IamA mental health and co-occurring disorder therapist, AMA!

I suffer from severe anxiety and become very anxious when I have to go see my doctor, end up telling him that everything is fine just to avoid conversation and getting upset. Any suggestions for me? A lot of the time I do want to talk but feel anxious about it.

I find that it is a lot easier to write everything down that you have been experiencing and taking that list with you to your doctors appointment. It's easier because you are more clear headed so you will be more detailed, and you can just give it to your doctor if you find your anxiety is taking over.

This is also a double whammy because journaling and writing is a great way to help reduce some anxiety symptoms.

Thank you for your reply. I actually have notebooks filled with journaling and lists (I make lists for *everything *) and never thought about this. Thank you so much!

You're welcome! I also live with anxiety disorder and I know that really helps me process my thoughts also :-)

How are you able to put distance between you and the patients? How do you handle listening to so many problems and hard stories without getting sad?

EDIT: Thanks for the answer.

This is a good question!! I have my own healthy coping skills that I utilize and a great support network that helps me separate work from personal life. I do have to admit there are days that I come home in a funk though because of a crappy or sad day.

I worked for a few months as a resident chaplain in an in-patient psychiatric facility and I can't even begin to say how important coping skills are in that sort of work environment. Prayers and well-wishes that you don't get burned out, this is really important work that folks like you do! (No question from me, just encouragement.)

Thank you for this! I totally agree. I am really blessed with a great support network that also helps me a lot.

Hi, I am currently looking for a new therapist to handle my depression and anxiety, however every time I call a Dr. thats covered by my insurance I get a voicemail and they never respond. What is the best way to look for a new Dr.?

I'm not sure if you have done this yet, but if you call the back of your insurance card they should provide you with a list of agencies that accepts your insurance. If you have already done this, keep trying back at some of these doctors. The sad thing is, there is no way to MAKE them call you, you can just keep bugging them until one of them does.

I'm sorry to hear that you are having this problem! Another thing that you can do is talk to your primary care and see if they can make a referral to a specific doctor for you, sometimes then they will do much of the work.

I've struggled w/ depression and anxiety for 15 years. I've been mostly stable but hit another road block and really really been struggling the last few months.

I started counseling today but I'm not sure we really mesh. How do I know if it's her or if I'm just reacting to things I don't want to hear? How many sessions does it take to decide that you don't mesh?

Thanks !

if you don't mind me asking, what makes you feel like you don't mesh? I know for our agency, the first appointment is a lot of paperwork and learning agency policies. It could be that you haven't gotten into the meat of what you will be working on. I say stick it out another couple appointments and if you continue to feel uncomfortable ask the agency if you could explore another option.

I'm not sure. She talks a lot. She smiles too much.

I think it's probably me. I'm in a very negative space and not taking encouragement very well. (ie, everyone keeps telling me I need to take "baby steps" and how it's so good I can get out of bed now ... I've been majorly depressed for at least 3 months now and I'm sick of hearing how great I'm doing ... If i was doing so great, why do I keep having thoughts of hurting myself?). I have bad experiences w/ previous attempts at therapy and I think i'm looking for an 'out' ...

I feel not ready for therapy yet but that doesn't even make sense ... not even to me.

Sounds like you're nervous and still feeling like isolating. Depression can do that to us. One of the hardest things when it comes to this is to NOT isolate (because it's all that you want to do). Isolating only increases depressive symptoms. It's feeling hard right now because you become comfortable in that feeling, you know at least what to expect there.

Give it a chance, if it becomes too hard or uncomfortable, take a break and try again!

Hmm this is interesting. I'm definitely prone to isolation when I'm depressed or anxious. But sometimes I find that if I force myself out then it's almost more traumatic. I'll get into social interactions that I replay over and over again and beat myself up about for days. It seems easier to avoid everything. How do I break this cycle?

Like others said, start small and work your way up.

For example, if you go grocery shopping and it makes you really anxious, start by going out later at night when it will be much less busy. Once you feel more comfortable with that go a little closer to early morning or afternoon when it won't be busy, but it will have a steady flow of people. Once that feels comfortable go during a more busy time and challenge yourself. If you find that is uncomfortable, go back to a time that you felt comfortable and challenge yourself another time. Keep trying until you are able to feel more comfortable in that situation. (also see if a friend or family member can go with you to start to help it feel less terrible)

Who was the strangest/most interesting person you've ever tended to? Did you ever find anything disturbing?

