Hi, I'm Lina from Counseling for Resilience, and I help people overcome stigma against mental health treatment. AMA

I am really curious about this. I do not want free counseling, I do have an excellent therapist. But I do have an enormous stigma against mental health care, and am upfront about it. Specifically medical and psychiatric care. I am not going to go into detail, but my experience has simply largely been bad. I have autism, I was too high functioning in some ways and too low functioning in others, and nobody knew it was autism until I was 16, so out of desperation I was put into a residential facility when I was 8 for 6 months. That place was abusive, it was eventually shut down and a couple people got jail time, I am part of a class action suit now. I am 38 now, am diagnosed with PTSD from that and a unusually abusive childhood, and have been hospitalized 3 times in the last 21 years.

When I was 17 I was molested in a psych ward, though in that case I never told anyone. When I talked about this to a psychiatrist in on one of the two other visits many years later I was shouted at, and my medical information divulged. The last visit was somewhat helpful, I was treated respectfully and given resources. There have also been 2 visits to the emergency room in my life. I was treated rudely and dismissively, told I was not really suicidal, it was all manipulation, and one nurse went on about Jesus for quite a bit. I do not know what to say.

I did have that one okay experience. And therapists, social workers, counselors, groups, all such things have done so much for me, I cannot speak highly enough about therapy. But I have completely sworn off psych or medical mental health care entirely. One okay experience is not worth the 5 other total bad experiences. I will keep working in therapy and will keep myself safe, but in the end people do die, I will never walk into an emergency room again under any circumstances is my feeling, and know the words I need to say so its highly unlikely to happen involuntarily, that is my feeling at this point. I am not really talking about my experience, I have good therapy.

But psych care or whatever, when a client tells you they have objectively almost entirely had poor experience, that their sole positive experience was only so good, how do you approach that?. Because I will never seek, and will act and hide as much as needed, to prevent ever doing anything to do with psychiatric care again under any circumstances. If it was solely me it would be less relevant, but its clearly not, many people feel this way. Is their something we're missing?. It seems like most suicidal stuff is based on trauma and chronic issues, yet all psych care is designed for acute and temporary problems. How do you encourage people to see it differently?.

Wow, that was so brave of you to share. No wonder you have lost faith in medication management. I have heard similar stories from clients in the past who have been hospitalized in facilities where they felt unheard, unseen, and disrespected and even abused. Often, like you, their experiences left them terrified of being hospitalized.

This is a terrible shame. Hospitalization for psychiatric disruptions should be nurturing and promoting of mental health and wellness. I think there are a number of factors that contribute to experiences like the one you've described, including the fact that traditional medical school education is not trained to nurture people to wellness. The Western model of medicine is to find what is wrong, and eradicate it. This doesn't work so well with mental health. Another factor is that mental health care is woefully underfunded, and the people hired to work in such facilities are grossly underpaid. This often means that the best doctors, nurses, and counselors don't want to work in psychiatric facilities.

When I worked in a Partial Hospitalization/Intensive Outpatient setting, the medication providers were APNs, that is, Advance Practice Nurse Practitioners. These nurses (many of whom have their doctorates) are at the top of their game in their knowledge of psychotropic medications, and because they are nurses, their training is very patient-focused, rather than disease-focused. They were wonderful to work with and many people find they prefer the care of APNs for medication management. I hope this was helpful. I want to move on to other questions, so if I haven't answered yours fully, please feel free to write back.

When I have clients who tell me they have been traumatized by the medical system, my first thought is "How do I re-empower this person?" Before effective therapy can take place, there must be a functioning relationship between the therapist and the client. Sometimes, therapists have to let clients tiptoe their way into the process in a way that increases their sense of safety.

Another factor is making sure that the therapist or facility is the right fit. I would never pretend I could treat any person or any condition. Each person and each facility has a focus, and it's important that client be able to find the right ones. I encourage people with serious, chronic diagnoses to complete a WRAP plan (NAMI developed this, I think), which includes sections on what to do in a crisis. This enables people to state which practitioners, medications, and facilities they feel safe with, and which ones they don't. It is intended to be shared with their support system so, in the event of a mental health crisis, their wishes are known. People can also file a Psychiatric Advanced Directive with the state (at least, New Jersey offers this), indicating their wishes, and hospitals and other facilities are bound to honor it.

I just wanted to say your kind words, really speaking to my question, it means a lot to me. I do understand how poorly funded the system is. I try not to blame the people in it, its hard at time, but I know just how difficult people's situations are when there are so few resources to help them. I will keep working in therapy, its been 2 years and she is wonderful, and group and the mental health drop in center I attend. There is even a practical social worker/case manager, I have a lot of really great support. Its just the system, the lack of resources, I have no doubt psych workers wish it was different as much as I do. Anyway thank you so much again, your kind words and real depth in your answer mean a lot to me, and I hope your day can be just a beautiful one. :)

Thank you so much. And I'm so glad you found a good support system. I wish you all the best.

