Hope destroyed the Death Star

At the end of Rogue One, Princess Leia Organa is handed a data disk and asked what it is. She utters one word: hope. This leads directly into Star Wars Episode IV: A New Hope. Later in that movie she implores Old Ben Kenobi to help them by pleading that he is their only hope. Clearly hope is an important concept in Star Wars (I can, and in fact plan to, document the use of hope throughout the saga). What is it about hope that nine plus movies can be made based on it?

Hope is being able to see that there is light despite all of the darkness – Desmond Tutu. When working with clients, I believe the most important thing I do is help them embrace hope. When someone starts therapy, it is with the hope that things can change. When someone commits suicide, it is almost always because they have lost all hope. We all have challenges to overcome, and as long as we have the hope that we can overcome them, we can move forward creating the change that we want and need.

Folks come to me to address all sorts of issues. Many come with the hope that they can live their lives authentically in terms of gender or sexuality. Others hope to conquer depression or anxiety. Some struggle with addiction and hope to overcome it. Still others hope to make improvements in their relationships. Hope to move through trauma or abuse form their pasts brings others in. The one thing they all have in common is hope for change.

When things are hard, find hope that they can change. They don’t always change in the ways we want them to, but change will happen. We may have to address additional obstacles to embrace that change, but hope lets lends us the strength we need to keep fighting. Even a glimmer of hope is enough to put us on the path to healing; find hope and you will see the light despite all of the darkness. Then you too will blow up the Death Stars in your own life.

Asexual Awareness Week - Celebrate with us!

 Ace With a Place! 

Celebrate Asexual Awareness Week With Us!

Meet & Greet – Wednesday October 25, 6-9 pm

We will be meeting at OutMemphis for board games, snacks, and chats. Feel free to bring your own game and/or snacks; we will have some already if you just want to bring yourself!

Flag Raising Ceremony – Saturday October 28, 1 pm

Join us at OutMemphis as we raise the Asexual flag on the lawn, and add the flag to the other pride flags over the entrance.

What is Asexuality?

Asexuality is a sexual orientation just like homosexuality, bisexuality, and heterosexuality. People who identify as asexual typically experience a lack of sexual attraction or low or absent interest in or desire for sexual activity. It isn’t a choice like being celibate; asexuality is usually a stable identity. Asexuals may desire intimate romantic relationships that may include lots of forms of physical touch like hugging, kissing, holding hands, and cuddling. Their romantic relationships may be homosexual, bisexual, or heterosexual, and they may be monogamous or polyamorous.

Why this group?

People who identify as asexual face significant societal stigma that frequently prevents them from being able to be out about their identity or to explore the possibility of being asexual. While there are groups online where asexuals can connect for support and camaraderie, there is a significant barrier to meeting other asexuals face-to-face. We want to change that by creating a group at OutMemphis that will give asexual-identifying individuals a place to go and be with other folks who understand them. We intend it to be primarily a social group, but we also want people to have a place where they can find support either dealing with or exploring the possibility of being asexual.

Use #AceMemphis to share your Ace pride and connect with others in the Mid-South area

Happy Coming Out Day! Or is it?

Recently we had National Coming Out Day, which is held annually on October 11. For folks just coming out it can serve as momentum for doing perhaps the most exciting (and scary) thing in their life. For those of us who have been out for a while, it's a day when we can reaffirm our sexuality and maybe joke about how, dang it, I don't get to come out anymore because everyone already knows.

However, for those who aren't out for fear of losing their family, friends, jobs, housing, children, lives, it can be a day that serves as a reminder that they have to continue to live a lie, one which ultimately is deleterious to their health.

If you are an LGBTQA (sexual/gender minority) child or adolescent who is stuck in the closet, please know that it will get better. There will come a time when you will be in a position to come out, even if your family will not support it. If you are an adult who feels stuck, please find ways to come out, even if it isn't in every aspect of your life. Sometimes we have to choose our families when our family of origin doesn't support us. While this is horribly unfortunate, if your family doesn't value you for who you are, please know that there are many folks who will be happy to be your chosen family, and give you the support you need to be your true self. Please don't hide your true colors, we need you in this crazy, sometimes confusing and scary, but ultimately fulfilling world of sexual and gender minorities. Please reach out to me if you want some therapeutic support in being your authentic self.

Trans Kids: Is that really a thing?

Currently we see posts online about transgender kids and adolescents - some of them are positive while others are brutally negative. The bottom line of the negative posts is typically something about kids not being able to know their gender and the dangers of allowing kids to take steps to express their gender in a way that feels right. Is it appropriate to let kids live as they experience their gender?

At this time I am working with a lot of transgender adolescents as well as some transgender kids. Not only is it appropriate to let them express their gender as it feels right to them, it is imperative that we allow them to express themselves, and not try to dictate how we think they should live.

There are two broad aspects of transitioning: social and medical. Social transitioning entails things like how we dress and cur our hair, what pronouns we want people to use to refer to us, what name we want to be called by, how we interact with the world. Medical transitioning includes hormone blockers, hormone therapy, and surgeries.

When we are talking about transgender kids and adolescents, we are talking primarily about social transitioning. There is nothing damaging about letting a child with a penis wear dresses and be referred to as she. Most of the transgender adults I work with have known from a very young age that they are trans, just as cisgender adults have basically always known they are cis. Our experience of gender is something we are aware of from a very young age, and no one except ourselves can know how we really feel. It is true that occasionally a kid expresses themselves as trans for a while, and then decides that isn't right for them. They go back to expressing themselves as their birth sex/gender, and no harm is done. For the vast majority of trans kids and adolescents however, they do not make such a decision and continue to live as a trans individual.

As far as medical transitioning for kids and adolescents, we are talking primarily about hormone blockers and occasionally about hormones (for the older ones) but never about surgery. Hormone blockers basically shut down puberty, but are completely reversible. If a child thinks they are transgender, it is appropriate to use blockers to stop the changes that happen with puberty. For biological males this prevents their voice from dropping or facial and body hair from growing, both of which are hugely problematic for transgender female adults, who then have to deal with erasing these things in order for them to pass. For biological females, blockers prevent breast development, which then eliminates a surgery later in life. If it is determined that the child no longer wants to continue with any sort of transitioning, the blockers are stopped and puberty picks right back up. No Harm Done.

