The Missing Piece: Cracking Therapy's Toughest Cases

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Porn is one of those therapy topics where people walk in already braced for judgment, and therapists can feel it too. We sit down with licensed professional counselors Melinda Arnold (also a sex therapist) and Dylan Robertson to talk about how we actually handle pornography concerns in the room when we are not trying to moralize, sensationalize, or rush to a diagnosis. Our north star is neutrality plus curiosity: we want to understand the client’s lived experience before we decide what “problematic” even means. 

We dig into assessment that goes beyond counting frequency. We look at impact on functioning, money, secrecy, relational distress, and the shame loops that can make someone feel “addicted” even when the core issue is moral incongruence or fear of normal arousal. We also talk about progression and escalation, including why novelty can increase over time and why clinicians must take safety seriously without adding shame. 

From there, we widen the lens to couples therapy, betrayal dynamics, trauma histories, and the extra complexity of neurodivergence and dopamine-seeking patterns. We share what tends to help: values-based approaches like ACT, mindfulness to interrupt screen habit loops, group support that reduces secrecy, and the humility to refer out when the case needs specialized support such as CSAT-level work or medication evaluation for compulsivity and OCD-like symptoms. 

If you want a grounded, therapist-to-therapist style conversation that still speaks to real human pain and real-world relationships, hit play. Subscribe, share this with someone who works in mental health, and leave a review so more listeners can find the show.

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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Can a True Narcissist be Helped? 

We hear “narcissist” everywhere. But what does the word mean clinically, and can someone with narcissistic personality disorder make meaningful changes?

In this episode of The Missing Piece, Heleen Woest, MA, LPC, talks with Dr. Page Donnelly about narcissistic traits, overt and covert presentations, and the challenges of working with clients who may arrive in therapy after a conflict, crisis, or partner’s ultimatum.

Page has a Ph.D. in Counseling and a master’s degree in counseling psychology. Her background includes 12 years working with CEOs, founders, and organizational leaders across technology, manufacturing, and academia.

Together, we explore what treatment can offer, why shame and defensiveness can complicate the work, and how therapists can remain compassionate without excusing harmful behavior. We also talk about caretakers, the pressure to keep a relationship functioning, and the importance of recognizing your own needs and limits.

Psychotherapy can support change, but outcomes vary. Understanding a person’s struggles does not mean you have to accept mistreatment. You can care about someone and still need boundaries.

Page’s website and biography: https://www.drpagemccarleydonnelly.com/about

The Missing Piece podcast: https://www.lifesolutions.io/podcast

Life Solutions Counseling blog: https://www.lifesolutions.io/blog

Groups and workshops: https://www.lifesolutions.io/groups

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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THE ANSWER IS YES! Breathwork is a psychedelic-like experience without the DRUGS.

What does it mean to move from understanding an emotion in your head to noticing how it feels in your body? In this episode of The Missing Piece: Cracking Therapy’s Toughest Cases, host Heleen Woest, MA, LPC, speaks with Natasha Stewart, a trauma-informed Breathwork Facilitator and Licensed Psilocybin Facilitator, about conscious connected breathwork.

Natasha describes her guided approach to breathwork and the role of body awareness and emotional exploration. The conversation makes room for both possibility and caution: a breathing practice may feel meaningful, but an intense experience alone is not proof of a cure. Pacing, choice, safety, and appropriate support all matter.

Guest: Natasha Stewart | Breathwork Facilitator

In this episode:

• What conscious connected breathwork is and how it differs from ordinary breathing
• How a guided practice may invite attention to bodily sensations and emotions
• Why trauma-informed pacing, choice, and integration matter
• How to hold personal experiences alongside honest, evidence-aware expectations
• Why breathwork is not a substitute for individualized medical or mental health care

Connect and explore:

Podcast page: https://www.lifesolutions.io/podcast/

Natasha Stewart: https://www.natasha-stewart.com/

Natasha’s sessions: https://www.natasha-stewart.com/work-with-me

Life Solutions blog: https://www.lifesolutions.io/blog/

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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What happens when someone has tried multiple medications, years of therapy, and other evidence-based treatments, and is still struggling?
There is actually new hope for these treatment-resistant cases: KETAMINE Treatment/Therapy.

In this episode of The Missing Piece: Cracking Therapy’s Toughest Cases, host Heleen Woest speaks with David Kleiman, CRNA - founder and  provider at NW Ketamine Infusion.

David explains the medical side of intravenous (IV) ketamine therapy, including screening, individualized dosing, vital-sign monitoring, and the importance of setting realistic expectations. The conversation also distinguishes the infusion itself from psychotherapy:  A licensed medical provider manages the  IV medication and physical safety, while a licensed mental health provider does the preparation, therapeutic support, and integration. 

Guest: David Kleiman, CRNA | Founder and Provider at NW Ketamine Infusion

In this episode:

• Why some patients explore ketamine after other treatments have not provided relief
• What medical screening and an IV infusion process may involve
• Why ketamine is not appropriate for everyone and cannot guarantee a particular outcome
• How medical infusion care and psychotherapy can serve different, complementary roles. 

