Empowering Teens and Families Justine Carino’s Therapy Approach Ep.78
Episode Overview
About Guest: Justine Carino
Justine Carino is a licensed mental health counselor and the founder of Carino Mental Health Counseling Services. With over a decade of experience, she specializes in helping teenagers, young adults, and families navigate issues such as anxiety, depression, and relationship challenges. Justine began her career working in an inpatient psychiatric hospital, treating children who had experienced severe trauma. This early experience fostered her interest in understanding the emotional and social needs of children and adolescents, particularly those facing difficult family dynamics. Her compassionate approach is built on the belief that treating individuals within the context of their family system is crucial for long-term healing and emotional well-being.
In her private practice, Justine combines cognitive behavioral therapy (CBT) with family systems theory, a method she developed through extensive training at the Ackerman Institute and the Family Institute of Westchester. Her work often involves using genograms to trace generational patterns of behavior and mental health within families, helping clients understand how their family history influences their current struggles. Justine’s holistic approach is tailored to meet the specific needs of her clients, often involving parents and other family members in the therapeutic process to create lasting change. Beyond her clinical work, Justine is the host of the popular mental health podcast Thoughts from the Couch, where she shares insights on topics such as managing anxiety, understanding family dynamics, and building healthy relationships. Her commitment to ongoing education and professional growth is evident through her continuous training, including specialized studies in cognitive behavioral therapy at the Beck Institute. Justine’s dedication to her clients and her field has earned her recognition as a trusted mental health expert, especially for those seeking family-centered therapy that addresses both individual and systemic issues.
Episode Transcript
Becky Coplen: So thrilled on mastering counseling today to have Justine Carino with us. She is a very experienced clinician, helping a lot of young people with all sorts of issues: anxiety, depression, relationship issues, many other things as well. Welcome to the show, Justine.
Justine Carino : Hi. Thank you so much for having me.
Becky Coplen: We are excited to learn from you today. And , she is the owner of Carino Mental Health Counseling Services and is a licensed mental health counselor. And why don’t you? Justine, we’re really excited today because we have an added guest as well. I will let you introduce her.
Justine Carino : Yes. Next to me is Sabrina. She’s going into her senior year of high school, and she is interning with me for the smer.
Juatine Carino : And learning a lot about the field of psychology.
Becky Coplen: All right. Welcome, Sabrina. Something your school sets up that you guys set up. Can I just ask about that for a minute?
Sabrina: Now I want to actually do something my school set up. I took a psychology course online this past year, and I decided that over the summer, I would be really cool to sort of reach out to different psychologists and see if any of them would possibly let me shadow them or intern with them. So I’m very lucky that Justine has replied. And now I get to shadow her.
Becky Coplen: my gosh, that’s amazing. I love the motivation and how you kind of took that upon yourself to do that, so that’s awesome.
Justine Carino : Yeah, when I saw her email and I, I get a lot of requests for internships, mostly college students. And, you know, it’s hard to like having an intern that can’t actually practice yet. Right? Then hands on with the clients and the patients. But I was like, you know what? I want to be able to make this work and figure out if there’s some way Sabrina can get some exposure to the field. So we’ve been figuring it out this past week.
Becky Coplen: Well, thank you for bringing that today. It’s a new thing for this podcast to have an intern on, so I’m thrilled about it. All right. Well, let’s talk, Justine, about your practice and maybe how you ended up working with a lot of teenagers and young adults in your passion for that.
Justine Carino : Definitely. So in my career, I actually my first job out of grad school was at an inpatient psychiatric hospital on a children’s unit, and it was intense. It was a lot of traa based work. These kids were little. They were between the ages of five and 12. They were in the foster care system, come from homes with a lot of trauma. So the hospital was a place to try and really stabilize. There was also a time of transition where one foster home may not be the best fit, and they spent a lot of time in the hospital until they found a new placement. That’s where I started to get more curious about what do children need in order to thrive socially and emotionally? And so much was rooted in what goes on at home and the stability of a home. So I was there for about two years and then moved into a new position at a family counseling agency, and it was very unique. I was hired from an outside agency but placed into a middle school, so my office in middle school, I worked side by side with the school psychologist and the school counselors. I ran lunch groups. I did 1 to 1 counseling. I also did a lot of parent support groups for parents of children with special needs.