Or were you ever uplifted by your experiences with your patients?

I can't give details on clients due to HIPAA but I loveeee working with kids and severe mental health disorders.

There are times when I am disturbed (child molestation and racism get me) but I am uplifted every day. For some people just walking into my office is hard work and I appreciate them coming in!

I'd also just like to thank you in general for doing what you do, the world's a crazy place and sometimes that crazy can get to people. So I appreciate you and all the other therapists and such being there to help. :)

Thank you a lot for this :-) I actually don't get thanked often (nor do I expect it) but when I do it feels really awesome and I really appreciate it.

My therapist was a student (the clinic was through a university). We did mostly exposure therapy and challenging assumptions that I got stuck on in my daily worksheets, and it helped reduce the impact of panic attacks a lot. I still get them all the time, but my life isn't falling apart because of it. She was good at asking questions that pointed out things I was assuming that probably weren't true. She's probably long gone and I have no way of contacting her anymore, but i really wish I had thanked her. I'll thank you instead. Your work makes a difference.

Made tears come to my eyes!!! Thank you. I'm so glad to hear of your positive experience :-)

You guys give me hope.

Ive been seeing a lot of people claiming mental problems and threatening suicide, when i was younger i was genuinely worried, as i got older i became skeptical of most people that told me they were suicidal and shrugged it off as attention seeking. This is probably ignorant of me so my question is what is the probability that someone is actually suicidal and has mental problems without having a terrible life situation?

Well, there are a few different ways, but typically I'm the kind of person who takes every threat seriously. Sometimes, yes it is attention seeking. But that is coming from somewhere.

When you should be worried (although if you have a friend vocalizing, please refer them to the suicide hotline!) is if you have a friend go from seriously depressed to suddenly happy and light. Typically that is when a decision is made and a plan is in the process. Now this isn't always, but in my experience if someone goes from having suicidal thoughts and being very low, to suddenly light and happy, it can be a red flag.

I'm struggling to cope with my wife's addiction problems/BPD. What is some advice you'd give to handle the ups and downs associated with these problems? It's so hard seeing her go from happy and intelligent to drunk, banging her head on walls. She seeks help for some problems, but never the full scope. As her husband I seem to come across as naggy more than supportive. I just don't think I have the willpower to slowly watch her die. I've admitted her for self harm and alcohol related injuries, everything else feels out of my hands even though the problems are obviously within grasp. It's like watching someone drowning in front of you and refusing to accept the lifeline.

Thank you for everything you do, I can only imagine having to shoulder the burden of hundreds of other people's problems.

I'm sorry I'm getting to this so late, I am just now seeing some of the posts I missed!

I agree with the other poster, DBT is really helpful with BPD. I have to give you a huge pat on the back for trying to find some resolutions to this. It can be a frustrating thing to deal with.

http://www.bipolarsjuk.se/pdf/Handbook%20in%20DBT%20Group.pdf

Here is a resource that you might find helpful when it comes to DBT.

Another thing that I think will help is to do things opposite of the mood she is in. If she is a low, depressing mood, put on uplifting music, a funny movie, etc. Have her start using her healthy coping skills (drinking is unhealthy) during really low days. Exercise is really helpful for BPD too! Another big thing is for her to get into journaling and identifying what specific triggers may be causing the low-lows.

If it gets to a point where she is being mean and destructive, make sure you put up your boundaries. Sometimes people can get verbally abusive when they get this way, and that does not justify them treating you like crap. Assert yourself if you need to, and allow her and you to have space in those situations.

If a loved one is in need of mental health treatment but refuses to get help what is the best thing to do?

Continue to encourage support and help but not enable. Until they want help for themselves , there isn't much you or I can do.

How much money do you make a month or year? Sorry if my question is off topic

Not a lot. I make below $30,000.00 yearly and I live in a city so I basically struggle.

are you working for a non-profit?

No, it's a chain currently, we have about 4 other office locations in PA. I used to work non-profit, i'm hoping to get back into that work someday or to create that work.

I know I'm late, but thank you for your work!!

