Dear diary…life is hard.

Expressive Therapy

Sbux1Every morning on my way to the office I stop at the same coffee shop. One of the joys of this type of routine is seeing the same people over and over, and developing some form of bond. For sure I have a few favorite baristas, and there is one in particular where we have developed quite a flirtation. She writes love notes on my coffee cup, and sometimes not-so-loving but enticing notes that make Sbux2me smile or even blush. (Yes, I’m still gay…or mostly gay…and that’s another post for another day.) Nice way to start the day. I also see the same customers over and over. The mechanic from down the street. The nurse from the nearby clinic. The retail manager from the mall next door. It’s reassuring to know I’m not the only caffeine junkie trying to get a fix.

Lately I’ve noticed this same guy every morning. I’m intrigued by him. He sits at a table right outside the front door. He has a stack of books that truly is just over a foot tall. Various books with no clear theme. Yes, I glance at the titles each day because I’m just that nosy! He also has a notebook where he is furiously scribbling notes. Some kind of journal. I haven’t been nosy enough to stand over him and read what he’s writing. My curiosity does have appropriate boundaries most of the time. But from the open books in front of him I imagine him to be capturing his thoughts on what he’s reading. Possibly he’s researching his own book. Perhaps he’s reading for deeper meaning and making a life plan. Maybe it’s a form of bibliotherapy, which is a fancy psychobabble term for reading books that encourage us to think and heal.

harry-potter-1640525_1280I love to read. All the time. People who know me well understand I have quite the love affair with the Harry Potter series. First it was from the perspective of an adult who didn’t quite get the hoopla of a children’s book. Then I read them and enjoyed every word. Then I reread a few years later for escapism. Afterwards I started to appreciate the psychology of this magical world. Books are written about it. Classes are taught about it. Entire fandoms have sprung up around it. I revisit the entire series every few years and always find something new to think about. This year it’s quills and parchment.

In the HP canon, Harry attends school at a time when computers are establishing dominance in educational settings and ballpoint pens have been around for a century. And still Hogwarts relies on quills and parchment for schoolwork, and the wizarding world hand writes letters for delivery by owl. Surely email is faster for keeping up with family and other wizards around the globe. Carrying quills and ink every where you go? Geez. Seems like a pen in the pocket or purse would be more practical. But is practicality really the best measure of an experience?

fountain-pens-1828646_1280I don’t use a quill and have never seen actual parchment. I collect fountain pens. Right now I own just under a dozen. I’ve recently started journaling in a lovely Moleskine notebook I carry everywhere. I’ve also started writing letters and cards on a daily basis. In fact, I spend a fair amount of time finding reasons to break out one of my pens and hand write something. Anything at all. Which is really a big deal for me because I have the most atrocious handwriting. I hate it. It’s the reason I’ve avoiding hand writing anything I could for the past twenty years. And now all of the sudden I cannot put down the pen. What happened to me?

notepadI discovered a new connection between my mind and the paper when I use an actual writing implement. For me it is the fountain pen. For Harry it is the quill. Writing something out by hand requires deliberate thought. It is an active process. When I see the stranger at the coffee shop writing in his notebook, he is truly thinking about what he wants to record because there is no backspace. There is a reason so many authors and poets and speechwriters compose in longhand. JK Rowling wrote the first Harry Potter novel in longhand. Quentin Tarantino. Joyce Carol Oats. Neil Gaiman. They all write longhand.

As I said I have taken to journaling. Every day. Sometimes more than once a day. It’s a form of expressive therapy that focuses on my internal experiences, thoughts, and feelings. It’s an attempt to make sense of the past and the present so I can better see the future. Journaling helps me process what is going on in my head so that I’m more active in my own therapy sessions. It has allowed me to uncover themes to the events in my life, and my role in those events. I can revisit something that I know has a meaning even if it hasn’t become clear yet. Sometimes my journal is like Dumbledore’s pensieve…a place to record excess thoughts and examine them later to spot patterns and links.

travelers-notebook-2245970_1280Sure, I could keep a digital diary on my computer or my iPhone or iPad or whatever device non-Apple users prefer. But I’ve found true joy in putting pen to paper and what it means for me to transfer my thoughts through a physical act. Deliberate thoughts where introspection leads to a new insight or just the release of pressure from clearing my mind. Sometimes I write a paragraph, and sometimes I write several double-sided pages. Maybe it’s all one topic, and maybe it’s a bit more jumbled steam of consciousness writing to just “clear the cache.” Certainly a blog like this is a journal, but what I write here for public consumption is not nearly as deep or personal as what’s in my little black book.

What have I learned so far? For a long time I have really hated myself. My thoughts and words and actions have been centered on so much self-loathing and self-sabotage that I marvel at how I’ve gotten out of bed some days. My view of myself has been so harshly negative for so long. Some of it dates back to childhood hurts related to being bullied in school and my family of origin. Trauma has played a role. Some of it is tied to failed relationships and rejection. And most of it is simply tied to daily life events that affect us all, but that my distorted view allowed to spiral out of control in a repeating cycle of self-destruction.

