Sunday, 28 December 2014

What to expect from an initial interview?

If it is the first time you have ever gone to see a psychologist, you might be wondering what to expect from an initial interview.  Here are some thoughts that might be running through your mind: What should I do to prepare?  Should I write some things down so I don't forget what to say?   What if my problems aren't serious enough to warrant seeing a therapist?  How will I ever be able to explain everything in just one hour?  What will the therapist expect of me?  All of these questions are very reasonable given the reality of walking into totally unknown territory with a complete stranger!

Actually, there are very few "rules or regs" when it comes to an initial interview.  Of fundamental importance is the understanding that everything you share is strictly confidential. You can bring notes with you if you want but this certainly is not a necessity.  Usually, the therapist's goal is to get as good an idea as possible of why you are there and what you are looking for.  While you need to take the lead in sharing what prompted you to call, after that, questions and information usually just flow from there.  As for covering everything, of course an hour will only allow you to share the tip of the iceberg, but if you proceed with further sessions, there will be lots of time to fill in the blanks. Don't worry about being at a loss for what to say.  Typically, therapists ask lots of questions in an initial meeting. They are trying to get a good fix on your issues and history in order to determine whether therapy is a good option and whether their expertise and skill is the right fit for you.

If you are one of those people wondering about whether your problems are serious enough to warrant therapy, stop right there!  Firstly, no one person's pain can be compared to another's.  Secondly, contrary to what some may think, the people who come to therapy are not necessarily those with the most serious problems. The truth is, people who seek out therapy are not those who are in the most distress, they are just not afraid to ask for help.

Sunday, 21 December 2014

If I take anti-depressant medication, am I a failure, weak or crazy?

I can’t tell you how many clients who have come to see me, started out believing that if they “had to” go on anti-depressant medication, it meant that they were weak-willed, crazy or had failed in some way.  I consider this to be tragic.  It is hellish enough to experience the depths of despair without having to add to it guilt about using medication as one means of coping.  One of my colleagues commented that when her clients felt like they were the only people in the world who ever had to take anti-depressant medication or anxiolytics (i.e., anti-anxiety medication), she would point out that the pharmaceutical companies were not getting rich due to a lack of business; and that they probably would be shocked to learn how many people they knew who were on medication but simply not broadcasting it!   

As a psychologist, my work is to help people to better cope with their problems.  I am pretty conservative when it comes to medication.  If a client is still able to get out of bed in the morning and is not at risk of harming themselves, harming someone else, losing their job or neglecting their children, my first line of attack is usually to work with them in order to see whether therapy (and lifestyle changes such as nutrition, exercise and good sleep hygiene) can improve their functioning.  However, experience has taught me (and I am so glad that I was not rigid about this) that even when people are able to muster enough strength to get through their day, this does not mean that they are living with any quality of life.  People can suffer brutally inside without anybody knowing. Sometimes, not even a parent or spouse know how much of a nightmare every day is for them.  

There are young people and old people alike whom I have worked with who after going on medication were far better able to make use of psychological assistance.  They had more energy;  they could think more clearly and medication took the edge off their symptoms just enough to enable them to better access their already existent resources.  This is when medication truly is a critical part of effective treatment and an excellent complement to therapy. Medication though highly used is still very much stigmatized.  Few have a problem taking medication for diabetes or high blood pressure and yet, when it comes to psychological problems, many of us believe that we should be able to handle these problems ourselves or we must be weak-willed in some way.  In general, I believe that people need to be a little bit more humble and a lot less judgmental of themselves and others about using medication to address psychological problems.

I have met few people who want to be on medication.  It is always a weighing of the scales.  Do the benefits outweigh the drawbacks?  The research is clear though.  If your depressive or anxiety symptoms are severe enough to warrant medication, those who go on medication and also do therapy show better long-term gains than those who use medication alone.  The choice to go on medication rather than being viewed as weakness can be understood as an act of self awareness.  The person has come to understand that one of the several routes to wellness is psycho-pharmacological.  There is no shame in making this choice.  In fact, it can be experienced as a act of empowerment and strength to know if and when it makes sense to take this step.  As long as people are also working hard to develop better coping skills, make lifestyle changes and decipher what has caused their distress in the first place, taking medication to treat depression or anxiety most definitely falls under the category of sound judgement and good coping!