Lina

"The Western model of medicine is to find what is wrong, and eradicate it. This doesn't work so well with mental health."

– This reminds me of a big debate in education, between certain education researchers who want to have a practice that's based on the same kind of evidence and research as medicine (programs and metods supported by "high quality" quantitative studies) – and those who want a broader and more eclectic approach that also involves philosophy, theory, different branches of psychology, and the teacher's experience and professional judgement. I wonder if there's a similar conversation going on among psychologists.

Omigosh, yes! This is why it takes so many years for each revision of the DSM!!!

You ask what has held us back from seeking counseling... my answer, because the number 1 way my anxiety manifests itself is a near total inability to speak on the phone. I can talk to my mom and that's about it. When I absolutely HAVE to do it, I'm anxious the whole time leading up to it and I'm so exhausted afterwards that I often need a nap, even if it's literally a 2 minute call to my bank or something. So how would you find a counselor if you can't call anyone? When you say "talk to them on the phone about (literally anything) before you go in for an appointment" my brain is already like "welp, that's out."

Wow, that's a brilliant question! Thanks for asking it! I had a client with this same issue when I was working in an agency. She communicated with me via secure text, and we had our sessions in person.

Today, most therapy practices have a way to reach them online, for example, through their website or Psychology Today profile. This would enable you to explain your challenge and ask for consultation via secure email or text. Because of HIPAA, therapists have to be super careful to ensure the confidentiality and privacy of client's communications, so you may need to try a few before you find the right fit, but I am pretty sure you will find someone. More and more of us today are using technology to reach clients.

Thanks for reaching out. You are not alone.

For me the last two bullets about bad experiences and finding a good fit were major blockers. I think also another is how do you know when you are healed?

I would get medicine in the past and feel better, but not heal the underlying issue. So when I went off the meds I would go back to same problems. The psychiatrist that prescribed the meds only seemed to care about getting me in to charge for the appointment. They didn’t really do any therapy or just gave a quick suggestion to go to a therapist. It felt like they just wanted to make sure I was coming back so they could charge, so didn’t want me to heal with therapy. Though I think therapist can have a similar issue of just keeping the patient as long as possible to be able to charge for the session. Is there anything being done to combat this? I think it leads to a lot of the mistrust in therapy and psychiatry.

That's a great question and I know it is an issue shared by many people.

Many (not all!) psychiatrists are not counselors or therapists. They do "medication management." For many people, taking medication is a lifesaver, but it is not meant to be the be-all and end-all. Medication is to stabilize the person so they are able to effectively engage in therapy. Although I know some excellent psychiatrists, I generally recommend for medication management that people seek an advanced practice nurse (APN), as they have all the necessary qualifications for doing med management, and often take much more time with the patient, looking at the whole person, and thus, I think offer very supportive care.

As for therapists, I know there are some not-so-great ones, as I have been to a few myself. But, I encourage you not to give up. It is helpful to find a therapist who specializes in your particular issue, in order to get more productive help. There are so many different specialties in counseling, and so many different treatment approaches, none of us can become experts in more that a few of them, and even that takes years of study.

Psychology Today, GoodTherapy, and TherapyDen are a few free directories you can look at to find therapists who specialize in what you want to work on. If you find a few you like, look up their websites to learn even more about them, and maybe book a free consultation. This way, you can ask all your questions about the way they practice before making a commitment or spending any money.

If you've been in therapy for a while and your underlying issues are not getting resolved, you need to bring this up with the therapist. An ethical therapist will not keep you on as a client indefinitely. If you have stopped making progress, either you or your therapist should talk about changing treatment approaches, or maybe the therapist needs to refer you to someone new. Trust me, it's no fun as a therapist when a client is not making progress. That's what we live for!!

And how do you know when you're done? When you feel good! When you feel like you are ready to move forward and no longer need to speak to someone weekly, biweekly, or monthly. It's Ok to take breaks from therapy to consolidate the gains you have made, and then return when you are ready to take another step. This is Your life. Therapy should be working for You.

Thank you for this ama. I’m married to a Licensed Mental Health Counselor, and I am a big cheerleader for mental health (I’m a heavy-thing lifter, not a counselor)

My question for you is about military trauma. How do you approach working with veterans and active duty soldiers? Their hardships are very specific, and they have been molded to certain behaviors, but the consequences are very real and extreme to us as civilians. Are there CEUs designed to help understand veterans and their specific traumas? Do you have any advice for us laypeople when talking to a coworker who starts sharing their trauma (even when we fully realize they need counseling, not just a friend at work)?