I really appreciate it!! <3

What are the major red flags to look out for in yourself to know if you're starting to develop a serious mental disorder?

There are many. Some red flags may be increased agitation, loss of interest in your usual activities, rushing thoughts , thoughts to harm yourself or others, feeling tired often, isolating, and breaking out into tears are just a few of the signs.

What kind of serious mental disorder can develop from these symptoms you've mentioned ? I've been feeling melt of the ones you've listed? What does that mean? I know I have anger management issues that I haven't really addressed.. And I've been referred before to see a psychiatrist but every time I never go.. I know it will help but I never get enough courage to actually get up and talk to someone.

Other poster suggested a great thing, see if a family member or friend will go with you to the first appointment! It takes just going the first time to reduce that anxiety! Avoidance behavior makes anxiety grow!

I don't experience any of those, but for the past year or so I have been having a lot of nightmares regarding things that I don't even think or worry about in my day to day life, and often times, those nightmares are nonsensical. I don't have anything negative going on in my life right now, in fact, things are going really well, which is what makes me worried that I may be developing something serious. I have brought this up to my doctor but he thinks that I am worrying too much about the possibility of developing a mental illness that I am causing the problem to get worse. Is he right in that I am worrying too much over nothing?

Sounds like it could be anxiety if you find yourself worrying often. You can work with this! First start here is to identify what specific things may be triggering your anxiety or worrying thoughts.

The issue here is that I have been trying to figure out what may be making me anxious and what my life problems could be, but I don't worry about anything specific and I don't have any pressing issues. For some reason the nightmares started about a year ago and happen almost every night. It's really unnerving not knowing what could be triggering this.

Keep a dream journal! Right by your pillow at night so that if you wake up you can write down exactly what you are dreaming. Sometimes you can pull stuff out of what you're dreaming!

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• It can be a problem if the person isolates and does not explore any social situations. It can also be a problem if the person is unwilling or uncomfortable to do things such as going to school, getting a job, or leaving the house) and it affects their life in a negative way.

• Now it is possible that the person is an introvert and prefers their own personal time, but if they don't socialize at all, there could be some concerns.

• Family members can help by keeping in touch with this person and encouraging attending small family functions. Things that would be counter productive would be forcing them into uncomfortable situations and telling them that it's not a big deal, or to get over it.

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I find it strange she only had to have 30 hours experience to treat alcohol and drug patients. The national accrediting body requires 220 (at least it did in 2012), in addition to roughly 1000 hours in internship and under supervision.

More proof would be good. That's really off/very atypical of the field.... VERY.

This person is an MSW, meaning Masters Level Social Worker. In many states the hundreds of hours we need in internship is topped with so many hours towards a specialty. Then we have to work 700+ hours under an LISW to ourselves become licensed to practice independently.

I was verified by the mod with tons of stuff for verification. My MSW helps me reduce my training hours, and I work primarily in mental health, which does not require me to have training hours.

I'm a therapist midway through training and I find it hard to switch off my therapist demeanour sometimes. It's not unusual for strangers to tell me their life stories - I'm working with my supervisor on learning how to switch my skills off!

So my question is: how do you cope when people try to talk to you about their problems outside of work?

Oh man, doesn't it feel like there is something on your face that says "I'm a therapist, tell me your life problems!"

Honestly when I use public transportation, I put headphones in and that helps reduce the issue there. Outside of that, I actually don't mind picking up conversation. I don't publicize what I do, but I don't mind listening to the kindly old woman complain about her day for a couple minutes while I am doing something. I don't mind using my powers for good or giving a couple moments of my day for other people.

Now running into clients is a different thing. I always remind them when I will be in the office again and call me then.

Yep, and I don't like walking around with headphones in which probably doesn't help. I am working on responding in ways that are respectful but don't open the door as it were. As it's not just a couple of moments and I get kind of saturated.

That's interesting - presumably you can only speak to them if they acknowledge you first or you're breaking confidentiality?

Only if they speak to me first. I've had people get offended by this, but I typically explain to all of my clients why it is that way.

In my country (Denmark) any use of cannabis is automatically labeled substance abuse when in the mental health system. What is your take on that?

