Paper Cranes Healthcare

Last fall, the practice I had been working for, East Valley Family Therapy, merged on a trial basis with a more-established healthcare company that was expanding the services they offer to include behavioral health care.  This merger has proven to be a valuable one that is benefiting their clients and allowing for greater growth, specialization and collaboration between mental health and medical care providers.  That merger is now graduating from “trial basis” to being a permanent change, and it one that I believe will be beneficial to the clients and communities the company serves.  I also believe that it will be beneficial to me as a professional as I am able to allow individuals who specialize in marketing and business to attend to those needs while I am better able to focus my time, talents and attention on becoming an even better counselor for the clients I serve.  Their facilities also allow better space for working with families and for providing groups to the community.

I look forward to my continued professional association with Paper Cranes Behavioral Healthcare as one of their employees, and I am also grateful for the personal association with the truly wonderful individuals who run this business.

One of the benefits of working with Paper Cranes is that they are established in several areas that are otherwise under-served by behavioral health providers.  Because of the greater needs for counselors and therapists in the growing Queen Creek area, I will soon be working primarily out of their Queen Creek office rather than in the Mesa area.  If you know of individuals who are seeking counseling services in the Queen Creek or Chandler areas, feel free to send them my direction and I or my colleagues would love to work with them.  If you or someone you know is looking for a therapist in the Mesa area, feel free to contact me and I am happy to try to help connect them to a local therapist who can help them toward their goals.

Finding The Right Counselor for You

It can be daunting to make the choice to reach out to a professional for help.  And it can be confusing to know which professional to reach out to.  Not knowing where to turn for help can sometimes be enough of a hurdle to further delay getting started.  Hopefully some of the information below can help you know where you can turn so that you can start on your path to healing.

Now, I should probably begin by mentioning that there is no such thing as an ideal counselor.  BUT, there may be someone (or several prospective someones) who is the ideal counselor for you.  Your ideal counselor is likely to be someone who:

1. You feel safe and comfortable with and that you “click” with
2. Specializes/has experience and success in treating the issue that you are seeking help for
3. You can afford to see

The ideal is to find a professional who meets all three criteria.  And sometimes that ideal is available if you know how to find it.

Finding someone who you feel safe with and who you “click” with

Because everyone comes to counseling services with different needs, and because everyone has different personalities, one person’s perfect counselor might not be your perfect counselor.  If you’ve had the experience of going to someone that was recommended to you and you didn’t have a positive experience, don’t give up hope.  Change and healing is still possible.  Research has shown that the therapeutic alliance (how well the client and therapist click) is the number one predictor of therapy being effective.  If your past counselor wasn’t a good fit for you, or if they simply didn’t have the background and training for your specific needs, that doesn’t mean that they are a horrible counselor, and it doesn’t mean that you are broken and beyond hope.  It simply means that it wasn’t a good fit.  So let’s figure out how to find someone who is!

Ask for recommendations

Your starting place should be to figure out what your options are.  Many individuals will start by asking for recommendations from friends or family members.  A friend of mine recently posted on Facebook asking for recommendations of therapists specializing in working with children on a specific issue.  Health professionals such as PCPs generally have mental health professionals that they can refer you to.  Similarly, ecclesiastical leaders often have mental health professionals that they are aware of that they can suggest.  Referrals from others can be a helpful place to start.  If you do not have individuals in your social network that you feel comfortable disclosing your need to counseling to, you may find it easier to use the internet to find local therapists.  This is a great way to find many therapists who may be a good fit for you.  If you want to cast an even broader net, you can go to the website for the state’s Board of Behavioral Health Examiners (or equivalent) and pull up a list of all licensed professionals in your city or state.

Learn about your options

After identifying some potential options, one of the best ways to figure out if any of these therapists are a good fit for you is to learn about them.  Many counselors have websites, and many more have online profiles that provide an image and write up about them and their areas of expertise.  If from these resources you find a few prospective counselors that seem promising, the next step is to talk to them.

Talk to prospective counselors and ask questions

Most therapists will offer a free phone consultation where you can talk with them via phone and ask them questions.  This is an opportunity for you to get a good feel for them.  You can hear their voice, get a sense for what they are like, and you can learn about them and their approach to therapy.

Of course, the best way to get a feel for a prospective counselor as a person and for their therapeutic style is to schedule an appointment and meet with them.  If you feel uncomfortable with your counselor after a few sessions, then it may be time to find someone who is a better fit for you.  It is perfectly acceptable to discontinue services if you consider them ineffective.  But, you may first want to express your experience with that counselor and together you may be able resolve the source of your discomfort, or they may be able to refer you to someone who will be a better fit.

Cultural considerations

Also, many individuals will feel naturally more comfortable with individuals who are familiar with the culture they identify with.  For individuals who identify with a minority culture, be it religiously, ethnically, or relating to sexual identity, finding someone who understands that culture often allows for a shared vocabulary and more comfort in discussing issues that may be relevant.  It is important to note that it is possible to find counselors who understand your culture without belonging to your cultural group.

