all 179 comments

[–]AdrianaAlejandreLMFTAdriana A. Alejandre 11 points12 points  (5 children)

Hi! I am Adriana Alejandre, a trauma and anxiety therapist trained in EMDR (and other approaches but we will leave it at that). My practice is in Porter Ranch-Los Angeles, CA. The same regulations about diagnosing applies here too. I am excited to be here. What can I answer for you? :)

[–]BridgetteBane 0 points1 point  (4 children)

Thanks for the AMA! My understanding of EMDR is that it related to traumatic events- is this accurate? Are there benefits for someone who just has general anxiety and depression?

[–]therapylydLydia Kickliter 2 points3 points  (2 children)

EMDR is commonly used for trauma, but the definition of trauma can considered more broadly. Oftentimes little "t" traumas over the course of a person's lifetime can set into motion a way of dealing that may not be necessarily helpful (anxiety or depression possibly). An EMDR therapist will help their client identify problematic memories related to a negative belief. Helping to reprocess those memories may free the individual from the negative belief and help alleviate some anxiety or depression. Positive belief systems can replace the old negative ones which is very empowering! As an example, a person may have experienced an embarrassment in their formative years. That simple embarrassment can get lodged in the brain in a way that is counterproductive and this same person can believe that they are not good enough or that they don't fit in somehow. If this same person can rework that belief system, they can start to feel better about themselves. So, in summary it really depends on the what I would call the root cause of the issue. Hope that helps!

[–]BridgetteBane 0 points1 point  (1 child)

Very informative, thank you!

[–]therapylydLydia Kickliter 0 points1 point  (0 children)

You bet! Glad to be of help :-)

[–]AdrianaAlejandreLMFTAdriana A. Alejandre 0 points1 point  (0 children)

Hi BridgetteBane, just got off work so I do apologize for the delay. Lydia is right. I have used EMDR with a wide range of issues people report. It was first discovered after Francine Shapiro (the founder of the technique) accidentally after she was walking through a park with upsetting thoughts and they had suddenly disappeared. Being a grad student she did some research and discovered the bilateral stimulation protocol. She studied it with people diagnosed with PTSD, but going back to your question, it is now used for anxiety, depression, sleep troubles, test performance, and so much more. I have seen some amazing things happen after just one session. It's mindblowing. So yes, there are benefits. Having a really good relationship with the therapist helps out a lot, too. I think it decreases symptoms quicker, from what I have experienced with my clients. Thanks for the question! :)

[–]drlisakbakerLisa Kukkamaa Baker 11 points12 points  (4 children)

Hello! I'm Dr Lisa K. Baker, a licensed clinical geropsychologist, which means I specialize in the issues that older adults face. I've worked in VA hospitals, nursing homes, and hospice settings, and now reach out to older adults in my private practice, especially caregivers of those with dementia. What questions do you have for me?

[–]DrAmberLydaAmber Lyda 2 points3 points  (3 children)

I have family members with dementia and often see therapy clients whose family members are diagnosed during the course of our treatment originally focused on other issues. Can you share some of the top pieces of advice you offer to families with a member recently diagnosed?

[–]drlisakbakerLisa Kukkamaa Baker 4 points5 points  (2 children)

Hi Amber, thanks for the question. A dementia diagnosis can be pretty terrifying, both for the person receiving the diagnosis and those that love them, and both sides might need help coming to terms with it and coping with what is to come. So that would be my first piece of advice, is recognizing that you also need support for yourself as you are supporting your family member. This is new territory for all of you to navigate, so give yourself grace and space for the time it will take you to adapt. And give yourself and your loved one room to grieve the losses that will come along the way, even the losses that come with the diagnosis, as it changes your expectations of the future.

Educate yourself as much as you can about the disease and how it will affect your loved one's cognitive functions and their body overall. A big thing I've noticed is that because of a lack of information about the disease itself, oftentimes there are misunderstandings and unnecessary frustration...for example getting annoyed because someone won't make a decision, not realizing that the deterioration of the frontal lobe of the brain has taken away their ability to make decisions, even simple ones, or feeling frustrated because they can't remember simple things you just told them but can remember their kindergarten teacher, like maybe they are "faking it," but that it is due to the nature of how memory works and is lost. As their disease progresses, there will be changes, and the more you know, the easier it will be to come up with ways to adapt. Teepa Snow has a great series of videos on YouTube that help to understand the disease from the affected person's perspective.

At all times maximize their independence and support them in maintaining meaning and purpose in their life. From the beginning, you'll have to navigate how much assistance to give and when to give it. As much as you can, talk about this as early as possible to find out how they would best like to receive support. Sometimes you have to get this information in indirect ways, but if you have your goal as supporting their independence as much as is safe and possible, then you're going in with the right perspective.

There's so much more I could say (and want to go on and on!!), but I'll end with pointing you to the Alzheimer's Association (alz.org) as an amazing resource for information and support at every stage of Alzheimer's (just one type of dementia, but the most common type), and a lot of it applies no matter what the dementia diagnosis is. For further information for family members dealing with a recent diagnosis in someone they love see: https://www.alz.org/care/alzheimers-accepting-diagnosis.asp

[–]DrAmberLydaAmber Lyda 1 point2 points  (1 child)

Thank you so much, Lisa. I can relate to alot of this. Especially the pieces about not being sure if they are "faking it" or not. It's crazy because parts of their old personality shine through, tricking you into thinking they are more "with it" than they really are. We've struggled to find reliable in-home caregivers to support my family in taking care of my grandparents. Are there any good resources on how to screen people?

[–]drlisakbakerLisa Kukkamaa Baker 1 point2 points  (0 children)

Yes, when their personality makes them seem like the person you've always known, it can be confusing to know how to take the stuff that doesn't feel like them. Some people can also be good at "covering" quite well pretty far into the progression of the disease, especially in kind of "rote" social situations.

As for finding a caregiver, this is a common frustration. There is such high demand for caregivers, and growing every day, and inadequate supply. The three main factors that come into play when hiring someone: cost, skills, personality. I think it's important to make sure you are balancing all three of these, and not overly focusing on any one of them. Here is a very comprehensive resource for finding a caregiver privately:


What I would add to that is during the interview process, giving some of the common scenarios that come up with your loved one and asking them to give examples of how they would handle it, so that you can get a sense of how much they "get it" when it comes to dementia care. Do they know how to diffuse a power struggle? Can they discern when the truth isn't helpful (for example telling someone over and over that the person they're talking about is dead)? Can they handle the trickier situations you've dealt with your loved one with kindness and patience?

I hope you find caregivers that give you peace of mind that your grandparents are in good hands!

[–]DrKevinHydeKevin Hyde 9 points10 points  (10 children)

Hi everybody! I'm very excited to be doing this since I'm a long time Redditer, but on my main account I'm more of a lurker and occasional commenter. My name is Kevin Hyde and I'm a Licensed Psychologist in Florida. I just opened my private practice a few months ago and I see patients both in person and online. My specialty is helping people cope with daily stress and anxiety, especially pertaining to family and children. I also work with kids ages 5-11 who have behavior problems at home/school, and those with ADHD. Looking forward to helping however I can! What questions do you have for me?

[–]Mr_Piggens 1 point2 points  (2 children)

What methods/techniques could an adolescent do to cure a (probably very prolonged for most cases) inability to go up and initiate a conversation with someone they are attracted to / infatuated with, probably due to anxiety (about the fear of the outcome, etc.)?

[–]DrKevinHydeKevin Hyde 1 point2 points  (1 child)

Hi Mr_Piggens, That's a great question and it likely applies to a great number of teenagers... I know it certainly applied to me! If I were working with someone like that, I would have questions about if there was anxiety generally around people, or if it was restricted to individuals to whom they were romantically attracted. If it was just the latter, we'd probably work on expectations.

One helpful tool when having a fear of the outcome of a situation is Worst, Best, Most Likely. Ahead of time you consider what would be the absolute worst case scenario. What would the situation look like? How would you feel? What thoughts would you have? And then, if that worst case scenario came true, how would you respond? What would your life look like in 1 day, 1 week, 1 year? Then you run through the best case scenario, and then you consider what is the most likely outcome of the situation. Anxiety has 2 components: that a situation will be scary/overwhelming, AND that I won't be able to handle it. The "how would you respond" and "what would things look like over various lengths of time" help you to recognize that you actually do have the resources to handle even the worst case scenario, and that it will likely be short lived. The most likely outcome helps you to not be completely wrapped up in the worst case.

So many people have a problem with expectations when it comes to dating. Specifically, we place extreme importance on things like asking someone out or going on a first date. Those high expectations that things need to go perfect put unbelievable pressure on us, which ironically enough means that we're more likely to either avoid it altogether, or to foul it up when we're in the situation! At it's most basic level, romantic relationships are 2 people that like spending time together. Best friends, but with kissing and stuff. Most people don't ask random strangers to be their best friend, right? Those things happen organically. It starts with a random conversation over some shared interest. That leads to exchanging numbers and further get togethers until you're eventually BFFs. That's sort of how I help people change their thinking about dating. Talking to a boy/girl you're attracted to is no different than talking to a boy/girl you're friends with. It starts with a conversation. If you're in school, find a way to ask a question about an assignment from class. Ask about how the weekend went. You want to have the expectation that you're simply making contact, not that you're going to get a date or a boyfriend/girlfriend. Once there have a been a few small interactions, many people find that it's not quite so scary because they haven't been rejected like their brain told them would happen.

The best way to cure anxiety is through what we call exposure. What that really means is practice. If you set very small goals for yourself and practice talking to people you're attracted to, you help build evidence that you can handle those situations. For example, it might even start with talking to random people you're not attracted to, and then to friends of your romantic interest, and then actually your romantic interest. Keep building those goals up until you're asking someone on a date. One way therapy is helpful for this process is through providing support if the worst case scenario happens. If you have a support system of friends you can debrief with, or if you're confident in your ability to overcome a negative outcome, then it wouldn't be necessary in this case to have a therapist involved.

TL;DR - Lower expectations for the interactions with people you're attracted to (e.g., just having one conversation or asking one question). Practice doing this until you're comfortable asking for a date.

[–]AnonymouslySuicidal 0 points1 point  (0 children)

Piggy backing on the question

If 99% of social situations don't give anxiety to someone, but a very few do, like "going to work" (as in: actually opening the door at where you work, and walking through that door), what would be a good way to do exposure therapy?

(Considering that to do exposure the person needs a job, but cannot keep one because they can barely handle the everyday stress of having to walk through that door/get to work)

[–]DraconisLee 0 points1 point  (6 children)

Hello, are there efficient ways to cope with daily stress? Or it varies from person to person?

Do daily stress harmful? How so? Can it be prevented?

[–]courtneyglashowLCSWCourtneyGlashow 1 point2 points  (4 children)

Hi! I know you asked this to Dr. Kevin Hyde, but I figured I could offer some advice as well since I see a lot of clients who experience stress. Stress does vary from person to person. For example, take two students who have an exam coming up. One student may feel very stressed and feel the need to study every minute of every day leading up to the test. While the second student may not feel as stressed about this exam so they study one hour each night before bed. Everyone perceives things differently- especially stress.

If you are experiencing daily stress then that can feel very overwhelming. That can negatively impact your physical and mental health. There’s a lot of research out there on how stress can increase your likelihood of having a chronic illness.

It is hard to avoid stressors in your life. But you can learn to manage your stress levels.

