear what the issue is without assigning any blame.
  2. Make a statement about what you hope a conversation would lead to:  “I would like to talk about this with you and see if we can come up with a solution.  We work together every day and it would be nice if we could get along.”
  3. Now, the most difficult step.  Be quiet.  Listen without interrupting them.  And listen in order to get a complete understanding of where they are coming from.  Allow yourself to be influenced by what they say.  Do not listen just to debate.
  4. Next, prove to them that you listened with the honest intention of understanding.  Summarize what they have said back to them.  “So, you feel that I was putting you down when I said that.”  Or,  “You don’t like it when I do that because then you have to pick up the slack.”
  5. Now that you have invested the energy to understand their viewpoint, agree with whatever you can.  “Oh, I didn’t realize that you had to be the one who finished that up.  Now I see why you are frustrated with me.”
  6. And, now, the most important step.  Let what they said sit with you for a bit.  Does what you now understand change your opinion in anyway?   Those who take the time to give serious consideration to what the other person said are those most likely to come up with a solution or compromise.
  7. It is now your time to respond with your feelings and opinions.  Don’t use this time to jab back at some of the comments they may have made that you found offensive. Stick with the issue – even if they haven’t.   Talk about the problem – not them.
  8. Keep calm.  If they are fired up and you add fuel to that fire with your anger, it will only make things worse.  Nothing will get resolved.
  9. Regardless of the outcome, I suggest you end by shaking hands or at least making a statement of appreciation for their willingness to have an honest discussion with you.
  10. And, again, regardless of the outcome, do not ignore this person later or talk about them behind their back.  Treat them with the respect and courtesy you would like to receive from them.

Fix the problem, not the blame.

Karen Wrolson, MS, MEd

Stein Counseling and Consulting Services, Ltd.

Build Up Your Love Account

February 24, 2017

Build Up Your Love Account


Ahhh, February  – the month of love.  A good time to give attention to our relationships.

Like most things in life, relationships change.  As time goes by, they either grow healthier or become weaker.  Relationships need to be nurtured and attended to if they are to flourish.  Reflect back on when your relationship began and think about the attention and love that you gave so automatically.   Sadly, as time has gone by, many of us have changed the way we treat our partners.

Here are three easy steps to make some immediate improvement.  We are going to borrow the idea of the “Emotional Bank Account” from Dr. Steven Covey, world-renowned author and lecturer.

Consider a traditional bank account.  We make deposits and we make withdrawals.  Our deposits are made in the currency the bank accepts.  In America, for example, we typically make our deposits in US currency and not in Chinese Yuans or Russian Rubles.  Hopefully we make larger deposits and much smaller, and infrequent, withdrawals.  If our account has a low balance and we make a large withdrawal,  our account might get closed.

Now let’s think about Dr. Covey’s Emotional Bank Account.  Some couples have such a large emotional bank account that you can actually see it.  They hold hands wherever they go, their faces light up when the other approaches, and they always seem happy when together.  Here are a few simple steps you can take to work towards that kind of a relationship.

Step 1.  Determine the currency you need for your particular account

Use the knowledge you have of your partner to determine the currency you will use.  Think about what he/she values.  For example, if your husband enjoys car shows, go with him and listen to him as he tells you about the cars on display.   Does your wife feel overwhelmed at times?  Imagine her delight if she got in her car Monday morning and found out you had filled her gas tank.  On the other hand, using the wrong currency will not add to the balance and could even take away from it.  I remember one man who gave his wife a space heater for Christmas because she always said she was cold.  While this certainly was a practical gift, it wasn’t anything she wanted and, hence, was the wrong currency.  What a missed opportunity!

Step 2.  Begin making regular deposits to build up the balance

Couples with that special connection are those who take time daily to let their partner know they are loved.  It could be a gentle touch on the shoulder, shutting off the phone when they want to talk, or even a simple thank you to recognize the things you may have been taking for granted.  Note: the cost of this type of an investment is simply your time.  Such an easy and yet powerful way to demonstrate your love.  