Finding someone who specializes

There are certain therapeutic issues that require a specialized skillset to treat.  For example, if I had experienced a major trauma and were experiencing trauma-related symptoms, I would want to find a therapist who specializes in trauma treatment, and perhaps someone who is trained in EMDR.  An otherwise good therapist without background in trauma could potential do more harm than good because they are not trained to work with those complex issues.  Similarly, if a couple is seeking marital counseling, seeing an excellent individual counselor may not be effective in resolving relational problems because they lack the training and specialization to work systemically.  They will see the problem and the process of healing it differently than someone with training in couple work.

In order to find someone who specializes, it can help to know where to look.  A good starting place is online directories.  One of the most established is Psychology Today.  It offers search filters that allow you to seek out therapists by location as well as by specialization.  But be warned, a person can claim an area of specialization simply by saying that they specialize.  Many on Psychology Today claim a dozen different specializations.  Realistically, a counselor may have competence in working with many different presenting problems, but are unlikely to have more than a few areas where they truly are specialized.  For this reason, it is important to ask good questions in the initial phone conversation (more that this another day).  It can also be helpful to find online directories on websites associated with professional organizations.  For example, ICEEFT, an organization for individuals trained in Emotionally Focused Couples Therapy, provides a list of therapists who have completed various levels of specialized training.  By going to their website, you can find local EFT therapists who have completed an externship, an extensive core skills training, or who are fully certified EFT therapists.

Finding someone you can afford

For a lot of people, finding a specialist often feels inaccessible because of cost.  Some specialists who are well-established and well-branded can charge over $200/hour.  And, since the course of therapy can often take a dozen sessions or more, the price adds up fast.  Here in Mesa, Arizona, the current average for a counseling sessions tends to average around $120-$150/hour.  This represents a big financial sacrifice.  And, while you and your well-being are absolutely worth it, it makes sense to find more economical options when they are available.  For many, the most economical options available to them is to find a counselor covered by their insurance.

Insurance

For those who have health insurance, there is the possibility of finding a therapist who is covered by your insurance provider.  If your insurance does cover counseling, a good starting place is to call your insurance company or visit their website in order to find a list of approved providers.  From there you can see if any of them have online websites or profiles before making calls to try to find options who are accepting new clients and who feel like a good fit.  Another approach can be to start on Psychology Today and use their search filters to see what local therapists claim to receive your specific insurance.  If you do this, be sure to follow up in your initial phone consultation to make sure they are still accepting your insurance.  You may also want to check your insurance policy to see if there is a limit to how many counseling appointments your insurer will cover annually.

Out-of-Network

You may have the experience of finding a therapist that you want—someone who is a good fit for you, someone who specializes in your issue, or someone recommended highly to you from someone you trust–who is not in network for your insurance.  If they are not covered by your insurance, there is sometimes an option to receive partial reimbursement.  You would want to first check with your insurer, but many insurance agencies will provide partial reimbursement when seeing an out-of-network provider.  In these instances, it is the responsibility of the client (you) to find out your insurer’s policy and to do the legwork to get reimbursed.  The therapist should provide what is called a “superbill” with all the information that your insurance company will need from you.  This option requires you to be able to pay your therapist upfront, and will require some work from you to get repaid.  It will be up to you to assess if the amount you are reimbursed feels worth the effort.

Choosing to Not Use Insurance

It is also important to note that some individuals with insurance will choose to forgo using it to pay for services in order to avoid a diagnosis.  There are also situations where a client is experiencing stress that is not explained by a formal diagnosis or where their presenting problem is not covered by their insurance.  These individuals will need to pay for services themselves and are often motivated to find more affordable options.

Sliding Scales

Also, for those without insurance, or those who decide to pay out-of-pocket to receive services from a therapist who does not receive insurance, you can ask a potential therapist if they offer a sliding scale.  Some counselors are able to offer an adjustable rate based on a client’s income.

Training Programs

Another option for finding more cost-effective counselors is to reach out to schools or training programs.  When, as a Masters and PhD student, I worked at community clinics staffed by graduate students who were being trained, costs to clients were as low as $15/session.  In these situations, you might not have the benefit of a therapist with as much experience or specialization, but your therapist will have supervisors helping ensure high-quality therapeutic services.  When your therapist is an intern or is associate licensed, their rate will often be considerably lower that independently licensed therapists.  If you are looking for a more affordable option, consider calling local schools with programs in counseling fields to see if their program has a community clinic or to ask where their students participate in their clinical internships.

Best Two Out of Three?

So what if you can’t find someone who meets all three criteria: Good therapeutic alliance, specialist, affordable?  Well, it depends.  In my mind, if I had to cut one of the three, the affordable aspect is the one I would be most willing to sacrifice if I was truly in need.  And this is coming from an incredibly cheap person!  But I’m an incredibly cheap, money-conscious person who recognizes the value of good therapy.  Going in for affordable therapy that isn’t helpful isn’t helpful.  I worked for several years at an agency that received individuals who were not required to pay anything out of pocket.  To meet the demands of the agency’s business model, therapists where given unreasonable workloads (up to 150 clients).  This didn’t allow clients to come in regularly, nor did it allow therapists more than 10 minutes of time per client for preparing to work with that client.  Far too often, session time was spent helping the client process their frustration with the agency rather than focusing on the issues that brought them to the agency.  Many such clients would have been better served if they had found ways to pay out of pocket and received regular services to help them meet their goals much more quickly.