What a great question. When I worked with active-duty military in a PHP/IOP agency, we were not given any special training on working with this population, and were left to wing it. I think all professional organizations will offer CEs (I know the American Counseling Association does). PESI probably does, and possibly the VA.

In my experience, working with active-duty is very different than working with veterans, who are not going to be returning to combat. There were two areas where I really felt that I helped the active-duty men and women, and that was with helping the to identify and manage emotions, and with teaching and reinforcing coping skills. Most of these came from DBT, because that is my specialty. I would have liked to do more trauma work with them, but I do not have specialized training in trauma, and also, I think this is more effective after they've been discharged and returned to the civilian war. I felt it was possibly counter-productive to do trauma work with military personnel, only to send them back into a combat unit.

With veterans, I think you can focus more on empowerment, along with trauma work. Another issue to address is stigma, because the military culture still frowns on admitting weakness, which is how a person may be viewed if they say they are suffering from panic attacks, night terrors, depression, or intermittent rages. I suspect that the view of the military is that if they acknowledge the risk of significant mental and emotional harm of serving in combat, it will harm their recruiting efforts. I think if they partner that understanding with a program of support following each deployment, they would have a better-functioning military who is more prepared to rejoin the civilian world following discharge.

As for coworkers sharing trauma with you, I might say, "You sound like you're having a really hard time. Have you thought of talking to a professional?" and I might refer them to Psychology Today, which is a great online resource for locating therapists.

I witnessed my stepson die by gun violence 8 months ago. My nightmares are vivid and awful. Im sick everyday. I have a lot on my plate career wise trying to get a foot in and I'm drinking a ton to cope. In CA and when I tried to get a therapist or mental health specialist I was basically told to walk in to a mhc. They basically said all I can do is claim suicidal thoughts or actions and they would commit me. I don't need that. I need to process this. I am on medi-cal so that's why I have no help. What do you reccomend?

Have you checked with your county? I checked with some therapists in CA and they told me your county should have a list of providers who accept your insurance. They also said to call the number on the back of your insurance card and ask to speak to a case manager. I know it's not ideal to have to fight to get the services you need, but I hope that you pursue it. One other thought that occurred to me is to use Psychology Today to locate some therapists in your area that specialize in PTSD, and ask for a sliding scale or pro bono arrangement. Most clinicians (once their practices become profitable) set aside some slots for sliding-scale or pro bono clients.

Omigoodness! What a horrible thing to experience! No wonder you're having nightmares and it's not surprising that you're using alcohol to cope. What you're describing is PTSD and this is definitively treatable.

I'm not licensed in CA and therefore, unfamiliar with their medical system. I found this page <https://www.dmhc.ca.gov/HealthCareinCalifornia/GettheBestCare/MentalHealthCare.aspx> which shockingly, does not allow you to connect to an online directory of providers, but instead, tells you to call "Medi-Cal Mental Health Care Ombudsman at 1-800-896-4042".

This shouldn't be so difficult. I'm going to suggest you call and ask them to refer you to a therapist who specializes in PTSD. I'm also going to reach out to my professional connections to see if I can find more info for you.

Thanks for being brave enough to ask for help. In the meantime, you might want to look at the PTSD Coach app, a service of the VA: https://mobile.va.gov/app/ptsd-coach

I hope you find the help you are looking for, and deserve.

Lina

I'm wondering how someone goes about finding a good fit for treatment for BPD. I have a friend in the states who has been quite literally turned away because of the diagnosis, and has even shown me pictures/online statements showing facilities that refuse treatment for cluster B illness.

And I'm sure most are aware of all the literature in book shops and the like for "how to survive living with a BPD [partner, friend, family member etc]", ironically found in the self-help sections, greatly overshadowing any books for how BPD patients might help themselves.

What's with the stigma against this particular diagnosis in general anyways? They can certainly be emotionally unruly but I've seldom met someone with the diagnosis who had ill intentions.

Thanks for reaching out. BPD is truly a challenge because yes, there is a huge stigma against it. I could get into my whole feminist rant about how political DSM diagnoses are, but that wouldn't be helpful. My recommendation is to look for clinicians or clinics with DBT in their title.

The challenges for treating BPD include a high risk for self-injurious behaviors and suicide attempts, which can deter most therapists and facilities from wanting to treat people with this diagnosis. Marsha Linehan developed Dialectical Behavior Therapy specifically to address these high-risk behaviors in people with a BPD diagnosis. There are decades of studies demonstrating its efficacy.

Generally, you will find DBT offered at stand-alone DBT clinics, or at Partial Hospitalization/Intensive Outpatient programs. These outpatient programs offer groups that meet five (for PHP) or 3 (for IOP) days per week, plus weekly individual therapy sessions and medication management. They almost always take insurance.