Justine Carino : And then I also saw people after school at the headquarters, the home base, and started doing a lot of work with teenagers and their families because I quickly learned, if we want to make change for a teenager or a child, we have to work with the family. We have to work with the parents. We have to understand those dynamics. Because a child and a teenager is in the context of their family system, and a teenager can only do so much work outside of the home. And if they’re going back into a home, that’s not changing with them, it’s kind of counterproductive. So that being said, I was like, I definitely need more training in this area. So I started doing training at the Ackerman Institute in Manhattan that focuses on family therapy and family systems. So I did about two years there and just fell in love with it. And the past three years, I swear I’ll never be done training. The past three years I’ve been training at the Family Institute of Westchester in Bowenian Family Systems theory. And so it’s interesting. I started with teenagers and those teenagers grow up and become college students. I really started getting a lot more calls for working with college students and young adults, and I just absolutely love that age group. Mhm.
Becky Coplen: I love that you kind of grew with them in that they wanted to come back to you because. Right. It’s so much based on relationship. And if it’s already established and you can help them in their new phase of life, that’s great. So , really cool story and I love that you were part of a practice, but they had you in the middle school. , and yeah. So you kind of have a taste of my world of being in schools and all that’s happening there. And let’s talk about. So I love the approach that if you’re helping teenagers very much, the context of their home is a part of it. , how would you say in your practice now you’re working with that age group? Are you spending time in the home as well? Do the parents come for separate sessions? How does that look in this whole family context?
Justine Carino : Yeah, such a good question.
Justine Carino: I think a lot depends on the age, but for the most part, and this may be differ different than other modalities, I need to meet the parents. Even if this is a college student who is 20 years old. Right. And they pretty much live independently nine months out of the year, they are still in the process of differentiating from their home life. So actually in my intake process, if it’s a teenager, I’m having a parent session. If it’s a young adult who’s still in college, I’m still letting them know. Part of my intake process is a parent session. And you know what? No one’s ever fought me on that. The parents love it. And the college students, the teenagers love that as well, because I get to ask a lot of questions. A for my intake process about developmental history, family relationships. I do something called a genogram, which is basically like a family tree of three generations. And first I have the client tell me their version of it, and then the parents come in and I learn so much more information about their childhood, what their parents were like. We see generational patterns. So I’m always pulling in parents, either for a separate parent session or they come in for a family session. I really tackle what the presenting issue is within the context of the family. And sometimes my treatment plan involves consistent parent sessions. I have a teenager right now who I see once a week and then once a month. Her parents are coming in for the parent session. I have another family where I’m treating the whole family, where it’s the young adult and their parents every single week, and we might bring a sibling in from time to time to really depends on the presenting issue. But I like to involve the family as frequently as possible because we get so much information about the presenting issue that way.
Becky Coplen: That is amazing and I love that. Did you say you use a genogram? Is that what it’s called? yes. Very cool and exciting. And right, so much comes from the history of families, and all families have their issues and trying to break some of those generational gifts, if you will, that are passed down that need to be worked. Breaking those chains a little bit is great. So very cool approach. Let’s talk then that you definitely emphasize quality over quantity. So in thinking of your specific practice and in light of you working, having those extra sessions with other parts of the family, how like how did you kind of map that out? What was there a time you took more clients and you pulled it back? How did that look for you?
Justine Carino: Yeah, absolutely. So there I feel like everyone has their threshold of the amount of people they can see each week where they’re still doing their best work, right. They can be present. They can be focused. They can manage the nodes. They manage the collateral calls. You know, I do a lot of calls with psychiatrists. I school counselors, school psychologists, parents. So there’s a lot of work outside of the session, too. I would say when I first started private practice, I went full throttle and saw about 24 clients per week. And so that was about six times a day, four days a week. , and it was also important for me to try and be present at home. When I started my practice, I had a ten month old son, so I really liked having Fridays off just to deal with. And I kept that every year. And when my daughter was born to till this day. So for the most part, take Fridays off. But then as you have more kids and your mom, you can’t really be at the office every evening, and there’s a lot of teenagers that are only available in the evening.