I have schizophrenia and recently started losing weight and exercising. I felt it did wonders for my symptoms in general, though suddenly I hit a small psychotic patch. Studies seem to indicate that exercise should be beneficial, but apparently lifestyle changes act as a stressor. Is this something you have encountered before?

Thank you for doing this AMA.

Depends on the person. If a person has a history of past substance dependence and is now smoking it could be a red flag of those past behaviors. There are those few people that only smoke marijuana and that's all they have done their whole life. As long as it doesn't effect your mental , social , financial or occupational life it shouldn't be too bad.

Second part!

Sadly until a change becomes more regular yes, it does act like a stressor. Exercise is great for both mental and physical health in appropriate moderation. That small psychotic patch may have nothing to do with that, many other triggers can come into play.

I've encountered people fluctuate with their mental health often. The change of seasons is also a contributing factor

What's your opinion on subs like /r/ForeverAlone?

I think people jump to the conclusion that they will never find their other half, but sometimes it just takes getting yourself out there and see what the world has to offer! I can understand too, until I met my other half 6 years ago, I was struggling with those negative thoughts.

What country are you in and what types of training do you have?

I needed my graduate degree to practice mental health. From there I am required to have 30 hours of training to be compliant with the state for addiction treatment. I live in the U.S :-)

Also, favorite ice cream?

Vanilla and anything with caramel 😍

I know I'm late but I want to ask: if my therapist hasn't brought it up, is it stupid to ask if she thinks I might have borderline personality disorder?

there is no such thing as a stupid question to your therapist! Especially to ask their opinion on your mental health!!

I just can't shake the feeling that if she thinks I have BPD, she'd say so. So asking feels redundant.

Not always. Sometimes we're told that telling you can make you feel bad about yourself. Typically I feel out the person and if I feel that by knowing what my opinion is on their diagnosis will make them upset or down on themselves, I wait for the moment when they may be able to handle it better. The therapy I do is always molded by what disorder I think it is.

If someone suspects they have a mood or personality disorder, how do they get diagnosed?

It is always good to make an appointment for a psychiatrist for a psychiatric evaluation. From there the psychiatrist can determine or begin to determine if you have a mental illness of any kind and what it may be.

do you need a research assistant?

God I could use an assistant in general if I were allowed one. I would teach them to do the filing and paperwork I need done :-(

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Alcohol is a depressant. If you already struggle with a chemical imbalance, it is likely that you did some funky work to your levels while you went on your binge. I've had people take as long as 6 months to feel that they can regulate their emotions regularly after drinking or using (that, however, is more from long term use).

Be careful! Not many people know how seriously dangerous alcohol and some substances have on your poor brain! (Those damn synthetics are killing me, it has become so popular and is so bad for the brain!)

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I never make fun of anyone :-D

Hey Jamie,

I have a friend who has been battling depression for the last few months. She talks about feeling alone, desiring to give up under the pressures of life, and believes everyone will be fine without her. She is a single mother of a 2yo, which she didn't plan for.

We've partied together since we met, and definitely have each had our own dark times with self medicating and addiction. But in the recent years, both of us have held down jobs, supported ourselves, moderated our drinking/drug use, and just over all started making positive choices. However, I've noticed an increase in her alcohol consumption coinciding with her depression.

I'm really concerned for her, but she curses me when trying to talk to her about not drinking. I wanna support her, show her she is not alone, and help her overcome this depression. I know her drinking is a huge obstacle, but am in no position to judge. What can I do or say to help her? Does my own drinking/drug use make me incapable of being support? Also, how can I best respond when she confides in me a desire to cease living?

Just because you also use doesn't mean you can't express concern for your friend. If you are nervous about talking to her about these concerns, write her a letter. Detail why you are worried and what you are willing to do to offer some support and help.

In the end, however, she has to want it for herself. Until she wants to help herself and accepts help, she's not going to get better.

/u/jaamiii please respond. My sister believes people are trying to use magic to take her life. These are the worst magicians ever because she's been saying this for years. She refuses to believe that she had a mental condition. When will not consult with a mental health professional. What can I do short of committing her? I really want her to live her own life making her own choices and decisions.

Unless she is suicidal , homicidal , or in a manic state you cannot commit her. You can maybe try and talk her into treatment though. It sounds like she has a paranoid disorder of some kind.

