We are Las Vegas Therapists who host a R-Rated podcast called "Pod Therapy" where we take on the stigma of mental health - Ask Us Anything!

If you could teach every single kid ONE mental health tool in school as part of their regular education, what would you teach them and why that over another method or tool?

In elementary school I'd like kids to learn to use meditation techniques to self-soothe when they are feeling overwhelmed or stressed. In Middle/High school I'd like kids to learn some basic cognitive behavioral therapy techniques to equip them for times of anxiety or depression. Both sets of techniques are big on confronting a perspective we *think* is happening and challenging us to see it in a new light. Young people face so many new challenges these days - especially due to the self-comparing, passive bullying, and less-than-ifying effects of social media - they really benefit from having tools to develop new perspectives to keep them mentally healthy.

You don’t happen to have a link to those techniques do you? Or a podcast episode number if you’ve already covered it?

We just covered *some* mindfulness in our most recent episode. We talk about CBT alot, anxiety too. If you go in our archives and type PAUSE you will find some good CBT stuff. Or type "Teen" that will open some similar topics

This will get buried, but Nick I used to work with you at a foster care agency!

Jim here - I saw this. Probably EQ right? I'll tell Nick

What are the tell-tale signs of a good therapist (or a bad therapist)?

What do you recommend if you feel you’re not accomplishing anything with your current therapist but don’t want to look for a different one?

GREAT question. Unlike other healthcare professionals, you actually need to like your therapist. It won't matter if you connect to your cardiologist or gynecologist on a human level, but that is absolutely vital to a therapeutic relationship.

A good therapist is anybody you feel you can connect to in a genuine way. Sometimes that is a person who's demographics/background look nothing like yours, sometimes that is a person who seems familiar to you. Key qualities in an experienced and effective therapist:
- They disarm you and put you at ease
- They facilitate sharing so you open up naturally
- They make you feel safe and unjudged
- They can leap tall buildings in a single bound
- They are comfortable with humor to put your at ease
- You don't dread visiting with them
- They have their own podcast and know how to reddit

If you feel stuck with your current therapist here are a few suggestions:
1. Share with the therapist that you feel like you've hit a lull in your personal growth. Don't necessarily blame the therapist, just reflect on feeling stuck as if its a weather system and ask them if they have any ideas or challenges for you to take the next step in your work.
2. Ask your therapist if you can revisit your goals with them. Tell them you want to identify some new areas to develop in and ask them for suggestions.
3. If you're not feeling good with your therapist because you just don't feel a good connection to them, or their style isn't really a good fit for you, its ok to go back to the pool and start looking around again. Lots of people do different work with different therapists, and we therapists are pretty comfortable with you cheating on us - er, collaborating with other professionals - on your quest for personal growth.

I have heard some people speak about having a therapist as though it's a normal regular thing, and not because they are working through a problem. Do you recommend finding a therapist even if you don't feel like you need one? What would be the frequency you would see this therapist in this scenario?

I love this question.

Therapy is for everyone. A lot of people aren't sure if they are allowed to see a therapist, but if you're feeling like you're not living your best life, if you can identify patterns in yourself that get in the way, or if you are aware that some of your life experiences have left an imprint on you that's less than helpful, you can totally go see a therapist.

A therapist is something everybody should have in their life the way you have a primary doctor. If life is going fine you might only check in with your therapist seasonally to maintain a healthy connection. When things get trickier you'll pop in more often. Either way its a good idea to make a connection and keep that person in your phone in case shit hits the fan.

An ounce of prevention is worth a pound of cure. I have lots of patients who just want to work on life - we sometimes call that life coaching - and I'm part of their mental health maintenance routine.

Go get you a therapist! Or just listen to our podcast. Actually do both.

How the fuck do you compartmentalize what you hear with your patients who are in genuine anguish?

It isn't easy. Imagine spending an hour with a person facing the worst parts of the human experience, then having to switch gears during a 30 second walk to the lobby where your next patient is excited to share their latest triumph. We tend to use "mindfulness" - a technique that emphasizes being "in the now" and authentically part of the moment. That and years of practice helps us be genuinely attached to what a person is sharing with us, but still slip into another person's truth only minutes later.

Of course, many therapists struggle with leaving work at work. Unlike other healthcare professions which may encounter sad things, our job is to become deeply familiar with the person and really connect to them - which makes it impossible to keep that sanitized indifference other professionals sometimes develop. For us we lean on other therapists, our friends, and the incredible support our fan-community has given us to process the sad stuff and get back in the game.

But remember that being a therapist isn't just being exposed to sad stuff. Its also witnessing the most incredible parts of the human experience. We see people overcome amazing challenges, transform their realities and their futures, fix broken relationships and free themselves from imprisoning pain and habits.

Our job is fucking awesome.

I find it annoying when people use phrases like “haha I’m so neat I have OCD” or “I can’t focus I must have ADHD” so flippantly without realizing what the diagnoses entail. How do you deal with that?

Right?! Or when the weather person is like "Whoa, this storm system is bipolar!" Or the financial news is like "the stock markets are schizophrenic today!"

Fuck that shit.

People don't mean any harm, but we have to stop using mental illness words as ways to describe things. They are healthcare terminology. They are DISEASES.

What's worse is it makes it ok to weaponize mental health among the public as well. People call one another "psycho" or "delusional" - they use mental health as a trump card to put people down or discount their perspective.

There is a great video by Hank Green on Sci Show (youtube it) where he does a great job challenging people to stop doing that. I'm a big fan of educating people and coaching them to stop using those words as adjectives.

You wouldn't say the weather is diabetic, you shouldn't use mental illness to describe things any more than you'd use physiological illness.

Great question.

I have a friend, early 30’s, whose always suffered from anxiety and it’s worse than ever now. What can I do to help them?

Just before Covid-19 they moved cross country back with their parents because they were overwhelmed (low paying dead-end job, couldn’t make expenses). COVID-19 just seems to have made things worse. Their schedule is flipped - up all night, sleep all day, drinks a lot, and are resigned to only being able to get another dead-end job. Some days you can talk to them, others you better get outta the way. This behavior has happened in the past and driven away every friend they’ve had.

What should I be doing to help them break the cycle and live a happy life?

First off - you are a good friend, and a good person.

Good people like you can sometimes internalize the pain of others, and that can be poisonous. As you brainstorm ways of helping you friend, make sure you remember the three C's of boundaries: You didn't cause this, you can't control this, you can't cure this.

However you are allowed to try to be helpful, and I like it.

The best thing you can do for a friend in that situation is make a list of things you have noticed in their story. The drinking, the anxiety, the stress, the sadness, the isolation. Then find a time to talk to them and explain that (a) you super care about them and (b) its really hurting you to watch them suffer and (c) you've been listening to this rad therapy podcast which talks alot about finding a therapist and you totally think they should.

Next you hit them with options of therapists you've already looked into for them. Tell them you know they have a lot to navigate in life and now is a great time to partner with a professional to get some results. If they reject all this and aren't ready, do your best to keep reminding them that they may not be responsible for their problems, but they are responsible to discover their solutions.

Keep on the positive pressure, and remember that pain is life's greatest teacher. I know we fear humans will spiral out of control if we don't rescue them, but trust me most humans don't like hurting and they will eventually become open minded to getting help.

Make sure you practice self care too my friend. Big hearts are easily broken, that's not a reason to stop caring, but attend to your own truth and process your reality as well.

How does one go about finding a therapist, when one of the problems they need to work on is severe social anxiety that causes them to put off any kind of formal interactions (i.e. making doctors appointments)?

Asking for a friend

Oh I completely hear you. That is actually super common. How the hell is a person supposed to "get help" when the idea of meeting with a person is itself anxiety provoking?!

The answer is TELEHEALTH!

One of the many gifts of the 'rona - along side exposing systemic inequality and the yucky underbelly of healthcare suckitude - is the advent of using Zoom, Skype, and other video conferencing platforms for therapy.

I see ALL my patients currently via telehealth, its great! Best of all I've been able to meet with my most anxious patients, and even people with agoraphobia (fear of leaving their home) easily.