For older transgender adolescents, hormones are sometimes started. This is never done without a huge amount of exploration, work with a therapist and oversight by a pediatric endocrinologist. This too is the right decision for adolescents who have lived as their experienced gender enough to know that it is the right step for them to take. Great care is taken before starting them because they do cause permanent changes, particularly for trans male (voice dropping and hair growth).

Yes, trans kids is really a thing, just a trans adults are a thing. We have the ability to take steps, both medically and socially to help kids who are transgender navigate their world in a comfortable and healthy way. These kids are some of the bravest people I know.

Why I expect to be called Dr.

Recently I posted on Facebook after a client called me "dear." This was the post:

"When talking to your psychologist, do not call them "dear". We have a doctorate degree. Unless they tell you otherwise, it's Dr."

This certainly wasn't the first time a client has called me something that felt disrespectful. The fact that I immediately responded by posted on FaceBook is primarily because of my immediate reaction in the moment, not specifically about this client. Since then I have thought a great deal about why I responded so quickly, and there are some significant reasons why I did. However, the post got a lot of comments, so I thought it makes sense to address it again here, where I can address it more generally and not be focused on the one interaction.

I have a doctorate degree, a Doctor of Philosophy in Psychology. After my four years of undergraduate school (in which I earned a bachelor's of science in biology) I was in graduate school for a full 11 years, first earning my master's in general psychology and my Ph.D. in counseling psychology. During those years I sat in classes countless hours, published five articles in peer-reviewed journals, wrote many papers, did hours and hours and hours of research, presented at many professional conventions, took many exams hours, completed hundreds of hours of clinical experiences, wrote a dissertation, passed comprehensive exams in the program and two licensure exams, and amassed a significant amount of student debt. I earned the title of Dr. If I am interacting with someone in a professional capacity, the only thing it is appropriate to call me is Dr.

Most often people call me by my first name, and less often they use terms of endearment like "dear." The fact that I am female probably explains some of this - in our country women are frequently referred to by familiar terms such as "honey", "dear", "sweetie", even "darling". When people use these terms, they will say that they use them out of love, showing Southern hospitality, making a connection with the individual. What they are really doing is erasing the time, effort, and money many of us spend in education and training to be able to help people in various capacities.

If I am working with you as a psychologist, then I am not your honey, dear, sweetie, or darling. Heck, unless I'm your kid or your spouse I'm really not those things to you either. I always introduce myself as Dr. Hiestand, and in doing so I am letting you know how I expect to be referred to. Therapy is an interesting relationship, because while I may end up knowing a great deal about you personally, you aren't going to know much about me in that way. Expecting to be referred to as Dr. is not an attempt to put myself above you, but the reality is that I have knowledge and skills that allow me to help people in a therapeutic setting. Knowledge and skills that I spent years and thousands of dollars acquiring. Calling me doctor acknowledges that I have earned a level of professional proficiency that few people do.

If you have not been told otherwise, always call your doctors by the appropriate titles. Some individuals prefer not to be referred to that way, but they will let you know. When someone introduces themselves as Dr. ---, that is their way of letting you know how they expect to be referred to. Doctors are no better than anyone else, but we've worked hard to earn the right to be called Dr. Doing otherwise is not loving, is not showing Southern hospitality; it's just disrespectful.

 not call them "dear".
 We have a doctorate degree. Unless they tell you otherwise, it's Dr.

Why can't boys wear dresses?????

I haven't posted in a while. I suppose my excuse is I have been really busy, and that is true. For a while I also struggled with coming up with something to write about that people might actually be interested in. If there is anything you are interested in that you would like me to address, please let me know. I'm happy to answer questions or write about subjects folks want to know more about, so just let me know.

Recently I read a couple articles about boys (children or adolescents) who wear dresses. The articles didn't identify the kids as necessarily transgender; they seemed to just be boys who like to wear dresses sometimes, and had parents who would let them do that. I imagine some of the kids may be transgender, but not all of them. Boys (or men) who want to wear dresses (or make-up, or skirts, or blouses, or panties) may not feel like or identify as women. Plenty of women wear pants (or ties, or loafers, or no make-up) but don't feel like men. It is now basically accepted for women to wear "men's" clothing; why is it still such a big deal if a boy or man wants to wear "women's" clothing?

I think one of the big issues is that it is seen as stepping up for a woman to present as more male, while it is seen as a step down for a man to present in a way expected only for women. To my mind there is absolutely no difference between me wearing the clothes I do (men's) and cisgender men wearing dresses. Absolutely - No - Difference. Why do people get so angry about it when parents let their kids dress the way they want? Boys used to wear dresses as an accepted part of culture. Blue used to be the "girl" color and pink was the "boy" color. These have changed, but why the rigid rules around color and clothes?

I find myself really losing patience with the anger that often is expressed if a parent allows their son to wear a dress because the kid wants to. Are we seriously so uptight about our boys not being the epitome of masculinity that is typically forced on anyone born with a penis? Seriously? If a boy wants to wear a dress, let him wear a dress. Maybe he is transgender and this is the first step she is taking towards being herself. Maybe he is just a boy who wants to wear a dress.

Asexuals have a place in Memphis

Asexuals with a Place

Join us for the second meeting of Memphis’s newest social group, a group for individuals who identify as asexual or are questioning this aspect of their identity. We will be meeting at OutMemphis for games, snacks, and chats. Feel free to bring your own game and/or snacks; we will have some already if you just want to bring yourself!

What is Asexuality?

Asexuality is a sexual orientation just like homosexuality, bisexuality, and heterosexuality. People who identify as asexual typically experience a lack of sexual attraction or low or absent interest in or desire for sexual activity. It isn’t a choice like being celibate; asexuality is usually a stable identity. Asexuals may desire intimate romantic relationships that may include lots of forms of physical touch like hugging, kissing, holding hands, and cuddling. Their romantic relationships may be homosexual, bisexual, or heterosexual, and they may be monogamous or polyamorous.

Why this group?

People who identify as asexual face significant societal stigma that frequently prevents them from being able to be out about their identity or to explore the possibility of being asexual. While there are groups online where asexuals can connect for support and camaraderie, there is a significant barrier to meeting other asexuals face-to-face. We are changing that by creating a group at OutMemphis that will give asexual-identifying individuals a place to go and be with other folks who understand them. We intend it to be primarily a social group, but we also want people to have a place where they can find support either dealing with or exploring the possibility of being asexual.