If she's a minor your parents can refer her to treatment but if she's an adult she has to want to be in treatment, sadly.

Good luck! Maybe your family can do an intervention of sorts.

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Can you think of a time when he was active and was able to do things on his own? What was different then?

It sounds to me that it may help if he made a to do list and each day checked off one or two things he needs to do. For example: today I will get up, shower and make something to eat. Tomorrow: I will get up, shower, get something to eat and make an appointment.

Also some doctors offices have it set up that you can email them or do it all online, this may reduce some of his anxiety.

Avoidance behaviors only make it worse so sometimes he will have to challenge himself to try.

Hope this helps!!

What's the worst mental condition to have?

Any mental condition is hard to have. Axis 2, disorders are particularly tough however.

I'm currently a case manager for my. states child welfare system. I see many children get taken from their parents beciase of substance abuse or mental health issues. I've now been interested in becoming a Licensed Mental Health Counselor. What would you say are the pros and cons of the field. I already know there's not a lot of money in it. Any tips? I should add that I didn't take school as seriously as I should have when I got my BS in Psychology. So I can't get into most MSW programs.

Don't give up on the idea of MSW programs! Research will be your best friend!

That being said pros: inspiring , days go quick, you will never be bored.

Cons: PAPERWORK (one my way to work now to do paperwork on my day off), possible overload, quick burn out rate, paperwork, working 60+ hours a week, paperwork, did I mention paperwork ?

Haha

I have had major depression and general anxiety disorder for over twenty years. I have also been diagnosed with adhd in the last 3 years. I feel like every time I get on a good med regimen, I end up having to switch psychiatrists due to insurance changes or relocation.
Two medications that have worked wonders for me are Adderall and Xanax. I am on low doses of both. My previous doctor would write my scripts in a way that I was able to adjust my meds based on what I felt like I needed. I NEVER abused my meds and most of the time I had a few scripts that expired because I didn't use them in time.
During my time with this doctor, I felt like my life and metal health was more controlled than I had felt in years. My husband and other family members agree.
Now I need to find a new doctor because we moved across the country. I hate this part because when I try to explain to my new doc what I feel works for me, I look like a pill seeker and I feel like I get judgemental looks which makes me back off and say "sure, I guess we can try this medication that you suggest that I've tried 6 times before and know doesn't work for me. You are the doctor." I hate having to switch meds because my new doctor thinks they have the best combination or because they are getting some kind of kick back from a pharmaceutical company. But what I hate more is feeling like a pill seeker because they don't know me and I know what has been working for me.
Any advice?

P.s. thank you for taking time out to do this. I understand that people in mental health sometimes have limited social lives, yet you are willing to sacrifice the little time you have to help others :) your patients are lucky to have you!

We do have limited social lives haha! I love doing this it keeps me wanting to work in mental health and help people after feeling burnt out from my job and I also feel bad for people that have lack of access to health care.

My suggestion would be to have your old doctor write you a letter stating why he choose that treatment method and how long it has been successfully working. If your husband is willing to also have him come in session and also vocalize. In the end even though it is scary you have to advocate for yourself! A doctors opinion is just that, an opinion. Change doctors if he is unwilling to provide you the support you need.

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I've had a couple people express interest in the past, but my clients understand that it cannot and will not happen, I'm gentle about breaking the news too when it happens.

I most often get clients that want to be my friend. I always feel bad telling them that our relationship is a professional one.

I know that there are confidentiality laws in place to avoid embarrassment but if I confess to something illegal during a session, are you legally obliged to not tell the authorities?

Well, depends. I've heard some stuff that could get some people in a lot of trouble but I am bound by confidentiality not to say anything, so I won't. If you have a consent for a probation officer or a case manager, the therapist can be like "yo, person isn't doing so hot, maybe you should check up more on this person." but as long as there are not consents to people, and it isn't harming yourself or anyone else, we are not mandated to report it.

I wonder if I'm late, I've got a question about people who are family/a SO of someone with bi-polar.

Recently my girlfriend (of 8 years) was in hospital for hypermania, she was then diagnosed with bi-polar, it was out of the blue and kinda of unexpected (I knew she was depressed, before the time admissions - but until the day she was diagnosed I actually didn't know that bi-polar was such a huge issue, mania, hypermania etc. it's serious stuff) It was probably the toughest 2 months of my life.