Step 3.  Reduce your withdrawals

Withdrawals are times in which we hurt or disappoint our partners.  For example, forgetting an anniversary could be a withdrawal. Getting home too late to attend the children’s concert would be another withdrawal.   Naturally, withdrawals are going to happen from time to time.  However, they have much less of an impact if your balance is high because of your consistent deposits.  It is important to note that some withdrawals could bankrupt an account regardless of it’s balance.  For example, having an affair is an extremely large withdrawal that ends many relationships.  Account closed.

Let’s review.  Here are the steps you can take NOW to improve your relationship.

  1. Determine the currency you will use.  
  2. Begin making daily deposits.
  3. Cut back on your withdrawals.  

Love.  Something we all desire.  Something worth investing in.

Winter Blues or Depression?

February 24, 2017

Winter Blues or Depression?


Wisconsin is not the easiest place to live – especially in the winter.  Often stuck inside, people are missing the sunlight and fresh air they benefit from in other seasons.  Many socialize less, avoid outside activity, and may even put on a few extra pounds from those “comfort foods”.  Sleep can also be affected from these unhealthy habits.  All of this can lead to what is known as the “winter blues”.


The clinical name for the “winter blues” is Seasonal Affective Disorder, or SAD.  The most significant characteristic of SAD is that it is cyclical.  Most in this northern area begin to feel SAD in the fall, find that it worsens in the winter, and that it begins to recede in the spring.  There are many simple ways to work through SAD.  Get as much sunlight as you can, exercise every day, and keep yourself on a regular sleep schedule despite your desire to sleep more.  Another option is to purchase brighter light bulbs to simulate sunshine.


Why is it important to figure out if you have depression?  Simply put, it is to improve your quality of life.  If you are depressed, you are feeling weighed down and will continue to be sad until that depression is gone.  Spring and/or more light will not lift your depression.  And remember, depression doesn’t only affect you.  It impacts those you love, work, and socialize with.  Also important to know is that depressed people sometimes don’t think clearly and may make permanent decisions to try to escape the sadness: divorce, quitting their job, moving, etc.  Unfortunately, none of those major changes will take away the depression.

There are two main categories of depression: situational and clinical.  When something tragic happens, like the death of a loved one or receiving a diagnosis of a disease, we can develop situational depression.  This type of sadness will gradually diminish when we become adjusted to the new reality.  Clinical depression, however, is a more persistent feeling of sadness which can lead to physical and behavioral problems that last for years such as those as listed below:


  • Difficulty in making decisions
  • Hard to concentrate
  • Avoiding things that used to give you pleasure (including sex)
  • Spending less time with friends and family
  • Significant weight loss or gain
  • Changes in sleep pattern
  • Frequently feeling sad or irritable
  • Having pessimistic or hopeless thoughts
  • Suffering from aches and pains that won’t go away
  • Wondering if others would be better off without you – considering suicide


Should you seek help for your depression?  Yes, if it is negatively affecting your life.  Otherwise your depression can deepen and go on for years.  It could even become a threat to your life as one in 10 people with depression commit suicide.


Check with your doctor first to find out if what you are feeling is related to a medical condition.  If it is not, seek out a mental health professional.  You may find that counseling will make a great improvement in your life and the lives of those you love.  In addition, develop habits that will improve your mental outlook: physical activity, healthy eating, adequate sleep, socializing, and eliminating those things that cause you unnecessary stress.


Take care of yourself.  You are worth it.

Karen Wrolson MS, MEd

What Kind of Parent Are You?

February 24, 2017



         I’m sure you’ve heard this before: “Some people shouldn’t be allowed to have kids. There should be a class you have to take first. I mean, after all, you even have to take classes to get a driver’s license!”

Where do we learn how to parent? And what are the different types of parenting?

Learning to Parent

            There are four main ways we learn how to parent.