The Meeting

Who: Anyone who identifies as asexual or is questioning that aspect of their life

What: Game night with snacks and chats

When: July 25, 2017, 6-9 pm

Where: OutMemphis, 892 Cooper Street, Memphis, 38104

Why: Because we need to

Sometimes the penis really does matter

Did I get your attention? Good. Say the word penis and people pay attention. This is a hot topic, and one with a good bit of disagreement. Perhaps I should steer clear of it - sometimes I don't like getting involved in things with the potential for drama - but today I do want to go there.

I have heard from multiple folks - clients and friends alike - that there is a discourse going on currently around people being transphobic. What I have heard is directed against lesbians, although there may be a similar thread towards gay men (or maybe even straight folks) that I'm just not aware of. The issue seems to be that there are lesbians who do not want to have sex with a trans woman who has not had any sort of gender confirmation surgery, and they are being called transphobic because of it. The idea seems to be that if someone is a woman, and someone else is typically attracted to women, then the someone else should be willing to have sex with the woman. I don't think this is fair.

For some people, genitals are an important part of their sex lives. They may definitely want a penis present, or they may definitely not want a penis present. I know there are lots of folks who don't care so much about genital specifics; these are the folks who identify as bisexual or pansexual. If someone doesn't care about the genitals, then pre-op or post-op may not matter. But for those who are not attracted to some genital configurations, it does matter, but it doesn't make them phobic.

We aren't typically in control of what turns us on. If someone is not turned on by a penis, that isn't a decision they are making, it's just how they are wired. They may be completely accepting of transfolks of all persuasions, but that doesn't mean they want to have sex with them all. Gender isn't the only thing that figures into sexual attraction - genitals are a part of it. A pre-op trans woman is completely a woman - being a woman doesn't depend on what is (or isn't) between someone's legs.

If we think about it, sexual attraction depends on all sorts of things. I'll use myself as an example. Straight guys typically aren't going to want to have sex with me because part of their sexual attraction is towards some level of femininity, and I don't have that. Gay men typically aren't going to want to have sex with me because, while I have the masculinity thing going on, I don't have the genitals they want. Same thing with straight women - masculine, check; penis, nope. There are actually quite a few lesbians who aren't sexually attracted to me, for exactly that reason. Their sexual attraction includes more femininity than I offer. Fortunately for me, there are women who are attracted to female genitals on a masculine body. Most of the people on the planet wouldn't be sexually attracted to me. I'm good with that.

Being bi-sexual or pansexual isn't being more open-minded than lesbians, gay men, and straight folks. They're just being wired in a different way such that genitals aren't a factor in sexual attraction. A lesbian who in every other way affirms a trans woman being a woman, but doesn't want to have sex with her if her genitals haven't been altered, is not being transphobic. Just because she is a lesbian doesn't mean she is automatically going to be sexually attracted to every woman on the planet, and to accuse her of being transphobic is simply not validating her sexual attraction. Transwomen are women, but it's okay for a lesbian to not want a penis involved when it comes to sex.

Breaking up with Insomnia

Recently I have been aware that many of my clients complain of difficulties sleeping, regardless of their other concerns being addressed in therapy. I went over my client list, and a full 40% of the adults I am working with have issues with sleep. Of these, 30% report sleeping too much as one symptom of their depression. However, the other 70% of my folks with sleep issues reported insomnia - difficulty going to sleep or remaining asleep. According to the National Institute of Health, 30% of adults in the United States struggle with insomnia, either as a primary diagnosis or a symptom of another disorder.

We live in a country where we tend to look to pills to fix all of our pain and undesirable conditions; insomnia is no different. Melatonin is the hormone produced in our bodies to regulate sleep and wakefulness; some people take melatonin supplements to treat insomnia with good results. In my mind that is definitely appropriate because we are simply supplementing the hormone in our body that already regulates the sleep cycle. There are many other medications that are prescribed for sleep. While I support the use of medication to treat a lot of different disorders (depression, anxiety, bipolar, etc.) I am fairly reticent to turn to medication to treat sleep problems. None of the medications address the origin of the sleep problem; they treat it as a symptom but the underlying cause is left intact. I am far less supportive of medication for insomnia than for other medical and mental conditions.

There are a number of other ways to treat insomnia without turning to medication. Cognitive behavioral therapy can be used to address it without relying on medication. Often unwanted thoughts or worries are making it difficult to sleep - that's the cognitive part of the therapy. The behavioral part is based on developing good sleep habits and avoiding behaviors that make sleeping more difficult. Some of these are things you can actually do without the help of a therapist, and include:

• Maintaining a consistent bedtime
• Avoiding naps
• Don't stay in bed for longer than 20 minutes if you are having difficulty falling asleep
• Avoiding caffeine or alcohol too close to bedtime
• Give yourself time and opportunities to wind down before bedtime
• Do not use handheld electronics an hour before you want to fall asleep
• Make sure your bedroom is comfortable for sleep: the right temperature, not too loud, dark enough, no other distractions
• Relaxation training: progressive muscle relaxation, breathing exercises, mindfulness, meditation techniques, guided imagery, self-hypnosis
• Paradoxical intent: remaining passively awake (actively trying NOT to fall asleep)
• Biofeedback

Poor sleep can have significant effects on the quality of our lives, but there are things we can do to improve it. Medication certainly is an option, but there are many other techniques that are just as effective, and which may actually address the underlying cause of the sleep disturbance. If you or someone you love is struggling with insomnia, consider trying some of these techniques; you deserve a good night's sleep.

The Psychology of Star Wars

May the 4th be with you! (Get it, it's May the 4th - May the force be with you...). So on this fabulous Star Wars holiday (one of my favorite days of the year) I thought I would just make a short post to announce a book I just found and am going to get and read ASAP...

 Once I read it I'll probably post some comments on here, but I was just so excited to see that the book has been written that I just wanted to share my excitement. Also, occasionally my posts don't have to be all serious and stuff.

Have a Happy Star Wars Day, you will!

Suicide is not painless

Far too many of our LGBT brothers and sisters contemplate, attempt, and complete suicide.

