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Interviewing Your Therapist

Al

One of the most common questions that I see from potential clients all over the internet and hear in conversation is essentially “How can I tell if this person is a good fit for me?”. The best way to do this is to take full advantage of your intake and first couple of appointments to ask as many questions as you can.

With insurance being the way that it is, you might have limited options or choices. Geographically you might be limited as well and due to waiting lists, it can seem insourmountable to have to ‘doctor shop’, but therapy only works when the client is comfortable with their therapist. Otherwise, resentments occur and grow, and the time spent becomes frustrating for the client, leaving them with a bad taste in their mouth and perhaps swearing off mental health options forever.

A mentor of mine said early on in my grad school process something that has stuck with me, which is “not everyone graduates at the top of their class”. What they meant was, not everyone is the best in their field. It’s possible that you are sitting across from someone who lives and breathes mental health, continuing their education and research to be the best they can be, or perhaps you are sitting across from someone who didn’t really care to put the work in and got into the field because they thought it might be easy. That’s why it’s so important to ask questions.

Ethically, therapists do not take clients on spec, and we provide each client with an unconditional positive regard. This means that no matter what the person across from me says, I don’t judge them nor do I let it affect my professional treatment of them. At the end of the day, I truly believe that EVERYONE is deserving of positive mental health and anyone who reaches out for help is welcome in my space.

But you, as the client, might have things that are important to you, and you need to know if this person is a good fit. After all, you’re paying them money and time in order to get some help, so you need to know – and DESERVE to know – that this person can help with your issues.

Some questions you should be asking include their approaches for issues that you want help with. How do they respond to you wanting to try things or not want to go down a path you’ve walked before? Perhaps you’ve done CBT several times and it doesn’t click for you, would they be able to work with another treatment modality? What are their views on things that are important for you, such as medication – would they respect your decision to utilize (or not) that tool within your treatment? Are they familiar with issues facing your community that are impacting your mental health and ability to thrive? What credentials do they have? What areas of special interest do they have? Do their views of spirituality within counseling match what your desires are? Do their views of sexuality, addiction, trauma, or other areas match what you are looking for? How about gender identity?

Ultimately, this is a job interview for you, where you get to hire us or not at the end of it. While we may decline to answer personal questions (such as, where do your kids go to school or what car do you drive) for safety concerns, the questions above are questions that many therapists won’t have issues answering because we understand the importance of clients feeling safe with us.

I can’t speak for every therapist out there, but I can promise for me, I won’t take offense if I’m not a good fit for you. It’s heartening to see so many other clinicians out there having this conversation as well, and giving space to our clients who feel uncomfortable asking questions about the things they value. We’re here to help you, and we know that the best way to help is for you to feel safe, secure and valued.

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Winter Blues

Al

The holidays have wound down for many people and now the long stretch of winter has started to set in. Something that also can happen for many people at this point of the year is Seasonal Affective Disorder (SAD). While SAD can be just as debilitating as depression, SAD differs in that it comes around during the same time of year for those affected, typically when there’s less sunlight. Other symptoms can include anxiety, cravings for carbohydrates, extreme fatigue and limb heaviness, feeling hopeless or worthless and losing interest in social or other activities, difficulty concentrating, increased sleep and thoughts of death or suicide (Cleveland Clinic). If any of these sound familiar, reach out to your primary care provider or a mental health specialist so they can help you determine if SAD might be a factor in your current state of mind. You might be at a higher risk of SAD if you already struggle with major depression or bipolar disorder II, ADHD, eating disorders, and panic or anxiety disorders. There’s also a genetic factor at times, and SAD can run in families (National Institute of Mental Health).

The good news if you are dealing with SAD is that it is highly treatable, and because it’s seasonal, it will pass eventually. Evidence-based treatments include light therapy, psychotherapy, medications and vitamin D (NIMH). Again, a doctor or mental health clinician is the best place to start, and you can work with them to determine the best treatment for you.

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New Year, New You?

Al

The secular New Year is celebrated widely by millions of people in the US, and it’s been an exciting and optimistic time in the past. However, the past two years have been fraught with many things that have increased anxiety and depression in millions as well. The idea of planning goals, opportunities, lifestyle changes and all manner of things can seem untenable when we have difficulty planning for the next month’s rent, keeping our jobs for a few more months, or even living in the same state. The uncertainty really can color the way that we view our new year coming up, and it’s absolutely okay to feel ambivalent or even negatively towards the concept.

For a period of about ten years of my life, I found it very hard to think about resolutions due to my own personal circumstances and when I would attempt to do so, I found myself panicking about two months into the year when I realized I hadn’t done anything towards my goals that I had set out. I took some time off and then when my life had stabilized, I found myself wanting to use the calendar reset as an opportunity to check in with myself and see where I was. I also knew that I had to figure out a way to set a goal that didn’t seem insurmountable or would make me feel like a failure when I got behind.