Tell your friend to search www.PsychologyToday.com for a therapist that fits their needs and then contact the therapist and ask if they offer telehealth. Most everybody does now.

See, even pandemics have a silver lining.

Cough.

Here are some questions that are a bit stranger,

1. How much does the Las Vegas life itself play into the experience of creating mental health problems, since the city does have a great deal of gambling? I wasn't sure if there would be any cross over from what you have seen because Vegas has a reputation.
2. In how many instances is the depression caused by one's own narrative or their own thoughts spiraling out of control, and does humor make this better for them?
3. How have recent times such as corona virus and recent protests affected your client's mental health?
4. What intellectual in the field of psychoanalysis (psychology) would you say is the most helpful?
5. Would you be for people wearing masks that look more unique and bizarre such as ninja masks, or even some other bizarre variation to make social distancing more interesting?

Thanks!

1. Las Vegas has legalized gambling (literally everywhere, even in gas stations), legalized marijuana, 24 hour bars (nobody hear has ever heard the phrase "last call"), 24 hour liquor stores, strip-clubs, brothels nearby, and pretty much everything else a person might find disruptive to their healthiest self. The result is that many of our patients run the gauntlet every day to practice self-control and avoid self-medicating with those things or abusing those things.

The joke in the industry is that Las Vegas is the superbowl of the psychotherapy. We like to think we are the best in the game because, frankly, we kind of have to be.

What I'm trying to say is I'm a god-damn gift to humanity, and everybody should say so alot.

Anyway, you get used to Vegas and eventually people navigate around those obstacles as naturally as people in Louisiana drive around alligators. Every city has unique challenges, humans are resilient and adaptable.

1. Human ALWAYS makes it better. Sometimes I make my patients select a different comedy stand up, podcast or comedic show as a regular part of their treatment routine. Having said that, depression is a fickle bitch. Yes its partly perspective (hopelessness, worthlessness, and suspecting that death would be a good thing are delusions and that aren't real no matter how hard much they try to sell themselves) and yes its partly bio-chemical (medicine is part of the solution and people generally benefit from incorporating it into their treatment). In the end depression is like a weather system that just sort of rolls in, partnering with a good therapist and being open to good medicine can really help. Also laugh alot, its healthy.

2. Corona has devastated Las Vegas. As the nation's playground the entire economy pretty much floats on top of a hedonistic capitalism. Unemployment topped 30% here, and lots of people are hurting. This has been the busiest I've ever been in my professional life, and most local therapists report the same. Our caseloads have doubled - and Nevada already ranked 51st in the nation in mental health so we were sort of busy as it was. The good news is people are learning how to be there for one another, and communities attached to things like podcasts - eh emm, listen to ours - have formed support groups online to get people through it. Another bright side is people finally figured out how to use telehealth, so now I don't have to wear pants anymore!

The protests were a big thing in patient's lives too. Whether people were scared by them, inspired by them, or awoken by them it always played a role in their therapeutic growth.

1. This is Jim and I'll say the baddest badass of them all is Carl Rogers. Dude literally wrote the book on the fundamentals of how to heal people and his approach is now the foundation of all modern psychotherapy.

2. We are pro-masks. If you listen to the corona era episodes of our show I (Jim) am either calling in from home or wearing a t-shirt over my face. Partly because I have a kid who is vulnerable and partly because my own generalized anxiety disorder no likey the rona. War masks.

What would you say are the best coping mechanisms for low spots in depression, anxiety, and essentially random anger popping up?

I'm a big fan of measuring your anger/anxiety/depression on a scale of 1-10 and keeping a log of the experiences. Why? Because anything we measure we manage. Start tracking your calories, or your spending, and you'll accidentally realize that you start controlling it more. Emotions are often the same way.

Along with that I'm a big fan of PAUSE - an acronym I've compiled from Cognitive Behavioral Therapy which sort of asks questions to help us orient to the thing we are facing. I'd lay it out here but its kind of long, we have an episode about it somewhere in the archives.

Finally, practice noticing your emotion without responding to it. As if anger, anxiety or sadness were passing by you on the street. Its something near you, visible to you, but it isn't you. You see it, without judgement, you just notice it. Acknowledge it. Allow it to pass.

Also otter pops are helpful in a pinch.

As someone who comes from Vegas but lives elsewhere now, where the availability of Otter Pops is significantly lower, I have spent a lot of time recently trying to convince people of their importance. You have just validated all of that frustration.

Keep the faith friend, one day we shall pop of otters in paradise.

Witness me!

cuts the side of mouth with otter pops

Its all for your Damien!

Jumps off building with otter pops in outstretched arms

Can you please explain PAUSE?

https://podtherapy.net/post/183933365293/66-pause-affair-update-death-disrupts-family

It’s very common that people think too much about things they don’t have control and stressed themselves . What is one thing to do to avoid thoughts & focus on things that you have control of?

There is this song called "Steady as she goes" by The Raconteurs that has a line "you've had to much to think" and I've always like that turn of phrase - even though I'm pretty sure the verse was about kinky martial sex but that's beside the point.

What were we talking about? Oh yea, practicing mindfulness. So alot of anxiety is caused by fixating on a billion things that *might* happen but *haven't* happened and the brain feeling like it needs to prepare for all these eventualities instead of sipping my fucking coffee which is cold so now I have to reheat it in the microwave which is never as tasty as when its fresh.

Being in the now - or practicing presence - is a technique where we dial in to what is happening riiiiiiiiiiiiight......NOW.

What do you hear?

What do you smell?

What do you feel?

Draw your breath. Just breathe.

Open your eyes and take stock of what you see, only think on those things. Notice textures, shapes, colors. Just be.

Stillness is a hard thing to achieve. Check out the book the "Power of Now", pretty good short text on the topic.

I am a lower class 29 year old with trash-tier insurance who's never been around the environment of therapy or mental health. I'd like to get started with some help but I don't know how or where to begin or how I'd pay for it. Can you offer some advice?

Contact a local college/university and ask if they have a clinic associated with a therapist training program. Masters and Doctoral students are required to do almost a year of free counseling for the community as part of their training, its a great way to start working with a trained almost-professional with no out of pocket costs.

The good news - well, not good, let me try again - the...news...is that EVERYBODY has trash insurance. That's what insurance is! Deductibles make it so most people are paying out of pocket for their therapy even if they are completely covered, because finding a therapist is a personal experience and the person you connect with isn't always in network. Anyway, go to www.PsychologyToday.com or Yelp and find a therapist you like, contact them and ask if they have a "sliding scale" - tell them Jim from Pod Therapy sent you and in their confusion of who the fuck Jim is and what a Pod Therapy is they will probably just give you an appointment and offer you a reduced fee. If they can't ask them if they know of any pro-bono options in your community, they will usually have some suggestions.

The only unacceptable thing is to not do anything. Get out there and make some calls. There is always a way to make it work.

How do you convince a loved one who is an adult and has a profound thought disorder to seek therapy when they have no recognition of their own condition and think they're perfectly normal and well? - asking as a desperate, anguished mother...

Hi Friend - I'm sorry for your situation. I know as a a parent myself that when our kids are sick we are sick, and I imagine you must feel pretty discouraged right now.

Sadly we have to remember that we have limited control over another person's willingness to get help. However, we sometimes have leverage. Meeting with a therapist yourself and hatching a plan to implement positive boundaries to nudge the person in the right direction could be a helpful place to start. Some parent's of adult children will use leverage (money, influence) to encourage the person to start a relationship with a therapist.

If we have leverage we, as parents or loved ones, are allowed to tell a person we require them to have a therapist visit. We can't pick that therapist for them, and we can't tell them what to share, but we can influence them to take that step.

I suggest meeting with a therapist on your own first and seeking more nuanced guidance, its something we therapists are very comfortable doing.

I found that mindfulness and meditation have been very useful to me for dealing with stress in life.

However, I have been on amphetamine based ADHD medication for about a year now and I find that while I am on it I struggle to get into a quiet mental place where mindfulness is effective.