It's a really challenging condition to manage. All the best to you and your friend.

What help me back was not knowing what councelling was or what it did. It took me a while to figure it out even after I started. As a side note where do you see technology like apps and wearables fitting into the future of mental health?

Great comment! Because people don't talk about counseling in public much, most of us don't know how it's "supposed to" work. Every therapist is different in their approach. I come from the Wellness/Empowerment school of thought, so my approach is to encourage the client to lead the therapy session and be active in setting their goals for therapy. The initial intake appoinment often helps clients wrap their heads around how they want therapy to work and what they want to work on.

As for apps, I recommend a lot of meditation/mindfulness apps to my clients, like Calm, Insight Timer, Liberate, etc. Not sure what you mean by wearables.

I have friends who will look at their sleep patterns on wearable fitness trackers like Fitbits, and notice patterns that match their depression. That kind of thing could be interesting for prediction, I would imagine.

I wonder about those. Are they helping, or creating anxiety? I wonder if people would be better served by practicing good sleep hygiene than by tracking their sleep.

What other work to end the stigma do you think has been most valuable? Any organizations or individuals you think are helping? What can everyday people like myself do to help reduce the stigma too?

Good morning! I can't speak to organizations, although NAMI is a huge voice for mental health. But I think what will really change things is for people to be open about seeing therapists. In my experience, people keep that a secret. Even people who know me and who were huge supporters of my efforts to start college in my 40s and pursue a professional career as a counselor, will say, "I don't need to see a counselor. There's nothing wrong with me."

This idea that there has to be something Wrong with you to ask for help is a huge barrier. I think when people are willing to tell their neighbors, parents, siblings, coworkers, "Hey, I've started seeing a counselor," it will have a huge impact on increasing the "normalcy" of seeking therapy.

Also, all the professional organizations in the field are working to undo stigma, like the American Counseling Association, American Mental Health Counseling Association, etc.

Sadly, our society listens more to celebrities, but hey, take the help where you can get it! People like Bruce Springsteen, Dwayne Johnson, Adele, Emma Stone, Ellen DeGeneres talking about their struggles with mental health issues is often the key to helping us to talk openly about our own challenges.

Hi Lina, while I'm doing OK, my wife is in a really rough patch in her career after losing her last job. She says that she feels worthless, she lacks the confidence to interview well, and has sort of fallen into a spiral of self-criticism and general bad-feelings. As her husband, I try and listen and try not to "fix" everything, but how can I suggest to her (with love) that she could benefit from counseling or therapy?

Wow, that's really tough. In the US, we place so much importance on our work that losing a job can really cause us to doubt ourselves and lose touch with our own identity. It sounds like you're trying to be really supportive.

You might try saying what you just said, that is, point out what you're observing and tell her your concern. Ask her to consider talking to someone. Psychology Today, as well as GoodTherapy and TherapyDen are online directories where counselors can make a profile, telling potential clients about their therapeutic approach, their preferred populations, and their specialties, along with their fees and whether they take insurance.

Have you ever done meditation or yoga together? These are really healing practices that can have a very positive impact on self-acceptance. There are some fantastic Mindfulness apps available, and you might suggest this as something you can do together.

When you speak to your wife, try to stick to what you Observe; don't editorialize; don't mind-read. "Honey, I've noticed that..."

I hope this helps. Lina

How do you feel about medication or too much medication treating depression/anxiety/etc? I feel that it will be the only answer.

Have you had a client be scared to go off medication, having been treating their symptoms for 5+ years?

Do you recommend medication?

For some people, medication is paramount. For example, for most people with Bipolar disorder, Schizoaffective disorder, or Schizophrenia, medication and regular med management visits are a must! For anxiety and depression, the *right* medication can be an extremely helpful adjunct to therapy, but are rarely effective on their own, for the long term

ALL medication has side effects. All. And sometimes, this is the reason people stop taking meds. This is unwise because some psychotropic medications can cause severe symptoms if stopped suddenly. They must be carefully reduced under the care of a medical professional, if the client wants to stop taking them. Also, people's bodies develop tolerances to medications over time, so regular visits for medication management are important to see if the client is on the most effective medication for them, and check for contraindications.

That being said, my focus of therapy is to help people manage symptoms of anxiety, depression, and other conditions by developing skills to manage their emotions effectively. I encourage Mindfulness practices, including Meditation and Yoga, to help clients build resilience and become less reactive to stressors. I have some clients who would not benefit from therapy without the help of medication, and I refer them to an APN for mediation management, Over time, ideally, they would be able to reduce or eliminate the use of medication, but this is not essential and I would never pressure a client to stop taking medication.

