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

I'm 32, an attorney, couple other worthless degrees in the mix, I'm fit, I'm tall, im told I'm attractive, and I'm motherfucking miserable.

I've been in and out of therapy for almost 20 years since my parents split and decade-long divorce began in 8th grade. I've tried everything I was recommended. I've taken dozens of different pills for generalized anxiety, depression, and PTSD, to seemingly no effect.

What would you do next? We just ended things w my last therapist because they concluded she wasn't equipped to continue to treat me. I liked her a lot, but our sessions, like literally all therapeutic sessions I've had, were not really productive. As you know, therapy can't change the problem, the IRL problem you've come to see the professional for help with. You guys can't sit with a patient and magically change the immutable. I am completely unfunctional at this point though, with worsening daily symptoms of anger, paranoia, and suicidality.

I don't know where to turn to. Nobody has any answer save "go talk to someone about it" and of course the ever so helpful "what have you got to be sad about, grow up, man up".

I dont want to die but this will kill me one day.

Hi there, a few points in response to your post.

1. Re: Stalled Treatment - The big picture you seem to be describing is what we call "treatment resistant" symptoms. Its when a person has tried all that is recommended (therapy, medication, etc) but despite managing their symptoms they don't see much success overall. This can be exhausting for you and the Clinicians, as we want to see you get better too. When this happens I usually tell the patient that I want to take a "kitchen sink" approach, really becoming open minded to throwing everything we can at the problem. Changing up medications (with the supervision of a Psychiatrist), making significant life changes, and changing some of our therapeutic focus. The key from your perspective is to be willing to keep going through the stagnation, and being willing to try new things even if they seem like they won't be valuable.
2. Re: What Therapists Can Do - I actually think Therapists are a big part of fixing the IRL problem, though I know what you mean that we can't reach into your life and touch the presenting issue ourselves. I also believe that humans can and do change (or I'm in the wrong damn business) and that you too are experiencing incremental and sporadic change as you go through therapy. Sometimes what we are doing in therapy is managing, stretching, like doing a weekly emotional yoga session. If a therapist can't dislodge the other problems in a persons life at least we can help them cope with their troubles, which is itself extremely valuable.
3. Re: Suggestions - I'd hate to just spam you with treatment suggestions, but I'll be brief. First, dont give up. Never give up. Even if you are just managing, that is success. Even if you are just slowing the symptoms down, that is success. Know that you are making progress, even if that is invisible. If your therapist says they can't work with you that can be for a variety of reasons, sometimes insurance, sometimes they don't feel qualified. That's ok. Just ask them for referrals and follow up with a new therapist. Your job is to keep trying, keep doing, keep going, no matter what. I also encourage you to look into support groups with your local NAMI Chapter, and you might also want to look into EMDR work for trauma.

Why do so many mental health providers insist on group therapy participation, regardless of diagnosis or inclination? How come refusal to participate in group therapy is so often perceived as antagonistic?

Also, what are the things you look for when doing intake? Or when you greet a regular patient?

What is your perspective on personality disorders vs trauma responses?

Have you learnt anything profound about society as a whole in your work?

Hi there! Thanks so much for supporting us! A few thoughts:

1. Re: Group Therapy - Depending on the situation, therapists like group therapy for a variety of reasons. The power of a peer to reveal our own attitudes, biases, and blindspots is so important to a person's ability to grow. A peer can say things you relate to that you might never hear from a therapist, and watching a peer find success in their own work might inspire you to imitate them which is great. But to be clear, group therapy is not something we recommend for every single thing, its something that is very useful for certain conditions. Refusal to participate is normally seen as against clinical advice if you are in a program (drug/alcohol rehab, psych hospital, intensive outpatient, etc). That is because at those levels group is considered a higher level intervention and if you refuse and opt instead for a lower level (like one on one therapy) it is sort of you declining the care that your team believes is in your best interest. There are lots of reasons for why group is often a higher level of care, mostly it has to do with the time we spend with you and the information we can share with you, along with accountability. But I totally understand your point, group can often feel redundant and it is greatly influenced by the participation of its members. That can make it a really difficult experience to control and keep high quality.
2. Re: Intake - When we do intake sessions we are typically looking for a lot of things. Firstly, our take away goal is to understand you. To begin the process of getting you. We want to get a feel for how you think, what matters to you, how you see your life and your situation, what you've been through, and what you want to see going forward. More specifically we are also looking for (a) the presenting problem (b) the history of this problem in your life (c) other issues that are important to know about like life trauma, medical issues, other mental health issues, (d) your history of health care experiences to date (e) your family history and what you grew up in (f) your life presently, who you live with, your relationships, your job (g) other relevant details as they arise. Some therapists are formulaic in their intake sessions, asking about all the above in a straightforward way. I prefer a conversational style. My patients usually don't even realize I have a list of things I'm looking for, I like to just make it a getting to know you conversation and gather the details naturally.
3. Re: Personality Disorders - I'm touchy about PDs because I believe more often than not they end a conversation rather than opening one. Declaring somebody to have Narcissistic Personality Disorder or Borderline Personality Disorder can sometimes put a label on them that doesn't help. The connection between trauma and the development of these PDs is well known, and I'm more often interested in addressing the traumatic underpinnings than labeling the relationship styles they find themselves in.
4. Re: Society Insights - Yes, being a therapist has given me a private viewing window into the inner feelings of our species. Humans are basically good. Their intentions are good, their motivations are good, they generally mean well. Humans are also basically selfish, which is not in and of itself immoral. They tend to make choices that feel good and avoid things that hurt, often that can confound the people around them and cause all types of trouble. When humans develop good insight into their patterns, they tend to use that information to grow. Being a therapist causes me to see global political struggles very differently, and I have a nuanced view of society in general.

How does one conquer the seeming impossibility of actually getting a therapist?