If I had to cut another criterion off the list?  It depends.  Generally, the therapeutic alliance is paramount.  Again, research has found therapeutic alliance to be one of the biggest predictors of therapy being effective.

However, with certain presenting problems, and when dealing with a certain severity of symptoms, I would recommend a specialist.  If I had a potential client come to me with an eating disorder, severe substance abuse disorders, or PTSD, I would refer them out.  Would I want to help them?  Of course.  Could I help them?  Maybe.  But not at a level or rate that others who specialize could.  To attempt to treat them with presenting issues that are outside my scope of practice would be a disservice to them and would be professionally unethical.  I recognize I will do more to help such clients by helping them find someone who specializes in treating their particular issues.

Summary

The right therapist for you is the therapist who will help you heal.  He or she is someone that you feel safe with and trust.  They are someone with the knowledge base and skills to help you with your particular issues.  And they are someone that you have the means to see throughout the course of treatment.    There are many resources available to help you find the counselors who will help you find the healing, perspective and growth you seek.

 

New Job at East Valley Family Therapy!

I am excited to now be working at East Valley Family Therapy, a new private practice in Mesa, Arizona.  If anyone in the Mesa/Gilbert area knows someone looking for a counselor/therapist, feel free to send them my way!  You can check out my Psychology Today Profile for more info: https://therapists.psychologytoday.com/338625

Invisible Illnesses

Credit: Abby Gullerud @ https://mommyandbeast.tumblr.com/

Yesterday I had a conversation with a friend who shared some of her experiences with a chronic illness that on any given day leaves her in varying degrees of pain and which saps her of her strength and energy physically, socially, mentally and emotionally.

Later that day, I came across a new webcomic, created by a very talented former college roommate, illustrating some of her experiences being married to a man with an unidentified illness that similarly leaves him in great pain and deprives him of strength and energy.

In my clinical work as a therapist, I have worked with many clients who struggle with invisible diseases, the most common being depressive and anxiety disorders.  I’ve also noticed that many who come in with depression also are affected by invisible disorders of pain, including chronic conditions such as arthritis, fibromyalgia or lupus.  A chronic disease refers to an illness that is ongoing and incurable.  Many chronic diseases are manageable, while some chronic diseases are less understood and more treatment resistant, as is often the case with certain pain disorders.  The National Institute of Health, on a fact sheet on pain management noted the following:

• Chronic pain is the most common cause of long-term disability.
• Pain affects more Americans than diabetes, heart disease and cancer combined
• Pain can be a chronic disease, a barrier to cancer treatment, and can occur alongside other diseases and conditions (e.g. depression, post-traumatic stress disorder, traumatic brain injury).

One client who struggled with multiple chronic conditions, including pain disorders and depression, introduced me to the idea of “Spoon Theory”, which she considers a helpful way to make sense of and explain the limitations she encounters due to her specific health issues.

“Spoon Theory” originated from a blog post written by someone with a chronic illness who recounted a conversation with a friend at a restaurant.  Her friend wanted to better understand what she was experiencing.  In an attempt at explaining, this woman gathered up as many spoons as she could find and handed the bouquet of utensils to her curious friend.  She explained that that cluster of spoons represented her available energy for the day, and that when the spoons were gone, that there would be insufficient physical, mental, emotional or social energy to function for the remainder of the day.

She then had her friend detail the events of her day.  When she referenced getting showered, a spoon was taken.  When she referenced putting on make-up, a spoon was taken.  Doing her hair?  A spoon was taken.  Cooking breakfast?  Another spoon.  Doing the dishes?  Another spoon.  Drop the kids off at school?  Another spoon.  By the time the morning routine was completed, very few spoons remained.  At that point the challenge and reality of decision-making became more evident.  Do you answer the phone at the expense of another spoon, or try to save energy to help the kids with homework after school?  Do you tidy the house, or take it easy in hopes that you will be able to make the family dinner?  To overstretch one’s self on a given day means feeling the effects of it and having fewer “spoons” available the next day.

While this theory isn’t scientific, many identify with the idea of having a limited amount of energy that has to be rationed in order to maintain any sense of staying functional.  This strategy is consistent with the scriptural counsel, “It is not requisite that a man should run faster than he has strength”.  My former roommate represented the struggle her husband faces in the image above, showing that he may start out the day with only two figurative spoons.

In addition to the pain and difficulty inherent in such conditions, those who personally struggle with such illnesses know the challenge and pain of interacting with those who cannot see or understand their conditions.  Because these illnesses are invisible, and because they do not go away, it is difficult for others to understand their struggle, to know how to act, or to make sense of these challenges that their family members, friends, church members or community members may be struggling with.