I may be too late to get a response (especially after those nasty comments from another redditer) but it's worth a shot. My main stigma about my mental health comes from my own parents. What is your suggestions for parents who don't understand? I am on disability for multiple reasons, but anytime I mention I am broke so I can't come out for fancy dinner or can't do huge Christmas this year I am told "Most people work for a living". When I mention I am having a bad mental health day, I am usually responded to with "Well can't you just come anyway?".

Omigosh! I have clients going through the same thing! Their families did NOT understand when they said they couldn't make it for Thanksgiving. This is tough, because one of the most important things we can do for our health is develop a strong support system, so we don't want to alienate our families or friends. But, geez! It gets exhausting having to explain ourselves all the time!

One thing that might be helpful in increasing your family's cooperation is to have conversations, when it's not a major holiday, or just before a big dinner, about the reality of your health challenges and limitations. I'm going to suggest a couple of videos as ice breakers. You may find they help communicate with your family, or maybe not, but at the very least, they might lift your spirits. Laughter is the King of Therapies.

https://www.youtube.com/watch?v=Bor9xVnbIz8 https://www.ted.com/talks/bill_bernat_how_to_connect_with_depressed_friends?language=en

Thanks for dropping in, and I hope this was helpful.

I just can't see myself going to a therapist. I thought about going multiple times. I just assume no actual improvement will take place as its just talking about personal issues which doesn't remove the problems. There are places online where I can reach out for free for advice. All therapy would do (for me) is waste time and money. Instead I self medicate and just deal with it. Why should I dump my issues on someone else when I should be able to resolve them myself?

Wow, where do I begin?!

1) One of the first lessons we learn in Intro to Counseling is to beware of "shoulds". These are judgments that are rarely helpful. "Should" you be able to resolve them yourself? Says who? A lot of us struggle with life issues because we never saw anyone model for us how to handle them. If we didn't grow up in a home where we saw [fill in your life problem] being managed effectively, we tend to grown up struggling with that issue without understanding why we are struggling.

2) It sounds like you haven't been to therapy which explains why a) you assume no actual improvement will take place and, b) you assume you would be getting advice. Therapists are not actually supposed to give advice; it's a dangerous thing to do. What happens if I tell you to do something, and you do it, and something bad happens as a result. No, that's not what would happen with a licensed therapist. Rather, you would have an intake appointment during which the therapist would ask you a ton of questions about your life, your background, your family, your relationships, your education and work history, medical history, history of substance use, your spiritual life, etc. They would ask about your Presenting Problem, ie, what led you to make the call to a therapist at this time. Then, they would ask you about your goals. What are you hoping to get out of therapy? What would make it worthwhile for you? Together, you would develop a treatment plan and you would be working together toward the goals you defined.

3) I sincerely do not mean this to sound flippant, but why would you hesitate to ask for help with your mind, the most precious resource you possess? If you called a tax accountant, would you think "I should be able to resolve this myself?" How about a tree surgeon? Or a plumber? If you take your car to a mechanic, are you thinking "I assume no actual improvement will take place?"

Your mind is the most valuable thing you have and you are deserving of having a professional sit with you and listen to your struggles. Everything you're suffering with is important because your suffering adds to the sum total of suffering in the Universe. And your Joy adds to the sum total of joy in the Universe. You deserve to have someone help you with your personal issues so you don't have to self-medicate them away. If you have ten minutes to spare, I invite you to listen to this TED Talk: https://www.youtube.com/watch?v=qzR62JJCMBQ&index=6&list=PLbiVpU59JkValOIEIo2Y65mBopHCjKvBo

All the best to you, Lina,

Over the past two years I’ve seen 4 different therapists for depression, and I’ve only found one of them to be helpful for me. People always say to keep looking until you find the right person, but it’s not like shopping around for a different brand of jeans. Typically I call 10-15 places, take the one with the shortest wait list, which is always several months, wait those several months. Then spend another month dealing with insurance stuff, then I can finally get in to see someone for an initial evaluation, not a recurring appointment. That takes more waiting.

In my experience it takes no less than 5 months to “try” a new therapist. If you had any sort of selection standards or do a mini-interview on a call as you suggest, that would probably take it to 8 or 10 months.

Do you have any advice for navigating this space better? It makes me want to give up on therapy when I spend months trying to make it happen and then after all that work it turns out that it’s “not the right fit”

Also, I’ve been seeing my current therapist for 2 months, and I don’t think she is ideal for me, but I think she’s better than nothing and really don’t like the idea of trying to find someone else for half a year. Should I try to stick it out and make progress with this current therapist? or just bite the bullet and start the whole process over even though there is no guarantee that it will turn out any better?

Oy! I've had so many clients tell me the same thing. One person I'm currently seeing told me they came to me because I was the only one who answered their phone call. Astonishingly (to me, anyway), insurance companies limit the number of clinicians they will accept in a geographical area. A clinician will fill out a 20-page application to get on an insurance panel and wait for months for a response, only to be told "sorry, we're full." This results in people being on long waiting lists to see a therapist.