There are multiple ways to help decrease your stress. Again, everyone is different. But some things that people find helpful are going for walks, exercising, taking deep breathes, practicing guided meditation, yoga, etc. You would need to find what works for you. A therapist can help you figure this out as well.

I hope that helps!

[–]DraconisLee 1 point2 points  (3 children)

Thank you for your answer! And also, when a person feel stress (and snap or something), how can they keep the feeling in control? So as to not affect their loved ones around them negatively or not lead to quarrel?

[–]DrKevinHydeKevin Hyde 4 points5 points  (0 children)

Hi DraconisLee! Everything Courtney said is spot on for dealing with daily stress. I just wanted to add some information about the harmfulness aspect. Dr. Kelly McGonigal, a health psychologist, has done a lot of interesting research on the effects of stress. The most interesting (and useful) thing she found was that the stress itself was not the factor linked to negative health consequences. Rather, the PERCEPTION that stress was HARMFUL led to the health issues. People who experienced high levels of stress but perceived it as meaningful didn't have the same negative outcomes! For example, think of a time in your life when you experienced the most personal growth. Was it easy, or stressful? For most people growth involves going outside their comfort zone so they answer that they did experience stress in those moments. If you're interested in learning more you can read The Upside of Stress by Kelly McGonigal, or watch her TED talk here: https://www.youtube.com/watch?v=RcGyVTAoXEU&t=543s

[–]courtneyglashowLCSWCourtneyGlashow 0 points1 point  (1 child)

No problem! It's what we are here for. :)

Lots and lots of practice! You will need to find what helps you feel less stressed and to relax. You can then practice this a few minutes daily. Even when you aren't feeling stressed. So that when the time comes and you really feel like snapping at someone- you are able to take that deep breath and walk away/ distract yourself/ challenge your thoughts and behaviors etc.

It is easy to take our anger out on others when we are feeling stressed and overwhelmed. The first thing to do is notice you are snapping at a loved one. Just noticing this is a big step. Once you notice what you are doing and that it is coming from an unrelated stress then you can really start to change your thinking and behaviors. If you notice you are about to snap at a loved one then that is the time to do one of your calming techniques. It's also okay to tell a loved one "hey, I need a minute before we talk about our days. I've had a stressful one."

[–]DraconisLee 0 points1 point  (0 children)

Thank for your response. It's very helpful!

[–]courtneyglashowLCSWCourtneyGlashow 0 points1 point  (0 children)

Hi! I know you asked this to Dr. Kevin Hyde, but I figured I could offer some advice as well since I see a lot of clients who experience stress. Stress does vary from person to person. For example, take two students who have an exam coming up. One student may feel very stressed and feel the need to study every minute of every day leading up to the test. While the second student may not feel as stressed about this exam so they study one hour each night before bed. Everyone perceives things differently- especially stress.

If you are experiencing daily stress then that can feel very overwhelming. That can negatively impact your physical and mental health. There’s a lot of research out there on how stress can increase your likelihood of having a chronic illness.

It is hard to avoid stressors in your life. But you can learn to manage your stress levels.

There are multiple ways to help decrease your stress. Again, everyone is different. But some things that people find helpful are going for walks, exercising, taking deep breathes, practicing guided meditation, yoga, etc. You would need to find what works for you. A therapist can help you figure this out as well.

I hope that helps!

[–]TherapyNTNicole Tableriou 8 points9 points  (15 children)

Good morning again! If you have any questions on mental health you can shoot them my way. I am Nicole Tableriou, a Licensed Chemical Dependency Counselor and a Licensed Professional Counselor Intern in the state of Texas. I work at a psychiatric hospital and detox center providing therapy to civilians and soldiers. So, what questions do you have for me?

[–]orioctopus 2 points3 points  (7 children)

Where do you think the defining line is for referring your client to drug rehabilitation vs. progressing with talk therapy?

[–]TherapyNTNicole Tableriou 3 points4 points  (4 children)

I don’t see active users in private practice. If a client is still using I refer to a detox center, since abruptly stopping a substance can be deadly (especially alcohol and benzos). In general I believe if your life has become non-functional you need more intensive treatment. That can be inpatient or outpatient. Many people are unaware of intensive outpatient programs that are available if you can still function in your occupational and social support systems. They typically are 4-6 hours daily but you sleep at home. One on one talk therapy once a week on top of that is a great solution most people are unaware of.

[–][deleted] 2 points3 points  (3 children)

How in the heck does anybody besides the homeless and filthy rich go to those? I imagine you see people from all walks of life, so do normal folks just not do this, or do their spouses do all the work in the meantime? It seems a bit crazy to pay for something like that and not be able to work the whole time.

[–]Daniela-P-CounselingDaniela Paolone 1 point2 points  (2 children)

It is understandable to think that these programs might be out of reach, but insurance can cover the cost of these programs or partially cover the expense. Also some treatment programs, both inpatient and outpatient have some sort of financial assistance option. They may also have been awarded a grant for the work that they do, and that money could also go towards covering some of the expense involved. Either way though it means looking into what resources are available in the area and contacting insurance where case workers could help in doing some of that legwork in finding the right type of treatment program for what is needed.

Out patient is probably more manageable for those who are able to work and function each day without safety or health concerns related to their substance use. That offers more flexibility in managing the work schedule and treatment program options (which often have a few different cohorts who come in at different times of the day). Do you have any other questions about this Megadumpukechute? I hope this helped answer your questions

[–][deleted] 1 point2 points  (1 child)

That makes sense. So outpatient tends to be just a couple hours, not all day?

Only other thing I'm confused by is how insurance can pay for it if you don't work, since then you lose insurance. But if you can do evening treatment then that isn't a real problem.

Do you ever feel like the bigger issue is how society treats substance users rather than the use inherently being abusive? Like if the same use was done in a society that approves of say, day drinking, it wouldn't be as harmful to the individual?

[–]Daniela-P-CounselingDaniela Paolone 0 points1 point  (0 children)

Well outpatient hours vary based on which treatment program someone is a part of, but yes there are patients who continue to work and then they go to outpatient treatment in the later afternoon to evening. There has been more efforts with treatment programs to offer more options to patients so that they can get the support they are looking for that works with their personal schedules.

I would say that the way society in general perceives and treats substances abusers (which can be abusive like you say) can play into greater stigma of painting people with a broad brush. And this unfortunately can lead those with addiction to not seek help, for fear of being judged.

My feeling about substance use, is more about concern for the person who is using. How strongly will their drug use impact their mental, emotional, and physical health? And also how is their addiction impacting those around them? I personally feel like the substance use is abusive on the body because it was not designed to take in these foreign substances. And then there are the friends and family. Their interactions with their loved one with addiction can be stressful, inconsistent, and hurtful because the dynamic of the relationships can change and become more strained.

And to your last question, I think that regardless of the substance, (even if society sees it as within what is considered okay behavior) anything in excess or anything that needs to be consumed to get a high and get through the day is harmful. That tends to lead to the standard path toward addiction which is where the person builds a tolerance to the amount consumed, and so they need to ingest more and more of that drug to get the same effects to get high. I hope this answers your questions and that the ideas I share here make sense. Please let me know if you have any follow up questions.

[–]heather_mckenzieHeather McKenzie 3 points4 points  (0 children)

Hey orioctopus, I just wanted to weigh in on this, because my situation is a little different than TherapyNT. I do see active users in private practice. For me the line is about the frequency, amount, and impact of the use. I work with people who use substances more than they want to, would like to stop, and are committed to learning how. At the same time, their lives are not in total chaos and their physical safety (or that of their family) are not in harm's imminent way. We can work on some new reduction strategies and alternative ways of coping with the things that drive the substance use. But this is where I find the line. If safety issues are of great concern, if the consequences of their use are putting their stability in jeopardy, or if we have worked together for some time and they are not making progress or implementing some of the reduction plans, I will suggest discussing something beyond just talk therapy. I should note that I practice Dialectical Behavior Therapy (DBT) and that particular treatment method is laser focused on reduction of harmful behaviors, so it offers a little bit of latitude to deal with things like substance use, self-harming, suicidal thoughts, etc., in a private practice setting.

[–]tisaaccastroT. Isaac Castro 1 point2 points  (0 children)

Thank You for the question. In my experience, If the client is willing, I am willing to make a drug rehabilitation referral immediately. It is an option for clients to do both 'drug rehabilitation and talk therapy.' There are sometimes multi-interdisciplinary teams that work together to provide a flow of treatment that includes talk therapy and drug rehabilitation. There are also Co-occurring disorder options for treatment of both. The defining line, for me, will both be safety and effectiveness.

[–]DraconisLee 0 points1 point  (3 children)

In your opinion, is providing therapy for soldiers any different from other civilians?What types of soldiers are your cilents?

[–]TherapyNTNicole Tableriou 2 points3 points  (1 child)

I personally feel it is different, primarily because most civilians have a choice to leave a job if it is too stressful. Those in the military not only don't have that choice, but the very nature of their jobs often feeds any emotional issues they may be experiencing. My soldiers are those suffering from PTSD, suicide attempts, and substance abuse. They are all active duty (I am very close to Ft. Hood). In addition, the nature of the military is to operate as a unit, so individual issues are often pushed to the side for the good of the whole.

[–]DraconisLee 1 point2 points  (0 children)

In that environment ironment, how is the army's view towards therapy?

Are the soldiers actively seeking for help? Or just going since they has been told? I saw some people suffering some form of mental health yet they avoid doctors or therapists. So wonder if that happen in army as well

[–]tisaaccastroT. Isaac Castro 0 points1 point  (0 children)

Hi DraconisLee - In my experience, like with other cultures, even within the culture of "soldiers" there are differences and different circumstances. Providing therapy to soldiers, for me, has been less based on treating a soldier and more so treating a person that has the experience of being a soldier (among other experiences). That approach is similar to how I provide therapy to other civilians. However, the processes of military seem to come up in therapy as excellent ways to emphasize useful traits of resilience and survival. And in some cases, there are sacrifices that were made that make treatment unique to soldiers that are unique to soldiers.

[–]Dragonnidh 0 points1 point  (2 children)

What would be the best way to get help for depression and almost daily suicide thoughts without me being seen as a crazy, mentally ill person from the people around me ?

Do I just go to the nearest therapist and tell him that I need help ?

[–]DrOsabenCarol O'Saben 1 point2 points  (0 children)

Dragonnidh, I am sorry to hear you are struggling so much and I do hope you will find a therapist in whom you can confide. You truly do not have to feel this way and therapy can, and does, help.

Regarding what those in your environment will think....I think we often fear our friends/loved ones' reactions will be worse than they actually are. I can't guarantee no one will think differently of you if you confide your concerns, but in my experience most people care more about their friends/family than about that person's diagnosis. And if this is something you are concerned about, you can certainly talk it over with a therapist to identify what would be the safest way of talking to your friends about your inner struggles.

I encourage people to look for a therapist in their area by using the Therapist Finder in Psychology Today and reaching out from there. But if you ever feel like you might act on those suicide thoughts you are having, I would urge you to call the National Suicide Prevention Helpline (1-800-273-TALK) or go to your nearest emergency room. Some hospitals have mental health professionals available to speak with individuals in crisis at the hospital and then they can help get you connected to a therapist. Take good care!

Edited to add: I recognize that lots of people have suicidal thoughts without having any intention to act on them, so please don't hear me saying that I think you are suicidal. I do think that having suicidal thoughts is an indication of how much pain you are experiencing and I do hope you can seek help for that.