So, what should someone who wants to be supportive understand, and what can they do?

Understand and accept that the struggle is real

People struggle to accept and understand what they don’t see.  It is easy to doubt that a condition is real, and it is easy to forget, especially if you only see people on their good days when they appear to be functioning normally.  It is important to respect and trust your loved one enough to accept that their experience is real and valid.  Don’t assume that they are faking or that it is “all in their head”, and don’t assume that it will go away or that it must have gone away by the time you see them again.

Understand that this is a problem that you can’t fix

 

Many people are natural fixers.  They like problems that they can understand and provide solutions to.  When there isn’t a solution, it becomes uncomfortable to be around a chronic sufferer, and some individuals stay away, while others may redouble their efforts to find a solution.  They may end up offering proposed solutions that seem to imply that the sufferer is responsible for their continued pain, or they may make comments that come across as insensitive.  By accepting that you can’t fix the problem, you can stand supportively with your loved one in their pain, rather than seemingly standing against them and their pain.

Seek to understand by listening empathetically, and acknowledge that you can’t fully understand

Depending on the person and the relationship, it may be appropriate to ask about their condition.  In such circumstances, ask to understand, and listen in a way that helps them feel cared for.  Approach with an attitude of caring and curiosity.  Avoid saying “I totally understand” or “I know exactly what you’re going through”.  Instead try to acknowledge, “I can’t imagine how difficult that must be, but I’m so glad you shared that with me” or “That sounds really hard; I’m sorry that you have to experience that”.

There is great power in feeling connected to others.  When someone listens empathetically, the person being listened to feels supported, loved and knows that they are not alone.

Recognize that cancelled plans aren’t personal

Understand that limits on energy may make it unrealistic for some individuals to consistently make and keep social plans.  The friend I spoke with yesterday shared that she has begun to experience some social anxiety that peaks later in the day.  This has made it difficult for her to attend social events.  She now limits most social interactions to one-on-one visits in the mornings.  Be willing to assume that cancelled plans don’t reflect that a friend doesn’t value you, instead value the efforts that are made to set up and keep the plans that they do.

Respect boundaries

If a friend has communicated that they are limited in what they can do, respect those limits and boundaries.  If someone had a broken arm, you wouldn’t ask them to haul 50 pound bags of concrete.  Similarly, if someone has communicated to you that they have an illness or disorder that limits their social, emotional or physical capabilities, avoid asking or inviting them to do things that are outside their ability to reasonably function.  And rely on them to know what level of functioning is reasonable for them.  If they tell you there are things they cannot do, trust them.

There is a lot more that could be said about understanding or responding to loved ones with invisible illnesses.  And perhaps in the future I will write more about depression or pain disorders in this context.  Consider this post to be an overview with a lot of asterisks.  I tried to keep recommendations general, because everyone experiences illness differently, and their needs, levels of functioning, and paths forward will be specific to them.  But hopefully some of the information provided here will be helpful in inviting a little bit more understanding and a little bit more compassion.

King Triton, Pendulums & Authoritative Parenting

I have loved Disney’s The Little Mermaid for as long as I can remember.  I loved the music, the characters, and the story.  Part of Your World is still my go-to Disney karaoke song.  I became especially  sentimentally attached to The Little Mermaid at age nine, during my tomboy phase, after my great-aunt Debra gave me a Little Mermaid diary.  She said that it reminded her of me because I had red hair, loved to sing, and wanted to be something I wasn’t (again, tomboy phase).   I love the childhood nostalgia I experience when I watch The Little Mermaid, now as an adult.  But, as an adult, I’ve noticed a few things about the film that I hadn’t during my childhood.  And I have to admit that I am disappointed with some of the messages, the parenting, and the horrible logic occasionally demonstrated by the characters.

The following is an example of poor parenting and poor logic taken from a scene at the end of the film, right before King Triton restores Ariel to a human form to be reunited with Prince Eric.  I have recorded what is actually said in the scene, and in italics I have included how I interpret some of those lines when they are spoken.

King Triton: She really does love him, doesn’t she, Sebastian?

She really is infatuated with him, isn’t she, Sebastian?

Sebastian: Well, it’s like I always say, your majesty; children got to be free to lead their own lives.

Well, it’s like I am about to say for the first time, your majesty; teenagers with little life experience and who prove their lack of good judgment by selling their voice and soul to a witch in order to physically changes their bodies for a chance at attracting a man she has never met, should be free to make their own choices.  Sure, if you hadn’t gotten involved she’d be a sea slug in the witch’s lair or the entire ocean could belong to someone evil.  But, hey, let her make her own choices.

King Triton: You, always say that?

Sebastian: <looks charming>

King Triton: Well then, I guess there’s just one problem left.

Well, if I am to use the same caliber of logic as everyone else, then I ought to assume that infatuation is love, and consent to what my 16 year-old daughter wants rather than consider what is in her best interest.  But there is still one drawback that I’m willing to admit to.