Any thoughts or advice?

I get it, amphetamine can have that effect. Id be curious what your prescriber would say about the effect its having though. The dosage might be off if its amplifying rather than steadying your mind. But hey, I'm not here to give medical advice so don't sue me (Lawyers, this will be referred to as exhibit A by the defense).

Consider guided meditation. Sometimes its hard to clear our mind when our mind is a super active place. Those minds tend to do better with guided work because they can focus on what they are being told to do. Consider downloading Head Space - an app that doesn't sponsor us yet but abso-fucking-lutely should because I've name checked them like 3 times already today.

Is there too many of us too far gone?

Nobody is too far gone. Nobody is lost forever. While it may sometimes feel hopeless and pointless, while we may sometimes have no energy or motivation left to give it another go, we have to remember that everything - EVERYTHING - is always in a constant state of change.

Change is INEVITABLE. Its happening in every part of the universe at all moments in all things. Its happening in you, right now. Change comes in fits and spurts. It starts small and snow balls. Sometimes is subtle, sometimes its slow, but its relentless.

No matter what you are going through things can get better. Things WILL get better. I just need you to believe it. You're never so far gone that we won't come find you.

Just hang in there.

What is the best way to manage anxiety? I am on meds and have done CBT. Anything else I can do?

First, I love that motivation. You don't sound like a quitter - which is key to your success.

Second, I love that you are an all ideas welcome kind of person. Medicine is a legitimate tool for anxiety and can be a useful part of the solution. Cognitive Behavioral Therapy is super duper useful as well.

Third, as somebody who lives with Generalized Anxiety Disorder I can tell you that it is a life long reality, but also something that can become super manageable. You mentioned that you *done* CBT, I'm wondering if that means you are *doing* CBT with a therapist currently. CBT is sort of like Karate. Sure, you can learn about it and even hiyaa some boards, but only when it becomes a discipline along side a good coach can it really empower you to whoop that skeleton costumed kid's ass.

Fourth, try downloading Headspace. They don't sponsor us or anything....yet....and most of my patient's say its another great tool for their toolkit.

This gets better my friend, I know your experience and just remind yourself that over time this gets better the more you karate chop at it.

Any tips for living with a partner that is dealing with depression and anxiety issues? She is seeking professional help but some days I feel like I need Al-anon for depression.

You *should* go to Al-Anon, you'd be welcome there. Most members love people who are also dealing with anxiety/depression so you'd fit right in. Another option is NAMI (National Alliance on Mental Illness) family support groups. Those are for people who love people who are dealing with mental health stuff. Lastly you might consider seeing your own therapist occasionally just to have a place to forage good ideas to help your partner while also keeping tabs on your own mental health. Anxiety/Depression don't happen in a vacuum, they can be contagious and disruptive, its ok for you to practice self care right along side your partner.

How do you find competent mental health support at reasonable prices? Everything in my area seems pretty solidified around $150 / hour. I'm not poor, but it's very difficult to justify that kind of spend. I'm looking to improve my life, relationships, etc., and I know you can't put a price on that stuff, but I've got a feeling I'll do therapy for years and not a few weeks. Is BetterHelp a good resource? Are there other online services / tele-[mental]health you could recommend? Thanks! Looking forward to checking out your podcast!

I've made comments elsewhere about how shitty the healthcare insurance system is - so I won't do that again here.

(A) if you have insurance, try going through that first.

(B) if you have a PPO insurance or out of network benefits, see if you can get reimbursed for your out of pocket therapy costs. About 50% of my patients get paid back a percentage of their fees by their insurance.

(C) Your employer may offer an EAP option with therapy included for low cost.

(D) Contacting a therapist and asking if they offer a sliding scale is a good idea, but if they are all booked they might not.

(E) Better Help and Talk Space (who don't sponsor my show but probably should) are good options too. They contract with actual therapists in your state, they are cost effective, and its a good idea. Another thing is using a platform like Teledoc, Amwell, LiveHealth Online, etc - those are built by insurances and work with insurances to connect you for very low cost.

(F) I get that the cost is hard to swallow. I also like that you don't think it'll be a one and done process and are preparing for a longer engagement. Consider this: if you saw a therapist once a week for a whole year (which is unlikely btw) and it cost $100 / session that is at most $5200 for the year. Thats a small cost when you consider 52 hours with healthcare provider one on one, and a small cost when you consider other things you might drop $5K on over the course of a year. But I feel you, spending money blows.

Aside from the stigma around mental health, what do you believe are the biggest challenges we face as a society to advance the fight to overcome the mental health crises?

I personally believe compared to the human body, we barely know anything about the mind and mental health in general. We have a long way to go to really effectively get more people over coming obstacles in the way of living a mentally healthier and happier life. Agree or disagree?

Thank you for your work !

Healthcare reform. People want mental health. Mental health is *criminally* uncovered in health care plans - and I'm using that word intentionally. Insurances break the law regularly and nobody does anything about it. They also intentionally under pay therapists so we won't sign up with their healthcare plans - if there are no providers in network the members simply can't spend the insurance's money. The system is broken.

We know everything and nothing about mental health. Here is what I mean:

We know nothing in the sense that mental health and psychology generally doesn't give a fuck about the scientific method. It refuses to be dissected, compartmentalized, biologically indicated, neurologically mapped, or generally compliant with modern medicine's disease model.

We know everything in a sense that each of us is a walking talking human brain. We resonate. We feel. "Psychology" originally meant "the study of the soul" - which is more important now than ever before. Human consciousness is greater than the sum of its parts, its ethereal and holistic. Therapists are good are helping people because we blend together the science and the art of healing the way a violinist blends together music theory and the ability to play. The more people see themselves as bigger and more expansive the better off we all are in helping them work though things.

How should someone progress their life after discovering that their parents paid the bills but were negligent toward one. Negligent like a father choking his son while saying " I'll kill you." You know putting him down all his teenage life. What do people do when their loved ones were the trauma source. I remember a young man dropping a tear after admitting he still loved his grandparents even though they abused him. The shitty parent even tries to convince him that its normal. And that hes a good dad. How does one look at their past abuser even if it was a parent?

Growing up through abuse is a deeply conflicting thing. We love the person. We hate the person. We are comforted by them. We fear them. It causes us to distrust the intentions of others in life and question ourselves and our own victories. I feel you friend.

I'll tell you that post traumatic events can result in post traumatic growth. We can overcome and unburden ourselves from the pain of the past. We can't forget it, but we can forge it into something better.

But I warn you: that which is not transformed is transmitted. If we don't change and grow and adapt we will pass on the very same sicknesses that have been done unto us, even without realizing it.

Consider a healing relationship with a therapist friend. You deserve to heal from this.

Hello! I am starting down the path of becoming a marriage and family therapist (grad school starts next week!). Even though my undergrad is not in psychology, I have a great passion for promoting better mental health, particularly amongst children and adolescents, and want to eventually become a school based therapist. Any advice for someone who is just embarking on the beginning of a career as a therapist?

Thank you for the AMA and I look forward to diving in to your podcast!

AWESOME! Welcome to the thunder-dome!

We love grad students on our show and have lots of episodes where we offer professional advice to them. Here is one: https://podtherapy.net/post/611734534076186624/113-psychology-todays-sexual-fantasies

The best advice I can give you is to stay connected to humanity. In grad school we pump your brain full of theory and science and techniques and ethics and sometimes you forget that you know how to do this already. You are naturally a helper, you are intuitive and genuine.

The secret to seeming sincere with your patients is to be so.

Stay human friend, you'll be great

I have a friend in her 60s that is finally starting to come around to the idea of therapy.

She is one of the funniest and nicest people that I know, and she is going through a really difficult time in her life where her family demands too much of her. She recently confided in me that she wondered what the point of living was and that she thought it would be better for everyone if she wasn't here.

I have struggled with mental health since the late 90s, and was diagnosed with borderline personality disorder in 2018. I know what she is feeling, and I also know that she has to want help to benefit from it. I don't want to discourage her by telling her that she might have to "try on" a few therapists before she finds the right one, because she really needs help now.