Anyway, she's out and as expected she's going through a huge low. (Which I was told will happen) But we're both struggling, our relationship is falling apart and I have no idea how to approach things, it seems as though I'm not doing anything right even though I try to take on board everything she says.

Anyway enough with the tangent...

What is your advice to someone who's with someone who's got bi-polar? It's probably a broad question and I personally feel a lot of guilt behind it since the event came seemingly out of nowhere and I'd consider myself the biggest part of her life (as I consider her to be mine).

This is a toughie.

Maybe to improve things on both of your front, what healthy coping skills do you share that you both like? Like, video games? Music? Walks? It may bring you both together and also help reduce mental health symptoms.

If not maybe you guys need to respect each others space and allow one another to take a deep breath and come back after you have both calmed down. Some people prefer to isolate when they are depressed (even if it isn't healthy) so maybe she just isn't vocalizing that she really just wants to isolate. If that is the case, tell her that you love her and that when she needs you, just to ask for you.

Good luck! I'm sourry you guys are going through such a hard time.

I'll be answering questions I didn't answer throughout the next couple hours! So if I didn't get to you earlier, I will now! Sorry for the wait, had work and family stuff today :-)

Strangest Phobia encountered or discovered?

Soy sauce!! It makes me giggle internally every time haha

I am bipolar and I have a really good friend who is (might be self diagnosed but I firmly believe she is) bipolar. I am working hard to be responsible and be honest with my doctor about my moods and stay stable. Especially since my stint in the hospital in January 2014.

She, on the other hand, lies to her dr, saying that she has narcolepsy so that he will prescribe her things to stay awake. These things keep her in hypo mania almost constantly and other than just crashing here and there where she just cries (its more like throwing a tantrum) for a night, she is managing to stay in hypo mania. She is excelling at her job (winning national sales awards in a small community), hardly has to sleep, exercising like crazy, and she is on point with everything. Is this ever going to catch up to her? I'm worried, and a little jealous since it seems like she gets to keep all the good, fun parts while I had to give them up for the sake of responsibility and keeping my family together. I do notice that her husband seems sick of having to deal with her all the time but that's about it.

I've never met, worked for or with anyone doing negative things and get away with those negative things for too long. Let her learn. She will need to hit rock bottom before she realizes a change needs to happen

Hey everyone I'm on my way to work (I've been answering questions on the bus haha) to do some paperwork. I plan on continuing until I've answered all the questions so if you haven't heard from me yet, you will.

http://imgur.com/7KcEnPH

What's the most common disorder people are not generally aware of?

Depression. For example most men demonstrate depression through anger.

How is it to treat an schizoid?

The same as is to treat any other mental illness. A lot of patience and research is involved :-)

Many of these comments seem very serious, so maybe to lighten things up in a sick and twisted way, have you had any truly horrible or messed up experiences regarding your patients?

Lol

Not what you are thinking. I've seen some deep bleeding gashes, had clients get aggressive at me and had a client die (recently, health related) bit nothing truly horrible or messed up.

Now have I heard some truly horrible or messed up stuff? Yup.

So, any suggestions on how to address the issue of the sociopathic money junkies that make up the entirety of the U.S. Government?

Not the greatest :-(

I always thought that if everyone got together and only voted for people that truly had their best interests in mind, from small local government and continue to vote for that person as their career excels, we can reduce some of this. However, that doesn't mean that individual won't get power hungry and become corrupted also. :-(

As a person with severe, treatment resistant anxiety/depression, whose had few gains from SSRIs, MAOIs, tetra & tricyclics, or 15 odd years of CBT, 'mindfulness', meditation (etc), are there any new approaches/treatments that may help? Neuroplasticity got my attention, but dunno how to apply it. I wonder if TMS might help. Does modern ECT really have good results with the treatment resistant? I get the impression it's only done as a last resort?

Has anyone tried DBT with you yet? I find that DBT is the absolute best for people who are other deemed treatment resistant.

HI I 33 yrs old. i have geeting problem about sexually. i am very very week in sex. even sometimes my penis cannot stand. what is the sulotion may i know please?

I may need more info for this one. But it honestly sounds like you could start by seeing your family doctor and addressing concerns from there. You may need medication.