[–]Daniela-P-CounselingDaniela Paolone 1 point2 points  (0 children)

Thank you for asking this question because many people have the same worry Dragonnidh. If you live in the U.S. you can do a google search for therapists in your area. There is an online directory called Psychology Today and you can do a zipcode search and search by keywords like depression and anxiety and so on. If you find a therapist there, their contact information is listed so you can call them and share with them what it is you want to work on. And yes just talking to them and letting them know you are looking for help is a great place to start. I hope this helps. Do you have any other questions that come to mind?

[–]DrMonaGMona Ghosheh 7 points8 points  (3 children)

Hi, I'm Dr. Mona Ghosheh, Licensed Psychologist in TX. I provide online counseling to 20-30 somethings struggling with anxiety, depression, low self-confidence, and identity concerns (e.g., race/ethnicity, culture, religious identity, sexual and gender identity, etc.). Excited to answer questions today about all things mental health--Ask Me Anything! P.S. I can't provide therapy via reddit, but can certainly answer questions and provide information. If you're experiencing suicidal thoughts, please contact the National Suicide Hotline at 1-800-273-8255 or go to your local emergency room. What questions do you have for me?

[–]basilcinnamonchives 0 points1 point  (2 children)

If you could send a message to a large group of 20-30 somethings with anxiety, what would it be?

[–]DrMonaGMona Ghosheh 1 point2 points  (0 children)

Thanks for the question, basilcinnamonchives. Here it is:

Dear 20-30 somethings with anxiety, I send you this message with a heart full of gratitude and humbleness. All your stories, questions, and fears during the AMAs this week are a testament of just how human it is for a person to feel afraid, scared, ashamed, and alone. I want you to know that you're not alone...that despite how excruciatingly painful your anxiety is right now...it CAN be treated...and even though it seems like there's no point, know that you deserve a fighting chance. Despite all the wrongs and all the hurt and all the mistakes of the past, you're worthy. It's truth beyond any other truth in this universe: you're worthy. Don't settle for this--whatever it is you're knee deep in right now. You don't need to know how or what to do to make it better. Just know that there are people out there waiting and ready to figure it out with you...when you're ready. Sending you love and wishing you peace, Mona

[–]tisaaccastroT. Isaac Castro 0 points1 point  (0 children)

I like this question! Thank you for asking. My message would be: I hate that you are having to experience anxiety. I would take it away if I had the power - just so you could have your life back. There are many people like me that are willing to help you to create a new reality and take control back over your life. Be excited about your ability to experience reduced anxiety and willing to participate in a process to make a difference in your life.

[–]heather_mckenzieHeather McKenzie 7 points8 points  (0 children)

Good morning! How can I help you with mental health questions for yourself or those you care about? I'm excited to try and help! I'm a licensed professional counselor and clinical supervisor in the state of North Carolina and nationally credentialed to provide online counseling. I have an exclusively online private practice providing video therapy specializing in helping folks with anxiety and relationships.

[–]secretsquirel25 8 points9 points  (5 children)

What are your thoughts on Attention Deficit Disorder and depression? Also what is a good medication that will work well with Ritalin?

[–]DrAmberLydaAmber Lyda 6 points7 points  (0 children)

While I can't speak about the medication (I'm not a medical doctor), I can say that for many of my clients with attentional problems and depression, it's been really important to tease apart the underlying cause of the attentional or impulsivity issues. Sometimes it's ADHD/ADD, other times it's related to the depression directly (it affects attention, concentration, motivation, and volition) and sometimes it's related to skills deficits (no training in those skills) and sometimes it's related to totally different things like effects of trauma (hypervigilance impairs concentration, attention, volition, and motivation on mundane tasks). I've seen folks treated for ADD/ADHD with meds that made them worse because the underlying diagnosis was wrong. I've also seen folks with actual ADD/ADHD respond amazingly well to the right med. Just another two cents:)

[–]KatieleikamlcswKatie Leikam 5 points6 points  (1 child)

This is a good question, although I am not a doctor, so I am unable to speak on medications. From what I have seen, ADHD and depression can be frustrating and some practitioners would work with both symptoms at the same time. So perhaps, learn concentration and impulse control exercises, while processing your depression. Cognitive Behavioral Therapy could be a good theory to work with.

[–]DrMonaGMona Ghosheh 2 points3 points  (1 child)

Hi secretsquirel25, great question! It's very common for people to have both ADHD and a diagnosis of depression and/or anxiety. Sometimes the depression is related to the ADHD diagnosis. As in, a person feeling sad about having to struggle with ADHD and feelings of hopelessness about ever living a life that they deem worthy. Those kinds of feelings can worsen the ADHD which in turn makes the person feel even more depressed. It can sometimes be a brutal cycle. Other times, the depression is not related to the ADHD at all and is about something completely different (ex: a recent breakup, moving to a new city, feeling lost career/life-wise, etc.). Either way, counseling can be very effective in helping folks work through both diagnoses at the same time. Since ADHD is best treated with medication, it would be best to get your counselor connected with your physician/psychiatrist. They can become your "treatment team" and help you address both conditions physiologically and psychologically. I'm unable to recommend a specific medication because I'm not a medical doctor but even if I were, I'm sure it'd be difficult to do that without first seeing you in-person and doing a full check-up & assessment. If you haven't already done that, it can be a great place to start. I usually recommend for clients to get a full physical exam with bloodwork to rule out any other organic explanations for the symptoms of depression and difficulties with concentration (e.g., thyroid issues, vitamin D deficiencies, sleep apnea, etc.) Hope that helps!

[–]secretsquirel25 0 points1 point  (0 children)

That really helps. I was diagnosed when I was in 1st grade.

[–]nburgesslmftNicole Burgess 5 points6 points  (5 children)

Hi, I’m Nicole Burgess, Licensed Marriage and Family Therapist in Indiana and California. I provide online and in-person psychotherapy to women who experience anxiety, mild depression, past traumas. What question do you have for me? Please note I’m happy to answer any general questions about anxiety, therapy in general, and online therapy. I’m not able to provide counseling across reddit.

[–]BridgetteBane 0 points1 point  (4 children)

Regarding online therapy, do you find clients who struggle with consistency and cost are more likely to continue to seek treatment? I'm very stop/start with therapy because I worry about the cost and my therapist doesn't seem to have very consistent scheduling, usually if I schedule an appointment, it's a 3-6 week wait before the next appointment after. It's very frustrating for my anxiety issues and I wonder if an online program would be more consistent. Having a $40 copay every time also really sucks.

[–]DrOsabenCarol O'Saben 2 points3 points  (2 children)

Hi BridgetteBane--I am sure you will hear different opinions on this issue, but I do think consistency in therapy is important and I don't think there is a significant difference in this between face-to-face and online therapy. I don't think therapy has to be every week, necessarily, but the way I do therapy, consistent attendance and work is important. I can see why difficulty getting scheduled with your therapist would be frustrating. I would encourage you to talk with them to see if something could be adjusted so you could attend more consistently.

Cost is a whole different issue, but can have the same impact on one's participation. If making a $40 copay is difficult for you, you might consider seeking other avenues for sliding fee scale therapists or lower cost alternatives. Again, I would encourage you to talk with your therapist about this; they might have additional ideas about how to make this a non-issue in therapy for you. Good luck!

[–]BridgetteBane 0 points1 point  (1 child)

Thank you for the response! I wasn't aware that sliding scales existed, basically I figured what my insurance company told me, I was stuck with. Thanks!

[–]DrOsabenCarol O'Saben 0 points1 point  (0 children)

Oh, sliding scales definitely exist! They can be hard to locate sometimes, but they are out there. The challenge for some folks is that means you can't use your insurance, usually, which can be a deal breaker. But for you, if you could find a sliding scale below $40, it might be okay. There is an organization called "Open Path Psychotherapy Collective" (www.openpathcollective.org) that works to connect folks who can't afford therapy with therapists who are willing to accept a fee between $30 and $50/session. That might not help you a ton, but if there was someone available to you there in your area (or licensed in your state and available online), you might be able to do sessions for $30/session. Might be worth taking a look! Good luck!

[–]nburgesslmftNicole Burgess 1 point2 points  (0 children)

Hi BridgetteBane. Thank you for your question. I agree with DrOsaben that consistency in therapy is important. I don't think there is a big difference between on-line video sessions and in office sessions due to each person being able to see one another visually. If you are wanting to attend more often than once every 3 to 6 weeks, then I would encourage you to speak to your current therapist. As for the cost, I also agree with DrOsaben about speaking to your therapist or seeking a therapist who has a sliding scale.

[–]DrAmberLydaAmber Lyda 8 points9 points  (3 children)

Hi! I'm Amber Lyda, a licensed psychologist providing online therapy in Florida, North Carolina and around the world. I also train other therapists to build their online therapy practice. I'm happy to answer any questions about my therapy practice (largely focused on anxiety, trauma or major life transitions) or in online therapy practice building. What questions do you have for me?

[–]orioctopus 0 points1 point  (1 child)

Hi Amber, what are the first or most important thighs you cover when beginning to train therapist in online practice?

[–]DrAmberLydaAmber Lyda 1 point2 points  (0 children)

I always ask them to check with three places before they even begin: 1. Their state licensing board to learn about regulations that would affect their online practice. 2. Their malpractice insurance to make sure it's covered. 3. Their professional body's guidance statements (like the APA, ACA, etc.)

[–]HopeEdenLCSWHope Eden 0 points1 point  (0 children)

Hi Amber! Would you tell us some reasons you favor online therapy? What do your clients appreciate about it?

[–]KatieleikamlcswKatie Leikam 6 points7 points  (4 children)

Hi Everyone! I am Katie Leikam, LCSW based in Atlanta GA. I am a gender specialist and I work with the LGBTQIA and transgender community in person and online through video. I also work woth college students, anxiety and perfectionism and with people going through other life transitions. I am happy to answer your questions you might have for me, but I won't be able to diagnose or give therapy via Reddit. You can learn more about me on my website www.katieleikam.com. What questions do you have for an affirming Gender Therapist? What questions do you have for general mental wellness?

[–]DrAmberLydaAmber Lyda 4 points5 points  (1 child)

Hi Katie - I have a question for you! As a therapist that doesn't specialize in this area, can you tell me/us a little more about what an LGBTQIA therapy client might find especially useful about working with a specialist? I think many people don't know what to expect in therapy in general, much less in specialized treatment and it can be really useful to know "what you don't know" about how a treatment method might be better than another option! Can you say more about what your clients might say is special about your work with them?

[–]KatieleikamlcswKatie Leikam 6 points7 points  (0 children)

Sure Amber! When I work as a specialist with my Transgender clients for instance, my clients would say that they appreciate that I am informed about what they are going through, both emotionally and medically, since I am a member of the World Professional Association Of Transgender Health. Clients can expect, from me at least to not be questioned about their identity and have the ability to have frank and open processing of all things related to transitioning, even those topics that they might not feel comfortable talking about. It's useful to work with a specialist because, HRT and coming out and surgeries, if someone chose to have them are specialized topics.

[–]basilcinnamonchives 1 point2 points  (1 child)

As a therapist, what do you think is most important for friends of people who are transitioning or have recently transitioned to know?

[–]KatieleikamlcswKatie Leikam 1 point2 points  (0 children)

As a therapist, I cannot speak for the most important thing. Some things to remember are that everyone is being their authentic selves when they transition. It’s important to be affirming, ask responsible questions when you need to, while not putting the burden of your friend to teach you. It’s really important to be as authentic in your friendship that you can in every way.