I know what resources are available to me (in that I have access to Psychology Today and a list of therapists my insurance would cover, which are not the same list and requires manual cross-indexing). However there are still hundreds of therapists with all sorts of different qualifications. Dealing with that amount of information and choice is incredibly overwhelming, attempting to go through the lists is exhausting, on like... a deep level. It doesn't help that I'm possibly depressed - so motivation is difficult - and one of the problems I want to look seriously into is whether I have ADHD, and if I do, this sort of task is exactly what I am least suited to successfully accomplish by myself. I also feel way, way too emotionally attached/involved/something to each attempt to contact a therapist - I'd tried it twice, and never got a response, and it was acutely painful in a way I am having real trouble facing again. But I can't ask other people to 'find a therapist for me.' What am I supposed to do? It's been many months

Hi Bobusdoleus,

I agree with Anglo_Dreams in saying "Getting started is far better than getting it perfect..."

You made a really good observation in stating that if you have ADHD, this task is particularly complicated. I would add, so would having depression (or any other mental health disorder). Having a disorder is characterized by how it effects your level of functioning, and going through the steps of finding a therapist requires a certain level of functioning. The whole thing seems paradoxical, but remember, we don't need perfect right now, we just need to start. :)

Where may one find access to therapy that is low cost or free? Some of us were hit hard by pandemic and are not able to start or continue therapy.

GREAT Question - I suspect we will hear that one alot today. Here are some suggestions for finding a therapist:

1. Start by contacting your insurance (website or phone) and asking for the list of mental health providers in your area. These are usually covered so they shouldn't cost you much.
2. Google, Yelp, or use Psychology Today to find therapists in your area. Don't be intimidated by their prices, if you see the phrase "sliding scale" that means they will lower their fees for you if you need support. Don't be afraid to reach out to a therapist you like and ask if they have a sliding fee scale for those with financial need. But I encourage you to also explain why you like that therapist and want to work with them specifically. They are humans afterall, and if they feel a connection to you they are more inclined to make it work for you.
3. Look into your local College or University. Therapists have to provide free therapy to the community while they are graduate students, and these therapists-in-training and usually quite qualified to be helpful to you. Almost every school has a free community counseling program attached to their graduate depts.
4. Contact your local NAMI Chapter and ask about resources, they will have a list ready to send you.
5. If you live away from larger cities consider searching in cities around your state. During the pandemic therapists adopted telehealth tech and now almost all of us are available to everybody in our state via Zoom. Broaden your search to include the whole state.
6. Lastly there are services like Betterhelp, Talk Space, etc. They can be really useful and very affordable. I have my issues with these companies, which I'm sure would go away if they decided to sponsor our show (give us money Better help, I can be bribed). But they exist and have helped a lot of people.

Hello! I also posted this.

Hey, guys! Excited for this year’s AMA! Just wanna start off by thanking you guys for the incredible work you do; my life has definitely changed since I found your podcast! So I have a couple questions:

1. Recently, I discovered (with the help of my therapist) that I have issues with codependency. She recommended working from the bottom up, becoming emotionally unavailable in my relationships, and slowly working to be more present in them without feeling the need to solve someone’s problems in order to feel content. I was a little hesitant at first but I gave it a go. I started sensing the strategy straining my relationships and I tried to speak to my therapist about it, but she dismissed my thought cycles as being rooted in a need to gain attention. She soon stopped attending my calls and I haven’t been able to set an appointment in over a month. I feel kinda lost with this tool because I can’t seem to navigate it on my own. Any advice on dealing with codependency and whether or not this really is a good strategy would be great.

2. On a related note, some of my relationships are predicated on shared trauma; I also discovered that one of the ways I can effectively deal with that trauma is to compartmentalize and take away it’s power by placing it in the past and finding healthier ways of moving forward. My friend, however, feels like I’m pulling away because I don’t find our usual routine of trauma validation healthy anymore. I try my best to be there for them but I can tell it doesn’t help my friend. I don’t want to be someone who puts their needs over others and I really want to help them. I would love some tips on how I can be there for my friend without compromising my mental health.

Thanks again for everything you guys do! You are awesome!

Hey! Thanks so much for listening and supporting us!

1. Re: Therapist Ghosting You - So, first it sounds like you were willing to follow their advice and bumped into some of the difficulties that come with redesigning your relationships (boundary setting, changing your emotional proximity). That is to be expected to some extent. I'm sorry that the therapist appears to have drifted away. I would caution you not to feel that is a personal attack. Therapists, like all healthcare professionals, get pulled in a variety of directions and unless somebody is regularly in our office its hard to bring our mind to their case with consistency. If you aren't able to get back in touch though (its been a month afterall) you should start looking for a new therapist as your original one may be going through some personal situation and discontinuing their practice. There are many great books on working through codependency, most of them tend to reference having an addicted family member which you may not relate to. There is also a support group, Codependents Anonymous, that has great resources.
2. Re: Shared Trauma - Part of your internal boundary setting is knowing what type of content or information is healthy vs triggering for you. Navigating that balance between empathy and toxicity is a process you will likely be doing for some time. I would challenge you not to embrace a feeling of shame (this is classic codependent thinking) but rather reframing your position as standing on the edge of the quick sand willing to pull people out of it and not climbing in yourself.

How are you guys doing?

I'm good thanks. I need another cup of coffee but otherwise ok. I get really pumped for Reddit AMA day but also super nervous. I don't like leaving questions on the board for too long because I really want people to feel seen and supported. Sometimes I get anxious while I'm typing my reply that I'm not going fast enough and maybe the question writer is disappointed. So that sucks.

