What’s Really Wrong With Me?

WWWM

For the past decade I have been conducting psychological testing for various reasons. Sometimes a person wants to know if they have ADHD or a learning disorder. Sometimes we are looking at career options and want to determine if college is a good choice, or maybe if a specific job fits their knowledge, skills, and abilities (KSA’s). Maybe it’s about a legal matter and making recommendations that are useful to an attorney or a probation department. Most often what I do is a diagnostic study to understand whatever is happening and make appropriate treatment recommendations. It’s the answer to the “what’s really wrong with me and what can I do about it” question.

In the course of hundreds of evaluations, something I’ve noticed is a lack of consistency and sometimes an outright lack of agreement among clinicians. Just this month I was beginning a therapy relationship with someone who disclosed every diagnosis along the Autism spectrum. Last month a client presented with “bipolar, major depression, anxiety, ADHD, PTSD, ADD, generalized anxiety, panic attacks, learning disorder.” What a laundry list! How is it possible for one person to have so many labels? How can one person run the gamut of an entire spectrum like Autism or psychosis? It’s more common than you think, and here are a few reasons why.

Point in Timesign
Any psychological evaluation represents a brief moment in time. Hopefully an evaluator thoroughly reviews your history, including medical and mental health records and prior evaluations. That’s certainly a best practice. It does give us more information (data points) to consider for diagnostic purposes. But even then, your evaluation a single slice in time of what that clinician observed or recorded (testing) on a specific day. Having a bad day? Testing might underestimate your best abilities. Forget your medication? Your mood might be a little more off kilter than usual. Or paying attention might be pretty hard. Leave your glasses at home? Probably going to make it hard to complete testing with speed and accuracy. Or the biggie…did you hold back some information? Sharing all the details is important for an accurate diagnosis.

Even if everything goes just as it should, it’s still entirely possible that a diagnosis can be right in that moment but not really accurate for your daily functioning. Or it might be accurate for problems lasting a few weeks or a few months, but not forever.

bullseyeMoving Targets
Another consideration is that diagnoses can be “moving targets.” There is a lot of overlap in symptoms for various disorders. For example, problems with attention and concretion can be related to ADHD, depression, psychosis, intellectual disability, learning disability, dementia….and on and on. Having mood swings? Could be a bipolar disorder, but it also could be a normal variation of depression or even personality traits. Behavior problems? Might be ADHD, depression, anxiety, Autism Spectrum Disorder, psychosis, personality-related, or a bona fide conduct disorder. See how easily this can all be confused? Yes, we get lots of training in diagnostics (psychopathology), but it takes good rapport and good investigative skills to understand what’s really going on.

This is never more true than with children and adolescents. Symptoms can look very different in young folks. Depression in a teenager often includes irritability, hostility, and acting out. Which can look like an oppositional defiant disorder. Some behaviors could be the result of medications affecting the developing brain. And, quite often, children and teens simply cannot verbalize what is going on the same way you and I can. They try, but they themselves might not understand it in order to explain it coherently.

Treatment = Change (hopefully)
Another consideration is that appropriate treatment really should change diagnostic labels over time. If you are taking medication and engaging in weekly therapy, your depression should get better and eventually that label should go away. Or perhaps your Major Depressive Disorder transitions to a Depressive Disorder NOS and then to nothing at all. ADHD frequently abates over time as the adolescent brain develops into adulthood. But not always, and more and more adults are given a label that traditionally had to be first diagnosed in children.improving together

The biggie here is Autism Spectrum Disorder. With appropriate and consistent treatment (social skills training, therapy, and possibly medication), it is very common for the more severe symptoms related to communication and social interaction to greatly improve to the point it really can be hard to see that a label is appropriate. The same is true for learning disorders. The schools refer to this as “response to intervention” and is now formally measured for those receiving special education services.

Arriving at the right diagnosis can sometimes be pretty straightforward. Other times it feels like I am a detective solving a mystery. The end result will depend on the available information, how willing people are to be open and honest, and the skills of the clinician. It is vitally important that you feel comfortable with the person evaluating you. You are far more likely to be open and honest if you feel safe and secure.

Feel free to contact my office if you keep asking “what’s wrong with me” and it seems like nobody can understand you.