Sunday, 14 December 2014

If I go to a therapist, will they make me take pills?

As previously mentioned, psychologists do not have a medical degree (here in Manitoba) and so they are not able to prescribe medication.  If a psychologist thinks that you need medication, they will likely get your permission to contact your physician so that this option can be discussed.  While I cannot speak for all psychologists, I do believe that most of us are conservative when it comes to recommending medication.  After all, we are in the business of helping people to learn better coping skills.  Unless a client is seriously suicidal, unable to get out of bed in the morning, incapable of performing their job and/or compromised in their ability to parent, a psychologist will often start by trying to assist by using talk therapy.  If therapeutic attempts fail because the individual is too distressed to be able to think clearly, remember and/or process information, a psychologist may suggest that medication be used in addition to counselling.  Even though they cannot prescribe, many psychologists know quite a bit about how different medications impact as they often end up seeing people who are on medication more regularly than a person's prescribing physician would.

Sunday, 7 December 2014

What is my job as a client?

If you are naive to therapy, you may be wondering what your job is as a client.  The therapeutic relationship is an alliance.  The therapist has the important role of being a facilitator, advocate, coach, challenger, questioner and/or interpreter.  You, however, are the only one who can make change happen and give birth to new beliefs, attitudes and behaviors.  Interestingly, researchers in psychology have found that if you have a skilled therapist, the single most important factor that
determines therapy outcome is how motivated you are to change!

Some people come to a first session clear about what they want.  For others, the therapeutic experience itself is a journey of discovering why they are unhappy or distressed.  You do not need to know everything about why you are there.  In fact, typically, as the therapeutic process unfolds, new questions come to light and new frontiers of exploration present themselves.  It is rare that people have only one problem. We are too complex.  Human beings and human problems are multifaceted.

What is required of you as the client?   Therapy entails a tremendous commitment on your part of time, energy and money.  Remember, this is your emotional and mental well being we are talking about here.  Of course, engagement is going to be a tall order. To benefit from therapy, you need to be willing to tell your story, share what you think and feel and be as honest as you can in the process. Typically, the more you reveal, the more a therapist will be able to help you. You need to be willing to trust, to be open and to be challenged.  Also, it is important that you play an active role in providing feedback so your therapist knows how you are being affected by what happens in the therapy room.  The therapeutic relationship is an ongoing dialogue. You may be called upon to be an active participant in identifying, monitoring, modifying, excavating, polishing, practicing, learning, unlearning and soul searching. Last but not least, you need to be willing to change.  This is no small feat.  It takes time to achieve and a whole lot of bravery.  

Sunday, 30 November 2014

What is the difference between a psychologist and a psychiatrist?

Many people get confused about what the difference is between psychologists and psychiatrists.  The difference rests primarily in the fact that psychiatrists have a medical background, whereas psychologists do not.  As a result, here in Manitoba, only psychiatrists can prescribe medication.  

Psychiatrists first train in general medicine and then specialize in psychiatry. While some psychiatrists do ongoing therapy with patients, more and more psychiatrists are devoting their time primarily to doing psychiatric evaluations in order to determine diagnosis and what, if any medication, is recommended.  

Clinical psychologists, on the other hand, spend their entire training learning how to assess psychological problems and how to do therapy.  Their practical focus is on doing assessments, therapy or both.  A family doctor is most likely to refer to a psychologist when a patient needs therapy, whereas, they are most likely to refer to a psychiatrist when there has been difficulty determining what the correct diagnosis is and/or when there have been problems sorting out what medication would work best.

Sunday, 23 November 2014

How do I find the right therapist?

I was going to entitle this entry "How do I find a good therapist?" but then changed the title realizing that you could find a very, very good therapist...a competent and knowledgeable therapist... but that would not necessarily mean that he /she was the right person for you.