But, as you'll learn on the show, I have all sorts of fun neurotic tendencies that I get to work though every day. I'll be ok, we all will. =)

Thanks for the mods for helping us sort out the malfunction on our first post a few minutes ago. If you asked a question on the now removed thread please repost here.

u/Physics_Hot asked us how to become a therapist and whether they needed to go back to school for a Psychology degree. Here was our answer:

Hi there! Glad you're looking into joining the profession! So here is usually the way to do things:

(1) Consider what State you want to practice in. Go to that State's Board of Examiners website for any of the Therapy disciplines (Social Workers, Marriage and Family Therapists, Professional Counselors, Psychologists, etc). Look up the requirements for a license. Identify what kind of degrees will qualify, what certifications a university must have, and precisely what classes the state wants to see.

(2) Go shopping for a grad school that meets the qualifications you just learned about. Look into that school's qualification requirements. Usually they want to see an undergrad in a humanities discipline, but most schools aren't very restrictive. Some require you to take the GRE as a prerequisite, but if you look around you shouldn't have any trouble getting in with a Pre Law major.

(3) Make your plan, submit your grad applications, and then get started!

Some disciplines require specific Masters Degrees (for example, a Marriage and Family Therapy license will require a Marriage and Family Therapy Masters degree) but if you look around at grad schools you shouldn't have too much trouble finding a program for you. BUT MAKE SURE IT MEETS YOUR STATE QUALIFICATIONS. There is no greater mistake than just signing up for school and then finding out later that your degree doesn't count.

Since this is Mental Health Awareness Month, I would like to ask how can we, people who are not in the profession of mental health, contribute to the cause? What is the best way to encourage dialogue about mental health in our daily lives?

What a fantastic question! :)

Being an advocate is always one of the best ways to contribute. You don't need to be a mental health specialist or an expert in the subject matter in any way. All that is needed is a willingness to talk openly and honestly about mental health. Send the message to others that mental health should be as easily discussed as heart disease, a broken leg, or any other health condition. Reposting pro-mental health messages on social media and sharing your own experiences can be a great way to send the message that it's okay to not be okay, and it's okay to talk about that.

Secondly, be supportive of others. Be compassionate and empathetic. Be a good listener. Thank people for being willing to open up and talk about what's going on in their lives.

Lastly, contributing to this thread is a great start. ;)

-Nick

I have an unhealthy fascination with death. Specifically the deaths of innocent people or civilians. Whenever a topic reminds me of a country’s military, or I see a PG movie that shows obvious mass destruction I can’t stop thinking about people dying and how they might have been killed and how their families might be feeling, or if they’ll even be able to have closure or catharsis.

I still get mad about how little the US’s drone warfare is mentioned in the news.

How do I ignore these thoughts?

Hi there, thanks for supporting us today!

So, first, it sounds like these thoughts bother you because you don't want to fixate on them. Being aware of tragedy is one thing, but obsessing or ruminating over it is another.

Thought stopping and rumination extinction are things that a therapist would be really helpful in working with you on. Mindfulness training in particular can be a useful basket of techniques to free you from the cycle of sad thoughts.

Ignoring scary things isn't always possible. But giving ourselves permission to see the problem, mourn the problem, and then move beyond the problem is a process that can give us a sense of peace. Maybe consider a discussion group or place to process these thoughts out loud with others, or an online forum to discuss. Focus on your emotional reactions to the news rather than just the news itself. Sometimes that can give you the freedom to place these thoughts on the table and walk toward others from time to time.

Above all, consider therapy. Vicarious trauma is a condition where we are traumatized secondarily by learning about things that happened to others. It is a very real condition that therapists must guard against for our own mental health. I strongly suggest sitting with a therapist to review some of these thoughts, you may be experiencing vicarious trauma.

How do you deal with social anxiety effectively?

Hi there! Thanks for supporting us today!

First, social anxiety (and anxiety generally) are the most common disorders in all of mental health. In fact, as Jerry Seinfeld once noted, the biggest fear in America is public speaking, the second is DEATH. So if people have to be at a funeral they'd rather be in the casket than delivering the eulogy - bah zing!.

Anyway I usually use cognitive behavioral therapy to help with social anxiety (and all anxiety for that matter) Its a method where we identify some of the perspective errors that are happening which tell the brain that the situation is dangerous, or causes us to worst-case or castrophize or mind read or any other number of cognitive distortions (false perspectives) that our brain does when we aren't paying attention. The good news is social anxiety is treatable! You won't exactly change into the worlds biggest extrovert, you still have to be who you are and that's a good thing, but we want you to also live your life without too much discomfort, especially if that is caused but untrue interpretations of the world around you or other people.

u/TomKSFW Asked:

Hey guys!

1. You've been doing your podcast for a while now; has there ever been a question that you decided to not read on the air due to it being dubious in nature (e.g. you figure it was not a true story or real question)? On the other side of that, have you ever answered a question to which the story seemed dubious, but it was still valuable for you to answer?
2. What's the weirdest thing Jacob has thrown at Jim?
3. Jim, wanna plug your book?

Thanks Tom! So...

1. For the most part we read almost every question we receive (eventually). Sometimes we get a question that is too poorly written to understand and we have to ask the person to resubmit. Sometimes we have gotten questions that are much longer than is realistic so we edit them down. Im pretty sure we haven't ever thrown one away, we put some on the bench for a while but never throw them away.
2. Jacob (our audio guy) throws poker chips at me (Jim) whenever he feels the urge. God help me if he ever runs out because has many heavy sharp objects on his desk including a gigantic bowie knife.
3. Why thank you! Check out "Dadvice: 50 Fatherly Life Lessons", a book of advice from a Therapist Dad at www.DadViceBook.com

I (33M) start seeing a psychiatrist next week for the first time in my life after a traumatic and abusive childhood/teenaged years. It scares the living shit out of me. I hate opening up to people about my struggles, and feel like a burden when I do.

How do I overcome this with a therapist?