I'm sorry you've been impacted by this. I do have a suggestion that might speed things up, if you're up for it: telehealth. The advantage of telehealth is that a therapist who is licensed in your state can see anyone in the state; you're not limited to who's available in your area. If you're interested, there are some directories you can search to find therapists who offer telehealth.

iTherapy

Psychology Today

GoodTherapy

Make sure to ask if the person offers telehealth, if it's not apparent from the profile. Also, because telehealth is new, a lot of therapists are looking to fill their practices and might have openings.

Best of luck to you,

Lina

Thank you for all that you do, and for taking the time to make this thread. I serve on the board of a nonprofit that provides free and low cost counseling to people struggling with substance use disorder.

I often find that our clients finally “get clean” only to look around and say, “now what?” Substance use has often left them unemployed, homeless, and disconnected from society. And because many of the now have records it becomes even harder to build up their lives in a society that sees the population as “the addicts, and all the remaining ‘normal’ people.”

Since poverty and disconnection from society are so deeply rooted in substance abuse, what advice would you provide to someone to help them get their life started again from zero?

And my second question if you have time:

For people who get and stay clean it can take as many as 13 relapses before recovery truly happens. What advice would you give to the families, friends and coworkers who are fed up and thinking about cutting their substance-abusing loved one out of their life?

I don't know what happened. I was writing a response to this, hit the backspace key, and suddenly was on another page.

I chose not to be an addictions specialist for many of the reasons you mention. It can feel so hopeless working so hard with clients to get them clean, and then having no way to help them move forward. I love the Portugal model, of connecting people with resources to keep them employed while they are getting treatment, and connecting them with all the social services they need to get on and STAY on their feet. I know that doesn't adequately answer your question, and I'm sorry about that. I find it heartbreaking.

As to your second question, one of my professors in grad school recommended the Community Reinforcement Approach and Family Training (CRAFT) intervention https://www.robertjmeyersphd.com/craft.html. This intervention was designed to help the FAMILIES of people struggling with addictions.

Thank you for your response! I will share it with the other board members as we are always looking for new resources and methods to help our clients.

We take a “whole person” approach to our practice, spending a significant amount of time helping our clients not just remove substances from their lives, but helping them fill that void with something better. Job placement, financial counseling and even classes on how to do a job interview and how to set up a bank account are crucial, as our clients often miss out on these skills due to when their addictions began. We are also working on a “success closet” where clients can get a free interview suit to help them land new, fulfilling jobs.

We haven’t figured it all out yet; the statistics are always going to work against us in this field as so few people reach and stay in recovery. But we take an open source approach to our practice. We plan to publish our model completely free, with no strings attached. No licenses, no attributions...just us saying “this worked for us, maybe it will work for you too.”

Are you offering meditation and yoga? Mindfulness practices are hugely relevant to people with addictive behaviors.

No but we aren’t averse to the idea. My director was certified recently to provide hypnotherapy which has been useful in some cases as well.

The value of Mindfulness practices is that individuals don't need someone else; they can practice and master these skills themselves, giving them independence. They are well-demonstrated to reduce nervous system arousal and can significantly contribute to wellbeing.

This is my first AMA and I am not certain how to close out the thread, so I am writing this message to indicate that this AMA is closed. Thank you all so much for your participation.

Do you have a number i can text for counseling?

I've been struggling with bad habits that i have being manipulative, overly possessive, and guilt tripping. I just want free counseling because my parents are too closed minded.

No. I'm a licensed counselor and only see clients who have contracted with me for therapy. There are resources you can find for free that would be beneficial, such as Mindfulness training. Developing Mindfulness is incredibly helpful for learning to notice when we're doing behaviors that don't serve us. Some that I am familiar with include Insight Timer and Liberate. Also, if you search Psychology Today, you may find some therapists who offer pro bono sessions.

Do you know any numbers or websites that offer counseling through texting? This has been helpful but i'm just curious.

You might want to try BetterHelp or TalkSpace. They are both national platforms, so you may be able to find someone who is licensed in your area who offers counseling via text.

My mother is extremely mentally ill but in denial. Shes schizophrenic and delusional. However, there's nothing I can do for her because she doesn't want help. Do you have any advice my brothers and I as we watch her become homeless and throw her life away? I can't save her, and she doesn't want help.

You said it. You can't save her and she doesn't want help. She doesn't want help because she has a brain disease which tells her that *she* makes sense and everyone else is the problem.