  1. Our own parents. Some of us had great parents. We knew they loved us but we also knew what the rules were. Others were less fortunate. Their parents may have been too permissive, unloving or even abusive. Most people tend to become the kind of parents they had unless they work diligently to do otherwise.
  2. Watching others. Grandparents, neighbors, parents of our young friends, and even teachers provided examples of ways to guide and instruct others. Again, some good and others not so good.
  3. Asking for expert advice. There are countless parenting videos and books, as well as counselors and parent educators that can answer our questions.
  4. On-the-job training. As the years go by, we hopefully will learn from our mistakes.


What is Your Style of Parenting?

There are four main types of parents.

  1. Permissive Parents: These parents want to be close to their children – even to the extent of being their friends. Their desire for this results in homes with few rules and parents who give in to their children to make them happy. Since they are not used to following rules, these young people rebel against anyone who tries to tell them what to do – teachers, police, and employers. If they get in trouble, their parents rush to the rescue. Sadly, this often results in adults with life-long habits of breaking rules and disrespecting people of authority.
  2. Uninvolved Parents: Like permissive parents, these parents have few to no rules. The difference is that they show little warmth and love towards their children. It could be because the parents are stressed out by financial, health or other problems. It could also be because they simply became exhausted with their children’s disobedience and eventually gave up trying to be in charge. Again, we have children who have too much freedom and become the victims of their own immaturity and impulsivity.
  3. Authoritarian Parents: Authoritarian parents run their homes with strict rules and show little affection for their children.   They want obedience more than closeness. Some of the children in these homes become very rebellious and show it through the way they dress, act and speak.. Others may never try to become independent and end up relying on mom and dad for the rest of their lives.
  4. Authoritative Parents: Parents who are authoritative show affection to their children while still providing clear boundaries. They explain their decisions and invite feedback. Children learn responsibility through household chores and eventually privileges increase to match their maturity level. Meals together and fun times are frequent. These children feel valued, safe and loved. They have no problem following the rules at school and work and, therefore, find it easier to become successful as adults.

Is it Too Late to Change?

There is always time to improve your parenting.   Check out local parenting classes, read books or work with a parenting expert. I guarantee you – this will be time well spent!


Karen Wrolson, MS, MEd

Stein Counseling and Consulting Services, Ltd.

The Power of Equality In Marriage

December 30, 2013

By Diane Walker, December 30, 2013

In my practice as a psychotherapist, I have talked with couples about the importance of “maintaining a level playing field” within their relationship. I define this as an equal balance of power, each partner allowing the other to be true to their personality.  Couples often come to therapy with a marked imbalance of power, one partner has become discouraged with “always being the one who gives in to the wishes of the other”.  Marriages require a constant give and take, “I will, then you will” type of respect.  Couples often talk about not feeling “respected or noticed” in their relationships. Generally, this means they are not feeling validated; they cannot be true to their identity, their true personality.


Think of your relationship with your best friend (who is not your partner); is this different from your relationship with your partner? Typically, we can be completely forthright and honest with our best friends.  We can get angry, frustrated with each other, or not agree with the choices our friend makes but we still maintain our close relationship. Best friendships are egalitarian, characterized by equal dignity, they evolve over time, as we enter new phases in our own lives.  As with making friends, dating is often filled with hope, expectation, disappointment, and happiness. As the relationship evolves into a commitment, our own expectations and hopes evolve.  In a mutually respectful relationship, we allow each other the freedom to grow together, to say what we want to say, to act as we choose.


I often tell clients they have the freedom to be who they are without judgement in my office and hopefully in the outside world.  We all need to make rules that are of our own choosing to accomplish goals and meet with success.  Within marriage, partners must  be able to listen to each other and be heard, even if one is in disagreement. One must accept influence from the other, as much as you may be influential. We have to be able to talk straight and ask for what we want/need even though there are risks involved, such as disappointing your partner. Talking about the disappointment with honest communication creates this type of equality.