First - good for you that you are willing to do this work. Trauma therapy can be really intimidating, mostly because we often are so afraid of looking at those memories that the thought of doing so on purpose is paralyzing. But, the reality is that ignoring the past doesn't fix it. We just leave ourselves vulnerable to the interrupting effects of trauma in our daily lives. Being willing to get the help is a huge step forward for you.

Second - Just to clarify, a Psychiatrist is a medical doctor who prescribes medication, they very rarely do any therapy (and, to be honest, aren't trained to do therapy). A Therapist on the other hand is the person who sits with you to discuss your reality for an hour each session. Both professionals are useful in trauma therapy, and it sounds like you have a good team.

Finally - As you prepare to discuss this with your therapist you should know that you can tell the therapist if you are feeling too sensitive about particular topics, or are not ready to open some of those boxes yet. We completely understand and will guide you through a gentle way to talk about trauma without actually describing the trauma in the beginning.

i've noticed that if you tell people you're depressed, they will pester you constantly with clumsy attempts to help, then get frustrated that it's not an easy problem to solve, but then if you don't tell people, they just assume you're an asshole.
is there some way to tell people what you're dealing with just so that they understand that you're not going to be cheerful and pleasant, without letting them think it's their own personal challenge to undertake?

What an awesome question. So many people relate. I think you share it with them just as you've said it here. "Hey, I just want to share that I'm working through some depression in my life, I'm going to be ok, this isn't a cry for help, I just want you to know in case I seem sullen or stern that I'm still glad to be part of things and not upset or anything"

Hi. My husband (40) has a therapist and a psychiatrist for years. He, like a lot of people, has taken a down turn with all the covid changes.

I love him and try to support him the best I can. I feel like I'm not doing "enough" even though that's absurd. Can you recommend anything that's best practice for supporting someone who has a long term mental illness? Also maybe something for me to read to help deal with my own emotions about long term support of a partner?

Thank you for your time.

Hi Jofinaro!

A LOT of people are going through this right now. As a family member, it can be easy to feel like you're not doing enough, when in reality you're doing all you can do. Being a support person for someone with a mental health disorder is very challenging, and a role that often gets overlooked. Finding your own support is going to be vitally important. By getting help yourself, you're better able to help others.

Two things I would encourage you to think about are:

1. NAMI - The National Alliance on Mental Illness. They have resources and local chapters that you can access for support. https://www.nami.org/Your-Journey/Family-Members-and-Caregivers
2. Consider finding your own therapist. Being a long-term supporter takes it's toll. Having friends and family is great, but one of the great things about seeing a therapist is that you get to let all your stuff go without feeling like you're burdening others. You're paying for that hour, so why not let it all out and walk away feeling lighter.

Best of luck to you

What can I do?

Long story short:

Daughter is 11. Me and her mom split 10 years ago. Mom had remarried a couple years after. Had another kid. 5 years ago mom cheats on husband with a drug addict, gets pregnant by addict, gets caught up in crime, goes to jail. I've had full custody since.

She remarried again two years ago. Has a 4th kid last year. Mom has now completed 5 year probation and is clean.

My daughter has had a really hard time coping with what her mother did. She also has a hard time being at her mother's house the once month her mother reaches out to see her. My daughter identifies as a lesbian, her new husband is conservative. That causes issues. He also has a short temper and yells a lot at the toddler, he also gets frustrated with the baby.

According to my kid, her mom hypes up the visit and then sticks her babysitting the toddler and baby or is busy with the toddler and baby herself.

Her mother is extremely passive aggressive and manipulative. My daughter has told me how she cannot open up to her mom about their issues because her mom will make her feel guilty. She also feels like she cannot decline going to her mom's house when she asks, because her mom will make her feel guilty.

Last night I went to her room to tell her I ordered something for her room redecoration project and I found her crying, dreading to tell her mom she doesn't want to go see her this weekend because of the way her husband acted the last time she visited.

I talked with her about the importance of self care and sometimes doing things for your own health and wellbeing even if it makes someone else upset.

But honestly I don't know what else to do. She is still dealing the trauma of her mom going to jail 5 years ago and everything that came after.

My daughter and I have a really good relationship otherwise. Shes a good student, she does what's asked of her without a fight, she's appreciative of the things me and her step mom do for her, etc. Great kid all around.

I also don't have insurance at the moment, but as soon as I do (30 days, started a new job last month) she will be seeing a therapist again.

Wow, I'm so sorry you and your daughter are going through this. This is a lot for an 11 year old to go through.

First off, it sounds like you're doing an amazing job already. I know that as a parent you are going to hold yourself to an incredibly high standard and constantly wondering if you can be doing more for your child, but it seems like you're doing all you can.

This reminds me of a question we answered on the podcast recently (can't remember if it has aired yet), but it was about an older sibling that had moved out of a very unhealthy home, but was worried about the younger siblings still living there and what they can do. Similar to that situation, I think showing your daughter how much you love her, care for her, and will be there to support her is having a much larger impact than you realize.

A lot of people in your situation would be tempted to talk discouragingly to the child about the opposite parent. Even though some of the things being said may be true, it's not a helpful strategy in the long-term. What tends to happen is the child becomes defensive against the attacks, even if they actually agree, almost like an instinct to protect. It sounds like you've been able to avoid falling into that trap, so good job. The best thing to do instead, is to demonstrate what a healthy parent-child relationship looks like. Kids are really smart. She will be able to see the contrast without negativity being pointed out. BTW, healthy does not mean spoiling the child to become the child's favorite, it means healthy.

I love that you are making plans to get the child back into therapy, because that was going to be my suggestion. Children are resilient. You providing her a safe and loving home, and with therapy giving her a place to process what she is going through with a professional who can guide her in that process, is already a great step.

Hang in there.

Are you guys on spotify?

Spotify

Hell to the yea we are on Spotify

Why is change so hard for someone with anxiety/depression?