[–]brookewilliamslpcBrooke Williams 7 points8 points  (0 children)

Hi ya'll! I'm Brooke Williams, a licensed professional counselor (LPC) located in South Carolina. I have an online practice and generally serve individual adults and couples focused on finding fulfillment in relationships by finding, knowing, loving, and being your authentic self. While I can't provide therapy or diagnose via reddit, I'm happy to answer general questions about anxiety and mental health. If you are experiencing suicidal thoughts, please contact the National Suicide Help Line at 1-800-273-8255 or go to your local emergency room. I hope that I can provide some help for you today - what questions can I answer for you?

[–]tisaaccastroT. Isaac Castro 6 points7 points  (0 children)

Good Morning! So Excited!! I am Thomas Isaac Castro, a LMFT in California. My practice is online only. I won't be doing therapy or diagnosing in this forum but I am willing to answer questions. Ask me Anything! What questions do you have for me? :)

[–]DrJanaScrivaniJana Scrivani 6 points7 points  (0 children)

Hello! I'm Dr. Jana Scrivani, a licensed clinical psychologist who seeks folks online in Florida and New York. My specialties are anxiety and related disorders, behavioral parent training, and emerging adulthood. I'm happy to answer your questions today, what might you like to ask?

[–]LivingInTheVoid 4 points5 points  (2 children)

Thanks for doing this AMA! I’m bipolar 1 with depression and PTSD. I’ve noticed that most medicines that can help me stabilize my mood severely affect my libido, which happens to also be a reason for the depression. Do you know of any promising research that is focusing on this major side affect?

[–]Daniela-P-CounselingDaniela Paolone 3 points4 points  (0 children)

Happy to do my best in answering your question LivingInTheVoid. While I am not a doctor, the research does point to there being side effects impacting libido with some medications. With this type of question, it might make sense to ask your prescribing doctor because I know that many people do have this side effect too. So what I am trying to say here is that you are not alone in having this experience. I realize you asked about research regarding this side effect specifically and unfortunately I am not aware of any research studies to share with you. If I do find information about that though I will be sure to put a link to it in here. Do you have any follow up questions about what I shared here?

[–]DrMonaGMona Ghosheh 1 point2 points  (0 children)

I second Daniela-P-Counseling but wanted to add a few things that might be helpful to consider. 1) By talking to your physician/psychiatrist about this, they might be able to help you try a different brand or type of the same medications you're already on. I've seen some client switch from one SSRI to another and get different results with regards to libido and other side effects. It's not a guarantee, but just something to be aware of. 2) You said that the reason for your depression is the lack of libido. The good news is that both depression and PTSD are treatable through counseling. In other words, the medications for depression & ptsd are never intended to be taken for life. The idea is that they help the person function until they are able to resolve the issues that led to the depression & ptsd to start with. Through counseling, if you are able to address these conditions, then ideally, you can get off some of the medications that you're currently taking and possibly not have to worry about the side effect of low libido after that. Hope that helps! Best of luck to you!

[–]danielsimon811Daniel Sokal 5 points6 points  (2 children)

Hi Redditors! I’m Daniel Sokal, specialized in working with recovering from a narcissist. I also work with couples. I’m based in Westchester County NY and see patients online as well. What questions can I answer for you?

[–]orioctopus 2 points3 points  (1 child)

Hi Daniel, what are the things you find yourself working on most with a narcissist client, in regards to their narcissism.

[–]danielsimon811Daniel Sokal 0 points1 point  (0 children)

Hi, I answered below , it got posted to the bottom of the thread somehow, thanks for asking!

[–]womanof1004holds 6 points7 points  (4 children)

I did ask this in the thread yesterday and Brooke was kind enough to say recommend trying this thread, so if anyone has had experience with DID I'd love to hear your input:

Has anyone worked with a patient with Dissociative Identity Disorder and do you think complete integration has to happen to heal? I've had successful integrations as I've gone through therapy but it's still hard to think about being a "whole" person if that makes sense. (I'm also going to add that I do realize my overall functioning and wellbeing has gotten better with each integration but some of my alters still feel so separate from me. And there's one in particular who still holds anger towards me so it's really hard to think of integrating.)

[–]heather_mckenzieHeather McKenzie 5 points6 points  (3 children)

Wow, womanof1004holds, it sounds like you have done a lot of work! I believe there are many perspectives on this great question you are asking. I am going to answer tentatively because I have only limited experience with DID (not my specialty by any stretch, but I do work with it). My reaction is that YOU are the one who gets to define what "healed" looks like. If that requires full integration, okay! If that means you are able to manage 2 alters in effective and healthy ways, okay! If "healed" to you means you feel that most days are good days and you are able to live the life you want without losing a lot of time in dissociation and also have multiple alters present, okay! You are the decider. :)

[–]womanof1004holds 2 points3 points  (1 child)

Thank you so much for your response! It was really validating since we really would like to have control over our healing process. I know of one other system irl and she's done a lot of heavy work too and has chosen to take a break before doing any more processing, since she and her system are in a good space. My therapist has pretty much the same view (he's a trauma specialist) but the answers really do vary. I've seen everything from "integration is the only cure!" to "DID doesn't exist!" Thrown around in books and the internet. Thanks again for listening to our ramblings lol

[–]heather_mckenzieHeather McKenzie 2 points3 points  (0 children)

Absolutely! And yes there is certainly a wide range of perspectives on DID out there. It sounds like you have a therapist who is an ally for your process and I also like that you have a connection with someone else who has DID. It can be too easy to isolate. Good luck to you!

[–]brookewilliamslpcBrooke Williams 1 point2 points  (0 children)

Oh Heather, thank you! I'm so glad that you have some experience with this - and womanof1004holds, I'm so glad you got a response today!

[–]therapylydLydia Kickliter 6 points7 points  (1 child)

Hi! I'm Lydia Kickliter. I am a licensed counselor with a practice in North Carolina. I help women with anxiety and trauma issues with a specialty in helping survivors of domestic violence and sexual assault. I see clients in person and online. While I can't provide therapy or diagnose on Reddit, I am happy to answer whatever questions I can. Please, if you are experiencing suicidal thoughts, contact the National Suicide Helpline at 1-800-273-8255 or go to your local emergency room. What questions do you have for me today?

[–]RosiGimenoTherapyRosi Gimeno 4 points5 points  (2 children)

Hello Redditors! I'm Rosi Gimeno, LMHC, MCAP Licensed Mental Health Counselor and Master Addiction Professional. I have a private practice-Rosi Gimeno Therapy, in the State of Florida where I provide Online Therapy to Florida residents as well as in-person for locals of South Florida. My expertise is in anxiety, depression, trauma, PTSD, grief and loss, and addictions. While I can't provide therapy via reddit, I'm happy to answer general questions on physical, mental and emotional reactions to symptoms, interventions that help, therapy in general and online therapy. What questions do you have for me?

[–]HopeEdenLCSWHope Eden 0 points1 point  (1 child)

Hi Rosi! When someone is newly in recovery and suddenly have overwhelming symptoms of anxiety or PTSD, which had been managed with substances in the past, what are some initial strategies you use to help them adjust to their sobriety?

[–]RosiGimenoTherapyRosi Gimeno 0 points1 point  (0 children)

Hi HopeEdenLCSW. I have been called away from reddit all day with work and unfortunately did not see your question until now. I apologize for the late response. I really love working with addiction so I am glad you asked! It is very rare that I have worked with a client who was addicted to substances that was not dually diagnosed with anxiety, depression or PTSD. Emotions have been numbed for so many years with drugs or alcohol that in the early stages of recovery a person can feel extremely overwhelmed with so many emotions bombarding them from what seems all angles.

What I usually do is help the person identify their internal and external triggers. Internal triggers can be anxiety, anger, depression, isolation, negative thinking and external triggers can be any person, place or thing. Although it is not always the case that someone can identify all their triggers, sometimes they just show up and they didn’t know it was a trigger until, well, that moment that they’re faced with it. The client establishes which triggers they will stay away from and which they will not be able to avoid and what they can do when around these triggers. I also help them identify their core issues. This is where they see that anxiety, trauma, depression, abandonment or sexual abuse may be their core issue. Since having to deal with these past traumas and newfound emotions can be so overwhelming, it is vital they develop a relapse prevention plan with plenty of coping skills in addition to having a solid support system in place. Some coping skills would be mindful breathing, grounding techniques for emotion regulation, exercise, going for a run, yoga, calling someone on their support list, continued weekly therapy, taking their medication, going to an AA or NA meeting if that is what they prefer, working, volunteering etc.

One of the things I love about recovery work is the resiliency of those suffering from addiction and other symptoms. In spite of the past trauma, feelings of depression and anxiety and intense cravings, they keep trying and learning and getting down to their core issues. What seems like a setback from a relapse is just a learning experience of how not to do something the next time around. Early recovery is challenging but certainly not impossible with the right support system and coping skills.

[–]BinaBirdLMFTBina Bird 3 points4 points  (0 children)

Hi! I'm Bina Bird, a Licensed Marriage and Family Therapist located in Haslet, Texas. I provide therapy both in office and online. My specialties are maternal mental health and women, couples and preteens/teen girls. While I can't provide therapy or diagnose on Reddit, I am happy to answer whatever questions I can. Please, if you are experiencing suicidal thoughts, contact the National Suicide Helpline at 1-800-273-8255 or go to your local emergency room. What questions do you have?

[–]jillgraylmftJill Gray 3 points4 points  (0 children)

Hi there! I'm Jill Gray, I'm a Licensed Marriage and Family Therapist in Redondo Beach, CA. My specialties include helping individuals and couples challenged with cancer, chronic illness, fertility issues, grief and loss. I work in a cancer-related community setting, a private practice office and I'm an approved TalkSpace therapy provider. What questions do you have for me?

[–]courtneyglashowLCSWCourtneyGlashow 9 points10 points  (6 children)

Hi everyone! My name is Courtney Glashow, LCSW and I am a psychotherapist with a private practice - Anchor Therapy (www.anchortherapy.org) located in Jersey City, NJ and I also counsel clients online who reside in New York and New Jersey. I specialize in helping children, adolescents, and young adults. While I can't provide therapy or diagnose via reddit, I'm happy to answer general questions about anxiety and mental health. If you are experiencing suicidal thoughts, please contact the National Suicide Help Line at 1-800-273-8255 or go to your local emergency room. So let's get started.. what questions do you have for me?

[–]orioctopus 2 points3 points  (3 children)

Hi Courtney, LPC here. I have a client who recently reported being close to at risk for suicidal ideation. What so you think are the best prevention steps to help tell their parent as well as the client (other than just rehashing a crisis plan or letting them know where the local psych ward is.)

[–]courtneyglashowLCSWCourtneyGlashow 4 points5 points  (2 children)

Hi, great question! Every person is different so I would really need to know more details, but it is not HIPAA compliant to share details of clients. So I would say in general, having a safety plan really is the most important thing to have in place and to continue to edit it weekly with the client to have them make it their own. I would break down each step of that plan- such as what are their triggers (spend a session on this), what are some things they can do to feel less overwhelmed (maybe multiple sessions about coping techniques when they're feeling down or overwhelmed), who is someone they can call and talk to (another session- discuss relationship patterns, communication techniques, and role play if needed). I would then spend a lot of time also on discussing what is their reason for living. This should be on the safety plan as well and it can change over time. I hope this helps!