The relationship consists of two separate individuals who have had different life experiences. Often, the couple’s expectations are that we handle conflict, money, chores, child rearing, in the same way. Two people who allow for their differences can create fairness and lower the likelihood of establishing controlling expectations. Traditionally, women have maintained the household and raised the children while the men supported the family financially, often due to social norms. Gender roles have dramatically changed in the past several decades allowing for an increase in equality of domestic and financial duties.  More importantly to the relationship though, is the feeling that our identities and worth are affirmed and valued. This allows for each other’s vulnerabilities, which is a difficult but necessary component for a successful, long term relationship while allowing us to be completely true to our own personhood.


Personal happiness is a quality that can only be achieved through individual work. Your relationship enhances this quality if it is already present although we cannot make each other happy.  Elements of equality include validation, respect, allowing for differences, accommodation, influence, paying attention to, being fair, making repairs when necessary, and fostering well being. These qualities create a level playing field within a relationship which often leads to personal satisfaction and positive growth. This in turn leads to intimacy and connection; which together create all the necessary components to a relationship that lasts through life’s milestones.


Counseling can help establish this platform of equality within the relationship.

This blog was inspired by an article I read in Psychology Today, February, 2014.

To schedule an appointment with me, please call 608-785-7000 x221 or click here.




Choosing the Right Therapist

October 21, 2013

By Jerry Nelson October 20. 2013

What is Psychological Health?

I have spent the last seven years working with our military Service Members and their families as they contended with the cycle of being deployed, coming back and being deployed again. As you can imagine, their service to our country impacted every area of their life. This was especially difficult for our National Guard and Army Reservists who came back home to their community without the same resources available to active duty personnel.  Working closely with these individuals, reinforced for me that our daily life consists of four main areas, as illustrated below, and that there is a lot of overlap. Psychological health takes a holistic approach to wellness – recognizing we are an integration of mind, body, and spirit. Difficulties in any one or more of these areas can have a major impact on other areas. Psychological health is achieved with balance in these four areas.

4 spheres

When Should a Person Seek Assistance?

I also used to work as a surgical nurse and often assisted with cancer surgery.  Most cancers start as a small group of cells that can grow to produce a noticeable lump.  If caught early enough, the cancer can be stopped in its tracks. In our daily life we can have early warning signs, lumps if you will, starting in any of the four areas illustrated above. These can spread into other areas and infect how you view yourself and/or others. For instance, there may be a situation in the social aspect of your life where a relationship has gone bad, such a divorce, unforgiveness, hurt by a friend, etc. Soon you notice you don’t want to associate with others, your appetite has gone away, sleep is impossible, you’re grumpy and irritable and it seems life is spiraling downward. It doesn’t take long for all four areas of your daily life to be affected.  It may be time to do something about these signs and look for a change.

Need a Change?

Need a change

Often the longer we wait to do something about the warning signs, the more entrenched the problem becomes in all aspects of life. Perhaps there is a lot of uncertainty in your life and you feel like you’re in a giant maze.  My experience with military Service Members and their families, as well as private practice, revealed that often changing one area of life, (such as emotions, behaviors, relationships, or even a direction in life) can help bring back the psychological health that was once enjoyed.

How CAN a Counselor Help?

Counselor Help 1 Counselor Help 2

You can think of a counselor as someone who comes along side of you and helps you sort out the changes you want to make. Often this involves giving you a new perspective on an issue, or developing new skills to approach old problems in a new way. Maybe you need someone to be more directive and point out things you just can’t see. In the illustration above, can you see the young woman/saxophonist, or the young woman/old woman? Some people can see the images right away, but others need more direction to make the distinction.

Wrong Results?