I thought back to my days in mid-tier management for call centers and remembered the SMART goal format that I was taught to use for my employees. For those not familiar, SMART is an acronym that stands for “Specific, Measurable, Attainable, Relevant, and Timely/Timeframe”. This method is also commonly used in creating treatment plans within therapeutic settings and if you’ve had therapy, you’ve already participated in creating a goal. The gist is that you take a large goal – something like, “This year I’d like to do more self-care”, and you either break it down into smaller chunks (objectives) or use your goal to create a SMART-formated goal.

Self-care looks like different things for everyone, and one of my favorite self-care activities is re-watching old television shows when I have the time. I find if it’s a show that I enjoy, it’s easy for me to get lost in it and I feel better afterwards. It’s also hard for me to find the time between work, school, family and personal obligations to actually be able to do this. So a SMART goal under this idea would be something like “Every other Saturday night after the kids are asleep, I will spend 1 hour watching an episode of The West Wing with no other distractions”. It’s specific, measurable (one episode a week), attainable (it’s only one hour every 14 days), relevant (a hobby I enjoy) and has a time-frame (the hour).

If you find yourself at a block of a large goal (like, “This year I’m gonna get back in shape”), give yourself the time and pacing to figure out what that looks like for you. Do you want to change your attitudes towards your body? Unlearn disordered eating habits or embrace new ways of eating that might be healthier for you depending on your current medical/physical needs? Exercise for strength or aerobic increases? Gain some weight? Once you know what that overall goal actually means for YOU personally, it becomes easier to look at those tangents and discover what you really mean.

And on the flipside, if you feel negative or don’t feel like having a new years resolution at all, then give yourself the grace and space to reject the idea wholeheartedly. Just because you’re at a point where you don’t want to have a long-term goal right now doesn’t mean that there’s anything wrong with you or that you’re missing out on something. It’s simply how you are coping right now and that’s alright. Your life might already be filled with short-term goals, like how is the light bill going to get paid this month, or making it through the next hour without a drink. It also might not be and that’s fine as well.

Whatever you need right now is absolutely fine, and allowing yourself the ability to listen to what you truly want and need is enough of a ‘New You’ to go on for today.

On a personal note, I wish everyone reading this a Happy New Year if you are celebrating. The past two years have been very hard for me and I know first-hand that my story is not unique. For all of us, I hope that we can have a better tomorrow. I leave you with Neil Gaiman’s 2021 New Year message, which has been so important to me over the past months.

“I hope we all get to walk freely in the world once more. To see our loved ones, and hold them once again.

I hope the year ahead is kind to us, and that we will be kind to each other, even if the year isn’t. 

Small acts of generosity, of speech, of reaching out, can mean more to those receiving them than the people doing them can ever know. Do what you can. Receive the kindnesses of others with grace.

Hold on. Hang on, by the skin of your teeth if you have to. Make art — or whatever you make — if you can make it. But if all you can manage is to get out of bed in the morning, then do that and be proud of what you’ve managed, not frustrated by what you haven’t.

Remember, you aren’t alone, no matter how much it feels like it some times.

And never forget that, sometimes, it’s only when it gets really dark that we can see the stars.”

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Suicide Among Youth has Increased, Ruch et al Study Demonstrates

Al

13 Reasons Why has been on my radar since it came out on Netflix. When the book came out for YA, it really didn’t strike me as something to pay attention to because I compared my own history to it. While I struggled with issues such as self-injury and suicidal ideation during my adolescence, the books that I read that hit on these issues never really drove me towards wanting to commit the act itself. Rather, the stark words across the page gave me some comfort that maybe I wasn’t alone, or that what I was doing wasn’t uncommon.

Then the television adaptation occurred, shorter-term studies have been released, depression, anxiety and rates of suicide have increased among our teens and children and now we’ve decided that this show MUST be the apex of the problem.

Honestly? I get the concern. A is also struggling with SI, depression and anxiety, and I noticed that this popped up on her Netflix watch list, so I figured I might as well take a dive in and see what the fuss is about. I get that there were moments when I was younger that I might have used this as a visual confirmation of everything I was hoping – revenge, people understanding how they hurt me, the realization that THEY were the cause of my pain and eventual death – and so I empathize.

When Bridge et al released their study highlighting a correlation between the release of 13 Reasons Why and an increased incidence in suicide among 10 – 17 year olds, the information was presented by a lot of outlets in a manner that suggested causation, and the sensationalist headlines were shared and reshared across social media. In a few different groups that I am in (including some that are not related to parenting in any way), the articles made their way there and mothers and fathers poured out their fears that their child might be using the show as a guide.