Justine Carino : And actually. So once I started taking more college students, I shifted that a little bit. And I have more balance between daytime sessions and one evening a week now. But I would say there was a point where I pulled back to 20 sessions a week, because I feel like I felt like 24 was a little too much to manage. But where I am now, I’m. Summer time is usually slow, but I’ve been having about 23 to 24 sessions per week over this summer, and I think that’s because I have a lot more adults right now than I do teachers. So I think it really depends on like, who am I seeing and how much time is spent on each client, because when it’s an adult who might be 30 or 40, I’m not doing a lot of family work with them, so it’s just the individual one on one. But if I take on a teenager, I know I’m gonna have more sessions because I want to involve the family. So I would say it ranges between 20 to 24 sessions a week. Mhm.
Becky Coplen: Yeah, it’s so much there and I love the details. You were able to bring in even times of year, summer. It is like a time to pull back. But I know even in my own family I feel like it’s a better time for anyone to receive therapy or help because there’s a few less of the other things. However you do travel, you know? But yeah, thanks for bringing the mom’s side of it as well. And times of day and how that works with kids. And we’ve talked on here before about, you know, a little bit of a shift of everything doesn’t have to happen after school. You know, people go to the orthodontist in the morning, they go to the doctor. And if you have a session and you need to miss, I know at our school if someone needs that help and they leave at 2:00, we applaud it because it’s a higher importance of, you know school obviously super important, but if you’re not in the right shape, you got to take that time. So yeah, things are bringing that out. , let’s talk a little bit about some of the techniques. And you have been getting a lot of training, and I think we’re all learning until we retire. Maybe not then either. Let’s talk about I know you’ve done some work with Gottman and you’ve done a lot of this. You mentioned the Ackerman Institute. Let’s talk about how some of those strategies are working for you with your clients.
Justine Carino : Definitely. So I loved I did level one and level two of Gottman for couples therapy because like you get a manual and it’s huge. And they have laid out step by step interventions to do with the couple. So you have that to bank on and go back to make photocopies. You hand it to the couple. So I really loved how Manualized Gottman became and the training. They have so many videotapes of observing couples and couples sessions with the Ackerman Institute and Family Institute of Westchester. It’s a lot of theory behind family dynamics, so we learn about fusion and enmeshment in families, we learn about differentiation, we learn about triangles. You know, a lot of triangles exist in a family as a buffer. You know, there’s always a triangle, usually between mom, dad and child or sibling to sibling and parent. And we learn about the functioning of those triangles and try and remove it from being a triangle and get people to talk directly to each other and communicate directly with each other. , with family systems theory, we really learn that our family of origin is our template for how we process emotions, how we communicate, how we set boundaries, how we form belief systems. I combine that, though, with a lot of cognitive behavioral therapy.
Justine Carino : So I did training at the Beck Institute in Pennsylvania on cognitive behavioral therapy. And I love combining cognitive behavioral therapy with family systems because in cognitive behavioral therapy, you’re unpacking someone’s automatic thoughts and their life experiences and their beliefs. And we often trace it back to childhood. Right? They form this belief about the world because of a childhood experience, a relationship with a parent. So I really it’s my favorite thing when I can do the Genogram really understand so much about this person’s family. But now I’m also doing the CBT to unpack subconscious core beliefs that they have and challenge the two and have them connect the dots for each other. And so even with anxiety, I treat a lot of anxiety disorders. I’m heavy on the CBT because we’re learning that’s the most effective treatment and doing a lot of exposure therapy. But I’m also doing the genogram and finding out where did the anxiety live in this family system? Are there parents that have struggled with anxiety? Are there grandparents? How have they modeled managing the emotion of anxiety? Have people sought treatment? What do people believe about therapy in their culture? So it’s really fun to combine all of those together.
Becky Coplen: Yeah, I love that. I feel like I can just see your brain between sessions working at like, what is going to be the best puzzle to put together for this specific family and their makeup? And yeah, I think family dynamics are so interesting. You know, you just read any novel or book and it’s so much of a huge part of it. I wanted to ask on the Genogram when you or I might. Yeah. Genogram when you do that, is that like a whole session where you work through it with them, or is that like homework paperwork that they do and kind of they process it all and write it out and then you process it with them Or how does that look?