Connect with Us

NW Ketamine Infusion: https://nwketamineinfusion.com/

Ketamine-Assisted Psychotherapy: https://www.lifesolutions.io/ketamine-assisted-psychotherapy/

*This episode is educational and is not a substitute for individualized medical advice. 

*If you are in a mental health crisis in the United States please call or text 988  or call 911 for emergency services. 

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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DISCLAIMER: This episode discusses sexual trauma, pelvic pain, pain during sex, sexual dysfunction, and difficulty tolerating medical examinations. Please listen with care.

The effects of sexual trauma are not limited to thoughts, emotions, and memories. Trauma can also affect the nervous system, muscles, breathing patterns, and pelvic floor. For some survivors, that may look like pelvic pain, pain during sex, vaginismus, erectile dysfunction, bladder urgency, constipation, chronic tension, or an automatic pattern of clenching and bracing.

In this episode, Heleen Woest, MA, LPC, speaks with Kara Schuft, DPT, a pelvic health physical therapist and the Director of Clinical Success at Mendwell Pelvic Health in Portland, Oregon. Kara has more than eight years of physical therapy experience and advanced training in pelvic rehabilitation, chronic pain management, and orthopedic care. Her approach welcomes all bodies and genders and places consent, communication, pacing, and patient choice at the center of treatment.

Kara explains what pelvic floor physical therapy actually involves, how trauma and PTSD symptoms may contribute to pelvic floor overactivity, and why some clients continue to experience physical symptoms even after meaningful progress in talk therapy. Research involving more than 25,000 adult women found that at least 32 percent had a documented pelvic floor disorder. Other research has linked PTSD symptoms with increased pelvic floor activity and has found an association between childhood sexual abuse and pain during intercourse in midlife women.

The conversation also explores what a first appointment may look like for someone who is afraid of touch or cannot tolerate a gynecological examination, why internal examination should never be assumed, and how pelvic health professionals can collaborate with mental health clinicians. Kara discusses care across the lifespan, including pregnancy, postpartum recovery, perimenopause, menopause, endometriosis, PCOS, chronic pelvic pain, bladder and bowel symptoms, men’s pelvic health, and gender-affirming care.

A Cochrane review found that women with stress urinary incontinence who completed pelvic floor muscle training were eight times more likely to report a cure than women in inactive control groups. Pelvic health treatment is not one-size-fits-all, however. Some people need strengthening, while others need help relaxing an overactive pelvic floor, improving coordination, and teaching the nervous system that it no longer has to remain braced for danger.

This episode is for survivors, partners, mental health clinicians, medical providers, and anyone who has been told that pelvic pain or dysfunction is something they simply have to live with. Healing often takes a wraparound team, and pelvic health physical therapy may be a missing piece.

Connect with Kara Schuft, DPT: https://www.mendwellhealth.com/team/kara-schuft

Mendwell Pelvic Health: https://www.mendwellhealth.com/

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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In this episode, Heleen sits down with Certified Personal Trainer Josh Martin to talk about exercise, mobility, and their undeniable link to mental health. 

Heleen shares her own four-year journey of transforming her body, and together they explore why the body is so often the neglected piece in healing.

In this episode:

• Josh's personal story of losing over 100 pounds and what he learned about himself in the process
• Why so much of what we blame on "aging" is really just deconditioning, and how it is reversible
• Functional Range Conditioning (FRC): what it is and why it is different from just stretching
• How mobility issues show up in athletes and how addressing them early prevents injury
• The Body Keeps the Score: how trauma gets stored in the body and how movement helps discharge it
• Vicarious trauma in therapists, first responders, and healthcare workers, and how exercise helps regulate the nervous system
• Heleen's personal journey from not being able to do a single squat to transforming her health at 50+

This episode is for clinicians, clients, and anyone who has ever felt stuck in their body.

Research highlights:

• Physical activity shown to reduce depression and anxiety at levels comparable to therapy and medication (British Journal of Sports Medicine, 2023)
• Resistance training reduces depression and anxiety symptoms in older adults (Psychiatry Research, 2024)
• Regular exercise identified as a significant protective factor against vicarious trauma in mental health providers

Connect with Josh: 

Josh Martin, CPT | Martin Method Fitness
Website: https://martinmethodfitness.com/

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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Where Do I Take My Child or Loved One Who Needs More Care?

What if we tried all the meds and weekly treatments, and it's no longer enough?

In this episode, Heleen Woest sits down with Larisa Klein, MA, an Advanced Treatment Placement Specialist, to unpack one of the most terrifying moments a family can face: realizing their child or loved one needs more care than outpatient therapy can provide.

IOP. PHP. Residential. Detox.
The options feel overwhelming, and the stakes couldn’t be higher.

Larisa’s entire role is guiding families and clinicians through that wall. She has personally visited and vetted programs across the country. She isn’t guessing. She knows.

