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

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Surviving Your News Feed

social-mediaIn light of recent geopolitical events, many of us are wondering how to move forward in our daily lives. Sure, some were ecstatic with the outcome. Others were ambivalent. And there is a large percentage of people who are genuinely scared for what happens next in America as a whole, but also to individuals who might be living on the fringe – our marginalized compatriots who are segregated by race, ethnicity, national origin, sexuality, gender, gender identity and expression, and socioeconomic status to name but a few divergences.

If you’re anything like me, you’re checking your social media several times a day. Facebook. Twitter. Instagram. Pinterest. Snapchat. Tumblr. And who knows how many more you might have. Leading up to the election and inauguration, many of us went on a rampage of “if you think ____ then unfriend me now!” and ourselves choosing to unfollow, unfriend, and outright block those who in opposition of what we know in our hearts to be the best for all of America.

But the election is over. The President has been sworn in. Now we have to move forward with our lives and that can be hard to do when we feel beholden to the social media onslaught that can be psychologically damaging. How do you stay connected and sane? Is there a way to use social media without spiraling into a depression with every post on your friends’ walls? Here are a few strategies that make my life easier. Hopefully some of these will work for you too.

Have Good Boundaries

lineinthesand.jpegBoundaries. Not walls. Not fences. Just boundaries. Know where your line is when it comes to devoting time to social media. I remember my dear sweet Aunt Robin always had a retort about answering the phone. “It’s there for my convenience and mine alone.” I think maybe that’s a healthy way to view social media platforms as well. Unless you are a paid blogger or paid activist, this really is hobby work. Limit the amount of time you are willing to spend sitting in front of a computer looking at the world through somebody else’s eyes. Not only is this about the grand total of time, but the number of times a day you check your feeds.

Stephen Covey, famous for the Seven Habits of Highly Effective People, divided tasks into quadrants. I cannot share the rubric here for copyright issues, but you can easily Google this. Covey believed that we should devote most of our time to Quadrant II. Without a doubt social media for most of us falls into Quadrant IV, which is the no man’s land of wasted time and wasted life. He never advocated getting rid of these activities completely, but rather taught that we prioritize our time so we don’t get trapped in the abyss of hours gone by. Surely we can all agree that much of our social media time would qualify.

Digital Disconnect

With my clients, we talk frequently about a “digital disconnect.” This is another form of good boundaries but with some escalation. Take fixed periods of time where you “log off” of your social media presence. A good starting point is a two-day weekend. Maybe from there build up to a seven day “cleanse.” If that suits you well, consider a full thirty-day abstinence. I have no doubt that when you log back on, you will see things through a different lens.

Consider the Source

I admit that I have been one of those people who share snopes.com and other fact checking sites to refute various posts and memes. I don’t know at what point we decided as a society to blindly trust so-called facts on the Internet and give up our willingness to critically analyze a situation. I fear some of us never learned that skill, or maybe we have become complacent because if our friends post it then it must be true right? In research terms this is known as confirmation bias. We select data sources that confirm what we want to be true and discard other sources of information that might prove us wrong. This is very easy to do in social medial because we surround ourselves with likeminded “friends.” What would happen if liberals also watched Fox News or conservatives logged onto Politico.com every day? At the very least our preconceived notions might be challenged enough for us to consider where we get our information.

truthometerAs a cautionary tale of what happens when we remained ill-informed, we need only look at the recent lambasting of Sean Spicer and Kellyanne Conway when they tried unsuccessfully to pass of misinformation as “alternative facts.” Or the frequent reactions by liberal and conservative news outlets to the tweets of the now President when his facts are not quite accurate (attack at the Louvre, NY Times falling readership and apology for coverage, threats of cancelling federal funds to universities based on their selected speakers, etc.). Just because somebody said it, tweeted it, memed it, or shared it does not make it true. Fight to keep untruths and partial truths out of your psychology.

Maintain a Schedule

We are creatures of habits, some good and some not so good. We take comfort in the safety and familiarity of routines. I get up at the same time very day of the week. I have the same coffee beverage every morning while reading the news. We enjoy the same Friday night pizza date every week. Routines are good. Routines give us a sense of stability. Keep going to gym. Keep meeting your friends for happy hour. Get those regular massages. Exercise every day. Make sure you get plenty of sleep. Take your vitamins. Allow your routines to shield you and to make you feel more confident in your daily living.