Owning Ourselves

As we progress through life, we meet people and sometimes have no idea what role they will play in our story. Nearly two decades ago I met  a teenage girl in Starkville, Mississippi. Her family is very near and dear to my ex, and once I spent some time in their home I understood why. They are a crazy mess of love and laughter, support and affirmations, success and struggle, hope and faith. Angie struck me as an awkward teenager. Pretty. Amazing vocalist. Witty (which I value more than funny). Smart. But there was a lot of teen angst when I met her. She was struggling to define who she was and what she wanted for her life.

I’d like to say that two decades later I know why Angie came into my life. I don’t. We aren’t at all close. She lives in New York and I am in Texas. I have not actually been in a room with her in more than ten years. We reconnected via Facebook, as is becoming a ubiquitous story. We’ve chatted a bit online. Exchanged messages and emails. And yet I feel I understand her much more now. Certainly distance lends perspective, but so does the maturation process. Hers and mine.

In fact, I will freely admit that Angie has become a source of inspiration for me. Perhaps that’s why she came into my life. I’m not going to tell her story. It’s an interesting one, but it’s not mine to tell. Much of it comes through in her music (Check her out here ). What I will say is that she is living the artist’s dream in NYC. We all know that dream. We’ve seen it in countless movies. Starving artist perfecting her craft on the gritty city streets, singing in clubs and doing odd jobs to make the ends meet. Waiting for that big break that might never happen. And if there is no break that’s okay because at least she’s being true to her craft and her dream. It’s a great plot line for a Lifetime or Oprah movie of the week. And, like most works in progress, her last chapters have not yet been written. We get to all hold out hope she does get her big break, whatever that turns out to be.

In the meantime, Angie posted on her Facebook this statement that stopped me midway to raising a much needed cup of coffee to an eager mouth craving a caffeine infusion:

I could be wrong, but I feel like folks’d be a lot happier if we approached adulthood less about owning property and more about owning ourselves.

Could be wrong? I doubt it. I think she couldn’t be more right. This is a woman who gave up so much to follow her dreams. She really puts herself out there with her music and her live performances. Following the progression of her songs, you can see moments in her life where she is gaining true insight. I’m not sure that’s really her goal, but it comes across regardless.

“Living within your means, but knowing that, no matter what your means, you always have YOU. Prince or pauper, unless you know and love yourself, the rest is all bullpoop.”

 I think of the growing Tiny House Movement (http://thetinylife.com and http://tinyhouseblog.com , I think about simplification and focusing on what matters in life. Believe me when I say I’ve spent just as much time as anybody trying to amass the perfectly curated collection of possessions. The right car, designer labels, house full of enviable decor (which is easier when your partner is a designer…double-edged sword), photos of great travel, and on and on and on. It’s pretty easy to do with enough money and time. To the point I’ve actually lived in a home and had TWO large storage units full of “stuff.” I don’t even remember what all the stuff is anymore. So clearly it was important! 🙂

What Angie’s describing is the quintessential existential crisis. Who are we? What is our place in the world? What do we want? What will fulfill us? Self-actualization. It’s the end-game of the human experience. And she’s sharing that insight most of us get at some point: it’s about the living and not the things.

Consider Maslow’s Hierarchy of Needs. We start with the most basic of survival need and build upward. Once we have food, clothing, and shelter and a physically safe space to live, we can focus on love and connecting with others. Self-esteem and self-respect develops when we are accepting and valued by others. Self-actaulization is the top of Maslow’s pyramid and represents a state of realizing our full potential and reaching it. If we miss a step, we never get to the top and slide back down. Each level is built on the one before it. Later in life, Maslow actually argued for a stage beyond self-actualization that he called self-transendence. He came to realize that self-actualization is only possible in conjunction with self-transendence based on having a higher goal beyond ourselves that we can reach through altruism and spiritualism.

Do we need the trappings of life to reach the top of the pyramid? Can we be happy living in a tiny home? A cramped fifth-floor walk-up? Is that five-star restaurant so much better than a candlelight dinner at home? Are designer labels necessary for self-esteem? Angie’s right. We spend way to much time focused on finding stuff and not near enough time finding ourselves. We lead over scheduled lives trying to acquire all the things we think we’re supposed to have to be happy, and we don’t take enough time to enjoy what we do have. We work too many hours to make more money for the next purchase or experience. We spend too much time trying to impress each other with status symbols or social media-worthy happenings. And then crash into bed, exhausted and unsatisfied, wishing there were another way.