In this episode, we cover:

• What a Treatment Placement Specialist actually does — and why their help is free
• The difference between IOP, PHP, residential care, and detox
• How to know which level of care someone truly needs
• Why 41% of people with co‑occurring disorders receive no treatment
• How the Stages of Change model affects timing (and why pushing too hard backfires)
• What real trauma‑informed care looks like, beyond surface behavior
• When outpatient wrap‑around teams aren’t enough
  
  Connect with Larisa Klein, MA
  Advanced Treatment Placement Specialist
  [email protected]

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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Content Warning: This episode contains explicit discussions about sex, childhood sexual abuse, BDSM, and death. Listener discretion is advised.

Today we are talking about the FX mini-series Dying for Sex, based on the true story of Molly Kochan. After a terminal breast cancer diagnosis, Molly realizes she has never had an orgasm with a partner. She leaves her marriage and goes on a wild journey of sexual self-discovery before she dies. But this story is about so much more than sex—it is a profound look at childhood sexual abuse, dissociation, and what it takes to actually stay in your body and experience true intimacy.

Host Heleen Woest is joined by Certified Sex Therapist Melinda Arnold to unpack the clinical and psychological themes of the show. We explore why dissociation is such a massive barrier to connection, how gender roles keep us from honesty, and the surprising ways that BDSM and consensual power exchange can help survivors reclaim their bodies and their absolute right to say "no."

We also dive into the existential aspects of dying, the beauty of platonic love, and the crucial role of somatic work in healing. For those who don't have the stomach to watch the explicit series, we made this episode so you can learn from it without actually having to watch it.

Show Notes Links:• Melinda Arnold's Bio & Contact: https://www.waypointpdx.com/melindaarnold

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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Family estrangement is a silent epidemic leaving a trail of devastation in its wake. In this episode, Heleen Woest, LPC, sits down with fellow therapist and friend Felicia Wallberg, LPC, to unpack the rising tide of young adults cutting ties with their parents — and the profound grief it leaves on both sides.

Together, they explore the emotional dialect gap between generations, how modern trauma language and attachment theory are reshaping the way adult children interpret their childhoods, and why parents who genuinely tried their best are often the ones being cut off. They also tackle the social media trend of "you don't owe your parents anything," the paradox of staying bonded to abusive parents while estranging from imperfect ones, and what repair can actually look like when both sides are willing.

Whether you are a therapist holding space for clients on either side of this divide, a parent stuck in complicated grief, or an adult child exhausted from trying to be heard — this conversation offers compassion, nuance, and practical guidance.

This is Part 1 of a multi-part series. Stay tuned for future episodes featuring therapists from younger generations who share their perspectives on navigating best practices from both sides of the divide.

Resources & Links

Dr. Joshua Coleman — Rules of Estrangement (book recommendation)

Felicia Wallberg's bio: https://www.waypointpdx.com/feliciawallberg

Support Groups for Parents of estranged Adult Children (launching Fall 2026): https://www.waypointpdx.com/groups

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/

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Guest: Dillon Robertson, LPC:
Email: [email protected]
Bio: https://www.waypointpdx.com/dillon-robertson

In PART ONE, we get into video game and screen addiction. Also tune in for PART TWO where we will talk about Pornography and the different and cutting edge treatments for these behavioral and digital addictions. 

35% of people with Internet Gaming Disorder also have ADHD. The neurodivergent brain is wired to seek dopamine - and screens deliver it faster than anything else in human history. 

What if the addiction isn't the problem at all, but a symptom of a brain that was never properly understood?

Today, we are diving into the complex, often misunderstood world of behavioral and digital addictions.

Research on Video Game Addiction

• Systematic review & meta-analysis (2023) – Epidemiology and effects of video game addiction. Link: ScienceDirect
• Gaming disorder & executive functioning (2024) – Meta-analytic structural equation modeling. Link: ScienceDirect
• Longitudinal risk profiles (2026) – Changes in gaming disorder risk over time. Link: ScienceDirect

 Violent Video Games & School Shootings
Consensus:

• APA Task Force: Violent video games show small, short-term increases in aggression, not real-world violent crime or school shootings. Link: APA Task Force Report
• Time-series analyses: No evidence linking violent video games to homicides or aggravated assaults; some data suggest violent crime decreases as violent gameplay increases. Link: Markey et al., 2015
• Racial stereotype research: Media more likely to blame video games when shooters are white, despite lack of evidence. Link: Markey et al., 2019
• Cross-sectional study: Violent gameplay associated with higher odds of weapon carrying, but findings are correlational and require caution. Link: CDC study (2014)

TREATMENTS:
We will talk more about the treatment options for these addictions.
ADHD Medication, Ketamine-assisted psychotherapy, and GLP-1

LINKS

Learn more about Dillon: https://www.waypointpdx.com/dillon-robertson

• Visit Heleen's Blog to learn more about this topic and the research behind it: https://www.lifesolutions.io/blog/
  
  
• Watch the video version of this episode on YouTube:  https://www.youtube.com/@heleenwoest/videos
  
  
• Explore upcoming topics that are dropping soon on The Missing Piece: https://www.lifesolutions.io/podcast/