They feel hopeless. Anxiety is a very physical experience and it can feel as if they will always have it. Depression is like a weather system that the person lives in, and at some point they doubt there is anything else beyond gloom and rain.

Change happens when they can find a glimmer of optimism and the right helper with the right tools. It can take some effort to get the ball rolling, but people get better if they lean in and keep going.

Hello Jim & Nick (I’ll acknowledge Jacob)

I listen to your show every week and it has gotten me through some very turbulent parts of this pandemic. I cannot thank you enough for the impact you’ve had on my life, and of those who have been sent the link by me. I even have a copy of Dadvice!

Have you ever thought about doing a live episode in front of an audience once Covid has passed? A small US Tour or something would be so great, to be able to ask you questions in real time and meet you in person. I know, this has been unimaginable for the last 15+ months, but do you have any plans on taking Pod Therapy on the road? If not, I understand, as you are also full time therapists and dads.

Would love to! Financing it would be the challenge. If it was possible to even break even on that venture we'd do it in a heartbeat.

For right now Scoopfest 2022 will have to do. Sounds like we'll be doing something small there; haven't worked out any details yet, but fingers crossed.

...and don't acknowledge Jacob, it only encourages him. :)

I’m a police officer and know I need to talk to a therapist about not only what I see at work, but also personal issues I’d like to work through. How do I go about looking for a therapist?

So glad to hear this. I was asked to speak to at the state attorney general's conference a few years back to address burn-out with prosecuting attorneys, but it wasn't actually burn-out they were dealing with. It was Vicarious Trauma that wasn't being addressed. Being a first responder, you deal with trauma vicariously and directly. I'm glad you recognize it's impact.

A couple things. First, we typically encourage people to start by accessing their Employee Assistance Program through their work (people forget they have that). However, I know a lot of folks in the military who will avoid that because they fear that their employer has too much involvement if they use that option. I don't know if that's the same for police departments, but if you don't feel safe opening up in therapy, you're going to struggle with getting positive results. The next place I'd start would be with your insurance provider. They should be able to provide you with a list of therapists that are on their panel. The other option that some people will take is finding a therapist that they can pay cash and not go through insurance. Not everyone is able to do this, but sometimes it can be helpful. Whether you're looking at option 2 or 3, you can start at psychologytoday.com and look for a therapist in your area. Their profile should list what insurances they take or if they are cash pay.

The second think I want to advise you on is to make sure you are debriefing at work. Hopefully that is already happening, but if not, I'd recommend it. Even if you feel like the shift wasn't anything traumatic, talk about it anyway. Trauma becomes a problem because it doesn't get processed; like a document that doesn't get filed away. It just sits there on the desk and becomes a source of stress. Talking about what happened is the equivalent of your brain reading through that document, understanding what it means, and finding a home for it. Little stuff can add up.

I hope that helps. Thanks for all you do as a first responder!

How closely do you think mental health is related to gut health? Do you have any insights to share about that connection?

Actually way more overlap than people realize! We call the stomach "the second mind" and its behavior, chemistry and function correlates with mental health extremely closely. Nutritional health is a big part of mental health, and alot of the things our brain needs are made in the stomach. Neither of us is an expert about the connection, but we are very aware it exists.

One of my friends told me her depression and anxiety went away when she got a higher paying job and good health insurance.

I want that life.

What do we do in the meantime?

For real though! During the pandemic we did an episode where we discussed a study that revealed that giving money to people literally decreased their depression, especially among the suicidal. Depression isn't just a chemical imbalance or psychology issue, it is also an expression of our life situations and finance is a big part of that.

It bothers me when we diminish a human's depression to merely bad thinking. The existential dread of our species when confronting real life obstacles or situations we have minimal control over is really important. We can't always fix those things, but they need to be understood and identified.

In the meantime I suggest we focus on the things you do have direct control over. Doing "the next right thing" is a formula I give people when they have big goals and inner longings but need to focus on the next steps in the mean time. One day at a time, being authentic and in our truth, being grateful daily for what we do have and not overly focusing on what we don't is how we begin to make the life we have enough.

Victor Frankle, a holocaust survivor and author of "Mans Search for Meaning" spoke about the only thing he had control over while he was in the camps was his attitude. He saw that as the one fundamental freedom of man. It may sound trite, but its actually quite profound.

What did you think of Lori Gottlieb’s book “Maybe You Should Talk to Someone”?

You mean our close personal friend Lori Gottlieb? Maybe you should listen to our podcast ;) https://podtherapy.net/post/183765084518/65-nyt-bestselling-author-lori-gottlieb

Hello I am a 27 Year old woman with a graduate degree and a stable career. I am allegedly good looking (though im petite and often look way younger which is an insecurity) and fun to talk to but I see myself as having nothing to offer. I feel stuck on dating apps and trying to get myself out there to the point where I think I am trying to sabotage myself. I am finally getting out of the texting stage and when a guy asks me out I look at a profile make up some excuse as to why I’m not attracted to him then freeze the conversation. Also when I have seen men in the past I OBSESS over personal hygiene to the point of avoiding eating on dates so I don’t get gassy and avoiding water because I am terrified of peeing during sex even though this has never happened. How can I navigate all this so I don’t miss out on a good thing?

Hello, thanks for the question!

So this "getting in your head" or "psyching yourself out" is actually a really common expression of social anxiety. It sounds like maybe there is a little bit of imposter syndrome in there too - you don't see yourself as other people do and tend to discount your positives.

Having said that, I would encourage you to approach the problem with a series of tools that come from Cognitive Behavioral Therapy (CBT). This method works on the perspective you have and helps you notice what exaggerations or distortions you might be experiencing that don't really track with reality. It examines the meaning you give thoughts and helps you question that so you can get past them.