What do you think is a good way to determine if a therapist is right for you? I'd love to help her find the right one.

First off - youre fucking awesome.

Second off - therapists try to be a little more visible than other healthcare providers because the experience is so personal. We try to give people a sense of who we are with little blurbs, videos, pictures, a list of my favorite songs and foods, etc. Usually when you begin the search for a therapist - www.PsychologyToday.com, Yelp.com, or just the good old fashioned google machine - you can sort of profile the therapists.

Usually its best to round up 3-5 possible suggestions. Usually a person in their 60's prefers a therapist closer to their age, or at least in their 30's. Look for somebody who sort of reminds you of the person. Then bring her those suggestions and ask which of them she might be willing to speak to *first*. Don't emphasize the whole trying on thing, just set the table and see what happens.

I've recently been trying to work up the nerve to go to therapy, but currently all the therapists are doing teleconferencing only, which doesnt work for me because I'm scared of cameras. I dont really know how long that's going to be the case, so I dont know if I should just give up on the idea for now or not. What should I do?

First - Awesome job being willing to start therapy! High fives!

Second - Don't forget you can also meet by telephone most of the time too, which takes away the pressure of the whole camera thing. Or you can turn on the camera just to say hi and verify your identity, then tell them you're turning it off because its more comfortable. We are totally used to that. Probably 30% of my weekly caseload turns their camera off or we do audio-only. Its totally fine.

When I was younger and depressed about girls and school, none of my friends liked hanging out with me. Because basically everyone has some problems and they didnt like the negativity.

Turns out I'm depressed again and since its 20 years later I have all new friends and even with the much greater awareness of mental illness is out there the response is the exact same.

My sadness is inconvenient to them and the negativity is undesirable. So stigma? I mean, how can you blame them? They'd be bummed if I was dead, but they cant ve bothered - everyone has their own life.

I get it, I dont blame them. The campaigns for mental health awareness seem more than ineffective, they have no real point except to what... trick overly empathetic people into trying to cheer me up?

Shrug. I live in Las Vegas, you wanna come cheer me up?

Fuck yea I do!

First - Your friends aren't trained to know what to do with depression, which sucks but if you and I are honest with each other, is sort of a fair cop out. I mean, I'm totally empathetic with the black lives matters movement but I also know that I'm not equipped to step in and heal a friend's struggle with systemic racism. People are inadequate to the task is what I'm saying I guess.

Second - But that's why there are support groups (go here: https://namisouthernnevada.org/support-groups/ ) therapists and podcast communities. We are the people who get it, so you should get with a therapist or other like minded folks and get connected!

Third - Last shot at a cheer up, did you know that koala fingerprints are so close to human fingerprints that they can taint crime scenes? How many innocent people are in jail because homicidal koalas are running unchecked through society.

Think about it.

What can you tell us about the r/radicalmentalhealth if you were to take a quick look?

I only glanced over at it just now but from what I can tell it seems like a reaction to a profoundly broken healthcare system and the fickle uncertain nature of mental illness in general. They look like they mean well, and I'm glad for any support group that wants to help people feel better even if they are venting about the brokenness of traditional methods.

How would you feel about someone who has lost attachment to their life, and while isn't suicidal in the sense that they would take any action on it, seek out opportunities that could inevitably lead to death by course of altruistic action?

Howdy friend - so that sounded guarded and cryptic. What I mean is, it sounds like the person wants to die but would probably just do so heroically, like pushing somebody out of the way of a bus or something.

Losing attachment to life is a tricky thing. I think we all relate to that happening at some point but at the same time it can become a slippery slope where we start to believe that life has no purpose and we become hopeless. As you seem to realize, that can become every bit as dangerous as feeling actively suicidal.

In that sort of situation Id really want to encourage finding a therapist to discuss that with. You have value. Life has value. These feelings of vacancy and emptiness aren't facts. They are perspectives that wound us and hollow us.

Remember that dying intentionally, even if we mentally tell ourselves its altruistic, is NEVER a gift to those we leave behind. No matter how dark things appear, depression is always a lie.

I hope you'll reach out to somebody soon my friend. You sound like a kind person who deserves to feel connected to life. We need you here, you're part of our time. Stay.

i (f24), like many people i believe, have been struggling to find a romantic partner for over 5 years now. i know it shouldn't bother me, and that i shouldn't "need" someone and i think i should get used to the idea that i may not have a partner to share my life with. my question is, how can i get around to.. be okay on my own?

i do try to tell myself to focus on things and people who are important to me right now and work on things i want to achieve in life, but my mind seems to keep drifting itself back to the thoughts of lacking a romantic partner.

thank you for your time, and thank you for this!

Hi Friend - First, I'm reluctant to accept your fate as forever-single at 24 years old. Most people spend their 20's and even often 30's developing relationships, learning what they like and don't like, and becoming who they are.

Second, I've always been opposed to that old adage "if you're not ok alone you won't be ok in a relationship" or however it goes. You didn't say that, but in case its simmering beneath the surface I want to speak to it. I think its ok to want relationships. We are humans, tribal people, relational to our core. No, we aren't happy when we are lonely. No, there is nothing broken or wrong about that. Yes, we are allowed to yearn for companionship. Yes, we are allowed to proactively seek it.

Having said that I also appreciate the need to sometimes reach acceptance about certain unchanageable realities. As I said (see point 1) I'm reluctant to see this as permanent, but 5 years is a bit of a drought romantically for some people. Im super interested in the way you are socializing, how you are meeting people, and what it might look like to adapt our strategy and expectations to make room for new people. Consider partnering with a therapist to discuss that, I'll bet it gets better.

Theoretically speaking, how would you handle it if other podcasters in your city used your mom as a character and turned her into a kind of weird hybrid bat-woman in multiple episodes?

More to the point, what does it say about the type of person that would create a character like that?

Great hypothetical.

I'd probably handle it by welcoming the character as an expression of friendship among other creatives.

The person in question would probably have to be a comedic genius and generously let me sit in his chair every week.

I have bipolar II, GAD, MDD, ADHD and binge eating disorder, couple questions.

1) Is it at all possible I could be over diagnosed? I know you can’t evaluate but it seems like so much to me.

2) If I enter a state of MDD where I’m so locked in that I can’t even talk, are there any coping strategies to break just a little free and ask for help or signal my state?

Thank you so much for doing this, and you’ve just gained a new follower to your podcasts. I really look forward to listening to them.

Awesome question and glad to get talk about diagnosis.

First, diagnosis as a concept is often misunderstood. Alot of people see it as an authoritative stance or a permanent label, which in reality it is only a short hand word for a constellation of symptoms. If those symptoms change, they diagnosis goes away.

Clinicians do something called "differential diagnosis" which sort of emphasizes avoiding over diagnosing. For instance how much of anxiety is related to hypomania? How much of depression is related to the drop of bipolar? How much of ADHD is related to manic episodes? A clinician wants to select the most appropriate label possible to do the most amount of good.

Sometimes a diagnosis has a purpose in your file. By diagnosing with all those different labels the providers might be able to force the insurance to cover the care the patient is going to need. Sometimes the clinician just wants a full report. For example: if a patient has had depression throughout their cycles, or before the onset of bipolar, then their depression may be chronic and independent of the bipolar even though of course its influenced by it.

Another way to look at it is the symptoms themselves. The clinician may diagnose anxiety disorder because they are noticing the panic attacks and thought processes consistent with the label despite the contributing factors of bipolar or ADHD.

In the end I get that all those terms can feel like a mouthful. I'm a big fan of not diagnosing at all if I can avoid it, because I want my patient to remember they are a human being doing life the best way we can, adapting and living authentically. If a diagnosis helps, great, if not, no big deal.

RE: MDD Lock Down - I like communication. Even if its just to let people know that you are ok, but pushing through the low end of things. Keep up communication as a discipline because its vital not only to solving the problem but to tracking and preventing worsening symptoms.