Schizophrenia is such a tragic disease. The best thing you and your brothers can do is to take care of yourselves and be there for one another. Continue trying to reach out to your mom, without expecting her to change. It's a terrible thing to feel helpless, especially when it means watching someone suffer whom we love, and who really could benefit from help. But accepting that she is unwilling to accept your help and that you can't change that will set you free. You and your brothers deserve to have a life, to have joy. If you can be there for your mom in the ways that she lets you, and let go of expecting her to be any different, then you can have peace,

What exactly is depersonalization syndrome and the regular treatments for it?

I always thought that my not feeling any emotion was just my autism, but I recently came out with this problem wanting to fix it and someone told me that it was this instead of my original assumption.

I am not an expert on depersonalization and have only really grasped the concept in brief snatches of insight. I would recommend consulting with a psychologist for an accurate diagnosis. Training in Mindfulness can be beneficial also, as it helps connect the mind with the body. Yoga, Tai chi or Qigong might be practices that could help with reconnecting, if that is something you desire.

What if I prefer myself as autistic ADD with laccluster social skils?

If your life is working for you, then there's no problem. I'm guessing that it's not really working though, because you took the time to write. Maybe you want to see someone to get some help with social skills?

I've been spending a lot of time talking to men on reddit and many of them have expressed that their issues with penis shaming/body shaming are all in their heads. This is coming from their therapists in varying styles of response.

There's a lot of mental help issues related to this individual problem. If mental health professionals are refusing to hear their issues, how can mental health be considered a priority for them? How can people overcome the stigma of getting help when their help provider is the person telling them they're nuts?

Their Therapists?! Their therapists are telling them it's all in their heads?!! That is so messed up!!! One of the things that was drilled into us when I was in my clinical training: if you are too uncomfortable to talk with a client about their issues, Seek Supervision! If you still don't feel you can help the client, then refer them to someone who can.

Clients should never be made to feel that their issues are not important and, if the therapeutic relationship is strong, clients should be able to push back at their therapist: "Hey, you're invalidating my pain!". Part of my education, both in university and grad school, was aimed at addressing issues that make therapists uncomfortable. Many of my assignments included writing papers on What Makes You Uncomfortable? and What Client Do You Think You Could Not Work With?. This forced us to face our limitations and expose ourselves to material to help us GET OVER roadblocks.

For me, sex was big. I was raised in a home were we never talked about our bodies, bodily functions, sex, or any other topics related to the body, which made it super difficult for me to talk about sex. During one of my classes in grad school, the professor forced us to go around the room and use words related to sex, sex acts, and sexual parts. I was stunned to realize that the majority of the students (most of whom were younger than my own children!) felt just as awkward as I did. By the time I started my clinical training, I was able to make clients feel comfortable to talk to me about topics I had never in my life discussed, including child pornography, being a male virgin who was raped by a female, transitioning gender, etc.

A therapist's role is to make a space where a client can work through their problems, and we are ethically bound to tell a client if they're presenting a problem that we are not equipped to help, and to help them find an appropriate referral. We DO NOT make the client feel that their problem doesn't matter.

Their Therapists?! Their therapists are telling them it's all in their heads?!! That is so messed up!!! One of the things that was drilled into us when I was in my clinical training: if you are too uncomfortable to talk with a client about their issues, Seek Supervision! If you still don't feel you can help the client, then refer them to someone who can.

Precisely my response. It seems like society has even seeped in even there.

Clients should never be made to feel that their issues are not important and, if the therapeutic relationship is strong, clients should be able to push back at their therapist: "Hey, you're invalidating my pain!". Part of my education, both in university and grad school, was aimed at addressing issues that make therapists uncomfortable. Many of my assignments included writing papers on What Makes You Uncomfortable? and What Client Do You Think You Could Not Work With?. This forced us to face our limitations and expose ourselves to material to help us GET OVER roadblocks

While that makes me feel great, I'm upset this hasn't helped my peers as much as it sounds like it would, although I recognize there are oodles of people being trained in many ways.

Although, considering it takes so much effort for these guys to even break their silence on this issue, it's not overly likely they will have the strength to push back. I know I would have an incredibly difficult time, and I'm pretty forward in general.

For me, sex was big. I was raised in a home were we never talked about our bodies, bodily functions, sex, or any other topics related to the body, which made it super difficult for me to talk about sex. During one of my classes in grad school, the professor forced us to go around the room and use words related to sex, sex acts, and sexual parts. I was stunned to realize that the majority of the students (most of whom were younger than my own children!) felt just as awkward as I did.

Yeah. It's a bit disturbing how our whole society revolves around it and none of us can really verbalize regarding it.

being a male virgin who was raped by a female,

I would guess this happens more frequently than people want to believe as well.

A therapist's role is to make a space where a client can work through their problems, and we are ethically bound to tell a client if they're presenting a problem that we are not equipped to help, and to help them find an appropriate referral. We DO NOT make the client feel that their problem doesn't matter.