Here are some statistics, according to the Trevor Project (www.thetrevorproject.org/pages/facts-about-suicide):

• The rate of suicide attempts is 4 times greater for LGB youth and 2 times greater for questioning youth than that of straight youth.
• Suicide attempts by LGB youth and questioning youth are 4 to 6 times more likely to result in injury, poisoning, or overdose that requires treatment from a doctor or nurse, compared to their straight peers
• In a national study, 40% of transgender adults reported having made a suicide attempt. 92% of these individuals reported having attempted suicide before the age of 25.
• LGB youth who come from highly rejecting families are 8.4 times as likely to have attempted suicide as LGB peers who reported no or low levels of family rejection
• Each episode of LGBT victimization, such as physical or verbal harassment or abuse, increases the likelihood of self-harming behavior by 2.5 times on average.


We have made so much progress in recent years towards greater equality and acceptance, that I hope we will start to see these numbers go down. However, at the moment it continues to be a significant mental health concern. You can't read news or look at Facebook without seeing stories dripping with hate towards LGBT folks. This hate is what pushes individuals to consider suicide, when they question their own self-worth because of some vitriol someone is spouting off.

Those of us who are fortunate enough to be resilient against the onslaught of hate must be clear that life can indeed get better. We know that acceptance for LGBT individuals, couples, and issues has swelled over recent years, and this will definitely help. However, we must continue to fight against those who continue to try to push us down, to call out the hatred for exactly what it is. Our voices of love and support must drown out the screeches of hate.

In 2013, Amy Bleuel established Project Semicolon 10 years after the death of her father by suicide. The idea is both simple and elegant. Writers use a semicolon when they could end a sentence but choose not to. The main thrust of the project is suicide prevention by folks getting a tattoo of a semicolon. The idea is that we could choose to end our life, but we make the choice to keep going. Here is the semicolon tattoo I recently got:

Sadly, Amy Bleuel took her own life recently. That was part of what prompted me to go ahead and get the tattoo. She worked hard for many years to help people stay alive, and ultimately she succumbed to her demons. I don't know the details, but I do know that we must continue to fight, continue to counter hate with love, continue to survive.

If you know, or even suspect, that someone is struggling with suicide, urge them to get help. There are many counselors out there who can help. There are many suicide hotlines folks can use to reach out and find someone to listen. People kill themselves when they believe that they have no other option to overcome the pain they are experiencing. We must exemplify hope as we fight, and love, and survive.

National Suicide Hotline: 1-800-273-8255

Insurance Update

When I started my private practice almost 2 years ago, I didn't fool with getting on insurance panels - I knew it would be a headache and decided to just use a sliding scale. However, when I went full-time with the practice, I knew I needed to go ahead and get on some insurance panels. I started the process months ago, and it has definitely been a headache. Here is where things stand.

Magellan: I have a contract and am finalizing a few details, but basically ready to bill.

Cigna: I have a contract but before I can start billing they have to check my credentials. They say it won't be more than a month (I'm not holding my breath).

Blue Cross Blue Shield: I have submitted all the documentation that I am aware of and am waiting on a decision. I do think this decision will be favorable, but don't know how much longer it will take.

Humana: They denied my initial application, but I appealed it and I think they are going to offer me a contract. Again, not sure of the timeline.

Aetna: I have submitted the initial application but haven't heard anything from them.

United: Initially they stated they are not contracting with any more psychologists in this area. I have appealed it but haven't gotten an answer.

Amerigroup: Will submit my initial application once I have a Medicaid number - they require that before they will consider an application.

Medicare: I have submitted all the paperwork and am waiting on the answer.

Medicaid: I have submitted all the paperwork here as well, so just waiting.

At the moment I think this covers it. As contracts become real I will notify folks.

When did we invent gender identities?

I found this quote on Facebook. Lately we've been hearing about all of the "new" gender identities, as if we are suddenly creating all of them. Fact is, they've existed since we've existed, but it's only now that we are recognizing that gender is more than man/woman or even trans/cis. At this point there are quite a few gender identities that are being used, and sometimes I get a little confused trying to understand exactly how an identity is different from all of the others.

The diagram above shows some of the most common ones, but there are lots of others. I'm not going to try to explain them all here, but I did want to share the initial quote and give a bit of an explanation. I do think it is important to acknowledge that gender is (and has always been) so much broader than was recognized; now we just have the language to describe it.

Religion and Psychotherapy

We live in a time where religion/spirituality is sometimes seen as not belonging. We are likely aware of the frequent disagreement about the role of religion in our government. Controversies around laws with religious content are very common at the moment. However, this isn't primarily a political blog, it is a blog about psychology. Another question we sometimes have to deal with is the role of religion/spirituality in the therapy room.

To be completely transparent, I am a Christian. I was raised in the United Methodist Church, and I continue to identify with that denomination today. Recently I have also been incorporating some additional spirituality into my life, meditation practices that could be considered more a part of Buddhist thought. Thus, religion and spirituality are important parts of my personal life.

As important as religion and spirituality are to me personally, when I am working with a client, my beliefs are not relevant. Early in my work with an individual I will ask them about their personal religious/spiritual beliefs. If they do have beliefs that are important in their life, I need to know so that our work can include their beliefs (as relevant). If they don't have specific beliefs, then our work won't include a spiritual component.

Living in the South, religion (Christianity) is a very visible part of the landscape. We don't have to go far to see multiple churches of varying denominations. However, there are folks who are not interested in religion, possibly because it has never been a part of their life, and possibly because they have been hurt by the religious beliefs of others. For these individuals it is inappropriate to expect psychotherapy to include religion; it is unethical for a therapist to try to include religious beliefs when the client does not want that.

Religious beliefs/spirituality are very personal endeavors. If you are contemplating therapy and want religion to be included, make that known to the therapist. If you do not want religious thought to inform your therapy, make that known as well. It is appropriate for you to ask your therapist how they utilize religion in the therapy room, and if their response isn't comfortable for you, then that therapist is not a good fit for you.

Mindfulness - It really is a thing

We live in a very complex, active society. So much so that we spend the vast majority of our time responding/reacting to our environment, which leaves us little time to pay any attention to ourselves. If we are lucky we do find time to relax, spend time with people we enjoy, or focus on hobbies that are meaningful for us. However, these activities are not the same as really focusing on ourselves.

Most of the time our focus is either on the future or the past. We plan for all of the things we need to take care of or get ready for, or we perseverate on things from the past that we wish we had differently but we can't change now. What we don't focus on is the here and now, the present moment as it is, the one thing we can actually experience. We have memories from the past and hopes (or worries) for the future, but this moment is our reality, if we can turn our attention to it. The only way to change the future is to be present in the moment, to cultivate intimacy with things as they actually are, and we aren't typically very good at this. We maintain high levels of stress as we react to the world around us, instead of taking charge and living fully in the present.