I've was seeing a counselor for about a year before all the covid stuff. Sometimes I'd feel like I got something out of the session, but for the most part it just felt like she was a sounding board and that's not really what I need. I've been considering trying to find someone else to talk to, but I really don't like the idea of opening myself up to someone else. Any advice?

Great question. Therapists often mirror what we see. If the person appears to want us to be directive (steer the proverbial ship) then we do. If they person appears to do better when we are non-directive (listening, partnering with them) we do that instead.

Sometimes therapy is bringing a box of puzzle pieces into an office and pouring them out on a table together. Sorting, organizing, and placing those pieces is part of the process of understanding, coping, healing and discovering. Sometimes insight and growth happens in unexpected conversations. Sometimes human contact is itself healing.

However, if you feel like you're ready for the next step tell your therapist so. Ask them to help you identify some new goals to work on, or ask them if they have any challenges or areas they'd like you to explore. Sometimes a therapist has a whole list of things they want to push you toward but isn't sure if you're ready or wanting that.

Its ok to tell your barber what you want, its ok to tell your therapist that you are ready for new therapeutic goals and challenges. Remember though, they are highly trained to match your speed and interest, if you seem fine with the puzzle pieces approach they will lean in on that, if you communicate differently they will adapt.

Is there a higher percentage of mentally ill individuals in Las Vegas? Seems like it.

Hi there!

I don't have any data on that. From my experience, I'd say it would be similar to any other US city of comparable size. LV does have it's own unique quirks that may lend to higher rates of some diagnoses, i.e., legalized gambling leading to higher rates of gambling addiction; having an economy completely dependent on entertainment leading to booms and busts that might factor into rates of anxiety disorders or acute stress disorders, etc. This is a great question and something we'll probably look into, but anecdotally, in respect to percentage of diagnoses per capita, I'd say we're on par with other US cities.

[...waiting for Jim to come in and disagree with me on this.]

-Nick

So- I am currently dealing with co-morbid depression and my therapist is pretty ok for what I am able to afford. But the only thing he has been telling me to do is to just let go of any exceptions I have and that should help. Since unmet expectations turns to hurt and anger, Which is something I skip over and got straight to, sadness and depression. So in some cases it does help but other times not so much.

I also have a serotonin imbalance- which according to him is likely the cause of all of my issues- So on Prozac what ever. I guess my question is- because I have a lot going on in my head I find it really hard to just be myself and make friends as I get stuck on this mind set that no one really cares. What is something I can do to change that kind of thought process? I mean chances are the people don’t care but is there a way to tell if a person is being genuine or not?

Love that you're with a therapist, love that you're open to medicine, love that you're working the problem, love the resilience.

People do care. Too much in fact. They care about the world. Themselves. You. All-You-Can-Eat-Sushi. They care.

The question isn't whether they care, its our ability to feel it. This is probably what your therapist means by "expectations". We have to remember that people love at their ability level, not our desire level. If my 5 yo draws me a picture of stick figures in crayon that is her Mona Lisa - its not super impressive or satisfying to me but its her way of showing love. I have to receive it not only by its effect on me but by the intention of the sender.

Its also ok to alert people to our feelings of loneliness. In our podcast community its common for people to just announce the need for affirmation on the internet and all of us swoop in to remind them that they don't suck. Feel free to do the same with your people, because, you don't suck.

And even if you do suck, you're still awesome.

Which casinos buy the data that you gather to improve their hooking system?

That's actually a thing. Casinos incorporate a lot of psychology. But they don't talk to us, we are the people who clean up their mess, they don't need anything from us.

But I'd totally welcome them as a sponsor, give us money MGM

As someone with BPD, I have a hard time distinguishing which thoughts and fears are genuine rather than caused by chemical imbalance. Is there any general techniques someone with mental illness can use to sort which emotions are overexaggerated/unnatural in day-to-day life?

Hi there -

So unsure if by BPD you mean Borderline Personality Disorder or Bipolar Disorder - when you mention chemicals I'm thinking bipolar but we usually use BPD to refer to borderline.

Anyway the answer is YES. Cognitive Behavioral Therapy is a suite of techniques used for exactly that purpose! If you have the ability to dive into those ideas I think they would be really helpful.

Have Jim and Jacob broken up Nick and Laura yet?

Sadly no. They are still enjoying a loving and friendly relationship

do you check in on your patients?

Kinda. If I have a reason to - they mentioned their spouse is out of town this weekend and they are worried they might relapse - I'll text them and bother them to make sure they are doing the right thing. I'm sort of a concierge therapist, which means I'm a lot more attached to my patients and available to them than other therapists can realistically be. But I don't hover around them like a guardian angle making them eat fruits and vegetables. I believe in the dignity of risk, and healthy boundaries. I give people space and encourage them to reach out as often as they like.

Hey, thanks for doing this Ama! Your podcast wasn't on my radar before but you've just gained yourself one more subscriber!

I have a question however it's a personal one rather than a general one; I'm unsure if it'll be suitable for what you're here for. If that's the case, I'll remove it 👍

I'm a 31yr old virgin. I'm not proud of it, but I'm not ashamed either. I don't feel like any less of a man or hyper masculine stuff like that. I've always tried to acknowledge sex & intimacy because it seems counter productive to pretend they don't exist. However I believe I could be so much more happier if I just didn't care about sex and lack of intimacy but no matter what, it's like a mindset I can't get away from.

If I could just not care I'd probably achieve so much and work towards being the person I want to be; and who knows, potentially solve the core issue too. What advice do you have to become comfortable with the loneliness?

I find it hard talking to people about virginity, as a guy everyone just dismisses it as being thirsty, being insecure, being juvenile and only wanting ‘one thing’. I'm not sad I've never had sex, but I'm really gutted I've never been intimately close with anyone. I wish it was a part of my brain I could switch off.

First off - youre awesome for being honest and bringing this question up.

Second off - I have lots of opinions about the way society has pathologized male sexuality. It is a super duper unhelpful thing and it creates a big stigma around sexuality generally, making it taboo for a man to try to explain his sexual side and forcing him to become repressed and confused.

Third off - I believe we have answered a very similar question before: https://podtherapy.net/post/181671376133/53-insufficient-complex-weight-identity-sex

[deleted]

Post traumatic growth is indeed possible and many many people have it! A therapist isn't always required, but self work is. Consider reading some relevant books that speak to your experience, or connecting with your local NAMI chapter for more resources and support groups!

What misconception of mental health needs to be debunked?

That mental illness is a choice. Its not. Choice is involved in the disease and the recovery from the illness, a person has choice as a responsibility in addressing the problem, but even if the person is sometimes dramatic or emotional or whatever, their illness happened to them without their permission and I promise they don't like it.

Why is your podcast "R-Rated"?

Do you:

• do it in the nude?

• use a lot of naughty words?

• have excessive violence?

Yes

How should an adult go about checking to see if they have ADD or ADHD? What kind of resources are available?

Usually they are evaluated by either a physician or a psychologist. There are assessments they will give you to nail down the diagnosis if they need to. But a better question is whether you care to know if the label applies to you, or if you'd prefer to address the symptoms which are getting in the way. I believe we have an episode on this here: https://podtherapy.net/post/190286551283/106-evolutionary-purpose-adhd-up-and-at-em

In your opinion, what makes a good therapist?

A podcast. If they don't have a podcast don't even bother.

Oh and glasses.

And a beard.

Yea all three of those things.

Also empathy, competence, accessibility, a sense of humor, professionalism, boundaries, warmth, connection, compassion, and most importantly....

a podcast.

Seeing as how you are in Vegas, and without divulging anything personal. Are you able to form a professional opinion on the mental affects sex workers have from their industry? Either positive or negative? My guess is it is really a mixed bag, but just curious if there is a trend.

Great question!

So as a Las Vegas therapist I get to work with men and women who work in all parts of sex industry, from sex-workers in brothels to dancers in strip clubs to everything else you've ever heard of.