We hear a lot about suicide in our youth, and for important reasons: Suicide is now the most common cause of death in teens. The average age of suicide is decreasing. The aforementioned increases in anxiety and depression. And now a study shows that we need to exercise caution regarding exposing children and adolescents to the series.

Interestingly, the Bridge study showed that the suicide rate increased much more in boys than girls, however the suicide rate among ages 10 – 19 has been higher in boys than girls historically. A cross-sectional study of suicide in the US from 1975 through 2016 wanted to explore the disproportionate increase in suicide rates among female youth found that even though male rates of suicide are still higher, female rates are increasing at a rapid pace, especially in younger individuals.

For me, this highlights the importance of speaking with our young men and boys regarding mental health, and ensuring that we aren’t just looking at our girls when we discuss these types of issues. There’s long been a conversation about toxic masculinity and how these leads to silence among men regarding mental health, and how that silence is passed down generationally by examples of those men that boys look up to.

I’m not here to rehash that, but rather to say that I am guilty of this, too. I paid attention to 13 Reasons Why because of a girl in my life, and not because of the children in my life. This is merely to serve as a reminder that it’s crucial that we ensure that we are protecting all of our children because it’s worrisome that suicide is killing our children more often than anything else. It’s a tragedy and we need to do better in ensuring they are aware of the fact that help exists and that they can ask us for it anytime.

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Vox Article – “Incels”

Al

Incels are fascinating for many researchers, for a variety of reasons. Sociology, psychology, anthropology – all fields that are attempting to learn as much as we can about the people who commit atrocious acts of violence because of this label they’ve applied to themselves. The Vox article does a good job of sifting through the mass amount of trolling that people tend to do when they know no one is looking and points out the thought patterns and possible reasons why this community has members that can be incited towards violence and assault. The community is very closed in, for reasons that become apparent very quickly, and it takes quite a lot of work to learn anything in-depth.

For me, the most stunning revelation was the original roots of the community. It didn’t come on my radar for a long time, and at that point it was folded in with MRA’s and MGTOW’s that I was researching. The original incel board was begun by a woman – liberal and queer, who no longer identifies as involuntarily celibate. Alana originated the first forum in the late 90’s and stepped back in the early 2000’s. She now works for social justice causes and has begun a website called “Love, not anger” aimed at helping people move beyond the label and life of being involuntarily celibate.

While I think that many persons who are members of the community might take issue with some of the assumptions made and information laid out in the article, I have to give credit to the author who seemed to present an empathetic view of those who would be drawn to these spaces in the first place. While I can empathize with the awkwardness, rejection, and isolation, I cannot empathize with the extremes that it’s gone to for many of these men (and women) because I don’t have the experiences they do. That is, I’ve never struggled in the area of seeking companionship or being intimate with a partner.

In my personal research, I’ve not been able to really answer any questions, but find myself having more and more of them. From a psychology POV, I think it’s fascinating to see how the echo chamber works. As social creatures, we will always seek out groups of peers that have similar issues as we do. I think that it’s worthwhile for those who feel socially inept or frustrated and confused by dating to have a place to talk about it freely, but at what point do we determine if the extremes are problematic? And are the problematic for society are large or simply for a small group of persons? When we remove the filter of real life against the backdrop of anonymity that the web and dark web provide, bravado becomes more extreme. The question that I would really like to have answered is at what point is the bravado a red flag of violence, and I know that there’s really no way to answer that with clinical certainty.


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Article: “Therapy wars: The Revenge of Freud”

Al

This article is a couple of years old, but I find myself returning to it every once in a while as I move from undergrad into grad school and am beginning to navigate what it means to be a therapist in today’s world. The title is somewhat misleading as it’s not giving any credence to the majority of Freud’s theories (most of which have been debunked although without his work, many believe psychotherapy today would not exist).

I’m honestly very happy to be coming up during this time when holistic approaches to psychology/psychotherapy are becoming the method being instructed and embraced – there are benefits to having multiple tools to use for multiple issues. CBT is really rad for short-term, adjustment mental health crises and crisis management, but long-term, life-long pervasive personality disorders do benefit from long-term therapy (albeit frequency wears down when the client isn’t in active crisis or feels good about handling their symptoms).

No one is the same, no course of depression/anxiety/etc is the same, therefore not all treatments will be the best every single time. And it’s a shame that insurance companies keep trying to box in mental health with limited visits and coverage only for one type of therapy because so many people will go, get through their initial crisis, then not have any time to develop skills needed for next time. They are left feeling abandoned and that therapy didn’t work for them, and research shows that this cyclical process is what leads to increases in harmful coping strategies (alcohol/drug/self abuse, other risky behaviors) and increased suicide attempts/risks.

TL;DR: Freud was still wrong about SOOOOO many things, but there’s benefits for long-term therapy that CBT simply doesn’t offer.