We are Therapists hosting a R-Rated podcast called "Pod Therapy", Ask Us Anything for Mental Health Awareness Month!

Six years in, are there any questions or topics you haven’t been asked yet that you wish someone would ask, whether it be about a certain mental illness, aspect of addictions treatment, relationships, etc?

In six years we have covered ALOT! We answer about 3 listener questions each show and just published our 278th show, so that's probably (counts on fingers and toes) like over 800 questions! But new topics are coming in all the time and one of the things we most love is the questions are very situation based, so even if two are about anxiety they will be about anxiety in different ways, which really gives listeners the chance to relate to specific ways.

We also do topical deep dives on our Patreon (Patreon.com/Therapy) which gives us the chance to take on topics in a bigger way. We recently published a 6 hour series on ADHD and got into the weeds of the history of the diagnosis since DSM 1, the anatomy of the brain, how therapists assess and treat, and why we are seeing a huge surge of new diagnoses.

All of this is to say that when things come up that we want to cover, we get a chance to cover them and publish content on them, but we are always looking forward to new questions and are sure to get something we've never talked about every week!

I can attest that the deep dives are great and super educational. Dr. Jim knows how to condense knowledge in a way that most clinicians have a hard time accomplishing.

Unless it’s his ADHD deep dive. Still amazing, but 6 hours is anything but condensed lol

Yea, looking back, it was kind of cruel to create 6 straight hours of audio content for an ADHD audience, lol

I listen to you guys a lot, and now I just want to know which one of you wrote the word "alot" so I can silently judge you from now on.

We live and die as a team and refuse to sell each other out.

...but that was absolutely Jim.

-nick

I'm pretty sure I have an addiction to social media. I am feeling the need to always open my phone to check Facebook, Instagram, TikTok etc. What are some good ways and tips to overcome the constant need to look at social media sites? Thanks!

So the irony of this question on a Reddit AMA is not lost on me lol. I completely relate to this! TikTok and Reddit seem to be my default screens on my phone, and I can find myself opening my phone seconds after closing it to "check again" or ending up on a long spiral of up swipes where an hour can pass without my noticing.

Social media "addiction" is absolutely a reality, and in many ways none of us should be surprised. The people who made this billion-dollar websites are very smart and designed them specifically to give humans dopamine bursts every time we use them. Our brains will naturally seek these bursts like a moth to a flame, and since we haven't evolved since our caveman days we don't exactly know how to stop accessing something (food, drugs, alcohol, love, Tik Tok) when its becoming unhealthy for us.

We've seen people have success by starting with a social media "detox". Deleting the apps from their phone for a week and giving their brain time to just get back to the duldrum slow reality of meat space. After that using your phone screen time limits *can* be helpful, though for me it just becomes one more screen I click through to get to the goodies.

In the end, most people don't want to quit social media, they just want to get their use under control. Physically disconnecting the apps from your devices for a solid week is a great way to recalibrate your brain's neural circuitry and give you a chance to return to the apps with less of a compulsive pattern.

Is it ever too late to seek a new mental health practitioner if you feel you’re not making progress with your current one?

Great question! So the short answer is: No its never too late, and yes its always ok to seek a new provider. But here are some more thoughts on this:

First, people change over time. If you've been seeing the provider for a while, maybe your primary challenges have changed, maybe (hopefully) you've changed, and it sometimes makes sense to find a new provider to address new concerns in your ongoing story.

However, my first choice before changing providers is to open up a conversation with your current one about what your treatment plan is, what your goals are, and how *they* feel you are doing on progress. Sometimes as Therapists we think you're doing perfectly fine, or we think that our role in your life has become more about maintenance than actively addressing big obstacles. It helps to open up a conversation with your therapist about how your therapy is going, what items you feel you want to work on, and to get their feedback on ways you might get more traction.

In the end we want you to reach your goals! Its ok to talk to us when you feel like you've slowed down or you want to identify new problems to work on =)

Hey Nick and Jim. I enjoyed therapy a lot. When I couldn’t afford therapy I went to a group for depression and hated every second of it. I had to wait around for two hours and do nothing but listen (it would be rude to be on my phone) and it was very bleak and depressing just to hear people complain while there was no discussion or feedback. Then I got to speak for ten minutes and I got zero feedback. Is group supposed to actually help people? Or are support groups supposed to be something different than what I experienced? Honestly, it was torture. Ps, love the podcast, you are the reason why I went to therapy.

Hey! Thanks for listening and SO GLAD to hear we influenced you taking that first step into therapy!

So, support groups have an important role in the helping ecosystem. Like you said they are often affordable (or free), they are usually easy to find and get started with, and its a great place to meet other people who relate to what you're going through. Importantly, it can be a first try at language your personal experience, and it can give you valuable insight as you hear what others are going through.

But sure, support groups can also be a drag at times. Its not uncommon for a person to visit Alcoholics Anonymous and say "that group made me want to drink more than ever!" or to go to a depression group and leave feeling *more* depressed than when you went in. As a therapist I usually take those groups and my patient's participation in them on a case by case basis. Usually, Im a fan of people having the experience because Id rather them have SOMEBODY to talk to and at a minimum normalize their their experience. But I also realize that it isn't easy to be among sick people who are sharing about their sickness, even if you can relate.

I do think that groups do help people overall. By the way, if anybody out there is looking for mental health support groups we recommend looking up your local chapter of the National Alliance on Mental Illness (NAMI)

It took me a long time to realize that I was constantly seeking my esteem and sense of self-worth from others. What are some things I can do to 1) look inward for my own worth and 2) stop seeking validation so much?

This is a great question that so many people relate to.

First, its not inherently bad to get a sense of our selves from the perspectives of others. Humans are social animals, we value community and its normal for us to want to please others and desire their approval.

However, as you've realized, this often becomes toxic to us. Maybe the people we look to for approval will never give it, can't give it, or have a myopic view of reality and we shouldn't trust their judgement of us in the first place. Maybe people around us see our conspicuous flaws and fail to be curious or interest in who we really are. Or maybe we are just surrounded by assholes.

Here are some things I'd like you to do. (1) Get a list of personality description words from the internet. Look through that list and circle as many positive qualities about yourself as you can find which you relate to. Then reflect on each of the words your circled, recalling memories and experiences you've had which you feel exemplify that word. Make it a ritual in your life to review your day, your week, your month and your year through the lens of what your personal goals for yourself were, where you've grown as a person, and what you are proud of. Part of how we let go of the voices of others is to consciously hear our own voice, so we have to make this a practice in your life. (2) While its natural to seek validation from others, we often do so in a passive way that is unsatisfying. We are *hoping* somebody will thank us, compliment us or affirm us. We post online that we are sad or feeling down to fish for some positive feedback (which isn't wrong to do). But a better way is to approach a few quality people in your life from time to time and tell them that you need a reminder of what they like about you, or admire in you, and ask if that is something they can take a moment to give you. I like being direct and honest about what we need from others because it gives them an opportunity to think about it and get closer to providing what we need.

Great questions friend, good for you for taking this on and realizing that you are enough just the way you are!

Hey there, I'm in my mid thirties, female, no kids. Lately I've been finding my friendships very one sided and disappointing. It seems like meeting with friends became so "serious". We either talk (a lot) about problems that need to be solved, some relationship drama or stress at work. I'm usually the one asking to do fun stuff like activities outside, play games, go to the cinema, but no ones really up for that anymore. Everyone is so absorbed with their jobs, always exhausted and there is always something to complain about. I have the impression it got worse since covid. I'm also very tired of always making plans which are cancelled the last minute and somehow feel like "giving up" on friendship. Do you know these feelings? Is it somehow my generation, is it age, is it me?

YES!

Nick here. Check out some of our recent episodes. This has been a question we've been getting a lot. It seems like we get asked this more in the past 2 years, but I can't say for certain.

I like you suggesting fun things to do, and making your time together based around an activity. It can lighten the mood. However, I also understand that that's not for everyone. As we get older, we become less active. It also sounds like some of your friends are dealing with a lot of stress in their home and personal lives. Getting active is probably one of the best things they could do, but when we are feeling stressed and depressed, doing something like playing a game starts to feel like a chore.

You might just be at a different place in your life. Don't give up on friendships, but instead be open to fostering new friendships. If you enjoy things like playing games, going to movies, engaging in outdoor activities, Keep Doing It! Look for social groups in your area that are based around activities, and look for ways to get involved. You can still keep your friends and meet up with them for coffee (or whatever it is that they like to do) while not feeling like you're holding yourself back.

Best of Luck,

Nick

Hi there, what are your thoughts on the recent ACT studies and their better long term outcomes compared to traditional CBT? Thank you!

Great question!

So for those who don't know the acronyms, ACT is "Acceptance and Commitment Therapy" and CBT is "Cognitive Behavioral Therapy".

The neat thing is that ACT is the child of CBT, we sometimes call it a "third wave" of CBT. It uses the fundamental principles of CBT - identifying the meaning we give events in our lives, challenging our perspectives and giving ourselves permission to find the truth - but it also incorporates techniques from mindfulness and meditation.

Research is always showing us how new theories and approaches are making headway with various populations of people, and ACT is showing some great results in some populations that might be less responsive to CBT. ACT's focus on positive values and accepting the presence of discomfort can be transformative.

In the end, every psychotherapy approach is better than placebo, but ACT has some great tools that many people are benefitting from!

In the end, every psychotherapy approach is better than placebo, but ACT has some great tools that many people are benefitting from!

What does placebo look like in these kinds of studies?

Sorry, lol I meant that as a joke. In this case I guess we'd say any therapy beats no therapy at all =)

Hey!

What advice would you give to someone who’s just become a qualified therapist?

Great question,

There are many answers we can give to this question. To narrow it down to a few pointers, I'd say 1) find a mentor. There is a lot we can learn from more experienced clinicians. Keep an open mind throughout your career and never stop learning. 2) Remember that everyone is struggling with something. Keeping that in mind can be useful when we find ourselves dealing with a hostile or verbally aggressive client. 3) Find a good self-care routine. Learn to separate your work life from your personal life. Be able to check-in with yourself and process your own thoughts and emotions at the end of your work day before heading home. Doing so can be the difference between someone who has a fulfilling career as a therapist versus someone who needs to find another line of work after a couple of years. Lastly, 4) when you feel scared, when you feel stuck and you're not sure what to do, your fallback position is always that of a cheerleader. Find some success the client has had, no matter how small, and fan those flames.

Best of luck to you!

Nick

Welcome to the profession!

In our show we often offer advice to new therapists or point out common mistakes when we answer listener questions. Here are a few things I'm preaching to new therapists these days:

1. Avoid value imposition. Every ethical code, every theory founder, and every state's laws specifically forbid a therapist from imposing their values beliefs or attitudes on the patient. However, in modern culture we have seen a dangerous trend of therapists feeling comfortable teaching their patients a political worldview or moral philosophy, believing that the greater challenges of society are so intertwined with mental health that as therapists we have an obligation to teach our patients whats right and wrong in the world to help heal them. New therapists are being influenced by social media voices with hundreds of thousands of followers who (spoiler alert) have more experience in social media than in the therapy chair. These outsized voices are influencing new therapists to impose their values, which is not good.
2. Avoid hyper diagnosis. New therapists coming out of grad school are often in a "case study" mentality. They are scanning all the clues and hints they hear in therapy looking for the diagnosis code as if there is going to be an exam after the session. But part of being an effective therapist is seeing the humanity in your patient, not their diagnosis. Carl Rogers said it best “We have come to recognize that if we can provide an understanding of the way the client seems to himself at this moment, he can do the rest. The therapist must lay aside his preoccupation with diagnosis and his diagnostic shrewdness, must discard his tendency to make professional evaluations, must cease his endeavors to formulate an accurate prognosis, must give up the temptation subtly to guide the individual, and must concentrate on one purpose only; that of providing deep understanding and acceptance of the attitudes consciously held at this moment.” (Client Centered Therapy: Its Current Practice Implications and Theory, 1951, pg 30)
3. Focus on connection. If you can provide a genuine connection with a patient where they feel unlimited positive regard, safety and freedom from judgement or scrutiny, and experience you as a curious and empathic listener, your patient will become to access and unlock parts of their human experience that they never have before. Healing happens when we can create the conditions of relationship that facilitate healing. It isn't a theory, it isn't a list of techniques, its a connection. Again the great Carl Rogers said “If I can provide a certain type of relationship, the other person will discover within himself the capacity to use that relationship for growth, and change and personal development will occur” (On Becoming a Person: A Therapist’s View of Psychotherapy, 1961)

With the WGA going on strike, will Nick be striking for the rest of this season of Pod Therapy?

As a rule we don't write anything for the show. Listeners provide the trivia and the questions. So they are the only writers who can strike. Also Nick can't quit me, he's in too deep (this is Jim)

Do you ever get bored by what your patients talk about? Does what they're talking about ever feel repetitive?

Repetitive? Yes. Bored? Never!

Its actually pretty common for a patient to revisit particular ideas, patterns or realities in therapy. We expect this, and call them "themes". In a sense this repetition is very important to a therapist because it gives us chances to develop insight for the patient into their patterns, notice when change is occurring and stimulate new solutions to familiar realities.

But speaking for myself (Jim) I never get bored with my patients. I'm one of those people who will be on the edge of my seat to find out what you had for lunch or how you slept last night lol. I realize that not everything a patient says is important, but my patients never bore me.

Having said that its ok if other therapists reading your question do feel bored sometimes. We are human beings after all. Even your dog, who probably thinks your the most interesting thing in the universe, probably loses interest in you every once in a while in favor of a chew toy or something lol.

So when I repeat myself over and over, I'm not being boring, I'm being thematic. I like this.

You should know that our discord community screen shot this "thematic" comment and likes you very much lol

How many neurodiversity people, in term of percentage, do you think suffer for depression or other mental illness? How much to do you think their mental heath is affected by misconception and the general lack of information of people around them?