I often hear “I tried counseling and it just didn’t work,” especially from men.  Perhaps the problem was you weren’t getting the results you were looking for after just one session. No matter who the counselor is, try to give it at least 2 to 3 sessions before you leave counseling with that individual. However, research shows that the best predictor of a positive outcome is being connected to your counselor. One way to avoid future conflicts is to interview several counselors before starting counseling sessions. I recommend you briefly describe your problem and ask the counselor how much experience they have with that problem. Ask them what their approach to your problem would be. Also ask them how they know when someone is done with counseling. You are listening for two things: the first is the actual answers the counselor gives you; and the second is how they answer you. Do you like what you hear and do you think you can connect with the therapist? You have a right to be proactive in your counseling.

The Bottom Line!

 Bottom Line Military

The military has a credo of leaving no one behind. Finding the right counselor to come alongside you as you work through some things in your life goes a long way toward having, and maintaining, psychological health.

Contact Jerry right now at 608-785-7000 x221 to schedule an appointment or click here to make an appointment request. 

Eating Healthy, Exercise, and Wellness

July 29, 2013

Wellness blog:    7/22/13 by Diane Walker

This past week, I attended the National Health and Wellness conference in Stevens Point, WI.  I have been out of the health and wellness world for quite some time; it felt very good to be back. There are tons of exciting and wonderful things happening in the world of health and wellness, including the creation and support of new jobs. There were physicians, nurses, therapists (mental, physical and massage), wellness coaches, retired people, college students, teachers, etc.. in attendance. The first keynote speaker was Larry Cohen, the guru of the smoke free movement. He is currently working on a project to bring refrigeration to poverty stricken areas. He believes, and research shows that if fresh fruit and vegetables are prominently displayed and accessible, more people will choose to eat them on a regular basis. I attended seminars in plant based eating, blogging for wellness, motivational interviewing, nutrition, Pilates, and yoga. I also completed a 5k run (without stopping) for the first time in a few decades!!


I have dabbled in the health and wellness world most of my life. I have coached numerous teams for both boys and girls, I was an aerobics instructor back when “step” aerobics was the thing to do, and have been a certified personal trainer. Since becoming a full-time outpatient therapist, I noticed that I have let some of the things I “used to know, go away”. After this conference, I am once again motivated to become involved in the wellness world. How many times has someone (or yourself) talked about needing to lose weight, or getting fit, or been told to make changes in your habits by a doctor or loved one? We all cope with health and wellness in our own ways and most of resent being “told what to do”. Our brains reject “being told”, or at least mine does. Weight and fitness are very personal issues; becoming healthy is an individual quest and can often be successful only after personal reflection. Reasons to make changes may include; I want to look/feel better, my clothes don’t fit anymore, my doctor says I am unhealthy, my spouse tells me I have gained, etc.. If we are able to decide on a health plan, course of eating and exercise, that we WANT and REALLY LIKE, we are significantly more invested in succeeding. Again, this is an individual choice.  The fitness “gurus” and “weight professionals” have tons and tons of answers for us, just look at the best selling books in the book store. There are entire sections devoted to weight loss and how to become fitter. How do we sort through all this information?  Where do we start?


First, find some time to sit and reflect about why you want to make changes in your lifestyle. This can be done in a few minutes, or over several quiet sessions. Sometimes, writing down ideas and thoughts can be helpful, this allows us to rule out things that might not work or we don’t really like. Support during this process is important, but choose carefully. Make sure your support system is truly that, supportive.  Once you have determined your reasons for making changes, recognize that change is very difficult and takes time. All the sessions I attended this past week emphasized that our brains go backwards in times of stress; we revert back into old patterns often without realizing it. Be true to yourself and begin slowly. Set goals that are reachable and can be relatively quick; this provides encouragement to keep on track.


Watch our website for tips as a health and wellness section will be added and updated regularly. Also, feel free to call and set up an appointment with Diane as you begin to make changes. Our bodies don’t really like change; it may become difficult to maintain and continue on our chosen path. Research shows that positive physical health has a direct and influential link towards positive mental health, to become “happy”.


Click here to schedule an appointment with Diane and begin living well again!

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