There is another way. A simpler way. A more emotionally and spiritually satisfying way. Stop chasing things and start chasing life. Stop living through cars and houses and wardrobes and exotic destinations. Start living in this moment. Start by accepting yourself just as you are, regardless of what you may or may not have, and believe that it is enough. Because it is enough if you let it be enough. YOU get to choose what is right for YOUR life. YOU get to set YOUR priorities. Not me. Not the neighbors. Not the snarky church lady two pews in front of you. No the other soccer moms. Not the guy in the next cubicle. You. It’s all on you to decide just how happy you will be with what you have.

Now…it’s time for me to start clearing out some storage space with a donation to the thrift store. I’m letting go of things, and in doing so I’m letting go of the mindset that led me to the things. Ready to join me? Ready to walk another path? One less travelled and far less littered? Hand in hand we go.

The First Session.

How to begin.

Therapy 1The questions I am most often asked by friends, family, potential clients, and even strangers at parties are “What is therapy like? What happens?” Some people who have never sat on the couch genuinely wonder what goes on behind that closed door. Others use this is as a way to tease out my particular therapeutic style. Most often, though, it is a question about what happens in the first session with any therapist. I certainly understand the question.

Picture it. Jonesboro, Arkansas. 1998. A young man goes to a therapist’s office for the first time. There was nothing that drove me to therapy. I was not depressed. I was not anxious. There had been no breakup. Work was good. School was good. I went to the therapist because it seemed like I should. Most of my friends were in therapy. Everyone had an “analyst” even if they had nothing to analyze. And then we analyzed that! Seemed very Woody Allen-esque to me.

I showed up for my first session and the therapist matter-of-factly asked what was wrong. When I explained that there was nothing wrong and I was perfectly happy, he had the unmitigated gall to accuse me of masking symptoms and living in a state of denial. Well now we had something to discuss! And we did. For three weeks. And I got bored. And then he got bored. We ran out of things to talk about. And I found other ways to spend money and be entertained.

I’m not sure if that was how my introduction to therapy was supposed to unfold. From what I hear from friends and colleagues, there is no one single way for a therapist and client to first connect. That’s certainly been my experience. In the last decade of working in mental health in various office, jail, and correctional facility settings, I have never found one sure-fire way to begin a therapeutic journey.

It’s perfectly normal and natural to feel nervous about your first counseling session, or your first session with a new therapist. I understand it takes a lot of courage to share your feelings and experiences with someone you just met. Our first interaction is really about establishing an initial connection. You deciding if I’m a good fit for you, and me deciding if I can help you. We work together to identify and understand your concerns and develop a plan to make changes in your life. This process usually takes several sessions. I think of it as the “getting to know each other” stage of our new relationship. This is a collaborative process, but ultimately you are in the driver’s seat.

Switchback at the base of Cape Smokey, Cabot Trail, Cape Breton, Nova Scotia.See, that doesn’t sound at all scary, does it? In my mind, therapy is a purposeful conversation between two people where one of those people happens to be in need of some assistance and guidance and the other one has some training to be helpful. We talk. A lot. We both talk. And I listen. A lot. We discuss. We explore. We. Both of us talking together. It’s a collaboration. And from my experience, if you’re able to talk to a friend then you’re pretty well able to talk to a therapist.

I know what you’re thinking….”does that mean you’re a paid friend?” Absolutely not! I am a paid professional who is good at relating to people and getting them to open up about what’s working and not working, and then helping them find better ways to problem solve and be happy. It sometimes seems like a friendship because there is genuine caring and a certain amount of back-and-forth in my conversational approach. But I am not a paid friend. I am a therapist and my job is to help you live your healthiest and happiest life.

But stop and consider this. If it often seems so friendly, doesn’t that mean it’s not really that scary? I sure hope so. I like to think I’m the least scary person on the planet. I take great pride in making people comfortable so we can effectively problem solve. I try really hard to lessen any anxious discomfort and allow you to focus on what’s happening. Does that mean it’s all laughter and giggles? No chance! There are tears sometimes. Every now and then you might even make realizations you didn’t want and consider throwing a brick through my window in the wee hours of the morning. I just ask you show up at the next appointment so we can talk about it and keep moving forward. And maybe that you wrap that brick in a reminder slip so I know who to bill. Just kidding. Sort of.