Also, as a rule I suggest ordering salad or soup on dates. Salad doesn't get cold so you can ignore it and continue the conversation, soup doesn't require chewing so you don't have to pause when talking. =)

In your professional opinion is suicide a symptom of mental illness?

So, let's define that real quick. Suicidal Ideation is when a person is thinking about ending their own lives, and we tend to think of that on a spectrum of severity. I like to use the Baseball Diamond to illustrate that continuum. First base is a person thinking about dying, but they don't know how they would do it and they don't have a plan. Second base, is when they are starting to think about practical ways of how they would end their life. Third base is when they are developing a plan, a where and when. Home plate is when they are acting on that plan, aka attempting Suicide.

Yes, suicidal ideation is a symptom of mental illness. However, that doesn't mean that the thought itself is particularly worrying. It is common among humans to have the thought at some point in their lives. In fact many of our species have the thought without even wanting to have it - these are called Intrusive Thoughts. So just because somebody has thought about suicide doesn't mean they have mental illness, but yes, suicidal ideation is a symptom of depression and generally something that needs to be addressed.

If you or somebody you know is struggling with suicidal ideation, please call or text the suicide hotline at 800-273-8255

Hi, my mom is a bat, can you help me Jim??

FYITF

Hi guys!

I've been a listener since your last AMA, and I love the podcast! On to the question.

I have a friend who is noncompliant in taking his medication. He had a manic episode last summer (moved out of his apartment, left grad school, broke up with his girlfriend, and then attempted suicide) which resulted in a psychiatric hospital stay and a treatment plan. He didn't keep seeing his psychiatrist long enough to get an official diagnosis, but they were thinking either bipolar or schizoaffective disorder.

Last fall, he began "tapering" off his medication (of his own volition, and way too fast) and is now totally unmedicated, with no professional help. He is living with his parents but has no job, no plans to finish his degree, and apparently just lies in bed all day.

His delusion specifically is that there is something wrong with his body. Last he said was that he is "tangled up in his skeleton". He believes he has an as-yet unseen disease that is slowly killing him. He sees doctors in the belief that he is a medical anomaly, but is frustrated that they "don't listen to him, as soon as they see mental health they try to get him to see a psychiatrist". No doctor has been able to corroborate anything he claims to be true.

My question is this: he's in so much pain. I'm willing to bet a considerable amount that his symptoms are the result of his untreated mental illness. But how, how, how do I help guide him towards seeking the mental help he desperately needs? He gets upset and angry if it's explicitly suggested to him. I am out of carrots, I am out of sticks. I just want my friend to feel better.

Thanks Dr. Jim and Mr. Nick, tell Jacob I said hi! You're great.

Hi there! Thanks for supporting us today!

So, first off the overlap between mental health and physical health is significant. Lots of people with anxiety are convinced they have a disease and frequently access unneeded healthcare. In your friend's case obviously this is more profound as he appears to be suffering with delusions as well as physical pain.

Many people with severe mental illnesses refuse treatment. They can often see the mental health support as minimizing of their larger concerns, as if they are being dismissed as "crazy" rather than validated. Chronic pain sufferers especially can get frustrated and dismissed.

Sometimes the first step to helping your friend is to validate at least their physical pain. I suggest pointing them toward Dr. Mel Pohl's book "A Day Without Pain" where he discusses his work in treating physical pain from medical and psychological perspectives. His work mostly focuses on opioid addiction, but your friend might find it relatable. You might also want to point him toward Fibromyalgia information, perhaps he will relate to that and from there realize there is value to allowing himself to have some mental health support.

All pain is emotional pain. Pain as a concept is a brain experience fundamentally. Knowing that doesn't dismiss the experience of pain, it broadens our understanding of it. Hopefully your friend finds the path toward help again by first feeling validated in their pain experience. But I'm sorry for your situation because I know it can feel powerless.

In a lot of situations I'm one of those friends that people go to talk about their problems and you guys have been a great way to learn about how to talk to them and giving suggestions. Any suggestions on when you should think about switching from friend who listens/gives advice to recommending seeking out professional help?

Its always ok to recommend therapy to friends, part of defeating the stigma (and the purpose of our show) is to humanize therapists so people don't see us as these white lab coat wearing weirdos. As often as you can normalize professional mental health helpers by talking about our show (also feel free to buy our swag) and if you do see a therapist yourself share about that with others and tell them about what you're working on and how good it is. Sharing your truth is the most powerful way to inspire others to get help for themselves.

How bad can untreated adult ADD effect your life? Should adults with ADD work with a life coach to help?

First, I'll just say that ADD is a mental health concern and I always prefer a qualified therapist for mental health issues.

Having said that life coaches, support groups, and literature can be extremely helpful for managing life long conditions like ADD/ADHD.

At the end of the day I encourage people use whatever works for them. Untreated ADD/ADHD can be frustrating because people wonder why they keep bumping into these unhelpful patterns, the more they learn about themselves and the more they access medicine and techniques that help the more successful they will be come.

How do you incorporate a client's faith beliefs?

We are big on respecting and utilizing an person's culture and life philosophy. If we speak that patient's faith language we try to blend that into the work to help translate key concepts so the patient will adapt them better. If we don't speak that faith language we try to learn from the patient as much as we can about how their faith influences them and then be conscious of that in our work. Some patients like to pray at the end of the session, most therapists are comfortable with that even if they aren't doing the praying. In the end, if its important to the patient its important to us.

Have you ever saved a life?

Yes. Mental health is the front line of healthcare. We are the ones curbing the opioid epidemic, the suicide epidemic, and fighting the fronts of domestic abuse, self harm, and the countless ways that human anguish lowers life expectancy.

Not to brag, but Superman aint got shit on me.

Except, ya know, muscles and powers and unreasonably beautiful bone structure.

Is there such a thing as too much therapy?