Sebastian: And what’s that, your majesty?

King Triton: How much I’m going to miss her.

I am going miss my teenaged daughter after I change her into another species, send her off to marry a stranger I know virtually nothing about (and with whom she has never had a spoken conversation), especially since I will probably never get to see her again since we will live in different ecosystems.

Is it just me, or is King Triton not thinking this through very well?

It is interesting to consider how at the beginning of the film, King Triton’s disciplinary style was rather harsh.  Okay, extremely harsh.  He yelled at her and destroyed all of her valuables.  His parenting style in that exchange could be characterized as authoritarian (high control, low warmth).

However, by the end of the movie, as illustrated in the scene transcribed above, his parenting style has changed to be permissive (low control, high warmth), authoritarianism’s opposite.    Neither style is particularly healthy.  According to research, children benefit most from parents who are authoritative.  In this style, a parent has a high level of control, alongside a high level of warmth.

It is reasonable that King Triton, after recognizing that his authoritarian approach elicited rebellion and acting out, would want to change his strategy.  And logically, he would want to do the opposite of what had failed.  Unfortunately, he still wasn’t acting in the better interest of his child.

Think about it.  He just changed his sixteen-year-old daughter’s physical appearance and gave her his blessing to leave home and marry someone that she met three days ago and has never even had a real conversation with.  This is not healthy parenting behavior.

Similarly, many parents make the error of acting opposite of something that they know didn’t work–perhaps it didn’t work with another child, or perhaps it was hurtful to them when their parents used a particular parenting strategy or style with them.  So they swing from one extreme end of the pendulum to the other.  They wisely avoid doing what they understand doesn’t work, but end up inflicting a different flavor of hurtfulness by going too far in the opposite direction.  There is a need for wisdom and balance, rather than reactive, oppositional, or guilt-driven responses.

I realize that it would have made for a lame ending to the movie, but it would have been better parenting if King Triton and Ariel had had a heart-to-heart conversation and if there had been consequences associated with her reckless behavior.  Those consequences should not have been destructive to her property or their relationship as was the case in his earlier reaction.  But to have no boundaries leads to no safety.

Take-away lessons:

1. Don’t adopt a parenting strategy of  “always do the exact opposite of what hasn’t worked”
2. Strive to be an authoritative parent.
3. If your sixteen-year-old wants to marry an older man she just met, don’t finance and host a wedding the next day and then send them off to live on the moon.  It’s not good parenting, no matter what Disney movies might say.  Just because something makes a good story, doesn’t mean it leads to a happy ending.

Problem or Solution? Lessons from Fainting

During the second semester of studying Marriage & Family Therapy in my Master’s program I started to experience an interesting pattern.  I would randomly faint about once a month, each time early in the morning on the first Monday of the month.  The first time this happened I assumed that it was because I had gotten up several hours earlier than usual and hadn’t eaten breakfast yet.

However, when it happened the following month I was in another state, it was a little bit later in the morning, I was engaged in a different activity, and I had eaten breakfast.  But I assumed that my cold cereal breakfast simply hadn’t been substantial enough or that my body was adjusting to a much colder climate.

But the next month, when it happened again, I knew that my body had acclimated to winter and I had taken to eating especially hearty breakfast meals in response to the previous incidents.  That told me that something wasn’t right within me.  And so I finally decided to go and see a doctor.  I went to the university’s student health clinic and was able to see a doctor that day.

When I met with the doctor she asked some questions, checked my weight, and ran a few tests but ultimately said that there wasn’t anything discernible causing the issue.  She said I fit the profile of a “benign fainter”, saying that some people with a slight build can be more prone to fainting.  I was disappointed to not have a more concrete answer.  I wanted a problem that had a solution so that I could fix it!

I voiced my disappointment commenting. “Well shucks!  I was hoping to find out what was causing this problem.”  And the doctor’s response was, to me, very profound and impactful.  She responded, “Your fainting isn’t the problem.  Fainting is your body’s solution!  The problem lies in not enough blood getting to your brain and your body is solving the problem by getting you horizontal so that your bloodflow to the brain is least obstructed.”

When I heard her say that, a lightbulb went on for me.  What I had been learning in graduate school about systems theory took on a whole new meaning.  The “presenting problems” that often bring clients to seek therapy generally aren’t the core problems.  Usually they are symptoms.  And they have a purpose!  They are their bodies’ or their families’ ways of trying to manage underlying and unresolved problems.  I thought about how families often come in with one child designated as the problem, or what family therapists refer to as “the identified patient”.  But often, the child isn’t the really the problem.  Don’t get me wrong; their behaviors are problematic.  But often, that child is a “symptom bearer”.  The behaviors are evidence that something in their world, be it in their family world, or social environment, isn’t healthy.  Just as my fainting was ultimately a solution rather than a problem, often times a child’s acting out isn’t a root problem as much as it is their attempts to manage the distress in their lives and/or family.