Mindfulness is awareness that arises in the present moment. It is not a state of the mind, but instead is a state of being. It is seeing yourself as you are, and accepting yourself as you are in this moment. Mindfulness is a dignified act of love that we can give to ourselves, but we can't give to anyone else, nor can anyone give to us. We must take the time to give ourselves this gift, so we can be fully present and fully ourselves. Mindfulness means we are fully awake. It is a shift from doing to being.

Over the next few posts I am going to explore various ways that we can be more mindful in our lives. I imagine when you think of mindfulness you think of meditation, which is a fair connection to make. You may envision someone sitting in the full lotus position, eyes closed, softly humming "ommm" to themselves.

This is meditation, absolutely, but it isn't the only way to accomplish it. It is true that some people meditate for long periods of time, but there doesn't have to be a huge commitment of time to be more mindful. In addition to classic meditation, a number of other practices include mindfulness: yoga, some martial arts (like Tai Chi), biofeedback, using mantras, and short mindfulness/meditation exercises (as short as a few minutes) to reconnect with ourselves in meaningful ways. There are also psychotherapies that utilize mindfulness: mindfulness cognitive therapy, mindfulness-based stress reduction, and hypnotherapy. I am learning about all of these practices myself (for both personal and professional reasons) and I will share what I learn with you all here. Mindfulness really is a thing, and it is a thing we could all use more of.

Why do people cut?

One concerning thing that I find myself working with a decent number of folks on is cutting. It seems more common than I would have thought, especially in adolescents and young adults. It's not a new phenomenon, but it does seem to be happening more now because kids are hearing about it and trying it out for themselves. While overall it is still a socially unacceptable practice, I think there likely is more acceptance of it with adolescent peers. I haven't gotten the impression that it is considered "cool", but I think there is less stigma around it in the younger population.

Cutting is something I have never been inclined to do. In order to better understand it, I've had to do research and also get information from folks I work with who do it. Cutting typically IS NOT simply a cry for attention. Most of the time when folks do it, they do it on a part of their body that is relatively easy to conceal (arms, upper legs, sometimes abdomen) because they don't want other folks to find out. If it isn't a cry for attention or help, then why do people do it?

I almost didn't include this image. It's hard to look at. However, this topic is hard to talk about anyway, and this is the main reason people do it. Although it seldom lasts long, individuals who cut swear that it takes away their mental/emotional pain, even if only for a minute. Physical pain (of any sort) causes the release of endorphins in our bodies that act to reduce pain. When an individual causes physical pain and then goes through the healing process for it, they feel better and are able to temporarily ignore their emotional pain. A cut or cuts may represent the emotional pain they experience, but are easier to manage. It can also give people some sense of control over the pain in their body. Finally, a physical cut is something that can be seen, it is real; although emotional pain is absolutely as real, because we can't see it it may feel less real to some people.

Cutting is generally not a suicide attempt. However, it is still a risky practice and so one we want to stop and prevent. Cutting may result in scarring that will be present the rest of the life, and most people really don't want that. While I have heard people state that they want the scars to remind them of what they have been, in most cases this isn't a permanent sentiment. More importantly, cutting can result in unintentional injury, sometimes of a serious nature. A cut that accidentally goes too deep or hits a major vessel can become an emergency situation.

Treatment for cutting involves identifying and implementing alternative coping skills. While we absolutely should communicate to people who are cutting that it is not a healthy practice, and parents absolutely can limit access to devices to cut with (although, honestly, if someone wants to cut they will find something - in a pinch paper will do the trick), people will not stop until they have other ways to deal with their emotional pain. I don't believe punishment for cutting is appropriate, other than taking away objects they can use which may include personal property like pocket knives. Folks who cut should be approached with care and compassion, and psychotherapy is the best treatment. For those of us who don't understand it, cutting can be a really scary practice. Fortunately, it is a practice that can be halted with supportive therapy.

Am I my mental illness?

Most of the folks I work with meet the criteria for one or more mental illnesses; I meet the criteria of one (Major Depressive Disorder). For some folks it's a temporary thing - you are feeling sad/depressed, but it is linked to something that you will deal with, and then you will no longer meet the criteria. This is especially common for things such as depression and anxiety. For others, your mental illness is something you are going to live with for much of your life. You will learn ways to cope with it, you will be able to effectively manage it, but it is going to be something you will have to address on and off, possibly for the rest of your life.

For those of us who do live with mental illness long term, it can become very easy to identify with our mental illness. I could think about myself as a depressed person, but that isn't accurate most of the time. Yes, there are times when I have to actively manage depression, times when I experience depression, times when I suppose I am a depressed person. But it would be unhealthy for me to incorporate depression into my sense of self. I live WITH depression, but I AM NOT depression. While it may be a part of my life, it does not define me.

If I identify with depression, I am giving depression power and control in my life that it doesn't deserve. By making depression part of my sense of self, I am guaranteeing that it will play a prominent role in my life. I don't want depression to play a prominent role in my life. I accept it is a part, but I do not accept that it is who I am.

For a long time now, I have used a visualization for my depression. This is what my depression looks like:

except the creature is all green, not purple. It is a ghastly obnoxious dancing green dinosaur. It is not of me. It is a separate entity that at times I have to attend to. Sometimes it is much harder to do this, to maintain the distance needed to control the beast. I have lived with it for over 30 years now, but it will never be me. Barney the Depression Dinosaur, you will never get to be me.

Asexuality

I have recently become aware of a group of people who struggle to have a community and a voice. Asexuals are people with low or no desire for sex. They may want relationships that include romance and intimacy, but it typically does not include sex. We know that there is huge variation in the way people experience sexual attraction or libido, so it makes perfect sense that some folks are on the very low end of these things.

While other sexual orientations have visibility in the world, asexuality does not. It is considered a sexual orientation. Asexual folks may also be gay, lesbian, or bisexual, in terms of the romantic/intimate relationships they may have. Being asexual refers specifically to how one experiences sexual attraction and not who someone is sexually attracted to. However, it is a sexual orientation.

You are probably familiar with the various pride flags for different groups. Above is the pride flag for asexuals. My understanding is that there is an online community for asexual folks, but they aren't a visible community. I imagine there are asexual individuals who would like to be out about their sexuality. It could be nice to find others in real time who they share that with. It would also be nice simply to not have to hide who they are. Many asexuals probably are asked a lot of questions around why they aren't involved in relationships (assuming they aren't) and being able to be out might help temper that. Visibility is one step towards acceptance.