This is an important question on several levels. Let me make a few points:

Comorbidity (the double trouble of having two mental illnesses at once) is statistically high in people diagnosed with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder - what most people call "neurodivergent". Sometimes this is situational as people with ASD and ADHD struggle in social lives, work lives or in a world not quite built for them. Sometimes this is chemical as the brain may predispose them to experiencing acute sadness and low joy in life.

However, one thing we are seeing a lot of lately are people who primarily have depression, adjustment disorder, or are going through difficult life transitions concluding that they are actually "neurodivergent" and seeking treatment for ADHD (stimulants) rather than addressing the depression itself. This is possibly due to the new global discussion around ADHD/ASD and especially its relatability and popularity on social media. So in some ways, the hyperinformation about these conditions is also creating a misconception about them which can also lead to some depression and neurodivergent (or perceived ADHD/ASD) crossover.

In the end, we encourage people to talk through all their experiences with a healthcare provider. The more information we can gather as helpers the more likely we will be to zoom in on the specific problems a person is facing and help them find better solutions.

Great question!

Thank you for the answer, which reminds me that a lot of people blaming dyscalculia for finding math hard, while there is actually difference between being math-anxious and having dyscalculia.

So, in your opinion, which aspect of neurodivergence is more prone to under-diagnosis due to lack of information and which is more prone to hyperinformation?

Presently I (Jim) see more people believing they have ADHD than ASD. The qualities of ADHD are extremely relatable, the diagnostic criteria have been lowered over time in more recent editions of the DSM, and social media has misinformed the public that an infinity of life challenges or thinking qualities are proof of ADHD.

ASD on the other hand, while also suffering from much misinformation, isn't as "sexy" to have and the qualities are always as relatable. Many people on the spectrum don't know they are. Having said that, diagnosis is not the most important thing. Knowing a person *technically* has ASD or ADHD isn't actually that useful in real life. This has to do with what mental health diagnoses actually are (not a cause to effect thing, but more a description of a bundle of symptoms). In the end what matters is treating any problems the person experiences in day to day life and increasing their coping skills.

Thx. Final question, a bit off topic. Do you have any book recommendations for neuroscience? I read Sack's the man who mistook his wife for a hat, and really enjoyed it.

If you're into music, "This is your brain on music" by Daniel J. Levitin is really good.

-nick

Hey there! Listen often and love the podcast. I’ve been listening since last year’s AMA when I learned about you!

Any advice on supervising interns? I’m a licensed mental health therapist, got my qualified supervisor license late last year, and would love any advice or tips that any of you have on being a great asset to the new Gen of therapists.

Thanks for all you do! I love the podcast and enjoy all the shenanigans in between the deep conversations. Breaks the facade that we’re all stuffy people with armchairs and chaises!

Thanks for listening to the show, and always glad to meet a colleague!

So Nick and I (Jim) are both clinical supervisors, and I'll tell you that we have some concerns about raising up the next generation. I (Jim) am actually working on a deep dive series for new therapists to help them avoid some mistakes that are becoming trends in the profession (values imposition, hyper diagnosis, victim mentalities, etc).

But in the big picture I'd encourage a new supervisor to remember that new therapists are often afraid they are going to "break" somebody. They need to be constantly encouraged and reminded that they "are the expert in the room" and that if they default to their training the patient will be ok.

The most important thing I want an intern to learn are the Common Factors (the qualities of effective therapy) with a focus on Carl Rogers Person Centered approaches. New Therapists need to develop those "chair skills" of unlimited positive regard, deep interpersonal understanding, and becoming a human mirror for the patient to have an experience they simply cannot have with others.

Supervisors have a lot of influence over this, and I think we need to make sure we demonstrate it and simulate it with our interns so they can *feel* the experience. Interns often struggle with being "book smart" for a while and they need to get that intuitive feel of therapy. Simulating that with them is a huge help to launching their career!

Hi Jim, Nick, and Whitney! I find a lot of people think their problems are "not big enough for therapy". I was wondering, do you ever find yourself in a situation where you recommend a new patient not continue treatment? Like in a "this probably isn't the best use of your money and our time" kind of way?

This is a great question!

So yes, as clinicians we sometimes find ourselves in a situation where we believe the patient is facing a "sub clinical" challenge that doesn't necessitate treatment. This doesn't mean we will turn them away, but it can mean that the patient's insurance won't cover their care. If that happens we make the patient aware of this and talk through their options. In situations where insurance isn't involved, most of the time the therapist will still work with the patient, but help them identify what the best use of therapy will be for their specific goals.

But you're right that many people never take that first step because of the stigma, or the fear they will be told they don't have "real problems". I can say with confidence that this is something nobody has to worry about. You don't have to have a named diagnosis or be about to fall apart to talk to a therapist. Mental healthcare can be PROACTIVE and PREVENTATIVE, which means we want to help you get ahead of patterns and struggles in your life before things get out of hand.

In the end, if you or somebody you know is wondering if they'd benefit from seeing a therapist, a great start is to write down a couple challenges in your life (these can be as simple as "I want to lose weight" or "Im not sure Im coping with stress well or "I feel stuck in my career" or "Im feeling unsure about my relationship") and then one or two goals you might have for yourself and then booking a session. If the therapist for some reason has other suggestions for your besides therapy, at least you'll be able to get those and know how to return to therapy if/when needed.

I've recently started exploring polyamory and have 3 partners with vastly different relationship styles. My parents are extremely against this decision, saying it's unhealthy. Is there any evidence to suggest either monogamy or polyamory is the "better" way to do things? Do you have any clients who have discussed this topic before?

So this is an important question because alternate relationship lifestyles are becoming increasingly common. People are exploring new ways of love as they try to find what is an authentic fit for them, which overall is a good thing, but as is always the case with love and relationships there will be challenges.

At this point I haven't seen hard data arguing for or against the "health" or polyamory, polygamy, or monogamy. I will say that when I see strife and emotional suffering in relationships of any type it often has to do with poor communication and a lack of needs communication. There is a book I've recommended to people exploring polyamory, open relationships and related things called "The Ethical Slut" by Dossie Easton and Janet Hardy. In my experience one of the biggest challenges of that lifestyle is feeling that all the relationship members feel heard, seen, validated and understood. Sometimes when humans lack a commitment that might come with an exclusive relationship they feel afraid and insecure, so poly relationships need to make it a priority to create space for validation and support.

In fairness to your parents, I don't think they are out of touch or merely traditionalist. While marriage as an institution has roots in patriarchy and property management, it isn't inaccurate to say that humans often like to be exclusive with a partner and tend to pair off more often than they poly off (new phrase lol). I would encourage you to seek what's authentic for yourself, you may find in some cases that a monogamous relationship is a better fit for some aspects of your life, or for the goals you want in a relationship overall, though you are still in your heart a poly person. Its ok to be two things but choose to live in one way as it serves you best.

Good luck on your journey and thanks for the question!

Has Jim finally given up on Spirit Airlines?

Jim here - I have 80,000 Spirit Points that I need to use, and after that Im done. Really. I could quit Spirit right now if I wanted to. I, ya know, just need to get rid of these points. I'm not gonna leave money on the table!

Actually this is funny because Jacob, Whitney and Nick staged an intervention in this weeks episode (the Patreon version, patreon.com/therapy) and came up with a pretty effective laundering scheme to help me get rid of my points.

But once the points are gone Im out. For good this time!

What changes would you love to see, at a Federal Government (aka whole Nation) level, and/or funding towards Mental Health in the U.S.?

Oh strap in, I (Jim) have a wish list.

1. Medicare, the VA, the DOD and other Federal Insurances need to recognize all licensed mental health providers, not just Psychologists and Social Workers. They are missing out on enormous portions of the workforce, and are restricting important funding from good providers.
2. Medicare needs to provide General Medical Education funding so Psychotherapy disciplines can create Fellowships similar to what surgeons have. We struggle in this profession to train new interns in an affordable and effective way, the mental healthcare system is not adequately funded and needs the same support other healthcare disciplines get.
3. Advocate for and encourage an interstate compact allowing licensed providers to practice over state lines. Its 2023, the internet is the primary mode of commerce and face becoming the primary mode of outpatient health.
4. Enforcement of the Mental Health Parity Act. Insurances ROUTINELY don't pay mental health providers a living wage, steal back funds, deny their enrollment in networks, use administrative delay tactics to starve us from our paychecks, or just generally use red tape to stop us from treating because they know we are too small to do anything about it. But the penalties for breaking the law are MINIMAL. I often compare what insurance companies do to parking in a handicap spot instead of paying for parking at a special event. Its cheaper for them to break the rules and MAYBE pay the fine than do things correctly. Until the federal government is willing to punish insurances for their illegal behavior, it just makes economic sense for them to keep doing it.
5. Forgive student loans for mental health providers. We have a special crisis in the USA, and if we don't ease the economic burden one way or another (force insurances to pay realistic rates and stop breaking the law, or give special loan terms/forgiveness to mental health providers) we are going to continue to see too few professionals coming into or staying in the field. The hard truth is that it takes 7 years of school and 3 years post graduate training to become a therapist, the cost of entry is VERY high and the system does not properly reimburse. If the government can't fix the "free market" insurance stuff, they can at a minimum grant a general forgiveness with generous terms to licensed providers.

For me, as someone who interacts online with a lot of people that could really use mental health resources. I really wish there was Free both Therapist and Psychiatrist availability for Low Income people with the absolute minimum of hoops to jump through. One of the biggest problems I see, is that while there may be some resources available to these people with no disposable income and very much in need of mental health, the difficulty of attaining these services and fear of rejection by the system consistently prevents them from seeking help. I don't know how many I have talked to that just give up after being denied due to arbitrary rules or clerical errors.

It just winds up either not being worth it to them to try and go through all the paper work, check ups, validations, etc. So they continue to suffer. I wish these people could just request help and get it without all of the bureaucracy.

Hi friend, Jim here. I know the process can be daunting. The Mental Health system generally is an enigma to most people and there are all sorts of barriers to entry. Then the costs can be annoying and unpredictable, the services can get interrupted, and this whole thing does a poor job of serving a person who is already inherently discouraged and struggling.

We made a blog post this morning on how to find a therapist, and include information on low cost and no cost therapy options. You can read it here: https://www.tumblr.com/podtherapy/716312595828817920/how-to-find-a-therapist?source=share

But I'm also going to post it in this thread because I think it will be helpful:

How to Find a Therapist:

Will you be paying out of pocket?

1. Search Yelp, Google or Psychology Today to find therapists in your area. All therapists take out of pocket patients, pick whoever you like.

2. Don’t be afraid to use telehealth therapists, most people say they find it to be very natural and easy to use.

Do you have insurance?

1. You may have a phone number on the back of your insurance card to call for mental health care.

2. Go to your insurance’s website and download the “provider list” for mental health. Start googling the names of providers and see if any of them are a good fit.

3. Go to Psychology Today and search for therapists by Zip code, filter those results by your insurance. You can also filter by specialties, but keep in mind most therapists are competent to treat most things and will tell you if they aren’t, so don’t over think it.

4. Websites like Alma, American Well, Live Health Online, and others may be able to use your insurance and connect you easily with a therapist.

5. If you have your state’s insurance (Medicaid etc) then contact them for the provider list or search Psychology Today. It isn’t the case that Medicaid therapists are lesser in quality, the same therapists take multiple forms of insurance.

Are you or your spouse/parent employed?

1. Contact your Human Resources department and ask if your company has an “Employee Assistance Program” (EAP). You may receive access to a therapist completely independent of insurance.

Uninsured and Unemployed?

1. Search therapists in your area and look for “Interns” or “Associate” therapists. Many therapists are in their “Intern” years, this is sort of like a learners permit, they are practicing therapy under the supervision of a master therapist. These are great lower rate options.

2. You can also contact therapists and ask if they have a “sliding scale”, this means they will charge some patients less if there is a financial difficulty.

3. Contact your state Colleges and Universities, ask if they have a program where graduate students practice counseling. These are usually nearly free for patients and exist so therapy students can get hands on experience.

4. Are you religious? Contact your church and ask if they have any options. Often religious institutions have lists of professional therapists they partner with and are happy to pay the bill for.

5. There are websites that create low rate directories of therapists like Open Path

In the Military, have Tricare or part of the VA?

1. Look into Telemynd, a service provided to all military members families and veterans which can connect you with a mental health provider.

2. Active duty and afraid talking to a therapist will compromise your clearance? Maybe start with couples therapy between you and your spouse. At last check, clearance forms make an exception for meeting with a therapist to talk about relationships, that might be a good place to start a conversation about how your mental health is effecting the relationship.

More Tips

1. If you contact a therapist you like and they aren’t taking patients, ask them if they can recommend a therapist they respect who might have openings.

2. Don’t give up! It can take some time to find a therapist that matches your resources and needs, and then finding a therapist who is a good fit can also be

I thought social workers mainly help connect people to food housing and mental health resources. What are other mental health providers you’re referring to? I know psychiatrist, psychologist and now social worker. (If you use acronyms please expound them thank you)

Also where do you draw the line between legitimate mental health service and just either quackery or just doing something fun there’s art therapy , presumably there could be basketball therapy or American football therapy if they cause a positive mental health outcome for people who happen to enjoy them

This is a very common misunderstanding actually! So "Social Work" has been around the second longest of the Psychotherapy professions, following behind "Clinical Psychologist". Social Workers are the OG therapists! However, society often uses their name as a synonym for child protective services and other social services programs - in part because Social Workers were the primary work force for those jobs for a long time. However, when you see somebody listed as a "Licensed Clinical Social Worker" or some phrasing equivalent, that means they have a masters degree in a therapy discipline and are a real life therapist. One of our co-hosts, Whitney, has a Clinical Social Work license and she is a damn good therapist (despite being from Texas =)

How important is physical heath to mental health? When does an obsession with physical health become detrimental to mental health?