That experience profoundly influenced the way I conceptualize problems, change and healing as a therapist when working with families, couples and individuals.  It has been over seven years since I met with that doctor, and I have not fainted since that day.  I like to think that a higher power orchestrated my string of faintings so that I would learn an important lesson that would help me to better understand, assess and provide healing to those who cross my path.

The Med Talk, Part Two: A Word of Caution about Meds

Since 2014 I have been working full-time as a therapist at a community behavioral health agency that also staffs a therapeutic nurse practitioner.  Most of the clientele I see come referred by their Primary Care Physician.  And they come to the initial intake session with the expectation of meeting with a med provider and receiving medication management.  Many are disinterested in or unaware of the potential benefits of counseling.  They simply know that they have symptoms that are disruptive to their functioning and that they want a medication that will make them feel better.

In our society, it is reasonable that many people will turn to a pill for relief.  Advances in technology and medicine have been amazing at allowing immediate gratification and immediate relief in many areas.  And it is human nature to want to avoid pain and discomfort.  However, (of course there is a however!) some issues cannot be resolved simply by fixing; they require healing.  And healing requires more than just a pill.

This post is written for the benefit of individuals who generally approach mental unwellness by only asking for a prescription.  I wish to offer them some cautions and considerations for maximizing their healing and minimizing risks for long-term limitations.

What Lies Beneath: Treating the Problem or Symptoms?

It is easy to confuse a problem’s symptoms with the problem itself.  In the case of a mood disorder such as depression, people generally seek a counselor or talk to their doctor because they are experiencing unpleasant symptoms of depression such as depressed mood, no interest in activities, issues with sleep, energy, and feelings of guilt or worthlessness.  Many do not give thought to why such feelings may be emerging, they simply know that they don’t want to feel that way.  And so they often turn to medicine to feel better.  However, much like filling in a gopher hole won’t take care of a gopher problem, taking medicine won’t help someone heal from trauma, relationship problems or an inability to manage a stress pile-up.

It might smooth things over for a while, but eventually, symptoms of an unresolved problem are likely to manifest themselves again.  Counseling can be a way to identify and focus on underlying problems that have caused symptoms to manifest.  In some cases, medication is an important part of treatment, but research shows that medication in conjunction with counseling tends to have far more positive and lasting effects than only relying on medication.  If you only want to consider medication for a mental health issue, you may be depriving yourself of both healing and better symptom relief.

Be an Agent to Act

A guiding principle in my life is to be an agent to act and not to be acted upon.  To me, this means I want to be in control of the decisions I make.  If a medicine is impacting me in a way that I do not feel like I am me, that is a problem. Some people take medications that are not a good fit for their body chemistry who may report feeling like a zombie or not being themselves.  To me, this suggests that that medication is not helping a person be an agent to act.  Some people take medication because they do not want to feel.  They want the medicine to act on them so that they don’t need to experience natural consequences or so that they can escape reality.  This is especially true when a substance is being abused.  Again, this person is not being an agent.

Medication used well will hopefully help someone be better connected to themselves so that they can act and make choices.  This is particularly valuable if depression or anxiety or another disorder has been acting on a person to the extent that they can’t act, as can be the case with someone with anxiety being paralyzed by fear, or someone with depression not having the energy or hope to act consistent with their goals.  When trying to distinguish between helpful substance use or detrimental substance abuse, I look at whether the substance safely helps a person be an agent to act, or if it causes them to hide from their agentive role.

Be an Informed Consumer

Some people allow fear to prevent them from considering using medications that could help them, while others may allow discomfort to keep them from carefully weighing out the pros and cons of medication before seeking a prescription.  It is important in all situations to make an informed decision about what you put into your body.  It shouldn’t be a thoughtless action.

If you are exploring medication as a part of your mental health treatment, it is important to approach your meeting with your prescriber prepared.  Be prepared with questions about various options, about possible interactions with other medications you may take, about possible side effects, associated risks, and about the course of treatment.

Beware of Side Effects & Interaction Effects

Most medications come with side effects.  These can be short-lived and minor, or they can be more disruptive than the symptoms that initially brought a person to seek treatment.  In some cases, these side effects can be life-threatening.  It is good to have a conversation with your provider about common side effects, and particularly about side effects that should be responded to by discontinuing the medication.

Another potential danger is interaction effects.  This refers to the effects of multiple medications interacting in a way that causes new problems, or that may amplify the effect of another medication unintentionally.  Certain kinds of medications should not be taken together.  Certain kinds of medications should not be taken if you drink alcohol or use illegal substances.  There are even certain medications that can cause problems if they interact with foods such as grapefruit.

Part of being an informed consumer is being aware of common side effects and interaction effects.  Interaction effects should be avoided and side effects should be considered carefully to determine if they are worth the benefit of the medication that caused them.  At times, medications can set off a chain of symptoms leading to wanting additional medications to treat symptoms of the original medication’s side effects.