For more information about asexuality, go to www.asexuality.org

Love yourself on Valentine's Day!

It's Valentine's day, so many of us are thinking about the people in our lives we love. My question for you is, do you love yourself? As cliche as it may sound, if you don't love yourself, you can't love and care for those in your life who need, want, and deserve you and your love. While it is appropriate to hold ourselves to reasonable standards, and we all get frustrated with ourselves at times (because, you know, we're all human) if you can't love yourself first in spite of your shortcomings, you won't be capable of compassionate love for others. If you are struggling in this area, please talk to someone. Your family and friends deserve it. You deserve it.

Couples Counseling

Couples counseling. Couples start counseling for different reasons and at different times in their relationships. Often, they wait until things get really bad before they start counseling, and that reduces the chances that counseling will be effective. It is far better to start therapy before things get too bad for the best chance of working things through.

Sometimes couples start therapy as more of a preventative measure. They start therapy when there aren't any significant concerns, and so use it to deal with things as soon as they come up. That way issues don't usually get too serious before they are working through them. This is a really nice way to stay on track with your partner.

A third option is pre-marital therapy. This is counseling done prior to getting married during which potential issues can be identified and discussed. The state of Tennessee offers a significant discount on the fee for the marriage license to couples who have done acceptable pre-marital counseling, and I am able to do this work. It requires at least four hours of therapy, so isn't a huge commitment, and can be a really nice way to be prepared for some of the challenges that often arise in marriages. Good relationships do take work, but doing that work can help us maintain healthy and fulfilling relationships.

Folks in therapy are brave!

It takes courage to do therapy. There is such a stigma around it, some people view it as something only weak or sick people do. Fact is, you have to be really brave to admit you need help and then be willing to look hard at yourself with someone you might not know very well, at least at first. When I do therapy with someone, I know I am working with someone strong enough to do it, even if they don't always feel it.

Pets make us happier!

Prescription: Pet your cat and call me in the morning.

Just like me, many of you have and love pets. We love our pets for lots of different reasons, but one thing that has been consistently demonstrated through research is that folks with pets tend to have better mental health. This is true for people struggling with mental illness, as well as folks who aren't. Across the board, pets make us happier.

These benefits come about in a number of ways. Having pets may increase our activity levels, which is a good thing. Caring for pets reduces anxiety; just sitting and petting a cat or dog (or any other pet you might prefer) reduces the experience of stress. Pets give us something to focus on outside of ourselves, and can actually give more purpose to our lives. They are a great source of physical contact and companionship, which decreases loneliness and depression. Finally, they are absolutely adorable and can be quite entertaining!

I use cats and a dog during my therapy sessions, and virtually all of the folks have commented on how much it helps to have them there. I know my pets have been a part of my own coping with depression throughout my life. Pets are now being used as therapy animals and emotional support animals, including being allowed in some college dormitories. The benefits are significant and firmly rooted in research. So all of you pet owners, go thank your animal companions for improving your mental health!

Never give up on someone with a mental illness...

Never give up on someone with a mental illness. When "i" is replaced by "we", illness becomes wellness.
-Shannon L. Alder

Can Politics and Hope coexist for LGBT Americans?

Politics. I tend to not discuss politics too much. Well, that used to be the case, but recently politics have become much more important and personal to many of us. I know that many of us are really struggling with things that have been done (immigration, healthcare) and things that we are afraid might be done. I'm with many of you in worrying about what steps might be taken that will prove harmful to us as LGBT folks. I want to be comforted knowing that the executive order preventing discrimination in government is going to be left in place. However, I am very aware that so many other things could - and very well will - happen.

I wish I could tell you that things are going to be okay. I do believe that our lives are going to be made more difficult, both by the federal government and by the Tennessee legislature. Even so, I know that our community is far more organized than we have ever been before. I know that we have more allies than we have ever had before. I know that the majority of the general population approves of gay marriage. I believe that they can make our lives harder for a while, but I don't believe they take back the progress we have made, not permanently anyway. In the past I haven't been especially politically active, but I am planning to go to Nashville to speak out as a psychologist against any bills they try to pass against us. I'm not the only person who is now far more politically aware and active than I used to be. Together we will fight back against whatever they try to put in place, and even if it takes a little time, I truly believe that we will prevail.
Like many of us sometimes I feel very afraid, very uncertain about our futures as LGBT Americans. There are days it is harder for me to hold onto this hope, but I have seen what we have accomplished so far so I know we will continue to overcome. I'm not telling you not to worry. I am telling you to be ready to stand up and fight, and if we do this, we will reclaim any progress lost and continue to march ahead. That is what we will do as LGBT Americans.

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Butch-Femme research

When I was in graduate school at the University of Memphis, I was fortunate to be able to do some research in the area of the lesbian gender identities butch and femme. I am posting the titles here if anyone is interested in checking any of them out. If you are but are unable to access a copy, let me know and I'll try to set you up.

Hiestand, K. R., Horne, S.G., & Levitt, H. M. (2007). Effects of gender identity on experiences of healthcare for sexual minority women. Journal of LGBT Health Research, 3(4), 15-27.

Hiestand, K. R., & Levitt, H. M. (2005). Butch identity development: The formation of an authentic gender. Feminism & Psychology, 15, 61-85.

Levitt, H. M., & Hiestand, K. R. (2005). Gender within lesbian sexuality: Butch and femme perspectives. Journal of Constructivist Psychology, 18, 39-51.

Levitt, H. M., & Hiestand, K. R. (2004). A quest for authenticity: Contemporary butch gender. Sex Roles, 50, 605-621.

Levitt, H. M., Gerrish, E. A., & Hiestand, K. R. (2003). The misunderstood gender: A model of modern femme identity. Sex Roles, 48, 99-113.

Also, although it was never published, the title of my dissertation was The role of butch identity in a model of self-esteem among sexual minority women.
 

Emotions: the Good, the Bad, and the Ugly...

Emotions. Some of us are all in tune with our emotions while others avoid emotions like the plague. Sometimes in therapy we focus on them while other times we focus on other things. When we think about emotions, we know there are lots of them...