I think the jist of the common complaint was that when they were talking about their anxiety due to their size, they were told "women don't care about penis size", and that was supposed to solve their dismay. There was a thread about it these conversations, people I've come to know well and have no reason to question their honesty spoke up. While I don't think all women care, it's extremely disingenuous to say none do. Spend some time on reddit and you can see why these men are terrified. Not only that, there's a discrepancy in the care for men, I personally keep getting told that men want to be in fetishes where they are emotionally abused for their penises. It's actually encouraged in society now to abuse men who are ashamed of their bodies. "they like it". like, yeah, they do because they think they have no choice. And frankly, they're pigeonholed so badly they don't have a choice. They're being told what they like, because people are too slow to realize how desperate their situation is. If you want to see a mental health crisis beginning, look at penis shaming. Honestly.

Great men being dehumanized, and not even for a reason. Just cause it's funny.

I'm sorry to lay that down all on you. I'm frustrated lol. I'm frustrated with society, healthcare, and reddit mostly.

Don't be sorry. You've raised awareness of a matter that many people don't know men are suffering from. Invalidation is never OK in therapy and I'm afraid that many counselors have not been introduced to body shaming as a serious mental health problem.

Wow that is concerning for me. Considering the state of social media and body shaming being pretty rampant and frankly socially acceptable.

I think ALL acts of unkindness should be socially unacceptable.

acceptable or unacceptable? I'm not sure if it's a typo or we're crossing wires.

LOL, thanks for catching my mistake!!! I've corrected it.

I went to therapy for about 2 monthhs. When i told him my issues with my penis size he laughed and said "girls dont care about dick size" I was told to my face how my dick was bad by multiple girls. idk what i should do.

Omigoodness. Therapists are not supposed to invalidate their clients' concerns. I'm sorry this happened to you. Penis size is not something I've ever heard discussed in any trainings, textbooks, or professional conferences, and so feel somewhat at a loss. Two things do come to mind. One is working on body acceptance. This may not sound like much, but it is possible to increase your acceptance of your body, as it is. Yoga is one strategy than can help with this. I know this was tremendously helpful for me to being to accept my body.

Another thought I have is to wonder about these "multiple girls." Were they casual hookups, or women you'd been in serious relationships before you took your clothes off? Bear with me here.

In a relationship where two people become a couple emotionally, over time, before the relationship turns physical, there is the potential for more acceptance of you as a person. I know this may seem "old fashioned" and unrealistic in our current culture, but it might put you in a position where you feel comfortable to risk talking about your concerns with a woman who, by this time, really cares about you and is less likely to want to risk hurting you.

I hope this helps somewhat.

they were casual. I dont want someone who accepts it, aka settles for my dick. i want my partner to prefer it objectively.

It sounds like you're saying you will only accept women who prefer men with smaller penises. Not only does that give you a much smaller pool of candidates, but I imagine it would be difficult to locate and identify women according to that limited criteria. Is it possible you're making things unnecessarily difficult for yourself by choosing to rule out a committed long-term relationship with a woman who accepts you completely?

Why are against people having the right to choose to die?

Ummm... not sure who you're asking that to. I said nothing about that. Is it a concern of yours?

Don't play dumb.

National Suicide Help Line is not help with suicide. They have one goal, a goal that you share, and that is to stop people from ending their lives. Who the fuck are you to decide that for anyone?

Wow, why direct all this anger towards me? Are you referring to the disclaimer on my post?

I'm referring to your entire industry. None of you have any concept of a person choosing to end their life as anything other than a tragedy.

Wow, way to lump us all together! That would be like me saying "All Men are..." or "All Women are..." or "All doctors are...". We're all different. We all come from different backgrounds and life experiences and those, along with our personal value systems, influence our therapeutic approaches.

A reminder, this post was about addressing Stigma that prevents people from seeking treatment. If you would like to talk about that, please join the conversation.

"AMA"

So, you don't deny my claim?

It sounds like you're in a lot of pain. I'm guessing something has happened to you or to someone you love, that is making you so angry. Although I'm not sure why you decided to direct your anger at me... My passion is helping people who are suffering, through psychotherapy, which is what I'm trained in. I'm a healer who teaches Wellness and Empowerment. I don't think I'm the person to argue your "claim" with.

Although I'm not sure why you decided to direct your anger at me

You're the one that started this AMA and my assertions are within the subject of your supposed expertise.

My passion is helping people who are suffering... I don't think I'm the person to argue your "claim" with.

I'm accusing you of a logical shortcoming: You cannot fathom the possibility that an individual's option of death would ever be better than living. Your 'help' is biased.

Wow, you can read my mind! That's an amazing gift! Since you are not interested in an actual discussion, but only in throwing unfounded accusations at me, I decline to respond any more to your postings.