Justine Carino : Great question. So it is something that I draw out and draft in session, and it is in my lap for that client every single session. Now I have clients that I’ve worked with for two years. I can barely read what I put on the Genogram because I’m constantly adding more and more information. And it’s amazing when a session happens and someone’s like, well, yeah, that happened to my grandfather. And I’m like, Bing, bing, let me look at this Genogram let me learn about this. Grandfather. How did they deal with this issue and how did they model to this kid’s parents how to deal with this issue. So it’s always connecting the dots. So I do it in session. I keep it in a folder. They can look at it. They I show them what I’m drawing and they know like this is always on my lap. They expect to see it even now they’re used to it. Some will say write that on the genogram or you should put this on a genogram so they just know it’s part of my language when working with them.
Becky Coplen: Yeah, I think that’s so brilliant. I mean, because when we work with so many people and they mention and such and such and sister, so many names, I know at this point in my life I’m forgetting. But for you, I think it’s a comfort when either it’s a friend or your therapist and they literally know your extended family, even if they’ve never met. I think that makes things feel safe. And and you don’t have to. You probably save time too. So that was really cool. Can I ask, is that totally your own thing, or did you get that from somewhere else?
Justine Carino : No. Yeah. I was taught that through my training at the Aspen Institute and the Family Institute of Westchester really pulled from different family systems. Psychologists of the past, specifically Boeing, really utilize the Genogram. And it’s just something that within my network here, the other therapists I work with do it too, because I’ve trained just, you know, it’s literally I can’t imagine doing my work anymore without it, because there’s so much useful information. For example, I’ve had a client come in and he’s been having panic attacks and is afraid of like just dying all of a sudden. And through the work of the Genogram, he has great reason. I learned that there has been so many unexpected deaths in his family system, or with childhood friends growing up, like we pulled from all over the genogram such tragedy in his life. So I’m like, wow, there’s a core belief here that he’s internalized over the years that, like, people literally do pass away unexpectedly. That’s what he’s been exposed to. And I don’t think if I did the genogram, I would have ever learned that information about him.
Becky Coplen: Yeah. Very fascinating. Yeah. It’s sometimes you hear people’s fears and anxieties and if you could never relate, you’re like, wow. , but then to see all that data, which sounds like a bad way to put it, it really helps you understand them more. So let’s shift a little in. You talked about teaching this to the other people in your network, in your practice. I know you have other clinicians. Let’s talk about the structure of that. Are people, , helping more specific types of issues? How does your practice service, your the people who come to you? Definitely.
Justine Carino: So I have one other clinician right now and I also have an office manager. So my office manager is amazing. She actually lives in Texas, so she’s a virtual office manager. Wow. And she helps with all my email inquiries, my phone calls. We have a phone system where she has her own phone line. She has her own email associated with my practice. , she will help with some paperwork like consent forms. I’m always needing consent forms signed so I can talk to doctors or psychiatrists or guidance counselors. She helps clients get those consent forms. She also helps them with my social media and my podcast. So she’s so important. I don’t think I’d be able to do the things I do without her. Yeah. , and then I have Anne Marie, who is another clinician, and she works part time, so she’s a 1099 employee, and she probably sees about 5 or 6 clients a week. , and she’s all virtual and specialty really is cognitive behavioral therapy specifically for anxiety. And she actually has worked mostly with young moms. So between the ages of 20 to 40 is really the age group that comes to her. , and talking about the anxiety of, , like generalized anxiety disorder, OCD, but there’s also a lot that comes up in her sessions around being a working mom with little kids and trying to run a household, and how to manage all of that. So that’s her specialty. She really is an independent contractor. She’s very independent. She makes her own hours. She makes her own sessions. Yeah. We meet once a month for case consultation to discuss cases and brainstorm different interventions to use. That’s where she’s at. I’m actually in the process of moving to a new location. I rented a new office suite with another office, and I’m going to hire a clinician specifically to work with teenagers this fall, so I’m really excited about that.
Becky Coplen: That’s amazing. Sounds like things are growing. And I really what I really love about this podcast so far is all the details you’re giving us. , you know, in all the little things that end up being big with, uh, someone in Texas managing so much. So, , I have to ask, have you actually met this person in person, or is it all all online?
Justine Carino : All online? We’ve only met via zoom. , I actually found her on Instagram. She was advertising herself as a virtual assistant. And I had heard people talking about this, and she’s been with me now probably two years. And we have like such an easy flow. Like we text, we email, we have something called Voter, which is kind of like a walkie talkie while we’ll voice note each other. , but it’s it’s pretty awesome.