There are definitely times when it isn't doing much for you and its time to slow it down and stop altogether. Therapists are usually mindful of this and always trying to keep your goals in mind to guide our work. Never be afraid to ask your therapist if they feel you are doing the right amount of work with them, or if you should slow down or discontinue.

With the pervasiveness of the internet, there is a great deal more access to free porn than there was just a generation ago. How do you think this easy access to porn has affected the mental health of the general populace? How does "porn addiction" factor into this assessment?

First there is a debate in the mental health profession about the ideas of porn or sex addiction. We are on the side that anything that releases dopamine can become addicting, so yes, compulsive porn use is a thing.

Your right that the quantity and access to porn has effected the porn addiction phenomenon, the same way liquor stores and dispensaries result in an uptick in substance dependence.

How has it effected people? For starters I see a lot of men in their 20's and 30's who can't keep an erection during sex with their partner, or can't climax despite being physically healthy. This is because of the unique way porn rewires the sexual circuitry of the brain (see Your Brain on Porn on youtube)

I'm not saying porn is bad, it isn't. I'm saying it can have an effect on the brain, sexual chemistry, and expectations. It also happens to be responsible for the plummet in teenage pregnancy and birth rates generally, which is interesting too.

Here are some of our shows on the topic: https://podtherapy.net/search/porn

Hey guys! Thanks for doing this. Will definitely check out your podcast. I'm an LCSW myself. I'm curious as to y'all's thoughts on (in the private practice settings) insurance vs not accepting insurance?

It's been something I've struggled with (though I'm not in a private practice setting atm) throughout my brief career in the field so far (5 years post-MSW). On one hand going through insurance can be cheaper, but you have to provide a diagnosis, you have to provide some details in your case notes, so there's less confidentiality. I go through insurance to see my own therapist. It's hard because he doesn't really have a formal diagnosis for me - I use my therapist for maintenance after shitty days/weeks in the field and I love it. But he has to provide a diagnosis for insurance to accept the claim. Iirc I'm diagnosed as Unspecified Anxiety Disorder. My co-pay per session is about $30. Which is great.

On the other hand, not accepting insurance means you can have complete confidentiality in your case notes. But some of the rates in the area I live in are just fucking outrageous. I'm in the DC Metro area and it's not surprising to see rates of $150-200+ per individual session. For me, personally, that's ludicrous. I try to be non-judgmental about rates like that because people need to make money and some of my colleagues/friends have rates like that. I know a lot more goes into it than just the rate. You have to think about leasing space, office costs, etc. So I know I'm simplifying it. But still....those rates baffle me.

Thanks for your time! Looking forward to this podcast.

Hey friend! Always great to meet a colleague! Thanks for supporting us today!

So I (Jim) am cash-pay private practice. I have really strong thoughts on this topic, so I'll try to be brief because I will easily get swept down a rabbit hole on this issue.

Re: Insurance - I hate it. I hate that they require a diagnosis, I hate that they require constant reminders of why the patient qualifies. I hate having to call their stupid provider lines and wait on hold just to get paid. I hate that they don't pay for months at a time. I hate that they don't pay enough to be in compliance with Mental Health Parity law. I hate that they deny claims. I hate that they dictate treatment. I hate that they are nosey and unprofessional. I hate that I have to convince some unqualified phone jockey that a patient needs help when I the expert have decided that they do.

Re: Cash Pay - I like it. I like that the patient gets to chose for themselves why they want help and when. I like the privacy. I like getting paid on time so I can pay my mortgage and buy groceries. I like the incentive it gives me as a therapist to do great work and develop a great reputation. I like that I get rewarded for being good at the profession and trying hard to give my patients what they need. But I hate the costs.

Re: My practice- In my area (Las Vegas) there are interns charging $125 an hour. Its not wrong, I want people to get paid. But it makes me feel uneasy because I don't just want to serve the upper middle class and above. I keep my rates at $100, despite doctoral level therapists charging $200+. I don't charge more for intakes or couples sessions. I do this because for now its congruent with my beliefs and it allows me to pay my bills. The average private practice therapist has a caseload of 10-15 patients per week. I have, on average, 30-35. I work 6 days a week. I could charge more and work less, and one day I might make that choice for my family. But for now, I have work to do, and I intend to do it. Being in private practice means I get to make that choice according to my values, taking insurance means I play by their rules. Fuck those guys I do want I want.

I had a coworker (long ago in the Old Century) who had a sign on his desk that read I is knot dain bramaged. The obvious joke being that he pretended he was.

Now of course people who suffer from dyxltia dizlectrica dyslexia have trouble reading, but how come they also have trouble writing?

Hi there! My understanding of Dyslexia is that it affects the way the brain decodes information, which means it primarily effects reading. Dysgraphia is the term we use to describe disorganized writing similar to how dyslexia effects reading. In the end people with those decoding/recoding issues can train themselves to slow things down and work through the challenge, many overcome the problem successfully but benefit from catching it early and getting into Special Education. Thanks for the question!

Hello! I have a significant other in my life who has been a therapist for a few years. It seems that the hardest thing for us to communicate about and for me to "be there" for, is when a high risk client of hers commits suicide after being a client for a longer period of time.

I'm wondering if you can help me find the words to help release the feeling of burden she has when a client dies by their own hand. I've tried to research this but it's not easy and I'm always positive that my so still feels some personal responsibility and deep sadness that I can't seem to help with or lessen....

Thanks in advance. Anything would help?

I get it. Its hard to support therapists because our experience is so unique. Sometimes listening to us talk about it is all you can do, sometimes encouraging us to talk to a therapist ourselves is helpful to. Like dentists can't drill their own teeth, therapists can't repair their own internal wounds, we have to work with another to help us.

For our patrons I do a series called Jim's Journal. Last year when a patient of mine killed himself I posted a recording to reflect on it the day it happened. Maybe you could share it with your SO, sometimes relating to another person who gets you is healing. https://www.patreon.com/posts/jims-journal-34636112

Stairway to heaven or free bird?