[–]orioctopus 1 point2 points  (1 child)

Yes this was a wonderful reply! I feel like half of my battle is making sure I'm doing everything I can and the other half is covering my butt with proper procedure, thanks for the post!

[–]courtneyglashowLCSWCourtneyGlashow 1 point2 points  (0 children)

Yes definitely. I'm sure you are doing the best you can. Some client's baselines are feeling depressed and with SI. It could be that we are there to help support them through their life and to make sure things do not turn for a worse. Or that they can cope with a stressor that arises.

[–]HereComesTheNarwhal 1 point2 points  (1 child)

Hi Courtney! I'm an older teen whose mental health isn't optimal, and who has friends who also struggle with mental health due to the academic stress and our personal lives. Do you have any advice for young people who can't tell their parents about their problems (due to the culture I live in) and who don't have access to professional therapy? Beyond resources like school counselling and online resources like 7Cups.

[–]courtneyglashowLCSWCourtneyGlashow 0 points1 point  (0 children)

I actually haven't heard of 7cups before. I do recommend utilizing your school counselors though because those are your best supports usually. They specialize in seeing older teens and can really help you through this stressful time. I definitely get that you don't want to share with your parents about your stress and mental health issues because of your culture. Sometimes your parents can surprise you though with how helpful and supportive they could be. For now though, I would suggest finding someone you feel comfortable talking to to help you through this stressful time. If you're not comfortable with your school counselor then another option could be finding a private counselor (if you're in the U.S. I recommend looking on Psychology Today). You can also look into online counseling (video/phone calls/ texting/emails) which you usually pay for a package that is more affordable. I hope this helps!

[–]DrOsabenCarol O'Saben 6 points7 points  (30 children)

Good morning, Redditors! I am Dr. Carol O'Saben, a licensed psychologist in Arizona. I specialize in working with transgendered individuals and their families, college students and those individuals who find themselves struggling to break out of unhelpful patterns in their relationships. My practice is completely online (which I love!). While I can't provide therapy or diagnose on Reddit, I am happy to answer whatever questions I can. Please, if you are experiencing suicidal thoughts, contact the National Suicide Helpline at 1-800-273-8255 or go to your local emergency room. What questions do you have for me today?

[–]orioctopus 2 points3 points  (24 children)

Can you elaborate on how you practice completely online? More specifically, what programs are ooh using to communicate that are HIPAA compliant, and how do intakes and sessions work? Really just all the details would be interesting to hear.

[–]DrOsabenCarol O'Saben 4 points5 points  (3 children)

Great questions, Orioctopus; thanks for your interest! I'm kind of a technology fanatic and I love answering questions about this stuff! My online practice is set up using a HIPAA compliant secure videoconferencing system and a HIPAA compliant electronic health record (EHR). So when a client contacts me for services I can send them all of my initial paperwork through the secure EHR and they can complete it and return it to me there. Then we schedule a session in the secure videoconferencing system. At the designated time we both log into the program and meet in my virtual waiting room! I know a lot of people worry about whether meeting virtually is different (or less than) meeting in person, but I've really found it to be pretty parallel. We communicate in real-time and an added bonus is I get to see the client's environment. Sometimes their animals come into view and one client even showed me her living space because it was relevant to our discussion! Does that give you a sense? Feel free to ask more questions!

[–]orioctopus 1 point2 points  (2 children)

Yes, thank you! I've spent 8 years working I. T. while getting my degree in CMHC, so the tech side does intrigue me for therapy. In some states I've heard that they are pushing for practices to be EHR, I wonder do you think that we will start to see a new wave of regulations/trainings for electronic-based counseling services?

[–]DrOsabenCarol O'Saben 4 points5 points  (1 child)

Oh, absolutely! In fact, some states and some liability insurance companies are already requiring specialized training/certification to be able to provide telemental health services. For example, in Arizona, my licensing regulations require that if I am going to provide telemental health services, I have to be able to document my training to do so. There are some great online trainings available in this area. I took one through the Zur Institute and I've heard of many others. With your background in IT, you would be super far ahead of the game if you wanted to get into the telemental health field. I think one of the leaders in the field, Roy Huggins of Person Centered Tech, also has a background in IT, prior to getting his counseling degree/license.

Edited to add: I think it is important to remember that being a skilled clinician is the first step in being a skilled telemental health therapist. Technology is just the vehicle through which we deliver our clinical services, but each of us has to have skills in working with clients first.

[–]orioctopus 1 point2 points  (0 children)

I completely agree, I've heard about it more in the northeast, (Kentucky is my licensing state) but it seems that telemental health hasn't really hit this area yet, barring a few establishments incorporating it into their practice. And yes, first and foremost my skills as a therapist come first, but I think once some trainings open up for this subject it would be smart to hop on board since this seems to be gaining traction. Thanks for the reply!

[–]Daniela-P-CounselingDaniela Paolone 3 points4 points  (17 children)

Such a great question orioctpus! I know you asked DrOsaben but I wanted to chime in too. I offer online counseling like many of the therapists in here and use programs that are HIPAA compliant, meaning that the information shared through a chat message or through the video session are encrypted. The programs I use are VSee, and RegroupTherapy but there are many other options therapists use to offer secure and confidential online counseling support. I hope this was helpful for you. Do any new questions come to mind now that I shared this information with you?

[–]orioctopus 2 points3 points  (16 children)

Thanks for the reply! And yes, I was wondering what demographic do you tend to see being a strictly online business. I imagine that limits a lot of lower income people who may not have a Webcam or internet. Also, do you feel as though your missing any body language ques by doing therapy this way (I'm imagining a lot of up close Webcam face).

[–]heather_mckenzieHeather McKenzie 2 points3 points  (2 children)

These are good questions! You are right that there are definitely some limitations. Smart phones and tablets can also be used for online therapy, so the access is not super challenging for most. Yes there limitations with body language that happens below the waist. I find that I notice nuances in facial expressions more easily though (since we are basically sitting face to face), so it's a tradeoff. I usually acknowledge the body language limitations and I end up asking aloud about their in-the-moment experience more frequently as I am getting to know them. Demographics I have seen flocking to online counseling: highly anxious folks, people caring for others at home (children, elderly parents), people with very tight/full schedules due to work/family etc., and people with significant physical pain or barriers making it hard to leave the home with ease.

[–]orioctopus 1 point2 points  (1 child)

I suppose the stay at home type makes sense! Do you feel they're more engaged because it feels as though you are catering to their specific situation?

[–]heather_mckenzieHeather McKenzie 0 points1 point  (0 children)

That's an interesting question! I had not reflected on that! My thought is that when there is a good therapist-client fit and connection, then the engagement is high. I would imagine that would occur online and in person equally. But it would be an interesting thing to study!

[–]Daniela-P-CounselingDaniela Paolone 2 points3 points  (3 children)

You are very welcome! So yes technology could be a limiting factor for someone in a lower income demographic, however there are still options for that too. If that person has access to a smartphone for instance, then VSee would still work. Some of these online platforms are more versatile in that a client can use a tablet, cellphone, laptop or desktop computer. And while each client's needs are different, some of the sessions could be done over the phone. For those that do not have internet, then yes, online counseling would probably not be a good fit. And as to your other question, I do not feel that I am missing any body cues that could negatively impact my ability to gauge where the client is at. Yes my ability to see them completely through a video call is not there, but there are other cues I am really focused on such as facial expressions, tone of voice, eye movement and so on. If a person is too close on the camera I will ask them to try and adjust it so that I can see more of them (from the chest area up).

Any additional questions you have for me? Also as a side note, if someone is not a good fit for online counseling or they do not have internet access, then I will reach out to therapists in their community to try and provide that person with some in-person counseling options. At the end of the day, I just want to see how best that person can get the support they are looking for in a way that meets their needs.

[–]orioctopus 2 points3 points  (2 children)

I may think of some more questions after lunch, but this was very informative. I wasnt aware that there is an app for it (tm.), that is a very big step for moving forward in accessibility! Oh! One last question, overall do you do any in-person therapy now or is it exclusively online? If so, do you miss the in person sessions?

[–]Daniela-P-CounselingDaniela Paolone 0 points1 point  (1 child)

Yes Orioctopus its really nice that companies are making these free apps available so that video counseling is more accessible! I continue to provide in-person counseling and some of those clients do both in person and online, or they are strictly in-person (unless they are sick and want to have as session or something like that). Other clients are only online and that greater flexibility in scheduling for them is a good fit for what they are needing. Does that answer your question? Also, I have been really enjoying your questions so please let me know if you have any more you want to send my way :)

[–]orioctopus 0 points1 point  (0 children)

It sure does answer my question, glad you enjoyed and I'm happy I could contribute some good dialogue!

[–]Daniela-P-CounselingDaniela Paolone 2 points3 points  (5 children)

I just noticed I did not answer your demographic question. I find that online counseling is a great option for those who have very busy work schedules, or schedules which change each week. It also can be a great option for entrepreneurs, those who live in a rural area, people with medical health issues or chronic pain, and also for those who experience high levels of anxiety and social anxiety. Can you think of other demographics where online counseling would be a good fit?

[–]orioctopus 1 point2 points  (4 children)

I think the mentioned demographics make a lot of sense thus far. I'm curious if it's not a double edge sword with those with social anxiety. I personally feel as though my clients who suffer benefit a lot from meeting in person and practicing social skills and other coping skills. Granted I can see an argument made for online therapy in that they are still learning the same things, but I do believe that face-to-face is more beneficial in the long run that screen-to-screen because it could be enabling their anxiety, all of which is case pending though.

[–]Daniela-P-CounselingDaniela Paolone 0 points1 point  (3 children)

I absolutely hear what you are saying and when talking with a potential client during a consultation. I really assess whether or not they are a good candidate for online counseling and if they are not a good fit for it (due to their specific presenting issues) then I will find them other in-person clinicians they may want to contact for counseling (in case I am too far away from where they live).

So yes, you are right that online may not be ideal for some with anxiety but everyone is different so that has to be determined on a case by case basis. At the same time though, it is very possible that those people with social anxiety or agoraphobia for example, might not even consider counseling if they only thought in person was their only option. Online could be something they might consider, and that willingness to try it and tolerate some level of discomfort, might be better tolerated because they are still in the comfort of their own home.

Also, these online sessions could be that gradual transition that could then lead the way towards in-person counseling, and getting more comfortable when in social settings in general. What do you think of the ideas I share here?

[–]orioctopus 1 point2 points  (2 children)

I think you bring a very valid point in. Like all situations, there's no specific right answer to every case. Using online as a stepping stone for some clients to get comfortable is an excellent point. I think that's valid in cases where there may not even be anxiety, and a client is just trying to get a feel for counseling or the counselor in specific. I'm always intrigued to see how this profession will evolve and how it will incorporate modern advances. Thanks for your insight!

[–]Daniela-P-CounselingDaniela Paolone 0 points1 point  (0 children)

you are very welcome. And absolutely, online counseling can be a stepping stone for a variety of populations. It really is exciting to see how the field is changing to meet the needs of our modern way of life!