Brain KeyMost of all I learned that I’m far more culpable than I wanted to admit. I am usually the architect of my own unhappiness. I have been one of the worst for taking care of myself despite what I advise clients. I learned that I have a creative side that wants to burst free and see the world. That I love deeply and passionately and have much to give others. That my view of the world, sometimes healthy and sometimes not, is perfectly valid so long as I use it to shape my life into something meaningful. That I am actually a fairly interesting person who deserves happiness and joy. And that I alone am responsible for making that happen.

Some of this was a bit tough to accept. After all, who wants to learn that no matter what happens in life we are ultimately responsible for our happiness or lack thereof? Getting over trauma requires an investment to be healthy again, and fair or not we have to do it. Moving past a failed relationship requires owning my part in the failure. Acknowledging positive qualities and traits is healthy and realistic, and good for me even when I want to discount myself. Seeing all the potential in life helps me set and achieve goals alone and with others. Yes, it’s been quite a journey and there is no end in sight. As long as my hand can hold a pen, I will be journaling to better understand myself.

Journaling just for me requires a level of honesty I was not ready to accept at first. I had to strip away the pretense of what I imagined a journal to be. This is not “Dear Diary, today Johnny called me a fag and everybody laughed at me. Still I think he’s the cutest boy in school.” This is real. It is deep. It is meaningful. It has helped me see the world and my place in it in a far more realistic way. I love that. And now I’m off the journal some more…

books-690219_1280

A Therapist Comes Out

ComingOutNo, I’m not coming out as gay. I already did that some 20 years ago. And yes, I realize Pride was last month. But still I’ve decided to come out of another deeply personal closet. This one might actually be a bit harder than when I thought I was going to shock my parents about sexuality … though they were not the least bit shocked and if anything were a bit underwhelmed by the revelation. I am coming out of the therapy closet. I am a therapist who sees a therapist for my own mental health and well-being.

DepressionIt would seem like a therapist should have no trouble admitting that he sometimes needs help just like anybody else. In my mind, I can easily accept that at some point in their lives nearly two-thirds of American’s will qualify for a mental health diagnosis like anxiety or depression or ADHD. I encourage people to live genuine and open lives where shame and pretense are cast aside. And now it’s time for me to do the same.

Years ago I was diagnosed with a depressive disorder. Like many people, I tried medication with limited success. I wasn’t ready to work on the “real” issues and thought taking a magic pill would solve all my problems. It did help to an extent, but since I avoided dealing with the root causes of my depression it was bound to relapse. And it did. Several times in my adult life. Recently I started a course of psychotherapy to unpack the longstanding issues that fuel my depressive states. I want to better understand myself and the things that have happened in my life so I can make lasting changes. I want to cast off the chains of depression and emotional oppression so I can be the happiest and healthiest version of me. I deserve that.

Depressed WomanMy fear in coming out as a working professional with a depressive condition is that clients would think I was unfit to do my job. After all, who in their right mind would go to a depressed therapist? Well to be clear, I have periods of depression that are cyclical in nature. They are not so debilitating that they prevent me from attending to my daily needs, going to work and doing a good job, socializing with my friends, and enjoying many aspects of my life. Does that sound at all familiar? A “mild” depression where you are living life, just not your best life?

I was fascinated with the notion that mental health professionals are supposed to be these perfect creatures living blessed lives of flawless grandeur. And when my clients ask, sometimes jokingly and sometimes not, how therapists get through their day without having somebody to talk to, I would give a standard answer about “being trained to compartmentalize and maintain boundaries.” That is a true answer. We are well trained to compartmentalize the things we hear and to maintain a professional distance to avoid a vicarious traumatic reaction to the struggles and stresses of our clients’ lives. But come on! We’re still people! We have feelings too!

So here I am, coming out of the therapeutic closet and seeing the world from the eyes of my clients. When I attended my first session with a counselor who specializes in treating mental health professionals, I was quickly assured that I am not alone or some anomaly. In fact, he said something that gave me pause for several minutes: “the best therapists have their own therapists, and it makes them better at their jobs.” I’m pretty sure I’ve said things that caught my clients off guard and helped them see themselves and their struggle in a different light. Or at least I hope so. With that one sentence I knew I was doing the right thing.

Why come out of this closet at all? Why take the risk of alienating current or potential clients by admitting that I also seek help? Because mental illness in America has been far too stigmatized for far too long. How can I in good conscience encourage people to accept mental illness as a variation of the human experience and be ashamed of my own struggles? I care not for hypocrisy, so it seems to me that if I want to encourage a shift in how we view those seeking help I need to change the way I view my own need for help.

Therapy 5What have I learned so far? Nothing groundbreaking. Nothing that I didn’t already know from my own professional training. And yet I’m learning more about me than I could imaging because I wasn’t open to the possibility before. I’m solidifying goals for my life. I’m unpacking a lot of hurts that impact my self-esteem. I’m learning to better care for myself and reach out when I need support. I’m discovering just how passionately I care about some issues and how I can help make my world and the world around me a better place. I’m learning to see the best in myself so I can be the best version of myself. All the same things I do with my clients, I’m ENJOYING for myself.

And I feel great! I’m no longer scared to say that I have a therapist. He helps me care for myself and better myself. I am living a healthier and happier life, and working towards being the best me that I can be. And I know that I am a better therapist for it. Not just because I have a better understanding of what it’s like to be “on the couch.” But because I have a better understanding of the change that happens when you take care of you.

LifeIsGood

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.