I'll tell you that I don't see any correlation with mental illness and those lines of work, though sometimes you hear similar life stories that caused the person to become so comfortable with sex as a profession. I do notice some patterns in profiles when it comes to relationships, and substance abuse is rampant in the industry as well but part of that is the "party scene" nature of the job.

A great resource on this is Doctor Victoria Hartmann of the Erotic Heritage Museum here in vegas, she has some great research and resources on sex psychology.

How do you guys address the current conflict between gender dysphoria being a real thing and the more popular position that seems to come almost entirely from tumblr, which is that it basically doesn't exist at all?

Great question! We have touched on this briefly in some places, but our friend Dr. Sarah Steelman commented on more meaningfully https://podtherapy.net/post/184754387113/trans-therapy-with-dr-sarah-steelman

I just lost the love of my life to an overdose 3 weeks ago. He was 36 and had a long, long history of mental illness and substance abuse. I had left him two years ago after a decade of this, but remained in his life.

The system failed him at every turn, despite having myself and his mother willing to fight for him. He had been involuntarily hospitalized for delusions and psychosis (in part drug induced). To get him there, he was tasered bu police (he was not violent). He was released at 72 hours to follow up outpatient. He had a psychiatrist who prescribed wellbutrin, but you couldn't get him to take his meds long enough for them to work, let alone get it together to show up and listen to his psych.

He was recently in jail for over 5 months on a simple possession charge (what the fuck) and was released early because of COVID. The irony here is that he would still be in jail if he were alive, and he would still be alive if he were in jail.

Recently he overdosed on a different drug. Spent two days in ICU. No one could visit, because COVID. They told his mom on the phone psych would see him. He was so scared he had disclosed to the team himself that he was bipolar, schizoaffective, and not on medications. Then he is discharged, at night, to AGAIN follow up outpatient. 5 days later, he was dead.

His mother has spoken with administrators and directors at the hospital, who hide behind the fact that he never said he was suicidal or homicidal (he was though, mostly passively suicidal).

What can we do to help change the way the mentally ill and the addicted are treated in jails and hospitals? What can we do to make sure that providers are truly stepping up for them because, as a hospital worker myself, I can tell you we are not. What can we do help make sure no one ever has to feel this way again?

You're story needs to be told. Is this something you would consider allowing us to speak about on our show?

I can't imagine how you must feel. To watch a system fail right in front of you is unreal. You feel powerless and hopeless.

Criminal Justice and Mental Health have had a very weird alignment throughout history. Often the two get conflated and therapy is a punishment or a check mark more than actual treatment. Mean while the system becomes so saturated that well meaning clinicians often become jaded and cynical, failing to bring best practices into the facilities and the programs they run.

I like drug court programs as an idea when they are expertly utilized, but unless we have third party accountability in these systems nothing will be what it needs to be.

I'm not sure how to ask this question sensibly, so I apologize for my wording.

But, how can you tell when someone is faking depression or is actually clinically depressed?

Great question. We addressed a similar one here: https://podtherapy.net/post/611734534076186624/113-psychology-todays-sexual-fantasies

My default advice is to always behave as if depression is real. At worst the person is given human contact and attention and starts working on life, at best we save their life.

Having said that depression is a confusing thing. It isn't black and white and a lot of people report it at various stages of severity causing friends and family to be confused as to when it is a problem and how to help.

I'm uncomfortable with the idea of "faking" it, because even if a person is reporting depression falsely there is still a reason behind that - that reason is worth them connecting with a therapist to explore.

What is it like having a mom that is also a bat? Follow up question, have current world events caused an influx in people being diagnosed with mental health issues? I don't know if I'm just getting older, or these events are actually taking a toll.

Batmom was loving and nurturing, though her shrill terrifying shrieks did keep me up at night.

Mental health is attached to social health. World events being what they are exacerbate and confound people's human suffering, confusion and struggle. It does take a toll, and the older we get the more times we've paid to drive on that road.

Thanks for jumping into the reddit with us =)

What would you like the show to become going forward?

This is Jim - Id like it to grow to a place where the global community surrounding it can begin creating its own mental health ecosystem. Support groups, workshops, courses, retreats. The most rewarding part of the show is connecting with the humans who attach to it, I want to see that become an entire marvel universe of mental health and positive vibes.

Is your podcast available on Spotify? I checked but can't find it.

It should be. https://open.spotify.com/show/5cQrvuOT3yXZRGoVWP92h6

Do you think there has been an uptick in people self diagnosing themselves with disorders such as autism and do you find this problematic?

Yes I think there is an uptick in self diagnosis generally and in autism specifically. Its problematic if ends rather than begins a conversation. If a person is experiencing distress in life I want to address that, I don't just want to label that.

I always feel like a fraud and like Ive done something wrong. I know I have skills but I can never feel like Im any good at anything and Im ripping people off if I charge for my work (I draw 3d files to print and use on scale models), doing so leads to immeasureable stress and a decrease in life balance and quality, and my joy just dissappears. Now I just upload free files and havent done commissions since last November. What could be a reason, or what is a common reason, for these feelings?

Easy mode question if that ones too eugh; WHY ME SAD IN BRAIN??

Haha love your TLDR at the end. But great question. We get LOTS of questions on imposter syndrome. Good news: you're not alone. Better News: You are qualified and good at what you do and feelings saying anything else aren't true. Bad news: Brain still get sad.

Check out this episode on the topic: https://podtherapy.net/post/178942743123/41-unhappy-wife-impostor-syndrome-smitty-scoop

Hey Nick and Jim! I’m in high school and I live with my grandmother and parents. My grandpa passed away in 2016 and my grandma has been living with us for a little over a year. My grandma shows pretty tale tell signs of depression and my parents have tried to talk to her about maybe seeing a therapist but she always shuts down and tells them no right away. Is there a way I can help take down the taboo or shame my grandma has over talking about mental health?

Hi friend! Great question! Also don't read any of my comments on this thread because I say a lot of cuss words and that might not be ok, lol.

I love that you care so much about your grandmother, and I love that you are noticing depression symptoms. One way you can help her confront her own misgivings about getting help is to talk to a school counselor (when school reopens) and share about your own experiences. If she likes books, she might enjoy our friend Lori Gottliebs "Maybe You Should Talk To Someone" which is a story about a therapist, her therapist, and our lives revealed (thats the subtitle lol).

Thanks for being awesome!

I’m a caregiver in my job right now. How do would you help someone close to you while dealing with the emotional aspect of it due to your relationship with them? What things have helped you with a situation like that especially dealing with mental health?

Compassion fatigue is real. We have a whole episode for you here: https://podtherapy.net/post/615535828471611392/119-compassion-fatigue-kids-in-quarantine

There are so many podcasts around now - do you have any advice for standing out from the crowd? What are the absolute dos and don'ts that you might not read about on a "how to make your podcast successful" article?

Love this question!

(A) Pick a show model. We liked the show Car Talk on NPR because it made complicated things that neither of us were interested in fun and enjoyable. Find a show you really enjoy and use that as a role model.

(B) Speak to an audience. Identify in your mind who you want to be speaking to, then try to design everything youre going to do to reach them where they are at.

(C) Be authentic. Lots of people are trying to be shiny and impressive. Be real, its more interesting.

(D) Be competent. If you want to talk about a topic, be good at that topic, or get somebody else who is good at that to talk with you about it.

(E) Speak no matter the size. I've literally given presentations to empty rooms before with only my phone tape recording. If we are faithful with the small things greater things will come.

(F) Like what you do. If you are only doing it to get big, it wont. Find something youd do even if nobody was listening, because for a while they wont be.

What do I do if I go through waves of depression because I’m gay, and would rather be straight?

There are periods during my life that I get very depressed, the feeling of loneliness absolutely consuming me, because of being gay. Just to clarify, I have a great, supportive family. I live in Iowa; some people may be surprised to hear that Iowa is very opened minded to LGBT people. I’ve never faced homophobia here. Iowa was one of the first states to legalize gay marriage.

That being said, I’d “fix” myself if I could. I’d turn straight within a heartbeat.