This might be a good time for a reminder about healthy sleep hygiene. My clients always chuckle at this because of my vision of beds. Our beds have two purposes: sleepin’ and sexin’. When you climb into bed your brain needs to know you’re either about to sleep or about to sex. If it’s clearly not a romantic or sexual interlude, you will be training your brain to “shut down” so you actually fall asleep. And if there is some fun about to happen….well enjoy! Our beds are the not the place to watch TV or binge watch Netflix, read, eat, study, text, chat, etc. As comfortable as it might be to do things on a pillow top mattress under our favorite blankie, it sends the wrong message to our brain and disrupts the routine we need for good rest and rehabilitation. Sleepin’ and sexin’. And if neither happens in the first fifteen minutes, leave the bed and come back later so we don’t train our brain to the routine of staring at the ceiling.

Get Involved

getinvolvedMy clients have been asking for weeks how to feel better about the future in these seemingly uncertain times. One of the best things you can do is get involved! Political activism can actually be good for your psychology. It is future oriented and action oriented. It involves you as an active participant rather than a political victim. Join your local political party. Join a national organization. Attended rallies and marches. Call your representatives. Host fundraisers in your home (it’s never too early to start raising campaign funds). Write letters to the editor.

A secret to involvement to feel better is scaling it for your life. If all you can do is write a check, it’s enough. If you can only find time to write a letter to the editor or make one call to Congress, it’s enough. There is no minimum standard here, and in fact starting small might make it easier for this to become habitual. The point is to do it because it engages the logical part of your brain (frontal lobes) just as much as the emotional side (limbic system). None of us really wants to be slaves our amygdala! Emotional overload leads to anxiety and depression. Getting involved can ward that off.

Be Emotional

But, we are emotional creatures and our limbic system sometimes does get the better of us. It is important to allow yourself to feel your feelings. Let it happen. Be open to emotional expression. Vent to a friend. Go for a run. Schedule a massage. Call your therapist. Just be. You cannot completely suppress the feelings or they will build up and overtake you at some point. We’ve all seen friends who kept choking it down until there was an explosion of anger or frustration. Hell, we’ve been that friend! Accept that you are going to have feelings about all the things happening in your life. All of your feelings are valid. Yes, they are ALL valid. Feelings are not what define you as a person. How you respond to those feelings is where irrational behaviors might come in to play and that’s when you should reach out for some help. But short of that, feelings come and go. It’s part of the human experience. Let it happen. It’s good for you!

Positivity and Future Orientation

positivityOnce you’ve had those emotional “breakdowns” or accepted those negative feelings, it’s time to move forward. This is a great time to remind yourself of all the good things in your life. Yes, even when it feels like the world is going to hell in a handbasket you still have good things in your life. We need to maintain our sense of gratefulness. I find it helpful to make lists of things I am grateful for and to thank people for their contribution. Who wouldn’t love to open the mailbox and receive a handwritten thank you note for being a meaningful contributor to someone’s life? Writing that note encourages positive emotional expression. Since it uses emotion, memories, and rational thought, we are engaging multiple parts of our brain in a positive exercise. A little boost of serotonin and dopamine to improve our mood and outlook.

Being grateful for what you have is an easy way to help you decide what you want to have in the future. If you love meeting a friend for coffee, do that more often. If family reunions fill you with love and hope, make plans more frequently with relatives you might not see so often, even if you’re limited to phone calls for those far away. Spend time with those people you love – your family of origin and your chosen family. Focus on activities that bring you joy and happiness, and do as many of them each week as your schedule allows.

Find Your People

It really does take a village these days to be healthy in a pluralistic society and make meaningful civic contributions. Find your people. Find your tribe. This is especially important if you are part of a marginalized group. Reach out and be supportive. Reach out and ask for support. Build alliances because change takes time and continual forward momentum. It is exhausting. You cannot do it alone. There has never been a more important time in our living history to connect with those who support us, and hopefully even build bridges to bring new people into our tribes to grow our spheres of influence and emotional support networks.

Take care of you. Take care of one another. Love freely and openly. Just be.

Be at peace. -wp

 

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.