Lots of times one of the things people want when they go to therapy is to stop feeling certain emotions. Frequently clients tell me they don't want to feel sad, anxious, depressed, angry, lonely, or scared. But is it a good goal to want to eradicate these feelings from our lives?

Most of the time, emotions serve a useful purpose (note I didn't say a pleasant purpose). Negative emotions alert us that there is something in our environment we need to attend to. Anxiety tells us there is something we need to attend to, to fix. If we are anxious about money, we need to take steps to improve our financial situations. When we are frustrated, perhaps we need to work something out with our spouse, co-workers, or friends, to alleviate the frustration. Fear lets us respond to keep ourselves safe. Sadness is a normal response to loss in our lives.

There are certainly times that emotions are too extreme. People may experience anxiety that is bad enough that it actually prevents them from responding. Depression may be so crippling that it is almost impossible to function. When emotions are this extreme, it is certainly reasonable to want them to go away, because in these cases they aren't being helpful.

None of us likes to feel bad, but emotions - the good, the bad, and the ugly - normally do serve a purpose. Therapy can help us reduce the extreme emotions, and it can help us learn to cope with emotions so that we can work through them. As nice as it might be to never experience the negative stuff, they are important and we need to learn from them and react in appropriate ways. When we actively address them, we can learn and grow, and that's a pretty great goal.

Breathe in, breathe out...

Breathing. We all do it, but are we doing it right? I'm going to keep this short, because this is going to be an ongoing dialogue for me. I've been learning biofeedback, which I referenced in a previous post. It is a technique that allows us to reset neural connections in a beneficial way, and we do it by breathing a certain way. Most of us have heard of meditation, and we know it is based in breathing, and some claim it is extremely beneficial. Some folks do yoga, and breathing is an important part of that. Breathing is utilized in hypnotherapy and progressive muscle relaxation. I am sure there are other techniques and such that utilize breathing in a therapeutic way that I'm not thinking of at the moment.

My recent research on and personal use of biofeedback has convinced me of the definite benefits of that technique specifically, and I think it makes the other techniques I mentioned likely more valid. At this point my focus is biofeedback, and I may incorporate a bit of hypnotherapy into my work. I'm also seriously considering trying yoga myself to see how that works for me. As I learn new things about breathing, I plan to share them here. Regular "talk therapy" like cognitive behavioral therapy, are still definitely very effective treatment methods, and I'm not going to stop doing CBT. I will be incorporating more of some of the other techniques into my work though, and I really think a lot of folks I am working with are going to benefit greatly from it.

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What is gender?

What is gender? Much of the work I do involves gender, so it is certainly something I think about on a regular basis. However, our understanding of what gender is has changed over time and in different societies. The history is absolutely fascinating, but for the purposes of this post, I want to focus only on how it is conceptualized now in our society, and give brief descriptions of some of the gender identities being used.

When most people think about their own gender, they use their physical bodies, and more specifically their genitalia, to define their gender as either a man or a woman. This works fine for many people, because their gender identity and their physical body are in agreement. However, it is not always the case that gender and physical body agree (I am saying physical body instead of sex intentionally. Often the word sex, or biological sex, is used instead of physical body, and while that often works, their are also folks whose physical bodies - genitals and secondary sexual characteristics - don't match their hormonal levels or chromosomal make-up. For this reason I use the phrase physical body, to avoid conflating any of the above factors when they really shouldn't be).

Okay, so then gender identity can be thought of as a person's internal sense of who they are as a gendered being, or what gender they identify with. It used to be, in our society at least, that gender was limited only to male and female, and was assumed to be consistent with physical body, so something that couldn't be changed. Last century, some brave individuals and their medical providers started exploring the idea of gender and physical body not matching, and looking at ways to bring them into alignment. One of those ways was attempts to use therapy to help a person change their gender identity so that it agreed with their physical body. Therefore, if someone had a penis and the ability to grow facial hair, they were encouraged to open themselves to the "fact" that they are male and should identify as such. Likewise, someone with a vagina and breasts would be encouraged to identify as a woman, even if that went against their internal sense of self.

That treatment failed dismally, with people simply being unable to changed their gender identity. Consequently, some individuals and their medical providers explored ways to change their physical bodies to be more aligned with their gender. Today we understand this process as transitioning, which may include the use of hormone therapy and gender-confirming surgery (but not always).

Another shift that we have seen more recently is the idea that gender is not limited to only male or female, pick one, for each individual. Certainly for many people they are able to choose one, and it is the same as the one assigned at birth. For others they can also pick one, but it is not the one they were assigned at birth. However, there is a portion of the population whose internal sense of gender does not fit neatly into the categories of male or female. There are a number of identities being used now that describe gender beyond just male or female. Some of them include agender, genderfluid, genderqueer, bi-gender, and nonbinary.

Agender, genderfluid, nonbinary, and bi-gender describe someone whose identity is not man or woman, may fall on a spectrum that includes masculinity and femininity, or feels as though they do not have a gender. Genderfluid indicates that gender may shift for some people, such that some days they feel more masculine and some days more feminine. These gender identities are all real, as we realize that gender is much more complex than the male and female boxes we have tried to put everyone into up until recently.

Why am I a psychologist?

Why am I a psychologist? Sometimes therapists refrain from talking about themselves in therapy. While I don't talk about myself much, I think it can be helpful for clients to know about my experiences when it can benefit their work. I also think it's reasonable for folks to know why I do what I do. So here goes...
I suppose many therapists might answer the question with some form of "because I like helping people." For me this is absolutely true, but it's not a full explanation of why I went to college for 14 years and put all that time, effort, and expense into it. A better explanation starts with the fact that I was diagnosed with major depressive disorder when I was 15 years old. Early on I really struggled, but I worked with a social worker for several years, then a psychologist while in undergraduate school, and today I live with it and enjoy a full life. I know how important counseling was to me, quite frankly just in keeping me alive, and decided that I wanted to be able to do that for other people. That's really why I became a psychologist.

Another reason I think it's important for me to be open with the fact that I live with mental illness, is that we live in a society where there is huge stigma around mental illness. Many people are too ashamed to even admit to themselves, much less anyone else, that they might be struggling with something. Mental illness is real. According to the National Alliance on Mental Illness, approximately 1 in 5 adults experiences mental illness in a given year. This means almost 44 million people could benefit from mental health services every year, but many don't reach out and so don't get the help they need. As someone who knows that mental illness can be overcome, this makes me very sad.
I'm a psychologist, I have a very good life, and I live with mental illness. It does not have to control your life. You can get help, and you can overcome it. Please feel free to call me - confidentially - if you need more information (901-486-5745).