[–]brookewilliamslpcBrooke Williams 0 points1 point  (2 children)

If I can just hop in here too - I find I get a lot of younger people that are really comfortable with technology already, so it doesn't even seem strange or different to them. With this population especially, online is already a really familiar space for them, so they are comfortable pretty much immediately. With those that don't fit the "younger" profile, I've found that they feel a lot more comfortable in their own space, and so we seem to be able to get to the root of things quickly - there isn't that weird "how I am I supposed to act in this environment" that happens at the beginning for brand new clients sometimes. Also, I use a platform through CounSol.com - it's set up similar to a portal like you would use at your doctor's office. My EHR is included within their platform, so it's all-in-one.

[–]orioctopus 1 point2 points  (1 child)

Please do hop in! The point about younger people is especially true, in their instance I'm almost more inclined to say that they need in-person experience more than any other age group, because the social structure for early 20's and under is so reliant on technology that I feel like they benefit more taking a step away. Granted, that's my own personal opinion and on a case to case basis.

What do rates look for platform and EHR? Also is it limited to those within your own area, or do you get referrals from outside areas, states, etc.

[–]brookewilliamslpcBrooke Williams 0 points1 point  (0 children)

Agreed that they could benefit from in-person therapy, but I think making them comfortable with the idea of what therapy is, through online therapy, can take away some of the mystery. Similar to those with social anxiety - if you're more willing to do therapy because it's online, and less likely to try because you have to see someone face-to-face, then by all means, let's get you in, in a way that is comfortable for you. We can always engage in other things after forming a therapeutic alliance - processing how technology impacts long-term relationships and social skills, etc. But if online takes away one of the barriers of just getting them in the door, then let's break down the barriers! :)

Rates are different depending on your needs. They range from being completely free, to a couple hundred dollars a month, really depending on what you're looking for. I use CounSol, but there's also VSee, Doxy.Me, Zoom, Regain, of course, iTherapy (who organized the forums this week so we can have this awesome conversation!) and many, many more. The field is growing, for sure!

Referrals are kind of depending on where you market and where you are licensed. I'm licensed in SC, so in addition to my local area, I am able to see clients online from all over the state.

[–]DrMonaGMona Ghosheh 3 points4 points  (1 child)

orioctopus, I use a HIPAA secure platform called doxy.me to meet with my clients through video (similar to skype or FaceTime, except it's designed for health/medical purposes). With regards to paperwork, my entire "office" is virtual and paperless. I have an electronic record keeping system that keeps all client files and paperwork stored securely. Clients complete paperwork through a secure client portal and it stores their information in my record keeping system. Does that answer your question?

[–]orioctopus 2 points3 points  (0 children)

Yes it does! Thanks for the reply!

[–]DraconisLee 1 point2 points  (3 children)

Thank you for doing an AMA!

1 How can a person (college student for example) find out that they have mental health problem or just under pressured or stress from school/work?

2 What signs do we can look into people to realize they need help?

3 How do you got into psychologist?

[–]DrOsabenCarol O'Saben 2 points3 points  (2 children)

Hi DraconisLee...thanks for the questions. I used to work as a psychologist on a college campus, so hopefully I can be helpful.

In response to your first question, I'm not sure I think it makes a difference if someone has a "mental health problem" (and by that, I'm guessing you mean a clinical diagnosis), or if they are under stress from school/work. I think a person in either category could benefit from having someone to talk to about their struggles. College students can be lucky in some ways, because many campuses have counseling services available on campus, often at reduced fees, so it can be a little easier for a college student to get some help and sort out what might be going on for them. Talking to a mental health professional (or sometimes a medical professional) can be the first step toward finding out what kind of help might be best for someone who is struggling.

Regarding your second question, one of my first suggestions is always to pay attention to someone if you are noticing drastic changes in their behavior. So, for example, if someone who initially is outgoing, friendly, extroverted, and over time they become withdrawn and quiet and uninvolved, I might start to wonder what is going on for them and if they might need some support. Sometimes, especially on college campuses, we might see someone who is struggling start to skip classes or skip meals or stop participating in activities. That's always a good time to ask some friendly questions and see if the person could use some support. Finally, in this day and age, I always encourage people to pay attention to the stuff others are putting on their social media. Facebook, Instagram, and other social media outlets can sometimes help us identify if a friend seems to be hurting. Again, having a conversation is the best way to determine if that might be true.

Finally, "how do you get into psychology?" People take LOTS of different paths. A good place to start, in college, is to take some intro level psychology classes to see if the topic interests you. If it does, you might consider majoring in psychology. Then, most people either seek admission to a doctoral program in psychology (counseling, clinical and school psychology are the ones that prepare folks to work with clients) or sometimes a master's degree program (some states license master's-level psychologists).

Of course there are also master's-level professional counseling programs that prepare people to be licensed counselors and master's-level social work programs that prepare folks to be clinical social workers. (You can see we have people from all those professions responding to questions here this week.) All of those program areas can lead people into a career working with clients. After completing a degree, if you are going to work with clients, you will need to get licensed in a state, so there will be an exam or two and some paperwork.

Hope that's helpful! Feel free to ask more questions!

[–]DraconisLee 0 points1 point  (1 child)

Thank you for replying!

Also, if I found out a friend had problems, but they are unwilling to look for professional help yet, is there any way to help them feel better emotionally until they do?

[–]DrOsabenCarol O'Saben 0 points1 point  (0 children)

You sound like a very giving and kind person! I bet you are a great friend! If you are concerned that a friend has some mental health challenges, one of the best things you can do is continue to be their friend! There might be an occasion when they open up to you about their concerns, and then it would be great if you could tell them about resources that might help them (like the campus counseling center or other resources nearby). You might even offer to go with them to the counseling appointment, just to be supportive. You could wait in the waiting room while they are talking to the counselor. Some students find that helpful. And you might ask your friend what they think would be helpful....do they want to talk, not talk, walk, see a movie, study together? You could be supportive/helpful just by being by their side.

Finally, if you are REALLY concerned about a friend, like afraid they might be suicidal or something, I would encourage you to reach out to the supports on your college campus or to the friend's family. It is important to take concerns at that level seriously so you can get them the help they need.

[–]roytay 2 points3 points  (4 children)

Some (many? all?) of you seem to work online. Since you're used to diagnosing people over video, can you tell us your thoughts on Donald Trump?

[–]DrOsabenCarol O'Saben 5 points6 points  (0 children)

Not going there, roytay! Diagnosing someone with whom I've interacted (on video or in person) is significantly different than diagnosing someone when all I know of them is what I've seen on TV or in the media. Some would even say it is unethical for a mental health professional to weigh in on a public figure's mental health status, but there's been some controversy around that issue lately.

[–]DrKevinHydeKevin Hyde 5 points6 points  (0 children)

Hi, roytay! That's a difficult question to answer because we aren't Dr. Phil. Meaning we actually have to stay within our ethical boundaries which preclude diagnosing someone we haven't met, and even then HIPAA wouldn't allow us to disclose the information. Not that that has stopped others from making their thoughts known to get into the headlines, but that's neither here nor there! I will say that I had many patients who really struggled with the 2016 election outcome and it was an issue we processed in therapy. I've been surprised just how large of an impact he's had on mental health over the past year. A lot of anxiety from following the news closer than ever, social complications from differing viewpoints, and a sense of hopelessness at times. Hopefully we can all get back to normal and forget about our president for days at a time like the good old days.

[–]DrMonaGMona Ghosheh 4 points5 points  (0 children)

Haha! Your question made me laugh roytay! I've actually been asked a version of this question a lot. I also get asked by friends and family members things like, "hey are you analyzing me?" and "do you think your cousin Larry is diagnosable?" and "can you guess my Myers-Briggs personality type?" lol My response is often: "I'm not working right now and you/they aren't my client" sooooo....no/I don't know. :) When I'm not working, I'm probably thinking about other people in the same way others think about me too...without the in-depth analysis and psychological conceptualization going on. Plus, there's the other stuff that DrOsaben and DrKevinHyde pointed out about our line of work. Fun question, though!

[–]brookewilliamslpcBrooke Williams 2 points3 points  (0 children)

Hi roytay! I do think a lot of us work online, or have a portion of online practice. The difference is that we each have interacted with our clients via those online sessions prior to diagnosing. So, because we are held to pretty specific ethical standards, we aren't able to do so for Donald Trump, unless he wanted to hire us and pay us some of those big $$. Ha!

[–]danielsimon811Daniel Sokal 2 points3 points  (0 children)

I mainly work on those recovering from a narcissist in their life (parent, guardian, partner, spouse, etc...), though many who have experienced a narcissist in their life, mostly those raised by one, worry they too will become one or are one. It’s a long process to make sense of one’s history so that it is less haunting, and to deduce and make sense of the repetitive traits that can be detrimental to important relationships (work, friends, partners, family). We identify all of these factors, sit with the affect, differentiate the here and now from the there and then, identify empathy and how it does and can exist in deeper ways, make sense of history and the perpetuating narcissist’s own history and developmental experiences, and rebuild one’s sense of self as separate from the object they became to the narcissistic other. We also build a framework of assertiveness and boundaries so aspects of maintaining or distancing from the other can exist safely and separately , so there is room for tolerance and or forgiveness .

[–]WaxStatue 2 points3 points  (7 children)

I've struggled for years with chronic pain and depression. My current psychiatrist has put a hold on our meetings until I can get the pain sorted out. Sadly, it looks like I cannot. It is a permanent issue. How hard is it to treat depression with a heavy pain element? Should I be seeing a different doctor who specializes in that sort of thing?

[–]courtneyglashowLCSWCourtneyGlashow 2 points3 points  (0 children)

I'm sorry that you are going through so much pain. There's a lot of research on how treating both the depression and chronic pain at the same time is effective. I would look into possibly going to an outpatient clinic where they have doctors and therapists/psychiatrists. Then you can have a care team that is working together to help all of your symptoms. I do also agree with you that it is always good to see a specialist who can help you.

[–]DrKevinHydeKevin Hyde 1 point2 points  (0 children)

Hi WaxStatue. It sucks having that daily experience of pain and it makes sense you'd feel depressed. The two are often linked together, and it is possible to live a meaningful life even with those challenges. There are doctors who have experience helping people in your situation so I would call around to see if there's someone better suited for your needs. I'd also recommend finding a therapist who practices from an Acceptance and Commitment Therapy (ACT) perspective. Because it seems there is nothing you can do to eliminate the pain, an ACT therapist can help you figure out what you CAN do to engage in meaningful activities. By living a life that fits with your values, many people experience improvements in their mood and quality of life, even if the pain does not subside. I know it's hard to imagine when you're in the middle of the pain. I wish you the best in your treatment!

[–]Daniela-P-CounselingDaniela Paolone 0 points1 point  (4 children)

I see that you have already gotten some great responses WaxStatue from a few therapists but I wanted to chime in because I specialize in chronic pain. I have dealt with chronic pain and health issues personally for a long time so because of this, I have done a lot of learning about ways to manage pain by exploring perceptions of pain, lifestyle habits, self care and more.

The biggest takeaway I have learned is that our emotions play a big part in how intensely we feel the pain because pain is not only physical / medical in origin.. there is also an emotional aspect to it. Clients who come in and see me tend to find that talking about the feelings and thoughts that show up when thinking about the pain, actually helps them to feel better both emotionally and physically.

That along with self care practices, regular mindfulness work and accepting and acknowledging feelings /pain sensations in the body seems to help them. Once book that many have found helpful is The Self Compassion book by Kristin Neff, PhD. Do you have any follow up questions based on what I shared here? I hope this response was helpful for you!