If you really want to get a feel for what that first session will be like, ask to talk to therapist for a few minutes over the phone. Most therapists are frequently quite busy and booked much of the day, but there are opportunities to return a five-minute phone call. Given that therapy is not inexpensive and requires some commitment, it only makes sense to me that you might want to chat me up for a few minutes before making an appointment. It’s similar to the “free consultations” offered by a lot of professionals, just briefer. Though it would be unreasonable to expect more than five or ten minutes, it’s a sensible request and one that I always honor.

From there the journey is something we navigate together. There is no one right way or one right path for all clients. See what happens. Take the chance. I don’t know the statistics on people dying from anxiety or fright in a therapist’s office but I’m pretty sure those are some low odds.

Happy SandSo back to the original question. When I went to therapy “for real,” the first session was nerve wracking. For all of about ten minutes. I didn’t know what to expect. It was a woman. And a very young one. Fresh out of school, in fact. But I went because someone I trusted recommended her. The interaction was professional, but friendly. She asked me so many questions I thought she was ghost writing my autobiography. We talked. We laughed. I cried. She comforted. I felt like she understood me. It still wasn’t that easy for me to open up, but once I did my life got a lot better. I returned. There was a lot of back-and-forth as I thought through issues and she made poignant observations and helpful suggestions. And from time to time I still check in as needed. Yes, therapists sometimes sit on the couch as well, but that’s a whole other blog entry. If you’re in pain or confused about life or want things to be different, go that first session. Walk through the door. Take that first step on a journey of enlightenment and improvement. It can be so worthwhile.

Enjoying Our Lucky Friends

I stumbled across an article this week where the author had this crazy notion that the happiest people are around when things are going right for other people instead of for themselves. The underlying assumption is that we too often define friendship based on having people around us when our lives are falling apart, and commiserating with others in their own misfortune. We reach out in times of need, or boredom, or to help others. Yet when things are going great for our friends or loved ones, we are less available. Happy people, so the argument goes, spend more time with their friends celebrating others’ success and triumphs.

Hmmm…there does seem to be a certain logic to this thinking. When I apply it to my own life, I am happier when I’m surrounded by happy people; likewise, I’m far more unhappy when those around me are miserable, or when I’m avoiding people because I think they are too happy for my sanity or for their own good. The more I thought about it, the more I realized why people are who present with things go right for others are happier.

For one thing, there is a certain amount of social learning that happens in our relationships. That’s a psychobabble word that basically means we learn how to behave from watching others. If our friends are happy, and we help them celebrate those joys, we should be seeing how they accomplished this happiness and maybe it will give us guidance. Also, I think there is something to be said for “leading by example,” and if I want my friends to celebrate my success and happy moments, I need to show them how it’s done! I’m going to raise the bar here! Up the ante! No puny celebrations…because when it’s my turn I want a party to rival Times Square on New Year’s Eve.

It’s good for other people too. There is research that shows us that storytelling changes the memory of the event. When your friend tells you about a particularly great date, the memory becomes more meaningful for them. The same is true for you. When you share the details of how you won a tough court case or worked long hours to earn a promotion, or even fought the laundry monster to finally defeat your sweat stain arch nemesis, these events have even more positive meaning for you.

Probably the best reason I can think of take pleasure in the joys of others is because it makes us happier. Sure, there is an altruistic component and it’s great to be there for friends. I bet there’s even a cutesy coffee mug with that sentiment you can give your bestie. But let’s not underestimate to value to ourselves in supporting those around us. Without getting into all the science of dopamine pathways and neurotransmitters, we feel good when we are happy and those good feelings can come in waves of positivity when we share in special moments of those close to us.

Here’s a challenge for you. Take a look at your social media footprint from the past 30 days. How many of your friends’ posts about good things in their lives did you simply “like” versus comment on with words of affirmation? You don’t even have to count for me to say it was too many. I’m guilty of it too. So for the next few weeks, let’s try and make a conscious effort offer some words of affirmation to our friends’ lives to help them celebrate their joys.