Hey!

As technology advances, allowing us to learn more about the brain, we are learning that the brain and body are integrally related. It has even been proposed that the main purpose behind having a brain at all is for movement. As research continues, we're seeing the link between exercise and mental health become stronger.

To examine the question, let's look at the extreme case of an eating disorder (with someone who has an obsession with exercise), the problem has to do with self-image. Exercise may be the mechanism they use to get there, but I wouldn't say it was the exercise that caused the problem.

So, can someone be so obsessed with physical health that it is a detriment to mental health? Absolutely. However, I feel like the issue may be the "Obsession" part, and not the physical health. We should spend some time looking at what's driving the obsession.

Hope that helps,

Nick

I know a few people who refuse therapy based on their experiences in the past. Do you have any advice for those people (or anyone with the same experience reading this?) who want help, but want to find other avenues outside of therapy?

That's a tough question, raptorclvb, but an important one. Thanks for asking it.

It's unfortunate, but people seem to have a standard for therapists that they don't have for other professionals that provide a service. I've had a bad barber before, but that wasn't the last time I've ever gotten a haircut. I took my car in for an oil change once and didn't care for the mechanic, but that wasn't the last time my car was ever serviced. But for whatever reason, if a person goes to therapy one time and don't like their therapist, they will refuse any type of therapy in the future.

But I get it, it's hard to open up to people. I'm way more vulnerable in therapy than I am when getting a haircut. But if the service is needed, we need to find someone we like to perform the service.

I've had people in my life express the same thing. I empathize, give my haircut example, and reassure them that no two therapists are the same. They just need to do their best to find one that fits.

-nick

best ways to get over psychological trauma. ideally related to infidelity? I have found "living in the moment" tends to help.... but can rarely stay there. i have always been either living in the past, or the future. my whole life has been like this. #i suppose my real question is... how the hell do i stop and live in the damn moment for longer than a few minutes at a time?!? how do i just let go of the past? how do i stop worrying about the future, and just focus on the now? and is this the right way to get over issues such as infidelity in a relationship, mixed with historic abandonment issues? how do you just get over stuff permanently and not just for a few months before you realise it still haunts you!?

for context its been nearly a decade since i was cheated on and yet still feel like i have PTSD over it. its been over 3 decades since i had my family torn apart by a nasty divorce that i never really got over either.... why!? how do i let it ALL go and just start living and not wishing i was never here to begin with?

​

​

so yeah... a couple of simple ones for ya lol.

First, I'm so sorry to hear you went through this. Infidelity is one of those things that happens a lot in our society, the majority of people have experienced it to some extent, but that doesn't negate how traumatic the experience is for us. Being cheated on, or being effected as a family member, can have life long effects on our ability to trust other people, value ourselves, or feel safe in relationships. Jealousy, anxiety and relationship self-sabotage are also common consequences when we've experienced infidelity.

I think describing this as a trauma is really the right perspective. Which means I also think that the path toward healing from the trauma is similar to what we'd recommend for other survivors. There are multiple therapeutic approaches, but most of them rely on intentionally and carefully reprocessing the events, the feelings the visceral unconscious realities we experienced throughout the process and as a result of it. Some more advanced techniques (like EMDR or Brain Spotting) might even incorporate techniques to help mitigate the pain of these memories while you are sharing them.

In the end I believe that experiencing infidelity - and often even perpetrating infidelity - can have long term effects on a person. However, if they are living with constant flashes of pain, memories, or regular emotional confusion related to those past events I would encourage them to speak to a therapist and do some trauma work.

you mentioned this in another response:

If somebody is ready to be honest, openminded and willing to get help, anything is possible for them!

How would you help someone whose problem is dishonesty with the self and others?

How to help someone who is dishonest...

My answer to this is different if I'm answering this as a friend or family member than it would be if I'm answering this as a trained therapist.

As a friend/family member, I understand that I can express concern, I can confront them if I feel comfortable doing so, and I can provide reinforcement when I see the individual make positive strides. When they recognize that they have an obstacle, or that they are not where they want to be, I can hold up a mirror (figuratively) and help them see the connection between their actions/decisions and the outcomes. I cannot control them, and I cannot force change.

As a therapist, I am mindful of the Stages of Change

1. Precontemplation - they don't even see the problem
2. Contemplation - see the problem, starting to think about it, not acting
3. Preparation - see the problem and internalizing it
4. Action - actively doing something to address the problem
5. Maintenance - the action has become the new norm

Everyone is in the Preparation Stage for something (e.g., I may not see my alcohol use as a problem [precontemplation], but I know my relationship with my spouse has deteriorated and I want to fix that [Preparation]). I find where the person is in the Preparation Stage of Change, and start there.

How many percent of the time are people cured of drug addiction?

Hi staskamaev,

Nick here, I'm a Licensed Alcohol and Drug Counselor here in Las Vegas. There isn't a way to answer that with a percentage, because drug addiction isn't something that one gets cured from. Drug and alcohol addiction viewed similarly to diabetes or heart disease, in that sense; it's not cured, it's managed. In treatment our goal is to improve functioning and decrease symptoms. The condition will always exist. It may go into remission, but it is always there.

In regards to success rates of treatment, this has always been complicated because we need to set clear perimeters in how we define "success." (i.e., if a client is being treated for their 5-year-long meth addiction, and relapses once in their first week post-discharge, but is abstinent for the next 5 years, would that be considered success? I would say Yes; some researchers would say no.) The best research has looked at success as the patient's follow-through of their aftercare plan. In those studies, success rates are right in line with what we'd see with the patient's success in follow-through for diabetes and heart disease (40-60%).

-Nick

Drug, alcohol and process (gambling, sex, risky behavior, gaming) addictions are tricky things to treat and recover from. The good news is that people do get these things under control. With proper treatment, support, and internal readiness in the patient, we see that people can leave behind their broken patterns and the misery that comes with feeling like they *have* to use their drug.

However, it is also common that people relapse into their old behavior, and we don't see recovery as a straight line from problem to solution. Clinically we know that its a winding path with steps forward and backward. The person isn't just quitting something, they are inventing a whole new way of life for themselves, and dealing with raw emotion and stress without the "medications" they have used to cope. Its expected that they will struggle along the way.

I prefer not to use the word "cure" when talking about addiction because it implies that there are sick people and there are well people. In reality, even people with years of sobriety may still see themselves as "working on it" and every day as a new step in their long term recovery.

But the good news is: People DO recover. People CAN get better. If somebody is ready to be honest, openminded and willing to get help, anything is possible for them!

Hi Nick, Jim, and Whitney, My sister in law who I'm not very close to and I don't really talk but other family members tell my husband and I that she is depressed and they fear that she might commit suicide. What advice should I give the people who are in contact with her on how to help her? Though I'm not the biggest fan of my sister in law I don't want to see anything to happen to her. Especially since she has three children (they are being raised by their father but she sees them on the weekend).

(Jim Here) So first off, you are a good person and Im glad you exist. Its easy to dismiss when people talk of suicide because we aren't sure how to help or when to take it seriously. Here are a few things I'd want your family members to know:

1. Take any talk of suicide seriously. That means that when somebody openly says they are thinking about it we need to sit with them and talk through it. Don't be dismissive of it, don't just assume it will go away.
2. If your Sister In Law is not already scheduled to see a therapist, or at minimum her doctor, that needs to be a priority. Your family should be encouraging, insisting, facilitating, and if needed driving her directly to appointments to make sure she has been evaluated and a plan is in place.
3. Listen, hear and understand. If a depressed person is talking about their feelings, that's huge. It might hard to listen to, its tempting to want to correct every poor perspective the person might have, but just giving them space to language their emotions is a big step in them becoming more resilient. They are metabolizing those feelings by talking through them, and even if we just listen with sincerity and agree that what they are feeling is awful, it makes a big difference.
4. If you haven't already, make sure your Sister in Law has information about the suicide hotline. You can call or text 988 and a real person will reply. These crisis counselors are trained and will listen to what's going on and point you toward good resources, they aren't going to send the cops or do anything rash, they know how to handle the situation.

Now, let's talk about suicidal thinking for a moment. Many people are unsure how to measure suicidal thinking, so I want to teach you how therapists think about it. Again, we take all talk of suicide seriously, and we want your Sister in Law to see a professional as soon as possible, but here is a way of thinking about suicide severity.

We use the metaphor of a baseball diamond. The further along the bases the patient gets, the more in danger they are the more intervention may be needed.

First Base - This is when a person just has thoughts of death. They are feeling sadness, loneliness, despair, hopelessness, worthlessness, fatigue and other general loss of joy. They think about dying sometimes. They don't have a plan, they don't exactly how they would hurt themselves, but them sometimes imagine dying as an escape from what they are feeling or a solution to their troubles. At this base a therapist wants to listen, get the person to language their experience, start to help them (slowly) challenge these feelings and replace them with facts, but we aren't panicking. First base is a very common place that many humans - depressed or not - may find themselves one day.

Second Base - This is when a person is not just thinking about death, but is starting to think about HOW they would do it. The actual way they might end their life. They don't have a plan, they haven't started writing goodbye letters or giving things away. But they have started contemplating practical ways to end their lives, maybe even doing research. Here a therapist is still interested in working with the patient to talk through their experience, we want to make a safety plan with them so they can easily recognize when and how they are to take action to protect themselves, and we want them to start having some accountability in monitoring what they are experiencing. If they aren't already on medication, we want to talk about this too.

Third Base - This is when a person is not just thinking about death, not just consider practical methods of suicide, they are now making a PLAN. They are thinking about the when, the where, and the how. They might even start saying goodbyes to people, write letters, giving things away. As they have progressed through the bases they may have become increasingly wreckless, using alcohol or drugs to self medicate, which can make them very unstable and difficult to control. When a person reaches third base a therapist is interested in protecting them. Its time to talk about being admitted to an inpatient program and making a plan for safety that doesn't rely on the patient's will power to make good choices.

Stealing Home - When a patient starts toward Home Plate that means they are in danger. Here there is only one solution: admitting them into inpatient care. We need to stabilize them long enough to slow this process down and get them help.

Having said the above there are also some important red flags to watch for which can increase the danger of suicide, causing a person to quickly round the bases.

Red Flags:

1. Using Drugs or Alcohol excessively. This can include addictive prescription drugs like Xanax or Adderall, pain killers, and yes marijuana (even if people say these things are helping, using them to excess is a warning sign that they could hurt themselves).
2. Risk taking behavior. Sex with strangers, gambling, adrenaline seeking, poor self care, all of this can mean a person is starting to give up.
3. Social isolation. Suicide likes solitude. Depressed people often withdraw from others for multiple reasons, but this can be a red flag because we lose sight on where the person is in their baseball diamond, and the voice of depression becomes dominant in their mind.
4. Firearms. 51% of suicides in America happen with a gun. If a person is feeling depressed they should IMMEDIATELY ask a friend or family member to take their firearms for a while until the person is ready to have them back. Another organization to know about is Hold My guns (https://www.holdmyguns.org/) a charity that will help you find a safe and professional gun store to take custody of your weapons while you recuperate. Guns in the home are one of the greatest risk factors for a person experiencing depression and suicidality and must be taken seriously.

Thanks for this question friend, I hope you Sister in Law feels better soon and Im glad you are in her life to help.

How do I get started with finding a good therapist? What are some key factors should I look for? Basically where do I start?

I ask this Looking up info with my insurance company is very overwhelming for me & kinda hard to figure out if I go with insurance or Teledoc. (Things are confusing & customer service is not the best)

Yay! You asked the GOLDEN QUESTION! This comes up every year and is really important!

We have a blog post with links on this: https://podtherapy.tumblr.com/post/716312595828817920/how-to-find-a-therapist

But here is a summary:

Will you be paying out of pocket?

1. Search Yelp, Google or Psychology Today to find therapists in your area. All therapists take out of pocket patients, pick whoever you like.

2. Don’t be afraid to use telehealth therapists, most people say they find it to be very natural and easy to use.

Do you have insurance?

1. You may have a phone number on the back of your insurance card to call for mental health care.

2. Go to your insurance’s website and download the “provider list” for mental health. Start googling the names of providers and see if any of them are a good fit.

3. Go to Psychology Today and search for therapists by Zip code, filter those results by your insurance. You can also filter by specialties, but keep in mind most therapists are competent to treat most things and will tell you if they aren’t, so don’t over think it.

4. Websites like Alma, American Well, Live Health Online, and others may be able to use your insurance and connect you easily with a therapist.

5. If you have your state’s insurance (Medicaid etc) then contact them for the provider list or search Psychology Today. It isn’t the case that Medicaid therapists are lesser in quality, the same therapists take multiple forms of insurance.

Are you or your spouse/parent employed?

1. Contact your Human Resources department and ask if your company has an “Employee Assistance Program” (EAP). You may receive access to a therapist completely independent of insurance.

Uninsured and Unemployed?

1. Search therapists in your area and look for “Interns” or “Associate” therapists. Many therapists are in their “Intern” years, this is sort of like a learners permit, they are practicing therapy under the supervision of a master therapist. These are great lower rate options.

2. You can also contact therapists and ask if they have a “sliding scale”, this means they will charge some patients less if there is a financial difficulty.

3. Contact your state Colleges and Universities, ask if they have a program where graduate students practice counseling. These are usually nearly free for patients and exist so therapy students can get hands on experience.

4. Are you religious? Contact your church and ask if they have any options. Often religious institutions have lists of professional therapists they partner with and are happy to pay the bill for.

5. There are websites that create low rate directories of therapists like Open Path

In the Military, have Tricare or part of the VA?

1. Look into Telemynd, a service provided to all military members families and veterans which can connect you with a mental health provider.

2. Active duty and afraid talking to a therapist will compromise your clearance? Maybe start with couples therapy between you and your spouse. At last check, clearance forms make an exception for meeting with a therapist to talk about relationships, that might be a good place to start a conversation about how your mental health is effecting the relationship.