Addiction Pending

There are certain kinds of medications that can be dependency forming.  Dependence is the term used to describe when the body has developed tolerance for a substances and when it experiences withdrawal in its absence; dependence does not always equate with addiction, but it generally leads to it and many use this terms interchangeably.  This can be especially true of opioids (Vicodin, OxyContin, Percocet, morphine, codeine), central nervous system depressants (Xanax, Klonopin, Valium) and stimulants (Dexedrine, Adderall, Ritalin, Concerta).   People taking medication exactly as prescribed are at risk of become addicted without even realizing it.

With many illegal drugs, the pathway to addiction starts with use, progresses to abuse, and ends up in dependence and addiction.  With legal, prescribed medications, the pathway to addiction often begins with use, evolves to dependence, and then leads to addiction and abuse.  When a person’s body develops tolerance to their medication, the prescribed dosage is no longer effective in relieving the pain.  And it isn’t an option for prescribers to continue to increase dosages indefinitely as tolerance increases.  When the prescribed dosage is no longer adequate, many individuals turn to illegal drugs because they are more potent, less expensive, and unlimited.

This can pose a serious health risk.  According to the National Safety Council, “Four out of five new heroin users started by misusing prescription painkillers”.  The director of the National Institute on Drug Abuse reported that “unintentional overdose deaths involving opioid pain relievers have quadrupled since 1999, and by 2007, outnumbered those involving heroin and cocaine.”  Not only can abuse of prescription drugs lead to addiction and abuse of more dangerous and illegal drugs, but more people die from abusing certain classes of prescription medications than from some of those illegal substances.

Because of these risks, many prescribers are hesitant to prescribe certain medications unless other options have been exhausted first.  An informed consumer should similarly be invested in first trying treatment options that are less likely to lead to dependence and finding adjunct treatment options to address the underlying problems.

Beware the Myth of the Magic Pill

Medication is a wonderful benefit and a marvel of modern medicine.  However, it is not a magic pill and should not be viewed as an automatic and universal go-to in the face of discomfort.  In many cases, medication is part of symptom management.  At times it may be the cure.  But more often than not, it will require sometime of the person taking it.  In mental health treatment, that something most often will involve counseling and possibly some changes in relationships or healthy habits.

An informed consumer and their medication provider will explore the source of their distress to determine if medication is an appropriate resource and for what period of time.  They should weigh out the pros and cons, the benefits and risks associated with a given medication, including potential side effects and the potential for dependence.  Informed consumers should follow a well-informed treatment plan with a projected end date.  And, when it comes to mental health care, more often than not, medication management services should be accompanied by counseling services.

The Med Talk, Part One: In Defense of Meds

 

I am going to approach this post as though I were writing a letter to someone who is resistant to the idea of using psychopharmacological medications but could possibly benefit from them.  Rather than approaching it from the perspective of a therapist addressing a client, I will write as though I were addressing a friend or family member. 

Dear friend,

You recently shared with me that you have been struggling with symptoms of depression and anxiety and that you have recently started attending counseling sessions.  And I wanted to say again and in writing that I think that you are amazing and I love and admire you and am glad that you were able to recognize that the ways you have been thinking and feeling aren’t you.  I am glad that you are seeking out help.  I know that doing so can be scary, and I admire and respect you for exercising the courage to act.

As I have thought back about that conversation, there has been something that you mentioned in our conversation that I didn’t comment on at the time, but want to share some thoughts on.  I hope that you don’t mind my unsolicited opinion.  You are welcome to disregard it if you feel so inclined.  The topic I wanted to share some thoughts about is medication.

You mentioned that you do not want to consider medication as an option.  You referenced friends who have had bad reactions, worries about becoming dependent on any kind of substance, and concerns that the side effects would be worse than the original problem.  And I respect and admire the way that you are thinking carefully and critically about the risks of taking medications.

Still, I do want to encourage that you also apply your careful and critical thinking towards a consideration of circumstances in which medication may be a helpful part of your support system.  That last sentence was a little bit vague.  Let me try to explain myself a little bit better.  First off, a disclaimer: I’m not saying that I think you should take medications.  But, I am advocating for considering the possibility.  And I’m not saying this based on what I know about you specifically.  This is advice I would give to anyone who says that they would never consider medication.  Because I know that there are many people who do benefit from medication, and that there are some who I would even say need it.  I’ll explain why I think and feel this way.

There are two scenarios in which I generally am in support of, and perhaps even an advocate of taking medication in the treatment of mental health.  I can best explain these through the use of two metaphors.  So, if you’ll humor me, allow me to explain why I believe medication can be helpful when it is used as a scaffolding or in a role similar to those of eyeglasses.

Scaffolding

A scaffolding is defined as “a temporary structure on the outside of a building, made usually of wooden planks and metal poles, used by workers while building, repairing, or cleaning the building.”  In an educational setting, the term scaffolding is used to refer to “a variety of instructional techniques used to move students progressively toward stronger understanding and, ultimately, greater independence in the learning process.”

In a lot of situations, individuals experience symptoms of depression or anxiety in response to stressful things going on in their lives, as a result of past traumas, or in reaction to negative thinking patterns and beliefs that have developed, often influenced by relationships and society.  These things, in turn, can elicit responses in the brain and body.