Biofeedback

Biofeedback is another treatment modality I use. It is very different from "talk therapy", so it may be something you have never done before, or even heard about. It is based on the biological connection between heart rate and numerous bodily functions and awareness, including emotions. It starts with a sensor that clips to your earlobe and measures your heart rate. The sensor also connects to my phone and I use a special application to do it (of course, because there is an application for everything these days). Using the sensor, the application calculates heart rate variability, which is the slight variation between heart beats; our heart does not beat nearly as regularly as we probably think.

The way we make changes if through our breathing. This isn't really meditation, although the theory behind it explains why meditation works. It isn't relaxation, although that often happens as a part of it. However, using controlled breathing, we can actually synchronize the systems in our body which brings us to a state of coherence, or balance if you will. Learning to get yourself into a state of coherence several times a day can help to reduce many psychological problems, including depression and anxiety. It is a great tool for stress management as well. Give me a call if you'd like to learn more! 901-486-5745

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is one treatment modality that I utilize. Research has demonstrated that it is very effective in treating a wide range of mental illnesses and other difficulties. It focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (thoughts, beliefs, attitudes), behaviors, and emotional regulation. It was originally developed to treat depression. It is action-focused, and is a collaboration between the client and the therapist. Research has demonstrated that it is as effective as medication in treating less severe forms of depression and anxiety, so often it can be used without supplementing with medication. With more severe mental illness, a combination of CBT and medication is most effective.

Meet Nimbus the therapy cat

Meet Nimbus the therapy cat! I've always known Nimbus was a really sweet guy, but I had no idea he is the perfect therapy cat until I started doing sessions with him around. He's the perfect therapy animal because he makes himself available if folks want to pet him, but he doesn't demand it. During a session he typically sits on a footstool within easy reach of the client. If they want to pet him he's perfectly happy to oblige them, but if they don't want to then he just naps. Sometimes instead he sleeps near them on the couch, where he can be petted but it isn't a requirement.

What has sealed it for him being a therapy cat, though, is his reaction when a client becomes upset (sad). When this happens, he often moves so that he is on the couch and lies down up against the client's leg. He still doesn't ask to be petted, but he seems to want to offer comfort in physical contact.
These behaviors weren't trained, he's just hard-wired this way. So many clients have said what a benefit it is having him around during sessions. He contributes significantly to my work, and I'm really grateful to have him as my assistant.

Carrie Fisher on mental illness

I'm fine, but I'm bipolar. I'm on seven medications, and I take medication three times a day. This constantly puts me in touch with the illness I have. I'm never quite allowed to be free of that for a day. It's like being a diabetic.
Carrie Fisher
If you know me at all, you know I am a supreme Star Wars fan, and adore Carrie Fisher. I quote her here, however, because she was open and unapologetic about having mental illness, and sometimes really struggling with it. We live in a society with such a stigma around mental illness, such that it can be quite embarrassing for folks to admit they do, or even that they are in counseling.

If you are struggling with things in your life, be it mental illness or something else for which you are considering therapy, please know that the real strength lies in facing your demons and reaching out for the help that you need. It's okay if you don't want to be public about it, but do what you need to do to take care of yourself. You're worth it.

Hope

Hope is being able to see that there is light despite all of the darkness. -Desmond Tutu. Sometimes it is hard to be hopeful when we are faced with problems in our life. Oftentimes claiming hope is the first step towards overcoming challenges, whether they be depression or anxiety, relationship stressors, or accepting and flourishing as individuals with multiple identities. From the onset of our time working together, we will establish hope as a foundation. From there we can address whatever burdens you carry together, to give you the knowledge and skills you need to live fully and happily.

The reason for Hiestand Psychological Services

In May 2015 I learned that OutMemphis (what was then the Memphis Gay and Lesbian Community Center) received numerous calls from individuals trying to get mental health services but having a difficult time finding professionals willing to work with them. From this conversation I established Hiestand Psychological Services, because people wanting mental health therapy shouldn't be turned away by therapists because of who or how they love, or because of their gender identity.

I earned my Doctorate of Philosophy (Ph.D.) in Psychology from the University of Memphis. I am licensed by the Tennessee Board of Psychology as a licensed psychologist, mental health practitioner, having fulfilled all the requirements for this designation. I am a member in good standing of the American Psychological Association.

I offer services including therapy/counseling for individuals, couples, families, and groups. As a psychologist, I do not provide any medications or perform any medical treatments. If medication seems indicated, I maintain close working relationships with a number of physicians and psychiatrists and I will gladly refer you to these practitioners.

My theoretical orientation is Cognitive Behavior Therapy (CBT). This is a very effective therapy for a vast number of concerns, and its effectiveness has extensive support in evidence-based research. When working with one or more individuals, I typically conceptualize things in terms of thoughts and behaviors, how they influence each other, and how one can be changed to help the individual(s) feel better. While I focus more on thoughts and behaviors, I am also skilled and comfortable working with emotions, and when that is warranted, I will focus in that realm.

I have extensive experience working in a number of areas, including depression, anxiety, relationship and family problems, LGBT (Lesbian, Gay, Bisexual, and Transgender) issues, basic life concerns such as transitions in employment and education, bipolar disorder, personality disorders, schizophrenia, grief, mental retardation, and post-traumatic stress disorder. I am competent to work with individuals with any diagnosis recognized by the psychological/psychiatric community. I typically work with adults, and will see anyone age 16 and above for any reason. For individuals seeking services for LGBT concerns, I will make a decision on a case-by-case basis.

One potential benefit of therapy is the ability to detect, challenge, and change those beliefs and attitudes that create, maintain, and worsen conditions such as depression, anxiety, panic, anger, frustration, fear, etc. Sometimes there are potential risks when entering any therapy relationship. Some people may experience a degree of discomfort, feelings of sadness, anxiety, anger, etc. when working through difficult issues. Some may recall unpleasant aspects of their life and at times, report feeling worse before feeling better. My desire is for people to be strengthened individually and in their relationships.

People should not be denied mental health services based on who or how they love, or because of their gender experience. Far too many people are denied mental health services for these reasons, which is why Hiestand Psychological Services was established. For more information, please contact KT Hiestand, Ph.D., at 901-486-5745