Becky Coplen: Yeah, I love that. That’s great. All the amazing things of technology that, , people we can work with all over the place. So let’s go back a little bit historically to the beginning of your practice. And what would you say were maybe some of the pitfalls? You could see other people, if they’re just getting into the, , starting their own. What would be some things that you would maybe guard against?
Justine Carino : I think, you know, as a therapist coming out of grad school, you learn about mental health and mental health disorders and how to treat them. You are not taught how to run a business, right? So if you want to go into private practice, you’re a business owner. Now you have to figure out how do you get clients, right? All my previous jobs, they were handed to me because it was in a treatment facility or a setting or an agency. Private practice. You have to learn how to. How do I get an accountant? How do I form a plc? How do I get a website? How do I put myself out there so people know I exist? And that takes up a lot of work. So someone could be the best therapist out there, but not succeed in private practice because they haven’t learned the ways to run a business. And unfortunately, we’re not taught that. I would love if grad schools started a course or two on business management for people to learn. One of the biggest things that really helped me, I think, was, you know, in the beginning it was slow, like I had one client and I was paying for an office and I was like, okay, it starts with one eye and I slowly, I would come to my office every day and say, okay, I’m not seeing clients, but what can I do to get myself out there? So I started writing blog posts. I started a website, and the hours that I spent where I wanted to see clients were spent on building the business. And before you know it, it really grew.
Becky Coplen: I love that, and instead of being worried and I mean, I’m sure there were some moments of worry instead of being like, I’m here at the office with no clients, you just found a way to get yourself out there. And yes, you have your own podcast, which is called From the Something about the Couch I know.
Justine Carino : Talk from the couch.
Becky Coplen: Yes. And then the blog and. Yeah, it’s it’s just a fun way to network. And thank you for sharing some of the difficulties that you saw in the beginning. I would love to explore a little bit your take on, , the internships. You had mentioned that you’ve had college people reach out and what’s your process for knowing like if something will work out? Or do you take one intern for six months? How does that process look? Yeah.
Justine Carino: So I met Sabrina and looked over her rese and had her come in and we talked a little bit about what her expectations were because, you know, she can’t see clients. And I would hate for her to feel like she was coming and not learning anything. Right. So I have a project that she’s working on, and I try my best to do a little teaching with her in between sessions. , when I’m writing progress notes, having her sit on podcast episodes, you know, talking over lunch. But I haven’t yet hired someone who is a college intern who is in the field trying to work as a clinician. But I have colleagues that have and they really have enjoyed that experience. So I think eventually I will head in that direction because you you know, they are able to to see some clients under supervision. So I would imagine that I would connect with local institutions, colleges and grad programs that have mental health counselors in training and put my name out there and say, like, I’m taking some interns for this semester, and I’d probably start there and, , be realistic about, you know, I’m not going to throw them a ton of clients, but maybe we start slowly and I can supervise them weekly on how they can support these clients. Mhm.
Becky Coplen: Very cool. And we’ve had other people on here talk about the interns that they’ve been working with in training, end up joining their practice in the future. And things just flow so nicely when that works out. So yeah I hope that goes great. And you are able to take on more people. Let’s just talk for a little bit about you mentioned a lot of the training you are doing in very specific types of therapy. And help. And you gave us your story on how you felt called to work with people of certain ages. Any advice on that for other people who are getting that general degree but then want to specialize? What would you share with them?
Justine Carino : I would say do as many internships as possible to get exposed to the field, right. This is a big field. There are addiction specialists, right? There’s anxiety specialists. There’s people that just want to do testing. Right. There’s people that just want to work in schools. People that want to just work with couples. Expose yourself as much as you can so you understand what you enjoy working with. I actually went to grad school thinking that I wanted to be an addiction specialist, and I did an internship and I was like, no way, this is not for me. And I’m so glad I figured that out. And it slowly unfolded over time. I was always really attracted to treating anxiety disorders, so that’s why I wanted to get the CBT training. I think I really grew my skills and confidence by going to post-graduate institutes to train, because you leave graduate school very generalized and then you, you expose yourself in different work settings and get the experience, see what calls to you, and then pick an institution that can teach you more about how to be an expert on that topic. And that gives you the confidence and and the support. Right? I’ve been doing this for a long time now. I still am in monthly supervision with a 1 to 1 supervisor. If I want to run a case by her to get her opinion on something. Also in group supervision. So I’m always learning and trying to like really niche down what I am treating so I can do the best work that way.