In these situations in which biological responses are the symptom rather than the root cause, enduring healing is most likely to be achieved by addressing that root cause.   BUT, that doesn’t mean that medication should never be part of the treatment plan.  In some cases, the symptoms have become so severe, that the individual is unable to function.  Or, they may be so limited by the symptoms of their depression or anxiety that it would be disruptive to engaging in therapeutic work.  In such cases, medication may be helpful as a scaffolding.

As the definitions above mention, a scaffolding is something that is temporary that facilitates building and growing, or, in the case of therapy, healing.  It gives someone the tools and the ability to do the work that needs to be done.

If symptoms are at a level of severity that it impedes general functioning, then something that gives a person enough reprieve from symptoms that they can engage in life and in therapy can ultimately be an investment in being able to do the work needed in order to not need medication anymore.

Corrective Lenses

As you have probably noticed, I am a glasses wearer.  I have been wearing corrective lenses since the first grade.  Without them, I would not be able to function well: I wouldn’t be able to drive, I wouldn’t be able to read signs, I wouldn’t be able to recognize people from a distance, and I’d likely accidently put myself into dangerous or embarrassing situations far more frequently than I do now.

I benefit from wearing glasses because I was born with deficiencies in my eyes.  I anticipate that this deficiency is largely genetic, as both of my parents wear glasses or contacts.  My vision isn’t something that can be improved through therapy.  But, by looking through corrective lenses, I can experience the world in a way that many people do naturally.  The lenses don’t change or fix my eyes, but they do change the way I perceive and am able to interact with the world.  They compensate for my deficiency.

Sometimes, medication can play a similar function to my glasses.  If the root of someone’s problem is biological, there is often a medication that can have a corrective effect that compensates for the deficiency.  It can help people see and interact with the world in a way that comes natural to many people, but that they feel removed from.  Mood disorders, for example, may have origins that are genetic, biochemical or hormonal.  In such situations, it may be helpful to use medication to compensate for deficiencies or disruptions in these processes.

Okay, so summary.  Are you still reading this super-long letter?  Thank you.  I know I can be verbose.  What I hope that you took away from this letter is this:

1. I love you and admire you and am happy you are seeking help
2. There are times when it may be appropriate to consider and talk witha professiona about the possibility of including medication as part of getting help:
   • When symptoms make it hard to function in life or therapy
   • If a problem seems biological at its root

Again, I don’t know enough about your individual situation to know if medication would be beneficial to you.  It might not be needed.  And there are always risks.  But I hope that you will allow yourself to entertain the option of medication as a potential part of treatment.  Think about it critically, possibly consult with a medical professional, and make the choice that you feel is best for you.  Thanks again for being tolerant of me in my unsolicited advice.  If anything I said has caused offense, please let me know and I will do my best to make things right.

Your friend,

Allison

The Med Talk: A Preface

As a therapist, I often interact with individuals whose functioning is significantly impaired by symptoms of depression, anxiety, bipolar disorder, or other disorders that can be heavily influenced (at least in part) by biochemical imbalances.  Accordingly, it is not uncommon to discuss the possibility of medication when co-creating a treatment plan with clients.  Many people presenting to my therapy office for help are in one of two camps as relates to medication.  And they make their views known without me ever bringing up the topic of medication.

Those in the first camp are eager (and sometimes overeager) to receive medications, confident in its ability to relieve their symptoms.  They see medication as a magic pill and they present to a primary care physician or psychiatrist so that they can have access to it and supposedly be done with it.

Those in the second camp are resistant to the idea of medication. They see it as a source of new and potentially worse symptoms.  They fear it will separate them from themselves.  Or they may fear that it will validate their diagnosis and confirm that there is a problem that they are still not willing to confront.  For any of a number of possible reasons, they don’t want to have to take a pill.

I wish to spend the next two blog posts inviting those in each camp to consider a few things.  To those who are overeager to use medication, and perhaps desire that medication be their only treatment, I wish to offer some warnings and invitations.  For those who are resistant to using medication, I wish to provide some context to consider so that the decision they make about treatment is an informed one.

And, before tackling this topic, I want to be transparent with my biases.  Here is where I stand: I have mixed feelings about the use of medications.  It depends on the person and the situation.  The following are a few beliefs I hold about medication (you’ll be able to read more about these thoughts and others in the following posts):

• I believe that medications can be a helpful and important element of healing, but that it generally isn’t a standalone cure.
• I believe that many can and do misuse and abuse prescribed medications in a way that is detrimental to physical and emotional health.
• I believe that for some, medication can help manage symptoms, allowing them space to heal.
• I believe that some people use medication in a way that disrupts or delays healing.
• I believe that for some, medication is essential in allowing individuals access to themselves and to healthy functioning.

So, let’s talk about meds!  I will post Med Talk, Part One: In Defense of Meds this Thursday, and Med Talk, Part Two: A Word of Caution about Meds next Tuesday.  Feel free to join the discussion by posting questions, sharing experiences, or providing insights.  Thanks!