More Tips

1. If you contact a therapist you like and they aren’t taking patients, ask them if they can recommend a therapist they respect who might have openings.

2. Don’t give up! It can take some time to find a therapist that matches your resources and needs, and then finding a therapist who is a good fit can also be

What Qualities Should I Look For In a Therapist?

1. Professionally licensed. While "life coaches" and "healers" have value in the world, there is a reason mental health is the domain of clinical professionals. When you see therapists names you will usually see some letters like PhD, LMFT, LCSW, LPC, LMHC, etc. Google what those letters mean in your state and make sure the Therapist is a licensed provider.

2. Professionally oriented. Its becoming increasingly fashionable for Therapists to signal on their profile that they dabble in some mystical, political or social philosophies. On one hand there is nothing wrong with them doing that, and its helpful if you find a therapist who aligns with your personal world view. On the other hand, when a therapist presents themselves in professional, clinical ways, they more likely to carry themselves in those ways.

3. Alignment. Maybe you'd feel more comfortable with somebody who looks like you, comes from the same religious background as you, has a similar gender or sexuality experience as you, has or doesn't have children, is of a certain age, etc. Its ok to look for those human factors. But don't prioritize them too highly. Like hiring a plumber, its more important that they be good at plumbing than somebody you'd like to have a beer with.

Hi can I ask some things about agoraphobia?

Why isn't agoraphobia accommodated as much as other disorders? (Example: must see Dr in person for meds)

Is agoraphobia rising because how easy it is to isolate now? (Especially how covid increased grocery delivery etc)

Do you have a episode on agoraphobia? Are there any other treatments other than exposure therapy? (Which is kind of like, tough it out)

A little unrelated but:

Why is disability/SSI so overwhelming and hard to complete/access to people who struggle to even keep a job because of their mental health?

ADHD and anxiety would be a good one too. How ADHD meds can help anxiety is really hard to explain to some ppl.

Edit: I found the one agoraphobia episode and surprise surprise it was covid related haha... ): People know this illness has been around since ancient greece, right? It's so fucking hard to find help for it! Please do a proper podcast about it!

Hell yes you can ask about agoraphobia!

You're absolutely right that historically agoraphobia (fear of leaving one's house, fear of being exposed in the world) has been poorly accomodated in the past. With the advent of telehealth we've gotten a lot better at treating this population, and I know in my own practice (Jim) I've treated way more of these patients in the past 3 years than ever in my career. Unfortunately the reason behind the failure has to do with the healthcare system not making special exceptions for particular issues. Insurances and their lobbyists force state legislatures to write laws limiting care anywhere they can, and they HATE telehealth because it means more people get help which costs them money. Agoraphobia doesn't get special treatment, it just gets put in the bin of mental health generally. HOWEVER the good news is that as I said telehealth has really opened up treatment for this population.

Yes, in my opinion, agoraphobia is rising. We saw a unique version of it emerge during the covid crisis that was difficult to diagnose because we all had good reasons not to socialize or leave our homes. The after effect of the pandemic is that much agoraphobia has been untreated or unrecognized, and many more people found themselves entering that isolated avoidant pattern without anybody in their lives growing concerned. The work from home movement has also accidentally facilitated this as a person can now choose agoraphobia as an entire lifestyle without many consequences. You can have food delivered, work from your home computer, date online and play video games with friends and nobody would think you have a problem.

We did an episode during covid about agoraphobia which might not resonate as much today (https://podtherapy.tumblr.com/post/660562525468917760/190-covid-agoraphobia-wife-attracted-to-female) We are overdue to talk about this, submit a question we'd love to discuss it!

Re: Disability/SSI - The process is meant to be difficult in part to dissuade people from accessing it too easily and without merit. Of course, this is sort of cruel to those who actually suffer because of course they will struggle to complete the process. Most states have a social service program with helpers who can assist in navigating the application process and support you in knowing what to answer and where. Another option is to contact a disability lawyer, they will take a cut of your owed pay (the government technically owes you starting from when you apply to when you get your first check, often resulting in a big check to start).

Re: ADHD Meds for Anxiety - The relationship of any med to any condition is very complex, and this is a big reason why I like people on medicines to also be talking to a therapist for a while so we can monitor their experiences and make sure we are getting the results they need.

Great questions!

My partner has social anxiety, parenting anxiety, and decades-long dermatillomania, but refuses to seek individual mental health/psychological treatment despite our constant discussion regarding these topics. Yet when I had my first slight bout of depression, they insist that I be medicated (and I did.) How would you guys address this situation?

(Jim here) First I'm glad you got help for your depression. I realize that depression has a sliding scale of severity, and that we might suspect that loved ones are overreacting to our situation, but I'm happy you chose to be proactive and preventative with your depressive symptoms. Taking medicine can be a very personal decision, but its important to keep in mind that if our healthcare providers are recommending this its probably a good idea.

Now lets talk about your partner. First, I get the frustration. If one member of a relationship is a chain smoker but gets upset at you for vaping it can feel like there is a inequality that must be addressed. However, I would point out that the nature of mental health is a uniquely personal experience. Anxiety is one of those things that people are sometimes afraid to deal with because they dislike the experience so much that when it isn't happening they'd rather not think of it at all. I'm glad you've encouraged your partner to deal with their anxiety and have been supporting them, but I know its hard to watch somebody suffer (and, honestly to suffer along side them) and not see them get help.

One idea could be asking them to go to a mental health support group *with* you. Afterall, your partner seems very interested in your mental health and insistent that you take action. Perhaps you could look up a local NAMI Support group, or see if a local therapist's office is doing any kind of special groups for general mental health support. Maybe they'd be more likely to come *for you* rather than for themselves.

This is actually how alot of people get their partners interested in going to therapy. They will invite their partner to come to a session and meet their therapist so the therapist can gather more info on the patient. The partner is treated as an "expert witness" who can teach us about the patient. But after getting a feel for what happens in therapy, the partner often feels comfortable trying it for themselves.

Last suggestion: Listen to Pod Therapy! That's the whole reason we created the show! Maybe find some episodes that speak to your spouse's experience and put them on during your next road trip. If your partner can tolerate our bullshit long enough to get something from the message they might just find that therapy is more approachable for them than they realized!

Your website says, on the subject of how to find a therapist, if you are uninsured or unemployed:

1. Are you religious? Contact your church and ask if they have any options. Often religious institutions have lists of professional therapists they partner with and are happy to pay the bill for.

If you have an LGBT-related issue, do not take religious counseling or religion-subsidized therapy. It will likely make things worse than getting no advice at all.

Howdy friend, thanks for being part of today and for reading the blog.

I definitely want to validate part of your observation. Its true, that some therapists, religious or not, may not be helpful to those in the LGBTQIA+ community, and some (rarely in the real world) may be openly hostile.

However, I do want to nudge against the conclusion that *all* self identified religious therapists are bad for LGBTQIA+ people. I (Jim) have a religious background, and I am a STRONG advocate for this population. Most religious therapists I know are as well. We have to remember that being a therapist is being a healthcare provider, we take an oath to do no harm, and we have a professional code and training in helping people of all types. While there has sadly been stories of religious communities using "therapy" as a way to hurt the marginalized, we have to remember that part of professional credentialing is its own validation process that should instill public trust in the profession and the ethics of the provider.

Having said that, comments like this often come from a place of personal experience. If you've experienced bad therapy from a religiously affiliated therapist, I'm sorry for that and I hope you have found healing and progress working with a more competent person.

What would you recommend to someone who is just stuck in a rut in their job? I have an ok job right now, but long term, it won't support me when I'm older. I'm hesitant to take a step to another field, but I don't have a grasp on what I want for myself. I don't see myself doing anything specific in the future. I'm just working aimlessly, I don't have specialized skills, and I've squandered my opportunities from when I was younger. Even though the people I work for are nice, I just need to have a better paying job.

Hi Quietwyatt211,

If you already recognize that this is not going to be a sustainable path for you in the future, then it's probably time to plan your exit strategy. It sounds like you're not all that optimistic about your salary suddenly doubling and this becoming your dream job, so there's no sense in delaying the inevitable.

On the positive side, the job is supporting you currently, so you're not in an emergency situation. This provides you an amazing opportunity to search out a career that you're passionate about. Sometimes people are forced to take big risks and jump full-on in a new direction. You have the ability to try things out on a part-time basis because your FT job to fall back on. Take advantage of that. Find some things your passionate about and explore what kind of a career you could create for yourself in that industry.

Lastly, it's never too late to learn new skills/trades. I decided, in my early 40s, to pursue a career in the fitness industry. I was able to study and start a business part-time while keeping my full-time gig as a therapist/educator. It was scary, and a lot of work, but I'm grateful I had my full-time job to take some of the pressure off.

Keep a positive, optimistic attitude.

-nick

Hi there! Thanks for doing this AMA.

Do you have any therapy-related book recommendations? I’ve been seeing books like “The Body Keeps Score” and “Maybe You Should Talk to Someone” make the rounds recently and I’d like to read something similar but therapist-approved.

First off, we don't want to brag, but Lori Gottlieb who wrote "Maybe You Should Talk To Someone" has been on our show: https://podtherapy.tumblr.com/post/183765084518/65-nyt-bestselling-author-lori-gottlieb

Other books I really like:

1. Overcoming Unwanted and Intrusive Thoughts by Winston and Seid
2. The Anxiety Workbook by Aaron Beck
3. The PTSD Workbook by Poijua
4. The 5 Love Languages by Chapman
5. Dadvice: 50 Fatherly Life Lessons by ME (www.DadviceBook.com)

Hi!

I have both of those books on my bookshelf right now, so I will say they are Therapist Approved. :)

If you're into Mindfullness, you could check out "Get Out of Your Mind & Into Your Life" by Stephen C. Hayes

What is your favourite part of doing the podcast?

This is Jim, my favorite part of the podcast is the community that has surrounded us. We have an active discord and our listeners are constantly sending us fun trivia, gifts, encouraging stories and support. The listener community has become a force unto itself and long after the show is done I believe the community of people that have surrounded it will be the legacy of what we've done.

Hi! Do you have any recommendations for books to read? Nonfiction or fiction. I’m going through a hard time right now and I find reading always helps me.

Anyways, I’m a huge fan of your podcast and look forward to every week when I can listen to your ridiculous conversations on patreon and then your compassionate answers to questions. You all have helped me learn so much about mental health and I’m absolutely grateful for it. Thank you!

Book suggestions that have nothing to do with therapy (from Jim, who exclusively reads sci fi)

1. Red Rising trilogy by Pierce Brown - Holy cow what a journey. Action packed, never boring, such an adventure and some great high level thinking about society and the future.
2. Dark Matter by Dan Crouch - Awesome trippy look into what would happen if Quantum Mechanics gave us anything we wanted
3. Expeditionary Force (series) by Craig Alanson - Who doesn't love space pirates?

Thanks for the kind words, whathouseareyouin. Glad you found the show helpful.

If your NOT wanting a self-help/therapy-based book right now, I loved "Lost at Sea" by Jon Ronson. Non-fiction.

When you’re trying to find a mental health provider that you mesh with, what are some good ways to determine fit? I read your comment about the importance of avoiding value imposition as a provider, but as a patient how does someone ethically ask a provider about their worldview/values in order to test fit. I, for example, would not feel comfortable taking mental health treatment from someone who doesn’t support women’s healthcare access, abortion rights, or Human Rights, but would I be crossing a line to (respectfully) ask about those views to assess whether we would match?

These are great questions!

So, when you're looking for fit you need to remember that you can assume by default that most therapists are not activists looking to impose their voting preferences on you. The vast majority of this profession are interested in your mental health, and if you say something they don't personally believe, they aren't likely to even wince at it, you'll probably never know.

In that sense, picking a therapist should be like picking a surgeon. You want somebody professionally competent who seems to want to be good at their profession. However, in therapy, it does help if the person feels approachable to you. Maybe they look visibly like somebody you'd feel comfortable talking to, maybe they appear to have some life experiences you relate to, or maybe they self identify as something that appeals to you.

However, you're not very likely to get much from a therapist if you ask them about their worldview. If you ask who they voted for, how they feel about contemporary political situations and what not, they will probably demeure and be more interested in your perspectives on these things - as they should be.

On the other hand if you fish through profiles long enough you might find a therapist who is signaling in one way or another that they have strong political or religious views. You might find that resonate with you and makes you feel safer with them, and if so that's great. In general I don't love therapists doing that because there is an inverse relationship between being a good clinician and being an activist to your patients, regardless of whether the patient agrees with you politically.

Generally if you look long enough you'll find somebody that fits you, but I encourage you to look for a person of skill and approachability over worldview match, you'd rather have a good therapist than one you'd have a beer with, but who knows you might just get both!

What are the mental health effects of being addicted to nicotine?

Hi benp242,

Like with any other substance use disorder, we can look at the effects of the use and the effects when use is stopped (i.e., withdrawal).

The main problem is the dependence. The use of the substance causes a physiological or psychological response (in the case of nicotine, that may look like a sense of calm/relaxation). This is not necessarily problematic until dependence develops (which in the case of nicotine, happens quickly and relatively consistently across populations). Dependency basically means that sense of calm/relaxation is now dependent on the substance. It becomes harder for my body/mind to achieve that state naturally. Also, tolerance develops meaning that I now need to smoke more frequently to maintain that sense of calm/relaxation.

Withdrawal symptoms, generally speaking, consist of the exact opposite of the physiological/psychological effects I got from using the substance. The opposite of calm/relaxed is anxiety. Which is why people are restless and irritable when they quit. The psychological part of this is also present in how I choose to deal with those symptoms. How did I deal with anxiety in the past? I smoked. So, I smoke again, making me more dependent on the nicotine, and the cycle continues.