[–]WaxStatue 1 point2 points  (3 children)

I just don't know how to come to terms with my situation, really. I a 35, and the pain has been here since I was in my early 20s. At this point my will to keep going is very low, and if my mom died, I know I would check out right after. How do you make yourself accept something like this? Is it possible the book you mentioned might help me with this?

[–]Daniela-P-CounselingDaniela Paolone 1 point2 points  (2 children)

Great questions WaxStatue, and I am sorry you are going through a difficult time. I am also in my 30's and so just having those pain experiences at a younger age can be hard too because it can feel like no one really understands it. Please know that the feelings of sadness and pain are common and that you are not alone. If you are feeling suicidal then please call the National Suicide Help Line at 1-800-273-8255 or go to your local emergency room.

If someone I know is feeling really low, then I always encourage them to work with a psychiatrist and a therapist, that way they can help be a support team for that person. Therapists and psychiatrists can also refer that patient to more support resources to keep them safe.

Whenever there is a big life event or significant life change, that is something I will help clients talk about in therapy. That is what I have done in my personal therapy work too. Talking about painful memories for me actually helped me to feel relief both physically and emotionally. There is a therapy approach called Acceptance and Commitment Therapy and that actually can be quite helpful for pain and sadness.

This approach does not mean you have to accept the current situation as something that is permanent. In fact, it is more about acknowledging the feeling, thought or pain and noticing it because the pain is showing up for a reason. Maybe that pain is trying to get a message across such as, I am stressed out and need more down time.

Noticing the thoughts and feelings and giving the pain the attention it is seeking goes along with the saying, "name it to tame it." The book is one that can easily be found online or at the library. The information shared in the book goes along with what I have shared in here. I do know some people who have felt the book helped them, but there is no one size fits all approach since we all are so individual and respond differently to different things. Do you have any follow up questions based on what I mentioned in here?

[–]WaxStatue 1 point2 points  (1 child)

No, you've been very informative and helpful. Thank you.

[–]Daniela-P-CounselingDaniela Paolone 0 points1 point  (0 children)

you are very welcome!

[–]Purple4199 2 points3 points  (6 children)

I have treatment resistant depression and anxiety. I’m on my fourth round of different medication combos to try and help me feel better. This latest round is not making a difference.

My question is, is there a way I should expect to feel? Like last year at this time I was really in to baking and cooking and excited about that. Now I can’t even get motivated to do any of that.

I am functioning at this time, so should I just accept that this is how it will be and not expect to feel as good as I did before? I’m worried my psychiatrist will become exasperated with me because nothing is working. (He’s never given any indication of feeling that way, it’s just a fear of mine.)

Is it reasonable to want to feel that good again, or should I be ok with how I am now, since I’m at least not suicidal? Thank you in advance.

[–]DrOsabenCarol O'Saben 4 points5 points  (2 children)

Thank you for your question, Purple4199, and your vulnerability in sharing your story. I have seen so many people get frustrated and demoralized when it takes awhile for any of their treatments to make a difference....hang in there! Sometimes it takes a while to find the right combo of medication to make an impact.

Others may have a different take on this, but one of my goals in working with clients is to help them find a way back to the things that used to interest them before the depression/anxiety became an issue. It might not be exactly the same, but I think you can generally expect to take joy from things you have previously enjoyed. I don't think you have to accept that you will always feel this way. Keep working with your psychiatrist until you find the right treatment. And I am glad you haven't gotten a sense from your psychiatrist that he is getting exasperated. I would be willing to guess that he's probably been down this road with other patients. You could certainly raise this issue with him in a session.

And I have a question for you....are you doing any talk therapy in conjunction with your medication? Many, many people find that the best treatment for mood issues is a combination of talk therapy and medication. Sometimes psychiatrists do a good amount of talk therapy along with their medication management, but sometimes a psychiatrist might want to refer you to a therapist who specializes in treating mood disorders. If you have not done that, or are not currently engaged with a therapist, I would encourage you to talk to your psychiatrist about his sense of whether this might be a helpful addition to your treatment.

Good luck!

[–]Purple4199 2 points3 points  (1 child)

Thank you for your response. I am seeing a therapist who specializes in EMDR as well. I really like her, and she was The one who recommended my psychiatrist to me. I think I am just feeling a bit defeated and it’s hard to keep up hope at times.

I didn’t think of the fact the my psychiatrist most likely has been down this path and I’m not a strange or difficult case, thank you for that perspective.

[–]DrOsabenCarol O'Saben 1 point2 points  (0 children)

Oh, good. I'm glad you are also seeing a therapist and it sounds like your therapist and your psychiatrist are working together with you as a team....that always helps! I know it can be exhausting to carry around this burden and to feel like nothing is helping. And it's okay to give in to that worry on occasion, as long as you pick yourself up and keep moving forward after some time. You sound very invested in getting better and engaging fully in treatment. I am hopeful things will start to feel better for you soon. Take good care!

[–]tisaaccastroT. Isaac Castro 1 point2 points  (2 children)

Hi Purple4199 - I appreciate you sharing and thank you for the question. I am going to add a couple of thoughts. I recognize the challenges of depression and anxiety frequently include "easier said than done." I think that what you are expecting to feel, can help guide your participation with your therapist and your psychiatrist. It is definitely reasonable to want to get to feeling good again - they are your team to help you to get to the place you want to be.

[–]Purple4199 1 point2 points  (1 child)

Thank you for those insights. I’ve been dealing with this for so long that when I got a few months of doing good I really liked it. You don’t realize how much you settle for feeling low until you feel good again. At the moment it’s hard to feel like it will get better, but I’ve been through these feelings before and they eventually pass.

[–]tisaaccastroT. Isaac Castro 1 point2 points  (0 children)

You’re welcome. It’s cool that you can get your insights and confidence from what you have experienced. I appreciate you sharing the outcomes openly on a public forum because I think it gives others a chance to have confidence that the waves of feelings do include “feeling better.” I like that you can give that to others and I like that others can get that from you!

Take Care!

[–]SEND_ME_CALM_NUDES 1 point2 points  (7 children)

What are your thoughts on the work MAPS is doing using psychedelics as a therapeutic tool for ptsd?

[–]AdrianaAlejandreLMFTAdriana A. Alejandre 2 points3 points  (4 children)

Hi, I'm a trauma therapist and I have an opinion on this. I do agree with Daniela that it is something to definitely discuss with your doctor first and foremost. I have been waiting for the peer-review research for this approach. The approach is still very new but in some peer-reviewed articles I have read that psychedelics are showing a reduction in mental health symptoms. I am curious. What are your thoughts?

[–]SEND_ME_CALM_NUDES 2 points3 points  (2 children)

Another question: why don't more insurance companies cover EMDR? Is it to force people to use pharmaceuticals, or because it's not an effective modality?

[–]AdrianaAlejandreLMFTAdriana A. Alejandre 0 points1 point  (1 child)

I am glad to hear that it has helped you process those experiences. In terms of insurance and EMDR. I know many insurance plans that do cover EMDR. Many (if not, all) insurance plans for military vets cover EMDR. I would also recommend calling the insurance plan yourself to get verification. I don't work for an insurance so I wouldn't know the rationale for a policy not covering it. There is years worth of research supporting the EMDR protocol, that much I do know. Was that helpful?

[–]SEND_ME_CALM_NUDES 0 points1 point  (0 children)

Much, thank you :)

[–]SEND_ME_CALM_NUDES 0 points1 point  (0 children)

I can only speak to my personal experience, but LSD has helped me process the most traumatic experience of my life.

(I know mdma is supposedly better and definitely more predictable for therapy, but those blue Mondays...)

[–]Daniela-P-CounselingDaniela Paolone 2 points3 points  (1 child)

Hi there send_me_calm_nudes, and thank you for asking your question. We cannot really speak to the use of psychedelics as that is not something that is within our scope of expertise. Any questions about medications or other substances should be explored with a psychiatrist. Do you think that is something you might discuss with a doctor?

[–]Ade_93 2 points3 points  (0 children)

Only if you insist! Thanks for everything you guys are doing.

[–]FutureOrBust 1 point2 points  (3 children)

My mom is diagnosed bi-polar. It's a touchy subject, but when it comes up she denys she is bi-polar. Thus not taking her medicine. She seems completely normal when she says she hasn't taken it in months. Sometimes I can tell she is a little manic, and sometimes she's so in the swing of it she has to stay in a rehabilitation center for a bit. This normally happens after a big change (ie death of my brother). My question is, should I be concerned when she doesn't take her medicine?

[–]heather_mckenzieHeather McKenzie 2 points3 points  (0 children)

This sounds difficult - it's so hard to see people we care about having to go through chaos. It also sounds like she's making clear choices about what she wants to do re: medicine and treatment. Rather than wondering about if you should worry or not, I would suggest looking out for her behaviors that start to seem erratic or of concern. It is not uncommon for someone with bipolar or related symptoms to want to avoid medications. Meds have side effects and some of them just don't seem worth it. What you could do instead of worrying about her and medications is to be a source of support, compassion, and assistance in helping her to reduce stress (this can push someone into mania) and increase a healthy lifestyle (diet, exercise, regular schedule and good sleep), as this can help stave off a manic or depressive episode. It boils down to: she is deciding how she wants to live her life and your ideal role is to live yours and do your best to support her choices while also getting her professional help when that is warranted or her safety is at risk. It could be that she has figured out how to manage and regulate her symptoms fairly well until the sh*t hits the fan. And that's when she needs you to be concerned. Otherwise, perhaps try to turn away from the worry thoughts.

[–]DrMonaGMona Ghosheh 1 point2 points  (0 children)

Hi futureorbust, sorry to hear about what's happening with your mom and the death of your brother. Sounds like it's been tough on multiple levels. It's completely normal for us to worry about our family members especially when they have health issues that don't seem to be managed well. As their loved ones, we want to fix the problem and see the other person healthy, happy, and thriving. But it's nearly impossible to make someone do something they don't want to do. Even if you increased your level of concern to 1000% it can't make your mom take her medications or go to counseling. That is completely up to her. The only time we can intervene as family members is when our loved one is in immanent risk of ending their own life or someone else's. In these situations, we can contact the police/mental health deputy and ask them to check in on our loved one and take them to the hospital if the above criteria is verified. Only then can treatment/medication be "forced." And even then, the enforcement is temporary, because once the person is no longer at risk of themselves and/or others, they are released from the hospital with treatment recommendations (which include counseling and medication) that the person does not have to comply with if they don't want to. I don't say this to make you feel hopeless...rather, my hope is to point out that making your mom take her medication/go to counseling is not something you (or anyone) can force her to do so it's best if you take that off your shoulders and off the list of things you're worrying about how to do. The best thing that you can do is be her child. As her child, you can call to check on her and ask how she's doing. You can tell her how you feel when you see her suffering and not taking her medications. You can go with her to the doctor's office if she wants someone to be there with her. It's not a perfect solution, but having positive sources of support, can help some people feel more open to making changes and asking for help when they need it. Hope that helps!

[–]DrJanaScrivaniJana Scrivani 1 point2 points  (0 children)

It certainly seems like you're in a difficult position. Thanks for taking the time to post and share. It's very difficult, but unless you have medical guardianship over your mother, there is little that you can do to make sure that she takes her medication, unless she is presenting as a danger to herself or others, in which case you should call emergency services. So while yes, it certainly is concerning, what I would recommend is that you focus on getting support for yourself. If you're in the United States, you can look up your local chapter of the DBSA, the Depression and Bipolar Support Alliance. It's a support group for folks with mood disorders and their families. I'm sure many of them have gone through similar things, and would provide peer support. You might also consider consulting with a licensed mental health professional yourself. While you cannot control your mother, you can learn to make changes to your thoughts and behaviors so that you are better able to cope with the ups and downs. Best of luck.