It is always helpful when there is someone in your social network who can highly recommend a therapist based on first hand experience.  Interestingly, because birds of a feather flock together, it is likely that if a particular therapist helped a friend of yours, that therapist's style and orientation will be a good fit for you as well.  If health professionals are not a part of your social network and if you don't know of anyone who knows someone, do your research.  With the internet these days, there is access to all kinds of information.  Most therapists provide information about their background, orientation and areas of expertise.  Take those sites, though, that rate therapists with a grain of salt. While if there are many entries, you can usually get a sense of the therapist you are reading about, such sites also attract people who want to vent and complain!  If you don't know someone in the field, choose someone with education and experience. While we all know that credentials are not the be all end all, when you do not know the network, it makes sense to look for someone who has done both quite a bit of study and also has experience under their belt. As regards psychologists, here in Manitoba, in order to become a registered psychologist, the criteria are strict. Unlike in some provinces, you have to have a PhD which typically means years of graduate school and hundreds of hours of training with highly experienced senior psychologists.

It is not enough that a therapist be competent.  You need to feel a sense of connection and rapport that makes you feel comfortable, safe, and heard as well as a confidence that this person can help you to change and to be more true to yourself.  Some criteria used to determine whether a particular therapist fits the bill are similar to those one might use in choosing a friend (e.g., Can I trust them? Do they understand me?  Do they listen to what I have to say?  Do they show me respect?).  Then again, some criteria used to determine whether a therapist can truly help are quite different from those that would be foremost in choosing a friend.  For example:  Can they be objective?  Do they push me to see things from a different point of view?  Do they challenge me?  Do they know things about change and about how the mind-body works that I do not?  You need to listen to your own inner voice for this information and trust it.  Your own instincts are even more important than other people's opinions or how popular that therapist is.

Experienced therapists understand that they are not right for everyone and the confident therapist is one who is not going to be put off if you decide after the first session that for whatever reason, there isn't a match. So don't be afraid to speak your mind and call it quits after an initial interview if it does not feel right. You don't have to give "good reasons" to yourself or anyone else.  You may not be able to articulate may just know that this person is not right for you.

Lastly, remember that a therapist is not a friend.  It's a one way street relationship where they are there to listen to you.  While I would never want to work with somebody I did not like, my primary purpose is not to like them or to have them like me, it is to help them!

Saturday, 8 November 2014

Can people really change?

For me, therapy has always been about the business of change.  If therapy does not result in an individual being able to manifest significant changes in their life, what is the point of all that talking and all those great insights?  Actually, many people do not realize this but insight does not occur using intellect alone.  To gain real insight, one has to experience the “aha” not just with the head but in one’s very guts and in the heart at a profoundly deep emotional level.  That is why it is possible to be very smart, grasp all kinds of new ideas about oneself and yet not change at all. That is why self help books continue to be a billion dollar industry.  Some clients laugh when I tell them that real insight is kind of like an “emotional throwing up”.  Something you thought was true is no longer and there is a whole new knowing that occurs at a gut wrenching level; old beliefs have to be discarded and then you have a piece of the puzzle that you never had before.  That’s insight and without it, real change, lasting change, does not happen.

Can people really change?  I think so.  No, I know so.  How?  Because I have seen it over and over again.  There is no way I would have stayed in this business if that were not the case.  Clients often wonder out loud how it is that I can do what I do...talking with people all day about their pain and their problems?  It is because I am in awe of the changes that I see people make, sometimes even jealous of their transformation and the rewards of witnessing such change is beyond inspiring. 

The reality, though, is that real change is hard and it is human nature to stick with what is familiar no matter how painful life may be.  It is because of this that most people do not come to see a therapist and do not make significant changes in their lives until they have endured a great deal of turmoil. Going to see a therapist is often a last resort after people having tried everything they know and have come up empty handed.  That is why, as clich├ęd as it may sound, crisis can indeed be breakthrough.  Some have called it “breaking open”.  In fact, significant change is not likely to happen without it.