My neurodivergent partner and I both go to therapy separately and it’s been amazing for both of us but we have a hard time talking together about our mental health and how we can work to support each other. Any advice on bridging the divide? (I will check out your podcast cause I think that would be good road trip material to get the conversation flowing!)

So glad you've both found good helpers and that its working! One idea that might make it easier to talk is to do a guest appearance in one another's therapy sessions. Sometimes, with your therapist's endorsement, this is a good way for the therapist to meet a very important person in the patient's life, and also treat them as an "expert witness" who can share more with the therapist about what the patient's experiences in day to day life are. This can sometimes provide both partners with better insight into what language the therapist uses and what each person is working on. Its also a good idea to ask your partner's therapist how you can be helpful and supportive, sometimes the therapist has good suggestions for you that might make it easier to talk about these things outside of sessions.

Of course, most doctors recommend listening to Pod Therapy with your partner to stimulate conversation about mental health generally. Its guaranteed better than placebo!

Awesome idea thank you! I don’t think my partner is ready for this yet but I will suggest it!

Most people aren't ready to listen to Pod Therapy. We've found that its best to just start with the intro, if you notice the person's ears bleeding or that they are clawing at the door handle to escape, pause the show and switch to something better.

Pod Therapy is not responsible for ear bleeds or listeners jumping from moving vehicles. Listen at your own risk.

Hey Jim, Nick and Whitney! Listener of the show and love the awareness you guys bring to Mental Health.

Over the last few years, I’ve noticed that my spending has become a problem. I’m guess you could say I have a shopping addiction. I’m keep buying clothes, books, house decor, etc. that I do not need nor really have the money for. It has gotten out of control the last couple of months. I have a credit card that my significant other doesn’t have access to, but name is on the account. They looked at their credit history recently and saw the balance bring it up to me. I panicked and broke down from the guilt. However, I am still spending on it.

I want to stop this before it gets more out of control that I can’t stop it. What are some helpful ways to deal with this? Should I bring this up to my current therapist?

Thanks for all you guys do!

YES! Bring it up to your therapist in your next session. Process addictions like Shopping, Gambling, etc. can get out of hand quickly. It's not too hard to recognize when a friend or family member becomes addicted to alcohol or meth, but a shopping addiction can fly under the radar for a LONG time. That means that by the time others are aware of it, the person has already put themselves in a very deep hole.

What you're dealing with may not be at the level of an "addiction," but in either case, it sounds problematic, at minimum. Let's address this snowball while it's still manageable.

Bring it up to your therapist, and be open to exploring some of the thoughts and emotions that are tied to the behavior. Another thing you may consider, if you're open to it is finding a Gambler's Anonymous meeting in your area. I realize you're not a gambler, but you would be welcome at that meeting, and it might be worth checking out.

-Nick

What should an ordinary person do to keep itself mentally healthy?(Yoga,outing,reading or other else)

Hi!

Nick here. Listeners of the show will vouch for me when I declare this to be my soapbox. Physical Exercise! A hot area in research right now is looking at the effects physical exercise has on the brain, and specifically mental health. It's astonishing. Daily exercise is one of the best things you can do for your mental health.

Additionally, I saw a study a few months ago that looked at indoor exercise vs. outdoor exercise and it's effects on depressive symptoms. It appears that exercising outdoors has a little stronger effect, so it seems being outdoors and in nature plays a part as well.

I (32F) was just diagnosed with Autism. Where do I even begin to start this late in the game?

Hi there!

So first, I encourage you to right size this diagnosis. Sometimes people learn something like this about themselves and it can frighten them into thinking they have to redo everything in life and fundamentally reinvent themselves. That's not true.

Learning that probably have ASD in your early 30s *probably* means you've managed to navigate life in your own way so far. Sure, you've hit bumps along the way, and sure, learning you have ASD helps explain some of your experiences. But remember that every human must adapt to life on life's terms using the personality, strengths and weaknesses they have with them. You've done that so far, and you'll continue to do that.

However, learning you have ASD can be really helpful. Mostly because it now gives you a direction to find resources, tips trick and life hacks that work for people who might relate to you. A good website to start browsing is Autism Speaks (https://www.autismspeaks.org/) which has a section for people who are newly diagnosed, support groups, question and answer areas, and LOTS of resources.

Autism is a way of being. Many people find it to be a super power of sorts that gives them special abilities in unique circumstances. I know it can be scary to have a "diagnosis" but I hope that by connecting with people who relate to you and utilizing resources and skills those folks have pioneered you'll find that knowing this about yourself is empowering overall.

I have finally booked an appointment with a therapist after hitting a breaking point with struggling with family issues, work/career dissatisfaction, and generally feeling lost. I have been putting it off because I didn't feel like I knew what I wanted out of the session(s). Do you have any tips for going in to my first session? Should I come to it with goals in mind?

First off, congratulations on taking the first step. Remember, nobody goes to therapy because they are on a winning streak. These are the exact challenges that lead many people to making that first appointment, and Im glad you did.

As for your first session, if I were your therapist here are things Im probably going to ask you to share about. (Btw, be prepared to do some talking, lol, this is afterall about you)

Im going to ask:

1. So, what brings you here today? This is a good place to describe some of the challenges you've been having lately. A good opening is to share a couple paragraphs about each area, maybe two or three bullet points each. Expect that the therapist is going to ask more about each item you list to try to understand what your experience has been like.
2. How long has this been going on? This question invites you to help me understand what life was like without these challenges you're facing, and help me compare then to now as we've seen these problems escalate. Its also a chance for me to learn how things went from "meh" to "uhg" to "uh oh" to "oh shit I need therapy".
3. Can you tell me more about your life? We want to learn about your "human ecosystem". Are you dating? What do you do for work? Do you have close friendships? Hobbies? Who do you live with? Are you facing any unique realities (legal, financial, medical, familial, relational, etc)?
4. Can you tell me about growing up, what was your family like? We want to understand a bit about what your childhood was like. What did your family household look like? Any important changes happen in childhood? Are you close to your parents, siblings, grandparents, etc? Who in your family supports you today? Did you have a unique experience in childhood that helps me understand who you are as an adult?
5. Have you done therapy before, or taken medicines? This is us trying to understand if you have any history that we should know about. Teenage depression? Anger management? Family counseling? Couples counseling? Anti-anxiety meds from your general doctor? Its all good to know.
6. Is there anything I haven't asked you that you feel I should know about you? This is where you tell me if you've been abducted by aliens. That the only answer to this question, so its yes or no.
7. What are our goals? What does success look like? This is where we get an understanding how you will know therapy has worked for you. You might say something like "I'll have better boundaries with my family, whether they like it or not" or "I will have a career plan that feels fulfilling and exciting" or "I will know what my life is missing and I will start taking action to get those things for myself". It can also just be as simple as "I will be happy to be around my family" or "I wont cry when I get home from work" or "I wont feel lost anymore". You don't have to over think it, its just a rough draft so we know what direction to help you go in.

Again, congratulations on taking this step. The good news is that when we do our lives on purpose, we get more purpose out of our lives. Im excited for you and hope you'll find the direction you're looking for!

Hello! I’ve recently begun listening to the podcast and really enjoy it. I usually wind down my day after work by walking and listening to an episode. It has truly become part of my self care.

Over the past year(ish) since roe was overturned, I have had a difficult time coming to terms with the worsening political landscape for women, especially being a woman of child bearing age. I feel overwhelmed that these issues can have a direct effect on my health and life. I really want children but don’t love the idea of not having access to healthcare if needed. I hate the thought of losing body autonomy. It’s a serious mind fuck.

I am essentially thinking about this at least daily. It does not help that I live in Florida, the epicenter of extremism in this country. Do you guys have any suggestions with how to deal with this feeling of losing autonomy? I’m tired of feeling insane while others around me don’t seem bothered, particularly men.

Thank you for all you do!

First off, I'm sorry you're going through that. The really challenging part in this is that it's not just the "feeling" of losing bodily autonomy, but the ACTUAL loss of bodily autonomy. In that sense, what you're experiencing is probably best described as grief.

I would encourage you to become active in the political process, but you probably already are. Aside from that, my feedback would be patient with yourself. Allow yourself time to grieve and express emotion. Consider getting into therapy if you need to.

I wish I had something better for you. I'm hopeful we can correct some of this.

Nick

What do you think about Regan closing mental institutions and forced and institutionalization of people including homeless and substance addicted?

So the United States government has had a pretty sordid history of dealing with mental health, from criminalizing it to medicating it to ignoring it. Regan's policies were bad, and so have been the policies of many other leaders.

Unfortunately to this day the number 1 provider of mental health services in any state of the country will be the criminal justice system. Because our mental healthcare system is so disjointed and under funded (Im looking at you insurance companies) many people don't find their way into help until they've decompensated so far that they've found themselves in legal trouble.

The good news though is that we are seeing the advent of speciality courts like Mental Health Court, Drug Court, Youth Offender and Veterans Court, which have been hugely successful in creating diversion programs to rehabilitate and treat people rather than just throwing them into the system and forgetting them forever.

Also, the government did eventually make it illegal to just institutionalize a person experiencing mental illness, by that I mean keeping them in care long term with no discharge plan. The unfortunate side effect however is something called the IMD Exclusion which prevents medicaid from funding long term inpatient care for mental health, which needs to be fixed (Im looking at you Congress).

The past few administrations have made some great progress in funding drug treatment and prevention programs, especially around opioid treatment, and most states are not understanding that part of addressing mental health and substance abuse is to address their social safety nets like food and housing. I think we are heading in the right direction overall.

Why is ending platonic relationships sometimes harder than ending romantic ones?

Great question, lots of people relate to this. I think romantic relationships have so much to do with chemistry, where as friendship has more to do with behavior. Of course, both types of relationship have elements of each of those things, but bear with me a moment.

So its devastating when romantic relationships end. Its a person we were deeply vulnerable with, sexual with, and to be rejected by them or to have to let them go feels like we are losing something of value that we once possessed. It can also feel existential in the sense that we are being evaluated somehow and learning that we are not acceptable to somebody.

Platonic relationships can be very deep. Because they don't rely on sexual chemistry or relationship exclusivity they have this sense of perpetual buy-in. You aren't always just "owed" contact with the person because they are you "boyfriend/girlfriend". They have to want to be connected to you, and so when they choose you there is a sense of joy and being valued that comes from that. When a platonic relationship ends it is usually after some difficult disagreements, an erosion of the friendship over time, or silence and indifference settling in. Its a different type of rejection that a person being seduced by their new coworker. This friend who was once a wellspring of affirmation and joy in your life had decided not to be in your life anymore. This leaves an emptiness, a sense of worthlessness, and vacancy in your life where once a constant connection stood.

In the end, the pain of relationship loss is measured by the significance of that relationship to your identity and life navigation, regardless if it was sexual or not.

I see a therapist, but it always just feels like I’m catching up with a friend and not really getting actual advice or ways to deal. Any advice?

Also interested in the ADHD deep dive, is there a way to listen other than signing up for a subscription? Like pay for just that content?

Talk to your therapist about creating some goals for what you hope to get from the remainder of your time in therapy. Having a treatment plan is like you and your therapist getting in a car, getting out the road map, and starting a cross-country drive to a specific destination.

Without a treatment plan, therapy can feel like getting in a car with your therapist and driving around aimlessly. Sure, you get to spend some quality time with your therapist (and maybe that's all some people need), but it can sometimes feel like you're not going anywhere.

-nick

p.s., regarding the ADHD Deep Dive. You can email us at podtherapyguys @ gmail.com and we can talk about a way to get that to you, but $5 at patreon is the fastest, easiest method to get it.

I've been depressed for a very long time. I've spent years in therapy, years on psychiatric medications. I don't improve.

What the hell am I supposed to do? Every year is a little harder to endure than the last.

Hey friend, first, thanks for sharing this and I'm sorry for the experiences you've been through.

The answer I'd want to suggest is talking to your therapist and your medicines prescriber (probably your Psychiatrist) about your experience with what you might call treatment resistant depression. They will want to ask more questions about what medicines have been tried, what therapy work has been done, and are in the best position to give you feedback about right sizing your experience and keeping in mind the longer story of what you've been through. They'll probably remind of you where you've made some progress, while also taking you seriously about why you still feel your struggling with these feelings.

There are some really exciting new clinical breakthroughs happening in the field of medicinal depression treatment. While there is also a lot of hype about some of these, the science is very encouraging and your Psychiatrist may have more information about taking some next steps.

Not long ago we did a deep dive for our patreon community about the long list of depression treatments over time, and we explained how new treatments like TMS and Ketamine, along with older treatments like ECT, have shown to be effective for those with forms of depression that haven't responded to other therapies.

Again, in the end we are here as educators, we don't know your condition of what other challenges you may be working through, but I do want to encourage you to open up with your doctor about your struggle and make sure they know exactly how you feel.

Hey fellas,

Over the years I've realized I use sex (specifically bdsm) as a coping mechanism. I've used it to regulate my anger - growing up in an alcoholic home has left me with a lot of that. The only thing that really helps on the same level is an unhealthy level of exercise (where I exhaust myself).

I also use bdsm to really feel like I can take a break from "life" and as a stress reliever. When I haven't had this outlet, my anxiety spikes and stress goes through the roof

I haven't had success in talking about my anger with therapists (literally told that they can't help me). I'm tired of being told to journal X amount before we can work on anything (I've been journaling for years, I can communicate with them just fine). How best to approach a therapist with these concerns? I've found LGBTQ therapists to handle the sex topics easier and I don't need a sex therapist because my coping is using sex rather than it being the core issue.

In the meantime, what are some good techniques for dealing with anger/ rage when it's triggered by normal daily things?

Thanks!

Hi!

Nick here. First, that's awesome that you've found a therapist that you feel comfortable with. I agree, I don't know if a sex therapist would offer you anything better than what you have. You've got a therapist you feel comfortable with, stick with it.

Regarding the anger/rage issue... First, I'll defer to your current therapist over anything I tell you. I know it sounds like a cop out, but your therapist knows more about you're specific symptoms than I do.