It’s incredibly lonely being gay. I’ve drove two hours to Minneapolis to go on a silly brunch date before. It just feels like because of my sexuality, I’ll never truly be able to live a happy life. I’m not sure if you’re familiar with intraminority stress. The Huffington Post did a great article on it. Essentially, the way gay men treat each other (approval through sex, etc) AND homophobia, the fear of coming out, literally damages gay men like me. We produce less cortisol than straight men.

There are moments in my life that I feel like my life would be better if I was straight. Straight women have flirted with me many times in my life. I would no longer have to worry about HIV. I wouldn’t have to deal with a “sex-first” attitude to dating that gay men have.

I saw a therapist once, last December, about this issue. When I explained I didn’t want to be gay, that I wanted to follow a “heteronormative,” life, not a “homonormative,” one, she laughed. So I stopped seeing a therapist completely. I don’t want to write an essay here, but I was just curious, have you dealt with this kind of thing in the past with people? What do you recommend them? What should I do?

Thank you for all of the positive energy you bring to the world.

First off - How would you feel about us using this question on an upcoming show?

Second - We've tried to speak to "conversion" therapy a few times
https://podtherapy.net/post/175566966748/27-gay-conversion-therapy-recreational-drug
https://podtherapy.net/post/188875366443/96-conversion-therapy-again-suicidal-intrusive

Third - Sex is a deeply complicated part of the human psyche. There is nothing simple about it, nothing uniform about it, and each of us is allowed to find our own way and choose as we want to live our lives.

I'm not pleased with how the therapist you visited reacted. I hope their intention wasn't to be dismissive, and if it came off that way I'm sure they regretted it. I really hope that hasn't prevented you from being willing to reengage a therapist to process these feelings in a safe place, I suspect it would be an important step for you.

Fourth - By way of a short answer, yes I have encountered lots of people who identify as homosexual but experience struggles related to it. Whether that is because society is abusive and unkind, or whether they have religious beliefs that are unaccommodating, or whether they have their own concerns and confusions. Its always a delicate process to navigate these waters, because I don't want people to live inauthentically, but I also want them to be allowed to have sincere challenges with life.

There is no easy answer. But at the end of the day I admire your sincerity and honesty. Your truth is valid, your experience is relatable, and your path is your own. Consider partnering with a therapist who identifies as LGBTQ friendly and maybe message them before hand to share a bit about the topic to make sure they understand.

Be well friend, thanks for sharing this.

How do you feel about the potential use of psychoactive substances (I.E. psilocybin, THC, etc.) as potential treatments for those with depression or anxiety? I'm not sure if you have spoke about this on the podcast or elsewhere previously, if so I'd love to check it out if you have a link.

Two perspectives!

One against it: https://podtherapy.net/post/190803473753/110-magic-mushrooms-as-treatment-what-to-do

One for it: https://podtherapy.net/post/618104398702329856/123-rj-the-baby-man-from-mystere

If you weren't in the field you are in what do you think your career would be?

According to Nick, Jim would be a used car salesman or a teacher.

According to Jim, Nick would be a male model or a professional mountain man.

What are some tips on dealing with reactive abusers?

Nick brings up this thing called the Power and Control Wheel alot which has to do with recognizing abusive control patterns, I can't find the episodes where we have unpacked it but here it is: http://www.ncdsv.org/images/PowerControlwheelNOSHADING.pdf

I'm confused by the term "reactive" in this context. Maybe you can write into our show and ask the question is more of a story filled way?

What about grief? I’m in a constant fight to try and not think about my mom being gone. It’s been six years but I can’t get over it. In those six years, I lost my dad, two brothers, my only sister, my best friend, my favorite cousin, and three of my aunts. My brother died the week before lockdown and I feel like I’m losing control of holding in the crying. My mom’s death was the worst. She was my heart and I can’t think of her without wanting to cry. People don’t want to hear about it, my husband is not demonstrative at all. So, my brother was the one who cried with me and we talked about it when we were sad. Then, he just died one day. I’m isolated for nearly four months now and not doing so well. I know I need help but I don’t even know where to start. Do therapists even work with grief?

First, I'm sincerely sorry for both your losses and your pain. Grieving is a process, it isn't linear though it does have phases, and it is never, ever, easy.

But it does get better.

In your brief story there is so much loss that its hard to even wrap my mind around it. I imagine that nobody in your life can adequantely confront the pain you feel in a meaningful or helpful way. I'll bet that makes the lonliness even worse.

I strongly recommend you look for a therapist in your area or online. Yes, we work extensively with grieving. There are also grief groups in most cities and states where people support one another, sometimes with a therapist in the mix too.

We did an episode recently on the grief related to coronavirus and life change, you might find some of that relatable. https://podtherapy.net/post/613633297741938688/116-7-stages-of-coronavirus-grief-bff-stealing

​

Be well my friend, this will change over time, but you may have some important work to do.

I constantly overthink things in my relationship with my partner. When he asks me to talk about it, I shut down. Any advice on how to open up?

First - look up an emotional vocabulary list. I want you to start there because I want you to get comfortable selecting words that hone in on how your feel in your relationship sometimes.

Second - I want you to consider reflecting carefully on perspectives. Sometimes when people tell me they "over think" their relationship it means they (a) feel fearful the other person doesnt love them / is cheating on them / is secretly Australian or (b) have baggage from past relationships that effecting the current one. There is some important work you might have to do on your own to challenge these distorted perceptions of things.

Third - When it comes to communicating with your partner you might open up by grabbing that word list from the first point and practicing using I feel statements (google it) during your conversation. You'll find its easier to talk about a thing when you aren't putting the other person on the defensive and you are practicing telling your own truth.

Last - if you notice this pattern is becoming an obstacle, consider visiting with a relationship therapist to see if you could get some coaching on effective communication. Few relationships come equipped with good sharing skills, you usually have to build them.

Why is there a stigma of mental health? Is it because being crazy is hip?

I think those sentences kind of bump into one another, haha.

Stigma usually means that people have a negative view of it. Like being poor is common, but if your stigmatize being poor it means you think poor people are yucky or less than and being poor is shameful.

The same happens with mental health. People experience mental illness or hard times, they consider getting help but then bump into negative talk about the subject. Stuff like:

"Therapists are only for crazy people"

"You're fine. I felt the same as you and I'm fine"

"Youre making a big deal over nothing"

"Mental healthcare is a scam"

"Just pray about it"

Those opinions are unhelpful. Our show tries to help people get past those old ideas and embrace help if needed.

Great question!

Hey 29 year old Vegas local. I had been on opiates since I was 15 and learned to live with them and graduate collage and had a successful life for awhile until it caught up to me. I just tapered off methadone last month after being on it for two years and I’m having trouble getting up in the morning let alone getting through the day. I recently started practicing transcendental meditation but it only goes so far. Now that I’m clean it’s great but it hurts to look back when I was using and had a job and a girlfriend and a relationship with other people. Will I ever be back to normal, whatever that is?

No. You'll be BETTER than normal. Living a life in recovery is HARD, but when done right, can provide you skills that most people will never develop. Cindy gave you some great advice! Meetings, meetings, meetings. They're not all the same, so find a few you really like and learn from the ones who have what you want.

It was always disheartening in my groups when I'd see my clients looking down on themselves and hear them talk about how they'd never achieve a "normal" life. I'd have to challenge them a bit on that idea and remind them that people who never have obstacles, never develop the skills to overcome them. Being addicted to a substance is one obstacle after another. The problem with substance use as a coping skill is that it becomes the coping mechanism for every problem, and stops development of new coping skills. BUT, every time you overcome an obstacle WITHOUT using, you get stronger.

In recovery you'll need to plan ahead more than the average person, you'll need to carefully evaluate high-risk situations more than the average person, you'll need to manage your emotions more than the average person, you'll need to feel comfortable asking for help AND helping others. These are all skills you can use in other areas of life, like school, business, raising a family, etc.