[–]HereComesTheNarwhal 1 point2 points  (5 children)

There's been a question about books already but it seems more oriented towards clinical practice. Do you have any recommendations for workbooks and the like that people can use to work on their mental health and self on their own?

[–]drlisakbakerLisa Kukkamaa Baker 0 points1 point  (1 child)

There are so many great books out there! It really depends on what you're looking for help for. My strategy when looking for books to share with clients is often to check out every book on a subject that my local library has and then skimming them to see what might be worth looking into further, or what might be a match for the particular person I'm working with. Different books resonate with different people...so really, just finding the ones that work for you. That said, I totally concur with Lydia's suggestions. Anything by Brene Brown!

Here are some other recent recommendations: Present Over Perfect by Shauna Niequist Things No One Tells Fat Girls by Jes Baker (fave resource for loving your body, no matter what your weight) The Anxiety Answer Book (especially like this one for the sections on panic attacks) The Feeling Good Handbook by David Burns (good for depression, anxiety, and general mental health) The Anxiety and Phobia Workbook by Edmund Bourne The Relaxation and Stress Reduction Workbook The Post-Traumatic Stress Disorder Sourcebook The Seven Principles for Making Marriage Work by John Gottman (anything by the Gottmans for relationships!)

Otherwise, there are so many apps and podcasts out there that are helpful. It's exciting how many resources are available now. :)

[–]HereComesTheNarwhal 0 points1 point  (0 children)

Wow, thank you for the considered answer! I will check them out :)

[–]therapylydLydia Kickliter -1 points0 points  (2 children)

Hi HereComesTheNarwhal! Thanks for the question. My favorite self-help book is "The Gift of Imperfection" by Brene Brown. She also has a powerful TedTalk on the topic https://www.youtube.com/watch?v=iCvmsMzlF7o. She talks about topics of shame, vulnerability and perfectionism and how we can show up in the world as our authentic self. Dr. Kristen Neff is doing great work on self-compassion and she has a website chock full of resources on how to develop self-compassion. One of my favorite books is Viktor Frankl's "Man's Search for Meaning." He was a survivor in a concentration camp and he explores how some people found meaning in those dire circumstances and were able to survive. It's a beautiful exploration of the human spirit. Happy reading!

[–]HereComesTheNarwhal 1 point2 points  (0 children)

They sound really interesting, and I love TED talks. Thank you!

[–]DraconisLee 0 points1 point  (13 children)

Any books that you guys recommend about your field? And why?

How do you guys get in therapy?

Thanks for providing an AMA.

[–]DrAmberLydaAmber Lyda 3 points4 points  (2 children)

Oh man, so many great books! One that really stands out is "Get out of your head and into your life" which is an ACT oriented workbook. I got it to help clients, ended up working through it myself and had to buy another copy to use with clients! It's very, very helpful. One of my favorite books for trauma is the PTSD Sourcebook because it is very helpful for people with complex trauma which I think is often treated as if it is the same as simple trauma and I find that to be dangerous for clients.

I got into the field at 17 years old in a clinic for people with Dissociative Identity Disorder. I loved my work from day one and knew this was going to be my path from that moment forward. I feel so lucky to have found a career that lights me up every single day. I love, love, love what I get to do for a living.

[–]DraconisLee 1 point2 points  (1 child)

If you don't mind me asking, what is simple trauma and complex trauma? How different are they to each other?

Thanks for the rec! Will check it out later. And congrats for finding your dream job!

[–]DrAmberLydaAmber Lyda 2 points3 points  (0 children)

I love this question.

Simple trauma occurs when a person has had a reasonably happy, healthy, typical life and BAM something awful and traumatic occurs. The symptoms for this include things like physiological hyperarousal (heightened startle response for example), efforts to avoid reminders of the trauma, and re-experiencing the trauma (flashbacks, nightmares, intrusive thoughts). Treatment is often pretty straightforward and I think most therapists are pretty capable of doing that work. The goal is to get them back to the pre-trauma functioning.

Complex trauma (or DESNOS) occurs when a person has a history that is marked by repeated traumas, exposure to an inconsistent, unsafe, chaotic, unpredictable childhood, or both. Sometimes people with cPTSD don't realize the extent of their traumatic experiences because it was their "normal".

The symptoms that result from this can overlap with some sPTSD symptoms, but they also have their own unique symptom picture. Symptoms can include things like difficulty with trust in relationships (either giving it totally freely, holding back completely or holding back in almost all cases but hyper-dependence on one person), typical PTSD symptoms, confusion about sense of self, mood disorders, difficulty coping, difficulty regulating their emotions, etc.

It's much more complicated to treat (and I love to provide this type of treatment) but to treat it the same way you might treat sPTSD can sometimes make the cPTSD person much worse. This is one of my soapbox things so it is important to get lots of opinions on this kind of thing. I have a very strong one:)

Some of my favorite resources on this include "Not Trauma Alone" by Steve Gold and The diagnosis and treatment of DESNOS by Bessel van der Kolk. One of the best treatment tools I've found for this is the PTSD Sourcebook:)

[–]TherapyNTNicole Tableriou 1 point2 points  (0 children)

Therapy is a second career for me, I spent many years in IT before making the change. I wanted a job that I couldn't age out of, since IT is often consider a career for the young! I recommend The Gift of Therapy by Irving Yalom as a strong starting point. Really easy read. For the addictions space, I live by In the Realm of Hungry Ghosts by Gabor Mate.

[–]KatieleikamlcswKatie Leikam 1 point2 points  (1 child)

I recommend the book TransBodies TransSelves if you are interested in the transgender community and their stories from their voices. I also recommend The Gender Quest Workbook for children and teens. I decided to become a therapist, because I had the opportunity to grow from therapy in high school and it's something I have always wanted to accomplish. I went to school for my master's degree and received my Licensed Clinical Social Worker license after several years of practice. Are you interested in becoming a therapist?

[–]DraconisLee 1 point2 points  (0 children)

They seem interesting! I'll check them out!

I'm interested about the subject. Psychology seems like a great thing to understand too. In place I live, mental health is overlooked and didn't acknowledged as real illnes so finding more about them is very helpful

The situation is better now but therapy in my place is still not that common.

[–]courtneyglashowLCSWCourtneyGlashow 0 points1 point  (0 children)

Great question! I see others answered about some books. I'll answer about my personal experience becoming a therapist. In high school I took an elective psychology class and really enjoyed it. The class was mostly us watching Freaks & Geeks haha but we did analyze all the characters. I think it was since that point I was interested in therapy. This led me to study psychology in college and then to my MSW in graduate school. I learned that with my MSW degree I could become licensed after 2-3 years of experience so that I would get my LCSW. I can now own my own private practice as a therapist. I love what I do!

[–]drlisakbakerLisa Kukkamaa Baker 0 points1 point  (0 children)

A couple of my favorite books especially early in this journey were "On Being a Therapist" by Jeffrey Kottler and second the suggestion of "The Gift of Therapy" by Irvin Yalom.

I always knew I wanted to be a helper, and as I explored my interests, psychology was clearly a natural fit. As I got deeper into it, I got experience in lots of different areas, and found that working with the elderly was what I loved most, and that led me to my specialty in geropsychology. Basically I followed my passion, and have zero regrets...I love what I do! Books that affected me were Viktor Frankl's "Man's Search for Meaning," and a lot of the work of Henri Nouwen, especially "Aging: The Fulfillment of Life."

[–]brookewilliamslpcBrooke Williams 0 points1 point  (0 children)

I love so many of the books already recommended, so I'm going to defer to those suggestions! Similar someone else that already responded, this is a second career for me, after IT. I got into it after interacting with mental health professionals because of a family member and how impactful those professionals were for my family, and I wanted to be that helpful for someone else.

[–]HopeEdenLCSWHope Eden 0 points1 point  (0 children)

Quite often, I recommend the book "Controlling People" by Patricia Evans. This book has greatly impacted my work. https://www.amazon.com/s/?ie=UTF8&keywords=controlling+people&tag=mh0b-20&index=stripbooks&hvadid=78408969406568&hvqmt=e&hvbmt=be&hvdev=c&ref=pd_sl_1wy6jqxz4r_e T

[–]DrMonaGMona Ghosheh 0 points1 point  (0 children)

Great question! I come from a family background and culture where people didn't really talk about mental health issues and no one ever went to counseling because "only crazy people do that." In fact, I didn't even know what counseling was until I was in high school and met with my school counselor to prep for college. Now I know...that's not even considered "counseling" lol (more academic/career preparation)! I wanted to be a pediatrician and even majored in pre-med in college. I had to work full time while going to school part time to pay for my education so it was really hard and caused me to reevaluate my career goals. I realized that I didn't even feel as passionate about going to medical school as I once thought. That's when I remembered that during high school, I took career tests that kept pointing to a career in counseling. At the time, I thought the results were stupid and "obviously" incorrect because it did not say medical doctor! But during college, it seemed to make sense to me somehow so I took a class in psychology to try it out. I loved it! That's when I started on a track to becoming a school counselor (again, the only type of counselor I even knew existed). When I went to get my masters in school counseling, I was introduced to the field of Counseling Psychology and the career of being a psychologist. That experience hit me like a lightening bolt--I knew instantly that this was the career I have always wanted. The rest is history. I got my doctorate in Counseling Psychology and have devoted my career to helping other young people from cultural backgrounds that "don't do counseling" get the help that they need. It's been an amazing ride.

Now with regards to books, my recent favorite is the Mindful Path to Self Compassion by Chris Germer. I've been recommending it to my clients left and right. Mainly because I think the book clearly explains how our mind can work against us and gives the reader specific ways to start to improve this. It discusses scientific research and it has specific exercises that you can do to not only understand the material logically but to feel it working too. Hope this helps and thanks for the question! :)

[–]DrJanaScrivaniJana Scrivani 0 points1 point  (0 children)

Hi there, I'm a bit late to the game, but here goes! So many people have offered wonderful resources. Back when I was an undergraduate I read Love's Executioner, by Yalom, I highly recommend it. I'd known I wanted to be some sort of therapist when I was 15, directly following astronaut, and then lawyer. When I got to college I started working on a Peer Counseling hotline, and I've been involved in mental health treatment in some form or another since that time!

[–]danielsimon811Daniel Sokal 0 points1 point  (0 children)

Some great recs already ! My main ones are:

Practical Psychoanalysis for Therapists and Patients by Owen Renik (honest and real account of therapists as humans and the importance of the role the therapist plays in healing through hearing, interpretation, honesty, and humanity in the milieu)

The Drama of the Gifted Child by Alice Miller (specifically for understanding the deep intuitive gifts and damage that comes from growing up with a narcissistic parent )

The neuropsychoanalytic treatment of self deficits , searching for complementarity by Joseph Polambo ( wordy and intense title, but amazing book by a mentor and professor that takes a neurological look at attachment and our search for others to complement our needs and how our histories relate to our present relationships )

Mag or Min, Which are you ? By Thomas Schur ( the life’s work of another mentor of mine, beautifully evaluates his own life and his existential anxiety and family of origin tied within the ups and downs of his own life, guides you in how to do the same ).

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