That being said, if I'm your therapist, I want to explore the emotions under the anger. Anger/Rage can sometimes be viewed as a secondary emotion, i.e., it can be a response to another emotion that goes unrecognized and unaddressed. As an example, you can look at Road Rage. "Anger" is the emotion that people will display, verbalize, and recognize, but if we dig deeper we will usually find other emotions, such as Fear (having anxiety about getting into a bad accident, or feeling like other people's behaviors are threatening your safety); Resentment (feeling like other people are getting away with breaking the law while you've been caught in the past); or feeling injured or wronged (this person did this behavior in malice with the intent of harming me). Once we identify some of those emotions, we can start examining the belief systems that led to them and the thinking patterns that support them.

Hope that helps

When I was working in a career connected to journalism, there were standing rules such as not writing articles about suicides if it doesn't have other newsworthy aspects as it might encourage other troubled people and cause a sort of social contagion.

I've then seen other people take that main idea and bring it into concerns about posting on social media, books, television scripts, etc.

Outside of journalism I've heard to not be afraid to bring up the issue. That talking about suicide can encourage people to acknowledge their suicidal feelings and talking about them can keep them in check or encourage them to seek help. That mentioning suicide to a distressed individual isn't going to make the idea pop into their head.

Is the difference between the two concepts one that a personalized conversation is different than a news report? Are the journalists basing their prohibition on something without a scientific basis? Are the journalists just full of themselves and their perceived power over the public's attention and actions?

Great Question,

I'm curious about the journalism stance. I don't know if that decision is based on any kind of scientific understanding, or if it's just a stance made by the publication for some other reason. But Yes, personalized conversation is much different.

We get a lot of questions to the show about friends/family being afraid to broach the topic of suicide for the fear of putting the idea in their head. That's just not how that works. In my years as a therapist I've never heard anyone say, "boy, I wish I hadn't mentioned that thing about suicide." But what I hear all the time is, "I wish I would have said something."

People sharing their stories about their own experiences sends the message to others that they are not alone at a time when they feel most alone. It also gives hope to see that someone else was in that spot and made it out.

Nick

Hello,

I'd like to ask you how could I cope with my fear for the future. Since I got my little kiddo, the love for him is making me paranoid and very anxious.

I wake up in the middle of the night (I don't have a good sleep for a year now), if i hear someone talking outside my window I get paranoid, I cry a lot, for the fear that something bad would happen.

What can I do? How can I get over this and accept that bad things will happen? How can I get enough courage to live my life as a sane father?

If you can answer, I'd be really thank-full.

Male, 36.

Cheers

If you've listened to the show, you probably know that my co-host Jim experiences this A LOT. I'll take a swing at answering this as best I can from his perspective, but he may add more later.

One great piece of advice I've heard Jim say that he's used in the past is to recognize catastrophizing thoughts and challenge them. The example used is, if you were sitting at home with the windows open and heard hooves outside walking on pavement and were not able to see anything, you're probably thinking "a horse." It's very unlikely that your brain will immediately go to "OMG, a zebra!" It's even more unlikely that you'd be thinking, "I'll bet it's a unicorn!!!"

But that's what anxiety does. When there is a cue that triggers a thought, we can often catastrophize, and immediately think of the worse case scenario. Then we continue to replay the event in our heads to lock in that fear even more. Instead, we want to get into the habit of recognizing that thought as a thinking error. "Do you really think it's a zebra, or is it more likely to be a horse?" The catastrophizing thoughts don't really go away, but with practice, they have less control over your life because you learn to recognize and challenge them.

-nick

Am I responsible for another person's ADHD/anxiety triggers? I keep getting told that their angry reactions are always my fault, that I am the problem in the relationship because of this. If so, how does one make sure not to set off someone else triggers all day , every day? Am I being selfish for saying I can't be on top of it 100% of the time?

Hey there! So what you're experiencing is very normal. When people we are close to are experiencing mental health stuff, it effects our relationship with them and we have to think carefully about what parts of their experience are their responsibility, and what is ours.

With "triggers" in particular this can be tricky. As a person learns more about what sets them off they will want to teach those close to them to hopefully avoid those problems. Its natural to want to help them as much as we can, but often we find that we can't possibly accommodate their every request. Also, the person has to learn the coping skills to live life on life's terms, not try to bubble wrap the world so nothing ever harms them.

If your person is seeing a therapist I think its a good idea to ask them for the therapist's opinion on this matter. If you are romantic or family with this person you might even ask if you can attend a session so the therapist can give you some feedback on how support this person, but also hear your thoughts on when "walking on eggshells" around this person is harming you in the relationship as well. This gives the therapist a chance to help the patient right size their expectations and start working on coping skills where they are needed.

No, you're not being selfish. Yes, you should try to help a person who is struggling by listening to them and working with them to make reasonable life changes. But in the end the person's growth is measured by their ability to function in the world around them, not change the world to suit themselves.

My question is about the blending of entertainment and information. What considerations do you make in providing a mental health podcast that's entertaining to your audience while still being safe and responsible?

To expand on my question, I think mental health content in particular can generate an "oh shit, they're talking about me!" response for some people. I have friends that tell me they're definitely suffering from x, y, and z because a youtube channel or podcast told them so.

I saw a previous answer about neurodiverse people and how symptoms of ADHD can be so relatable that many people diagnose themselves as ADHD (which resonates with me; half my social circle now claims to be neurodiverse, including some people that... probably aren't?)

FWIW I have been diagnosed with ADHD by a licensed psychologist, so "fakers" for lack of a better word may strike close to home for me.

I'm also troubled sometimes by the way various mental health communities can become problematic echo chambers rather than channels for support and good-faith sharing of experiences (thinking of some popular subreddits here, and the lack of empathy I see there).

What do you think of the risks posed by the integration of social media and entertainment products with medical topics? Obviously it's great for generating awareness... but is there any element of voyeurism/self-diagnosis/misinterpretation that concerns you about this medium over others?

Hot damn I like this question! Let me tell you friend, I think if you can get past how annoying I am on the show you'd really like our podcast! This is Jim btw, the annoying one.

Anywhozzle, I love so much of what you said on here. Our project, and the community that has emerged around it, is actually a direct response to much of what you've observed in other internet mental health communities. Sure we have our bad apples - I'm probably one of them sometimes - but I'm proud of how this project has tried to teach people how to have a moderate, even handed, serious tone about mental health while also asking people to relax and not take themselves or mental health too seriously.

So lets talk about how we did that.

When Nick and I started planning this project in Summer of 2017 we had two observations and one proposal:

Observation 1: Half of the "Mental Health Podcasts" are a famous or funny amateur giving advice while being relatable and entertaining.

Observation 2: Half of the "Mental Health Podcasts" are clinical experts educating the public while being credible, serious and academic.

Proposal: What if we found the middle of those ideas? Could we be clinical experts offering sound, practical education to the public while being entertaining, casual, and approachable?

Nick and I had worked together at several treatment programs throughout the years, and sometimes we'd go out for a beer after work. People might over hear us talking shop and become curious, they'd ask us what we did for a living. When we told them we were therapists they were honestly surprised. They assumed therapists were aloof, tweed jacket wearing scholars who judged you with unblinking eyes - not two assholes in sports jerseys trying to get the bar to do the wave when the game cut to commercial.

We found that people at the bar found us approachable. Because we didn't take ourselves too seriously, they felt safe talking to us. We'd get a chance to show them what talking to a therapist might feel like, and when we'd encourage them to go see one many often did now that we'd humanized the field.

We wanted to recreate that experience in a podcast.

But as you might expect, danger lurks in every corner. If we are too crass, too dude-ish or too irreverent, we lose credibility. If we are too clinical, too scholarly or too serious, we lose approachability. We had to try to find the middle. After 6 years I can tell you we haven't found it, but we try every week to get closer to it, and with the help of our audience, a comedian "life coach" and finally a female therapist willing to put up with us, we are helping a lot of people become willing to get help.

Re: Social Media Influence over Mental Health

This is an area I rant about a lot on the show. I'm glad the world is talking about mental health. Im glad that its stigma is so weakened that now its "cool" to be diagnosed. But as a clinician I want people to understand that mental-illness cosplay is often hurtful to those that suffer and can have real effects on the mental healthcare system at large.

Its our job as clinical educators (therapists with a podcast) to help people navigate the tricky waters of self reflection, self help and diagnostics. We are careful on the show to discourage people from self diagnosing, we are also careful on the show to always point people toward a clinical helper in their area, our job is to start a conversation about mental health and get people thinking about it. Which we've enjoyed doing the past 6 years.

Hey, so I was diagnosed with ADHD as a child. Hated the medication I was on because I wasn't accustomed to it and (regrettably) asked to be taken off of it. Looking back this probably hurt me more than I could have realized at the time.... As an adult I'm highly aware, and my coworkers and boss even comment on it, that I still have ADHD and would like to get back on medication for it. What would the process be for me to get the ball rolling on that? Do I have to dig through old medical records from 20 years ago? Or would it just be easier to look into getting re-diagnosed?

Hi there, great question and this is a topic that has gotten a lot of attention today.

So the answer really depends on where you live. If you are in the UK or Europe, you might find the process to be daunting and highly involved. You'd need to get a referral from your general doctor, then get on a waiting list for a multi-hour evaluation, then do a long form clinical interview with further testing, then wait to be approved for the medication. A friend of mine recently went through this process and it took her almost 2 years from diagnosis to dispensing of the medication.

If you live in the United States you can talk to an online Nurse today and have the pills delivered to your house by Friday.

This is also why the diagnosis of ADHD is triple in America what the global average is, and why the ADHD medicine industry ran out of pills last year.

So the good news: its very easy to get the diagnosis and the medicine if you need it.

The bad news: its so easy that now its hard to get the medicine because of supply shortages.

Can you help with the below as I feel like I'm going crazy?

When asked "have you had suicidal thoughts "

What does this really entail, cos I always answer that i don't have thoughts of offing myself, or harming myself. Yet I get what I consider intrusive thoughts where I'd imagine myself dead, like laying in a bathtub, or when I'm cutting up some food part of me would be like hmmm I wonder if this knife would be sharp enough. Then I catch myself and just get on with my day.

Is that suicidal thoughts or is it "normal"

To be clear I do have depression, anxiety, loneliness, and possibly adhd or similar. I'm not on meds, and have not attempted or plan to hurt myself or others.

Hi there! So what your describing sound a lot like "Intrusive Thoughts", these are ideas that pop into our heads which frighten us, make us feel awful, and really seem contrary to who we are and what we believe in.

There is a great book on the subject I encourage you to read called "Overcoming Unwanted Intrusive Thoughts" by Winston and Seid. They do a great job explaining and helping with this experience in a way that I think you'd find relatable and useful.

Hello! Thanks for doing this AMA!

I’ve seen several therapists and counselors over the years, my most recent issues coming up have been lack of self esteem and confidence, putting too much expectations on myself, with anxiety and possibly depression. Failing my first romantic relationship has spiralled me into thinking “what’s the point of it all? Why do I work so hard in school, at work, on myself, for anything?” Now I’m closely approaching college graduation, and I feel burned out, and constantly worry that I won’t be able to hold down a job, or find something meaningful that can keep me going. I’m not suicidal, but I don’t know what I’m living for.

Have you encountered clients with similar situations? If so, did they ever improve and get out of this rut, and how did that happen?

Thanks again very much, hope you have a wonderful day.

Howdy friend! So the short answer is yes, many people experience burn out and worry, especially during life phase transitions. Finding meaning and direction in our lives is crucial for us to feel we have a purpose and have confidence that we are making the most of our human experience.

This is definitely something a therapist would be interested in working on. I'm glad you've worked with therapists on other issues in the past, but this might be a great thing to work on presently. Its a very common area of focus.

What views do you have on the current state of the field of psychotherapy? Where do you think the future is?

I can't speak for all of Pod Therapy, but I feel we are very far behind where we need to be when it comes to accessing therapy, and funding for it. That's not going to shock anyone.

Personally, I'm optimistic. When people are ashamed to speak out about their own mental health and being in therapy, then there is less pressure to make systemic changes to improve access to care. As our society becomes more open to talking about mental health, with shows like Ted Lasso or Pod Therapy (which, I feel, equally impact society), the demand for psychotherapy goes up and the voices of MH advocates get louder.

-nick

I've been thinking about going to see a therapist for a while. I've been married for ten years, together for fifteen, no major issues other than different "love languages" and mismatched sex drives. But I've held onto a lot of baggage from past relationships (I was cheated on in most of the long term relationships I've been in, not this one though) and have made some mistakes on handling situations that are definitely linked to that baggage. I also have a bunch of anxiety challenges and self esteem. It's all really fun stuff.

So I've been looking for a therapist through Spring Health since my insurance gives me a bunch of sessions before I have to pay out of pocket and where I live I just couldn't afford to pay out of pocket.

How do I actually pick a therapist? I end up looking through profiles and credentials and either roll my eyes at things that are written in their profiles or find myself comparing their credentials (LCSW vs LMFT. Phd, PsyD, MS, etc.), something I'm not even remotely qualified to analyze. I also compare these potential therapists to a friend of mine who is an LCSW and it kinda horrifies me that she is in a position to give anyone advice about just about anything, so I get hung up on that as well. And I have some sexual hang ups that maybe would be appropriate for a sex therapist, which Spring doesn't employ.

Anyway, that's all a really long question, any advice on this would be greatly appreciated.

Hi lordicarus,

This can absolutely be an overwhelming endeavor to pursue.

First, I wouldn't stress about finding a sex therapist. Given what you've shared with your history in relationships and the effects of having been cheated on, it seems like that would be a bigger priority at this time.

Regarding the credentials, you're 100% right. There's really no way to tell by looking at credentials only. I do believe (I know, I'm biased) that most therapists are good therapists. But that doesn't mean that if you have a good therapist that that therapist is right for you. Unfortunately, I think in your case, this is going to be trial and error. Pick one, schedule an assessment, and keep an open mind.