Embrace a life in recovery and want good things for yourself. It's not all roses and lollipops. It's a lot like Andy Dufresne escaping from prison in the Shawshank Redemption; sometimes you need to crawl through a sewer pipe to get to paradise.

Keep your head up!

-Nick

Do you think that the spreading awareness of mental health could be unintentionally detrimental to unwise teens? (i.e. the increasing amount of unwise kids self-diagnosing illnesses)

Great question. Yes and No.

Shows like "13 Reasons Why" really REALLY (really) piss me off. I think it normalizes suicidal ideation in the wrong kind of way and creates a narrative of blame and heroism behind it. Its the wrong message.

Meanwhile like it or not depression and other mental health issues effect our teenagers. They tend to be more resilient with their experiences and able to come out of it on their own with basic life changes like socializing or new experiences, but overall I want them to be able to identify what's happening and talk about it.

More important than identifying the diseases by name is identifying the appropriate coping skills and methods to get better. Thats the area I want schools and programs to focus more on because that's where the education is lacking.

What do you recommend to police officers who come across someone who has excited delirium, won't follow directions, is unresponsive to sweet talk, etc and is coming at you with a hatchet in one hand and their severed penis in another...how do you get them into an ambulance?

You had me until penis. I advise them to call for backup and double check their zipper.

I have my first ever therapy consultation on Monday. I'm in the UK so I understand the process is probably slightly different compared to in the US, but what can I expect from the consultation and first therapy sessions going forward?

Congratulations! Glad to hear it!

Here is an episode that speaks to the first session experiences: https://podtherapy.net/post/184593064718/70-mental-health-month-first-therapy-session

So are you two in support of the research that supports a non-drug path of therapy or are you in line with the status quo of heavy drug usage to combat mental issues?

We are the organic option, we don't prescribe medications. However we both believe that medicine can be a useful tool coupled with good therapy.

Any advice of coping with my husband going through the pink cloud syndrome 4 months later of soberity?

Representing Vegas!!!

W00t What up local!

Yea so the pink cloud your referring to sounds like that effect where sobriety is great and everything is easy the person isn't really taking the whole recovery thing seriously.

The good news is that pink cloud always - ALWAYS - goes away and at that point the person is left with their resources. Do they keep up with a sponsor, do they attend meetings, are they keeping regular with therapy/group/programming, are they reading their affirmative texts like "Just for Today" - I encourage you to ask your husband what resources he utilizes every week in his sobriety and encourage that as much as you can.

Ever think about getting Robin Lehner on your podcast?

If any of the Vegas Golden Knights would like to be on Pod Therapy we would absolutely welcome that.

The offer however does not apply to any person remotely affiliated with the San Jose Sharks, LA Kings, or Capitals.

How do you deal with a severe narcissist? My gf and I live next door to her mother, who is by far the most self-absorbed person I’ve ever met and can be quite mentally abusive at times. Based on our limited research, we suspect she also has histrionic personality disorder, but as with most narcissists, is completely ignorant to her conditions and believes (or tries to convince herself) that she’s absolutely perfect in every way. She scoffs at the idea of therapy, is there anything we can do?

So first - as a general rule I am anti mother in law. This almost counts so I feel you.

Second, arrogance and an inability to recognize our own wrongfulness is toxic and the pungent smell pushes people away. Its a lonely road to be so stubborn and I get your frustration in the situation.

I do have some nuanced thoughts about Narcissistic PD and Sociopathic diagnoses, you can listen here: https://podtherapy.net/post/184430183683/69-psychopathy-narcissism-machiavellianism

Third, sometimes you can get a person to start going to therapy by telling them you'd like to go as a family. Or she and her daughter can go. Its opens the door to the relationship and the therapist eventually has enough rapport to suggest doing some individual sessions along side the family work, which can really generate some momentum toward personal recognition of bad patterns and change.

I applaud the work that you are doing. Throughout the years spent wandering this world I have watched as many friends and acquaintances have decided that it would be less painful to leave this life than to endure any longer. I miss them all and often spend time with them through the memories that I have retained of the time that we spent in each other's company. How does our current society and culture need to change in order to identify those at risk and to promote the idea that it is the struggle to overcome and understand the depression and hopelesness that in the end help us to grow and be capable of moving forward?

I believe that one if the answers lies in our failed education system and the people that are chosen to teach our children a failed curriculum that has no allowances for empathy and tolerance. I don't know, but believe that it is one of the responsibilities of all of mankind's different peoples to help in promoting these ideas of love and the acceptance of things we don't understand.

You hit the nail on the head. Mental Health awareness and skill building needs to start in childhood, and honestly it should be required curriculum.

I have hope for society. Culture is starting to take mental health seriously and be kinder to one another. Our podcast is evidence that the world's appetite for the topic is growing.

We have lots of episodes on depression work, here is one: https://podtherapy.net/post/173983459838/20-atheism-vs-mothers-day-depression-rx-chaos

I am struggling with a pain syndrome, and is therefore depressed. I do see a therapist, but because of the pain and that there is no real way to handle it, or cure it, it has been impossible to make any progress with the depression. Any tips?

Im glad you asked this. Chronic pain makes everything more complicated because its both physical and emotional. That absolutely amplifies depression. Besides having a good treatment team including a pain specialist in your life, you might consider reading my friend Mel Pohl's book "A Day Without Pain" https://www.amazon.com/Day-without-Pain-Mel-Pohl/dp/1936290626

I worked along side him for years in a chronic pain addiction clinic and I have seen amazing results from his methods.

What’s the best way to get therapy right now without insurance? I feel trapped if I look up mental health through my insurance as it will be documented and may come back to my employer. My life insurance policy tripled due to mental health treatment and I’m worried it may impact my work status too.

This is something they get asked all the time. In fact, there is at least one other people here asking the same question. There are many clients that choose to pay out of pocket just for the peace of mind that their employer has no knowledge. In Episode #56 they specifically address Employee Privacy.

#56: Coping Skills, Distance Relationships, Employee Privacy

https://podtherapy.net/post/182265118063/56-coping-skills-distance-relationships

Yes! This was the episode I was looking for! Great memory man!

Are you on Spotify???

Yup https://open.spotify.com/show/5cQrvuOT3yXZRGoVWP92h6

You mentioned mindfulness in one of your comments - I've been taught mindfulness by more than one therapist and it never helped, try though I might, and they never tried anything different when I told them it didn't really have any kind of useful effect on me or help me at all. Is this a failing on my part to learn it? Or are there people for whom mindfulness just does not work/help?

You didn't fail. It doesn't fit for everybody. For some people they don't benefit from "clearing" their mind as much as they would from "steering" their mind. In you're case I'd recommend looking into guided meditation (if you dig meditation) or Cognitive Behavioral Therapy

How do you help someone who doesn't want to get help? I know someone who is not well but refuses to see a therapist..

Great question. We have had a bunch of questions on this one over time so I know its something a lot of people relate to.

Self care is first - We have to remember we didn't cause it, we can't control it, we can't cure it. Its important we dont slip into personalizing somebody else's pain.

Second - sometimes we have leverage and can nudge a person toward help by setting boundaries with them and making it clear what our expectations are.

Third - Sometimes we have no leverage whatsoever. Part of the reason we created our show was to give people a taste of what talking to a therapist is like. Maybe you could find an episode that might resonate with the person and share it with them. That drip-drip-drip of a positive message can sometimes loosen them up and make them willing to try something new.

What's a gentle way to introduce an older family member to therapy who never really had any healthy emotional development?

Buy them "Maybe you should talk to someone" by Lori Gottlieb!

Do you have any tips for OCD? My bf has OCD and I have GAD. We are planning to tie the knot. Will our kids have the same problems?

Howdy!

First - I have a family member with OCD, so I feel your relationship with your boyfriend.

Second - I have GAD, so I feel you there too.

Third - No, children are not destined to have either thing, except that what we do not transform we transmit, so if you guys don't learn how to cope with your stuff the kids might inherit it as a pattern.

Fourth - We cover this topic a bit here: https://podtherapy.net/post/174205923043/21-marijuana-ocd-irrational-jealousy