Bibliotherapy – Or How I Learned to Write What I Feel

Over the past few weeks, a popular prime time television series has included a plot line about adult siblings meeting for the first time. Part of the story has included their deceased mother’s journals. Box after box of journals. Journals documenting nearly every day of her adult life, from the mundane to the extraordinary. For some reason watching those episodes made me think of the oft-used phrase “Dear Diary.” That, in turn, let me to think about the excitement of adolescent diaries along the lines of “Dear Diary…I met a boy…” And welcome to the windmills of my mind. The life of a therapist always making connections.

Bibliotherapy is a rather unfriendly word for a relatively simple act – the expression of feelings through the written word. We’ve all done it in some form or fashion. Don’t believe me? Ha! I dare you to look at your Facebook posts or Twitter feeds. Complain about a bad day? Participate in the annual fall tradition of 20, 30 or even 40 Days of Thanks? Share really great news that made you happy….including the emoticon? Congratulations! You are well versed in bibliotherapy.

For the sake of simplicity, if for no other reason than I prefer to avoid “psychobabble” when at all possible, let’s talk about journaling instead. This blog is my personal form of journaling, though not my only effort. Journaling is a great way to explore your feelings and experiences over time. Just about every self-help book and pompous daytime talk show circuit “expert” recommends journaling. Research has shown that effective journaling can be a good tool in your toolbox of psychological wellness. And I firmly believe it’s critical for me to “know myself” before I can know anybody else or how to include them in my life.

So now I write a blog. I’m just starting this new project, but I’m excited and hopeful others will at least get a chuckle every now and then, if not find something useful. I also keep a private journal on my MacBook (Day One app, available for iOS devices). Just the other day I wrote an email to an ex who was my first love. Classic unsent letter exercise. It still sits in my draft folder for me to tweak until I’m satisfied. I doubt I’ll ever hit the SEND button, but that’s not the point. The point is for me to explore my feelings. Often times it’s easier if I write them down rather than having them swirl around in my head in what I imagine looks like a satellite view of a hurricane approach the shore. Yes, there is a metaphor buried in there what would amuse Freud. Journaling, in whatever form, is for me. And it can be for you, too.

Why do it?

  • Gives you a chance to sort through all the clutter in your head by getting down on paper. Then you’re better able to concentrate on your wants and needs.
  • Allows you to step back and evaluate your thoughts, emotions, feelings, actions, and reaction.
  • Express thoughts that sometimes you are too scared to say out loud.
  • Explore your core values, and learn to bring your emotions and desires in line with those values to live your best life.
  • Step back and see things from other perspectives.
  • Explore a creative side of yourself and turn negative energy into positive energy.
  • Look for recurrent themes in your life that are holding you back, and recognize the things you do well that propel you forward.

How do you do it? Where do you start? How do you know you’re doing it right? Will it help? Those are great questions I often hear from clients when I assign journaling as homework. That’s right…I give therapy homework. Sometimes clients resist and roll their eyes. Eventually they give in. And in many cases, they have continued their journaling well after we have finished using it in therapy. I bet most of them even continued after their therapy was over.

There are lots of books and guides you can buy, borrow, rent, or download. And they are totally unnecessary. If you completed junior high, you already have the skills you need to journal. It’s writing. That’s it. Pretty simple, huh?

I’m serious. There is no right or wrong way to begin this. Some people begin in a very structured way using a diary app or similar format. Others carry a notebook with them and jot down thoughts as they occur. Some people write long and winding narratives for hours on end. I’ve seen great work come from what we call “stream of consciousness” writing where you start with whatever words land on the page and continue without thought until you run out of words, with no regard to punctuation or structure or style. To my mind, and based on my experiences with clients and my own life, the way you do it is far less important than the fact you are doing it.

I like to occasionally review what I’ve written to start looking for common themes. Do I feel depressed the same time each year? Am I writing a lot about hurt feelings with my friends and family? Do my thoughts about my work sound like maybe I want to make a change? Are there lots of mentions about something that excites me that maybe should be a new hobby? What’s working and not working in my life? What do I want to be different?

As with most things in life, practice does not necessarily make it “perfect” but does make it a lasting habit. Try and develop a regular writing habit and see what you learn about yourself.