Best of Luck, friend,

Nick

I love asking this to therapists: What have your own experiences with Vicarious Trauma been like? What resources have been helpful for the helpers, and what advice do you have for anyone who was interested in the field of psychiatry regarding this?

Hi FordBeWithYou,

This is a great question, as vicarious trauma is often overlooked. I did a presentation for the State Prosecutor's Office a few years ago. It was an issue they were dealing with because prosecuting attorneys will look at a lot of crime scene photos and hear a lot of traumatic details about violent crimes. The trauma doesn't show itself right away, or in obvious ways. Instead, it seems to accumulate and come out in the form of a Substance Use Disorder.

In this presentation, I focused heavily on the importance of a debriefing. Being able to talk to others at the end of the stressful day and express your thoughts and feelings as you went through the experience is very helpful in avoiding the cumulative effects of vicarious trauma. It doesn't need to be therapy, or have structured facilitation, per se. Simply being able to verbalize and express your thoughts and feelings allows the brain to process the event and file it away.

That would be my #1 tip for anyone who regularly deals with 2nd hand trauma.

-nick

How would you address people harmed or traumatized by mental health treatment, especially in cases where there wasn't any reportable wrongdoing on the part of prior therapist(s)? It's something I've struggled with a lot because it often seems that the vast majority of therapists don't seem to want to engage with the idea of treatment potentially harming a patient. I know when I've tried to bring it up with future therapists in real life I usually get a shocked "oh I would never do anything to harm a patient!" or something, which is honestly a problem because in my experience the most damaging therapists were the ones that were completely convinced therapy was going great. (Often in retrospect I feel like I was manipulated by the therapist to continue because the therapist believed we were making progress. At the time I didn't see how therapy was doing harm; I thought the therapists were great and I was just too messed up to understand, or that if it wasn't working right it was my fault for not being a good enough patient. In my experience most therapists tended to encourage this view, albeit in more positive-sounding language.)

​

What sort of safety standards beyond the really basic ethics would you suggest or look for to ensure a therapist isn't causing harm to a patient in their treatment plan, and especially how would you address cases where common treatments might cause harm to particular patients? Again, this is something I've tried to address on the ground and it's just been impossible to get a straight answer.

That's a sincere concern, and something we take very seriously in the profession. To provide a more informed answer, can you give me some examples of harm? There are many steps taken, but a lot of those depend on the type of harm. What are the most common forms of wrongdoing that are unreportable, that you were mentioning?

how does one deal with a family member going 0 contact out of nowhere? i have no idea what i could have done to have this happen and i'm going insane trying to figure it out.

This seems to be a more common occurrence in the last 10 years. It may have to do with contact being so much easier these days with social media that the lack of contact seems more obvious.

I'm of the opinion of being open and honest about it. It's not worth all the stress and mental/emotional anguish of trying to figure it out when you have access to the person. Reach out and ask. When you do that, come from a place of observation and concern , not accusation and judgement. "Hey, I've felt like we haven't had much contact lately, and it has been causing me some stress. Is there anything that you feel that is going on that maybe we can remedy?" AS OPPSOSED TO "Hey, why'd you stop talking to me? If you have something to say to me, say it."

They may not give a reason, and if it continues then you need to decide how much of your effort you're willing to invest to try to salvage the relationship.

-nick

Is it worth to seek diagnosis of ADHD in the adulthood? What are potential benefits of the diagnosis if for example work or family life is rarely affected by potential disorder?

Hey there! So ADHD has come up a lot in this thread, which is great because it gives us all a chance to talk about something a lot of people are thinking about lately.

So the thing I'd encourage people to think about here is the idea of "seeking a diagnosis", as if this will change who you are or what your experience is. A lot of people think that mental health diagnosis is the same as a medical diagnosis, but actually they work in opposite ways. Let me explain:

In gastroenterology you may show up with a stomach ache. Your symptom is stomach pain, you want to know the *cause* of that symptom, or the diagnosis. When the doctor does tests she tells you have diverticulitis, this is important because now you can know what other symptoms you might experience and how to manage this condition long term.

In mental health diagnosis works in the opposite direction. Patients arrive with a list of symptoms they are experiencing, let's say sadness and despair, loss of joy in life. We don't tell them the *cause* is "depression". We explain that what they are describing is called "depression". In mental health, a diagnosis is a description of a bundle of traits, its a short hand word used by the field to summarize the symptoms, not to explain them.

Generalized Anxiety Disorder isn't a cause of fear, it is the phrase we use to describe a certain style of fear. Attention Deficit / Hyperactivity Disorder isn't a *cause* of one's life experiences, it is a word we use to describe those life experiences succinctly.

Social media often presents AD/HD as something you *are*, when technically speaking it is something are *experiencing*. This is why more than 50% of children diagnosed with AD/HD eventually find remission and no longer meet the definition of the diagnosis in adulthood.

Now some things, like Autism which has many similarties to AD/HD, are seen as a permanent condition which we try to help patients manage and adapt to rather than eliminate. But generally speaking mental health diagnoses are bundles of symptoms, not causes of symptoms.

It should also be noted that part of the way we define the diagnosis of AD/HD involves how much the symptoms negatively effect areas of life like work and family. Unlike many other mental health diagnoses, AD/HD often evaluates the external effect of the symptoms on other people.

Anyway, if you feel this is something you'd like to look into further I encourage you to talk about it with your primary doctor. They should be able to get you a referral to a specialist who can do an evaluation.

Hi there, my wife is a fairly new psychotherapist.

Do you have any tips or suggestions on how I can help support her?

Of course after dealing with such trauma all day, some days she comes home very emotionally fragile. Sometimes tv shows trigger her if they involve infidelity, trauma, etc. Let alone her own personal history.

So yeah just looking for any resources, trucks, tips, etc (we are in Canada) to help her cope.

Also, are there therapists that specialize in seeing other therapists? Is it a specific professional she should be seeing?

Thanks so much for all the great info

Hi Bennett21,

Excellent question. The advice I always give new therapists is to set good habits of daily self-care right away in the beginning, and learn to build separation between your personal life and your work life.

I answered a question earlier today about vicarious trauma. A lot of therapists will leave the profession or move into administration early in their career because of what they call "burnout," when in reality it's actually vicarious trauma that continues to accumulate without being dealt with.

We hear a lot of difficult stories, and over time, that can take it's toll. If she has co-workers or peers in the community that she is close to, I recommended her getting involved in a peer supervision group. In that group, she can verbally process events, thoughts, and emotions she has, as a way to debrief. Doing so allows the brain to language what she is experiencing, process it, and file it away so it doesn't sit there and accumulate.

And yes, many therapists have therapists. I went to therapy several years ago, and it was the best money I every spent. It is not uncommon, and there is no therapist specialization needed for it.

We're excited to have a new colleague! Send her a warm welcome from Pod Therapy!

-nick

I have avoidant attachment style, and my husband is anxious. We are stuck in the loop, as it happens. Our therapist has just told us that we just might not be compatible. He suggested I get a workbook to help me work through and heal my avoidant attachment. He did not have a suggestion on what workbook to do, though. Any ideas? I feel like my life is falling apart and I will do anything to save it.

I'm sorry to hear you're going through that. I totally understand that challenging dynamic. In that relationship, communication is very important in order to allow yourself space while reassuring your partner that the space is temporary.

In full disclosure, I have not personally read or worked with these, but a couple you could try might be:

Overcoming Avoidance Workbook by Daniel F. Gros, Ph.D.

The Essential Guide to Overcoming Avoidant Personality Disorder by Martin Kantor

I hope that helps and I wish you the best!

Nick

Hey guys! Never listened to the show but I’ve come to read these responses, and now I’ve got a question of my own

Recently I was talking to a girl at work(great start I know), we’d agreed to go out for a date, but then one day she sorta stopped talking to me for 2 weeks and later said she didn’t want to do anything right now. I didn’t pressure her on this, because why? but now it’s made my work life really miserable. I can’t explain how or why, but I’m absolutely filled with anxiety (or maybe fear) around her to the point I completely ignore her. It’s getting really toxic since it affects my whole mood for the day/days, and I need something to change (and getting moved around isn’t an option)

To make matters worse, my manager is… clingy, in a way. She likes to be really friendly, sometimes touching me (like cheek pinching stuff) and calling me her buddy and stuff… and if I hint or imply I’m not her best friend she gets offended. Recently she asked me to come in on a day off, I said no and she was then upset for the entire night. Do I have to just put my foot down and piss her off?

Thanks!

Yikes. That does cause some awkwardness.

I'd start by examining where some of this anxiety comes from. You mentioned that it could be fear. That's a good observation. I might spend some time examining what is driving that fear.

Personally, if I'm in that situation, and I'm having so much anxiety that I am completely silent around her and intentionally avoiding her, my guess is that she's picking up on that, and is probably having a similar experience. My strategy would be to force myself to say "Hi" or "Good Morning" when I see her. BUT HERE'S THE KEY, do so without any expectation of having any deeper conversation. Saying "Good morning, Cindi," as I pass by her in the breakroom and keep on walking, helps me work through my anxiety and sends a message to her that 1) I don't want to treat her any differently than I would any other co-worker, and 2) by me walking away and not pushing the conversation any further, it sends the message that I have accepted that we won't be dating and she can feel comfortable knowing that I won't be pursuing it any further.

-nick

I just recently stopped seeing my therapist because she will ask me what I think is the best course of action to fix the things going on. She doesn't think I need therapy because I say I don't know what the best way is. In my opinion If I knew the best way to deal with it I wouldn't be in therapy. Is this a normal outlook on the situation? Should I try finding another therapist to talk to? Or will it boil down to the same thing.

This is a great question.

We get questions like this on the show, and I always start with the caveat that it is difficult for us to know the therapists intentions as we look in from the outside. What I can say, is that I don't think this should deter you from therapy in the future.

Not giving direction, and putting it back on the client to determine the next course of action is a tactic used by therapists, but it's not used by ALL therapists, and it's not used in ALL situations. Therefore, your next therapist might have a completely different approach.

We talked about this a little bit in one of the questions in our latest episode. Sometimes people can become dependent on other people making decisions. Putting it back on the other person with "What are you going to do about that" type question can be useful to force the person to verbalize ideas they have that they wouldn't otherwise verbalize, and to build trust in one's own decision-making. But again, it's not the only strategy, and not used in all cases, so please continue on with therapy if you feel that therapy is still needed.

Alternatively, if you were sticking with that same therapist, I would encourage you to bring it up to them and have a discussion about it.

Hope that helps,

-Nick

What can I do with my burnout by working?

Hey buddy. This is a common thing that LOTS of people relate to. Im a big fan of reevaluating your life direction. There a free test you can take on a government website called ONET called the Career Interest Profiler. That could be a neat way to explore other career paths if thats something you're in a position to do. If that's not something that's possible, another way to get through burnout might be to sit down and do a values inventory for yourself. Consider what are the 10 most important things for you to live a quality and satisfying life. Then evaluate how you are currently doing with each of those things, maybe give yourself a letter grade. This can sometimes give you perspective on what areas of your life you want to focus on to bring balance back.

I’ve recently learned that my father has shifted blame from my mom to me in regards to her infidelity when I was 10. He’s former navy and since I have adhd/independent/gonna ask why personality, he told multiple family members I wasn’t his and the his care of me versus my sibling who is a people pleaser was vastly different.

New mom of a now 1yr old. I’m hyper aware of how much not feeling loved can damage a child. But how do I keep from damaging my own child with my trauma? I’m a glass half empty kind of person and the few attempts I’ve had at therapy have not gone well. Does talking about this regularly with my partner in a safe space help? Or is that just banging the problem over and over? We’ve also gone no contact with my parents and sibling despite it not being what I ultimately want but I can’t force them to have a positive relationship either.

Hi there, this is a great question and many people relate to family trauma.

So, first, Im actually glad you are talking about this with your partner and that you've tried therapy. I know therapy, like all of healthcare, isn't always a winning experience. The fact that you have given it multiple tries, and are here in this AMA, tell me you are a mental health advocate and somebody who doesn't give up, which is awesome.

I think you're also asking a good question about your own trauma effecting how your raise your child. We have a saying in trauma work, "that which is not transformed is transferred". Meaning, if you don't pay your trauma bill your children will, in one way or another.

Dealing with your trauma can look like talking about it with your partner, your friends, doing a trauma workbook, journaling, doing reprocessing work in therapy, or any number of times you reflect upon your lived experiences as you develop as a parent. Sometimes trauma can make us a better parent, we have a "Im not gonna do that shit" mentality for our kiddo which causes to try harder than if we'd never experienced pain. It can also cause us to "over correct", where maybe we do more than we should because we so fear replicating what we've experienced - this btw is also part of "transferring" what we didn't "transform".

I encourage you to pick up a trauma workbook and so some personal reflection work on this. Its not something you will "solve", its part of your lived story, but its something we want you to develop deep insight into and bring into your awareness when you're navigating your own relationship with your child.

Do you ever have any ethical concerns about running an explicit podcast? I feel like my Older colleagues are so stuck in the past about social media usage by therapists.

Yes! I have concerns about this every day. I feel that a lot of my colleagues (especially older in age) would be very turned off by the explicit nature of our podcast. However, I don't regret it at all.

Not everyone will enjoy our content, and I realize it's not for everyone. But by making our podcast entertaining, we're able to reach a population that otherwise would not be exposed to conversations about mental health and therapy in a positive light. When someone writes in and tells us they sought out therapy because of our show, it feels amazing, and that's why I have no regrets. ;)

-nick

Hello! Thanks for doing this. My partner is currently going through pretty extreme anxiety to the point where they sometimes have to come home from work because they are struggling to come, unable to think / work etc..

We've been talking about it, the stressors at work and I've been trying to help.