Becky Coplen: Yeah, I know, that’s great advice and we’ve had many people on here who are teaching at institutes or have their own modes. One of the last episodes, they have a whole training thing as they do a lot of pre-marriage counseling, so they have a whole unit for people to use. So but they were still learning from other people, and people are just very complicated in their needs. And we’re always having to learn and grow to be able to support them in the best way we can. So I love that you are helping and training, but at the same time still learning from others as well. So let’s just share a little bit about maybe the future of your practice and your career and what you see in the next 5 to 10 years. What would be ideal? Obviously, it may not work out that way, but what are you seeing for the future?
Justine Carino : Yeah. So I’m really hoping to create this group practice that is healing families, helping families heal, helping families move forward. So I imagine that I have therapists that specialize in specific parts of the family. Someone that treats teenagers, someone that treats couples, someone that does family work, maybe someone that does as children. And it’s a comprehensive treatment team, right? One clinician may be working with the teenager, and another clinician in the practice might be seeing their parents, and that collaboration and communication can help them all move forward. Right. Obviously, they would give consent that they could speak to each other, but maybe there’s even joint sessions between the teenager and their therapist and the parents and their therapists, and can do so much work faster when we have that collaboration. Right. And right now I refer to colleagues and we get consent to collaborate with each other and how to move a family forward. But I have this vision of helping families heal and having it in house where people can communicate with each other and the work is done so much faster that way.
Becky Coplen: Yeah, that is really exciting and efficient as well. Right. And I’m imagining, you know, the different rooms of your space modeling what is needed. You know, even I, I’m maybe not as much the younger kids when I’m like, there’s the playroom, and then there’s this room, and I love that. That’s your dream. And I’m sure it will be helpful to many people for sure. And I don’t think we talked about that. You do some in person and some. Yeah, okay.
Justine Carino : I would say so. I’m licensed in New York and Connecticut so I can do virtual in both of those states. , but it’s like 50 over 50. The the client really. Some people love the virtual because it’s so convenient and they can log in between classes or between their work schedule. Other people prefer to come in person. So it’s really up to the client what they prefer.
Becky Coplen: Yeah. And just for you, do you if you see clients online, do you stay home and have an area there, or do you always do work at the office?
Justine Carino: So I’m home on Mondays. And that made me a helped me be able to get my son from the bus again on Mondays and Fridays. I enjoy that and then Tuesday, Wednesday, Thursdays I’m in person, so clients know and I’ll remind them if they book a session for Monday will have to be virtual, and if they want to come in person, it will have to be a Tuesday, Wednesday or Thursday.
Becky Coplen: Okay, great. I love I love the personal piece that you brought for us to see you doing what works for you. And, , and I think the clients probably adjust as well. I’m imagining some of the clients come in person on Wednesday, two weeks later, they need a Monday and they go online and it’s okay because we’re all so much more used to it. Definitely. So definitely. Yeah. Well, anything else that you feel like we didn’t get to talk about or you wanted to share? , for mastering counseling?
Justine Carino : Yeah. I think if someone’s thinking of becoming a counselor or going into private practice, there is, I always say, have the best job in the world. It doesn’t feel like work. I love what I do, and I feel like I’m constantly learning and growing, and I like the challenge of Working with difficult clients, but also figuring out the business side. It’s really exciting to see something grow and chase a dream and have it come to life. So I if you’re thinking about it, go for it. You can totally make it happen for yourself.
Becky Coplen: Thank you for those encouraging words. , well, we’ve learned a lot today, Justine, and I love your outlook on your practice, Sabrina. Thanks for being on here with us. It’s awesome to have an intern join. I hope you learned some little tidbit of knowledge that maybe you didn’t know. Thank you guys so much for your time today.
Justine Carino : Thank you for having us.
Becky Coplen: Thank you to our listeners. We’re so thankful you’re a part of this. Please leave us reviews or questions. Feel free to interact and we hope you join us again on future episodes. I’m signing off for today. Have a wonderful day.