But what do you think are the best ways I can support them?

When do you think therapy needs to be considered or not?

Hi RichardNz69,

The best way to help, be someone they can count on for support. Be there to listen and empathize. Also, you can help connect them to a therapist.

It seems like now is that time. All humans have anxiety, but when it is starting to interfere in daily functioning and causing a clinically significant amount of distress, it's time to seek some help.

It would probably be a good idea to have a conversation about being open to medication. A combination of psychotherapy and psychopharmacological treatment has been shown to reduce symptoms and improve functioning.

-nick

I graduated from my Clinical Mental Health Counseling program in December 2022 and began working at that same university’s counseling services center. I spent practicum and internship there as well and have really enjoyed working here. Unfortunately, the university is unable to offer additional full-time positions and I’m left debating between continuing to be a contract therapist here and fulfilling the remaining days at a different site, or dropping university counseling completely and working full-time at another site.

I really enjoy the university population but I’m new and I also understand different populations will provide me with a more versatile experience and help me to identify the population I want to focus on.

In y’all’s experience, what are pros and cons of having one foot in one site and another in a different site? Also, as a new clinician, how much should I weigh the joy this university site brings me vs weighing the importance of trying new sites/new populations early in my career?

Thanks and love the pod! I tend to ramble so hope this question made sense!

Hey welcome to the profession! Always love meeting colleagues!

So in my (Jim) view, I'd like you at multiple sites and here is why:

The University bubble is a specific one. Sure there are lots of types of people in college, but the life challenges they face and the backdrop of that reality is similar. As a new clinician you've definitely developed some expertise already serving this population, but I'd love for you to start getting experience with the very very large pool of humanity who aren't in college.

Loving what you do is super important, and I don't think you owe it to society or the field to go on a clinical world-tour forcing yourself to try every job the field has to offer so you are "well rounded". When you find a population you like and a job you love, I'm on team "do more of that". A happy therapist is an effective therapist.

But in your unique situation I think if you can have one foot in two different pools that would be great. When I did my graduate practicum/internship I intentionally practiced at three different sites in three parts of town serving three different populations. I'm glad I did, because it kept me from being myopic in my clinical worldview, or elitist about certain populations.

If your career has handed you an opportunity dabble in a couple different clinical spaces, I strongly encourage you to do that at this point in your career!

how do you as a professional call out a client on their shit for blaming everything on their mental health or not dealing with it?

That's a big question with a long, complicated answer.

The short version is that it depends on what therapeutic module you're adhering to. Some are more direct than others. Most approaches would include some form of a redirect that moves the focus from problem identification and stagnation to something more client-driven that puts the individual in a position to identify action steps they will take to overcome, or at least minimize the problem.

It seems like many times people attracted to mental health as a profession are not mentally healthy at all. How do you take the advice of mental health professionals who fail to practice what they preach? Or why would the general population?

Hi Speak_like_bear,

It is true that a lot of people enter helping professions that they were once helped by; having a good experience in therapy motivates a person to be come a therapist, being saved by a firefighter motivates someone to become a firefighter, watching a nurse care for a dying family member motivates someone to become a nurse.... it's a very common story.

The thing that makes the psychotherapy profession unique from the rest is a clinical supervision process that is a requirement prior to licensure. The profession is very much aware of the this pattern and therefore requires 2-3 years (different depending on states/countries) of direct supervision before being able to practice independently. Even to become a clinical supervisor requires years of training, which focuses heavily on the gatekeeping function we have to our profession. I, personally, have had to deny someone of the opportunity to enter the field because I was concerned about their unstable mental health. It was devastating to that individual, but my loyalties are to my profession and the people we serve, not to my interns.

I obviously cannot speak to your personal experiences or to the specific therapists you know, but I can say that I am proud of the efforts made in my State and with my Board to ensure clinicians that earn their license are capable of treating others.

-nick

Can you explain the difference between ADHD and ADD in adults?

Hi there! So as you'll hear elsewhere in the thread, I did a 6 hour series on ADHD for our patreon.com/therapy community in which we go over the entire history of the diagnosis, why we are seeing a surge in diagnoses today, exactly how we test and treat it, and a ton of other interesting tid bits.

But for your question let me point out a few things:

So in the 1980 edition of the "Psychology Bible" (the DSM 3) the diagnosis was "Attention Deficit Disorder". By 1987 the revised edition of the DSM 3 replaced that diagnosis with "Attention Deficit Hyperactivity Disorder".

In 1994 the DSM 4 kept ADHD as the diagnosis but identified 3 flavors: “ADHD Combined Type”, “ADHD Predominantly Inattentive Type”, “ADHD Predominantly Hyperactive-Impulsive Type”. Colloquially many people started referring to "Inattentive Type" as "ADD" and the other two as "ADHD". But really it was always clinically called "ADHD"

In 2013 the DSM 5 stayed with ADHD as the official name, but offered two sets of symptoms, an inattentive set and a hyperactive set. If a patient satisfied either set they received the diagnosis of ADHD.

In 2022 the most recent revision of the DSM 5 pretty much kept everything the same. So today, we only have a diagnosis called "Attention Deficit / Hyperactivity Disorder", we do have some specifiers to note whether the patient presents with predominantly inattentive of hyperactive of combined types.

TLDR: They are not different diagnoses, but some people with AD/HD are inattentive, some hyperactive, and some combined.

Now let's talk about Adult AD/HD:

Its not special. We don't have a different diagnosis for adults than children, and part of the diagnosis requires onset of symptoms at an early age (currently 12 yo). The symptoms are easy to google but they are the same for adults or children.

Before I turn this thread into another 6 hour lecture on the topic I will conclude by pointing out that AD/HD is not considered a life long condition. 50% or more children with condition are expected to go into remission by adulthood, and "neurodivergent" is a word coined by Judy Singer (Australian Sociologist) as a way to destigmatize people who had mental differences, not a *type of person*.

Has there been any good new research/methodology on treating depersonalization/derealization?

Well, actually....

Admittedly, this is not my area of interest or expertise; I'm mainly interested in addictions and the use of physical exercise in mental health treatment. BUT I did see a study that came out this month looking at Dance/Movement Therapy reducing symptoms of DDD. It was in this month's Complementary Therapies in Clinical Practice Journal.

I'm seeing more and more research supporting the use of movement and physical exercise as a treatment for a wide range of mental health symptoms.

So that's hopeful :)

-nick

Do you have any tips for someone who's gifted and slightly suspects very well masked ADHD when it comes to avoiding misdiagnosis?

A lot of people are very interested in diagnosis these days. I'll tell you that overall, the experience the person is more important to me than nailing the exact criteria which fits a particular word on a piece of paper. If a person is functioning well in the world and finding ways to cope, adapt and grow, Im super duper proud of them. If they relate to diagnostic words like ADHD and they benefit from what those with that condition do to navigate life, all the better. Im really just for functional life progress.

Whenever I'm watching a movie or tv show and feel a welling of emotion (either happy or sad), I feel something inside me cut myself off from crying - like I'm not letting myself feel the thing I feel in the moment.

Is there a reason why this happens? Is there something I can do to break down that barrier?

Totally relatable!

I've found that I've gotten more emotional as I've gotten older. And over weird things, like award shows. I don't even care about the Oscars, but when I see someone win...

Anyway, my first thought is "is this something you feel like you need to change?" and if so "why do you feel the need to change it?" It's a strange question, but I ask it because sometimes people have this idea that we should never hold back emotion. Sometimes, holding back emotion is healthy (or benign).

The question we always like to ask is, "is this causing a clinically significant amount of distress?" We don't want to pathologize normal human behavior. I don't want you feeling like you have to cry. If stopping yourself from crying is not causing significant problems, then maybe it's not something we want to jump in to try to fix.

If on the other hand, your doing this in many areas of your life and it is causing significant distress, it could be something a therapist could help you with by finding strategies specific to your needs.

Probably not the answer you were hoping for, but I hope it helps,

-nick

How do you handle your past when it's mostly negative memories? I was refreshing my skills with geometry and it reminded me of how much I did not like high school, and I'd rather just forget the whole thing (but keep the knowledge)

Therapy!

But seriously, in a way, you're already doing it. We call it Cognitive Reframing. The part in the parenthesis is what I'm referring to. "Keep the Knowledge." Cognitive Reframing is about being able to acknowledge/accept the negative pieces without discrediting or minimizing them, but also reframing the experience to a perspective that will be beneficial for you today. High school sucked, it was miserable, and I hated it. ...but I learned a lot from it, and I will use that knowledge to make my life better.

If you're open to therapy, a Cognitive-Behavioral Therapist could help you develop these skills.

Hope that was helpful,

Nick

Hey Nick & Jim!

Long time listener and supporter of the show! The discord community you two have brought together is full the greatest people. So thank you for that outlet in my life!

Onto my question, how do you help someone who doesn't want to get help? My brother in law has been going through a hard time since he and my sister in law (who honestly both are having a bad time right now) moved to another state due to work. It seems anytime tries to help him, he doesn't want to talk about it. He shuts the conversation down and that's the end of it. Especially when a lot of family members have tried to talk to him about quitting his job and moving back which I know is easier said than done, but he won't even try.

Also, he (and my sister in law) seem to be drinking alcohol a lot heavier since they're really only around each other most of the days, and that is how they tolerate each other. I told my sister in law that isn't healthy which she knows.

I just struggle with trying to figure out how to help them since I seem to get caught up in the middle of it. It has started to affect my mental health as well, but I don't want to have to set boundaries in place when I know they're needing help.

Thanks!

Hi!

First, thanks for supporting the show and being a part of the community. We've got the greatest listeners!

Secondly, I absolutely empathize with your situation. It's really painful to be in a front-row seat of a loved one's struggles. Normalizing seeking therapy was the main drive for creating this podcast, and we have a long way to go. For a lot of people, many of them males, talking to a therapist is like admitting defeat. I'm hopeful that as more people open up about their own experiences in therapy, it will motivate people like your brother-in-law to get some help.

In the meantime, unless they are deemed to be a danger to themselves or others, the best we can do is be supportive and continue to encourage them to talk to someone. Express your concerns, tell them you are there to help, but that you cannot do what a trained professional can do.

I'll also take this time to talk about self-care. Boundaries aren't put in place to keep a distance from others, but instead for self-protection. When you're in the middle of all of this, it takes a toll mentally and emotionally. Like jumping into the ocean to save someone from drowning, their instinct is to push you down to keep themselves up. We need to learn to help in ways that don't put ourselves in danger. For this, I'd just remind you of the Al Anon 3C's:

1) You didn't Cause it

2) You can't Control it

3) You can't Cure it

Be a cheerleader and continue to point them in the direction of help. They need to take the steps to get there.

-Nick

Do you have any recommendations on what type of therapy to go for if you struggle with a lot of (often crippling) self-hatred and existential stress/dread?

I’ve tried ACT for about a year, only on a bi-weekly to monthly basis, but I loved it; however where I live it’s hard to find anyone proper educated in ACT specifically(waiting lists are months long). I was late diagnosed with ADHD(28 y/o then) and been struggling with depressive episodes for 15 or so years(currently also being screened for bipolar type II).

Hi there! Glad to hear you've got helpers in your life and that you've committed to the work! Acceptance and Commitment Therapy is a great method and I imagine has already given you great tools for dealing with existential dread and self hatred.

Finding a specialist in a particular modality (theory, approach) can sometimes be difficult. However there are usually some great self help resources like workbooks and online support groups that might be a helpful supplement to what you're already doing. If you haven't already I'd encourage you to look up your local chapter of the National Alliance on Mental Illness (NAMI) and see if they have any support groups you might be interested in joining. Especially as somebody who has experienced several mental health realities, you mind find so many people to relate to at NAMI and could probably bring some of what you've already learned to the community.

You might also enjoy the book "Man's Search for Meaning" by Victor Frankl, he is considered the father of Logotherapy, or Existential Therapy, which has a lot to say about existential dread and finding purpose in our lives.

Soooooo.....my therapist had me do two sessions of EMDR, the first time (two years ago) I had a very bad reaction to it that left me feeling physically ill for weeks and I couldn't bring myself to go back for 6 months. Last year we did another session and my reaction was the same....haven't been back since and can't imagine ever going back to that. Is it normal to have such a negative reaction to EMDR therapy? Is my therapist screwing it up somehow? We are trying to work through some childhood trauma with resulting PTSD.

Hey friend, Im really sorry to hear about your experience with EMDR. Childhood trauma can be a debilitating thing, and attempting to confront our trauma consciously can cause a physical reaction like you experienced.

We don't speculate about the work another therapist is doing. We defer to the professional on the ground, they know the patient, they know the case, they have a strategy. However, I would encourage you to talk to your therapist about how the experience has gone for you and discuss whether they think its time to try another method, or whether they might have clinical recommendations to work with another provider who maybe has some other specialties that might be a good alternative to EMDR.

Why does the psychology field take perfectly normal, long existing words (such as "depression", "anxiety", "boundary", "trigger", etc. Maybe "gaslighting", but that is a newer word) and come up with their own domain specific, precise definitions that no longer matches the colloquial definition. (well its only depression when it ...")

How can we get psychology to just come up with their own words and acronyms ( agoraphobia, CBT, aboulia , ADHD, maybe depersonalization, etc.) and stop stealing our words?

Interesting question, SpringLoadedScoop,

I don't see that psychology does that. For example, "Depression" wasn't taken from the lexicon. It's also not specific to emotions, nor specific to mental health. Depress can be used to describe the action of "pressing down."

Depression is not a diagnosis. Major Depressive Disorder is. What psychology has done with these terms is very important and necessary. Every human experiences depression. We don't all have Major Depressive Disorder. That is a very important distinction to be able to make, otherwise we can't treat it.

Also, I feel like it's a bit a of losing battle. If the field of psychology created a whole new language, we'd be accused (rightfully so) of being pretentious.

-nick