Finally, we get to the important stuff. I gotta go with Free Bird.

are you proud to be therapists?

Proud is a strong word. I think we are satisfied. Its a good profession and uniquely fulfilling every day. I'll be proud when Oprah calls me to replace Dr. Phil.

What are your thoughts on Selective sound sensitivity syndrome aka misophonia?

Glad you asked: https://podtherapy.net/post/184593064718/70-mental-health-month-first-therapy-session

Stumbled upon this and am so happy I have! I struggle with no motivation and energy. I can make to do lists and reward myself with every little thing I accomplish, but I always end up regressing and end up hating myself even more. Are there certain techniques that I could do to actually keep a habit and progress my life? I'm looking into habit tracking apps, but I know I'll just stop using them too.

Hi! Great question.

I've struggled with this myself. For me it has always been an issue of momentum. I would start, but couldn't keep actively moving. Like trying to pull something behind me through the mud. Never any traction.

First off, we need to stop beating ourselves up for it. There are A LOT of us out there. If we hate ourselves for this, we're just going to end up hating a lot of people. We're going to trip and fall, and that's okay. I like to remind myself that everyone falls, I need to give myself credit for getting back up.

Next, be careful comparing yourself to others on social media. FB, Twitter, Instagram have given us very distorted views of reality. We see how other people are doing and staying motivated and accomplishing their goals, and then we get depressed. But that's all distorted information. They only post accomplishments. Never compare your struggles to other people's highlight reel.

Also, for me, I realized that a lot of my challenges to do with not being specific and measurable with my objectives. I would have an idea of what the end result was (goal), but my objectives (the steps I take to get there) were very vague and and subjective. Be very black and white when creating these steps. You either completed it or you didn't; no ambiguity.

Lastly, I hate to say this because I always got so annoyed with others when they would tell me this, but.... write it down. Actually put it down on paper. It works.

I hope something out of all this was helpful for you. Best of luck!

Hi Nick and Jim, I (22F) have been struggling a lot in my relationship with my bf (23M) due to lack of erotic and general intimacy. We moved in together last May, and our sex life was great and he was very affectionate for the first 6 months. Afterwards, it all dropped off a cliff, and we hardly share any intimacy at all anymore. Every time I broach the subject, I am often faced with stonewalling, snide comments about my high sex drive (ie. why is it so important? It shouldn’t make or break the relationship, if I have sex toys then why don’t I just use those, etc). I feel like he has a lot of insecurity due to his low libido, and he has said as much to me that he worries about how unsatisfied I am sexually.

I will admit, when things first dropped off, I didn’t handle it the best. I would retreat into myself, and would very openly display how much the rejection hurt. It has been a huge blow to my self-esteem, but I have been trying to not let it get to me so much. I don’t react like that anymore, and try to just let him come to me, but that’s once maybe every 1-2 months if I’m lucky. When we do have sex, it lacks passion on his part, and it has led me to feel extremely unattractive.

To try to temporarily bridge the gap in my sexual dissatisfaction, I had turned to masturbation to try to keep my sex drive satisfied, but it doesn’t scratch the itch quite the same. Without the emotional intimacy that is tied to it, I feel really unenthused about sexual pleasure, and it has gotten to the point where I can no longer orgasm. Masturbation would make me feel so sad afterwards, because it seemed to just reinforce how unwanted I feel, and how much I miss how our relationship used to be. So I started fantasizing about women instead of our past sex life (I’m bisexual and lean towards female attraction), but that made me feel so guilty. As a result, I think I Pavlov-ed myself into having an aversion to sexual stimulation in general because it stirs up negative feelings every time now.

This has now stemmed into when we have sex, as I struggle to become physically aroused, and I often think resentful thoughts about how lackluster our erotic side of our relationship is.

A couple of caveats/special considerations: he nearly lost his business due to Covid-19, so he has been under immense pressure. He is also on Prozac for depression, and has been since he was a teen, and has struggled with high blood pressure due to weight gain from the pandemic. Meanwhile, I am a date rape survivor and struggle with depression and anxiety as well, and am medicated. The sickest part is I feel so bitter that my rapist wanted me, but my boyfriend doesn’t seem to. I know it’s a twisted way to think, but I feel it might just be the resentment talking.

He has also been exceedingly withdrawn, and snappy. I have quite a few personal insecurities that have developed due to his behavior, including feeling like I talk too much, that I can’t sing when I’m around him, and feel like I cannot out my needs at the forefront ever. However, we have recently had some more productive conversations about these topics after I called him out on his hostility during confrontation, and these aspects have started getting a bit better the past month.

I used to be this bubbly, confident woman who was very comfortable with her body and sexuality, and I don’t even recognize who I am now. How do I cope? And how can I try to bring about positive change for our erotic intimacy, and reestablish my own positive relationship concerning sexual activity? I’ve felt like I’m drowning from this. I feel like I can’t really even trust when he says he loves me, because his rapport for illustrating this feeling with words and actions have been counteractive. Help!

I really appreciate this question. Sexual mis match is very common in relationships and it can cause things to stagnate as well as lead to resentment, hurt feelings and internal confusion.

I want to offer a lot of feedback to this question, but I'll say that I highly recommend the book "Mating in Captivity" by Esther Perel. She does a great job of breaking down sexual disconnection and offering real strategies to get back into a mutually satisfying place.

Having said that I think you might also benefit from doing some couples therapy. While sex may have been the cause of some of this, there appear to now be some underlying communication hostilities and issues that might benefit from a more direct therapeutic approach.

How do you manage self sabotage? Particularly when you are aware you are doing it

Developing awareness is really the first step toward fixing it. Insight building is a big part of what therapists try to do in session, we are trying to replay the game tape of your life and see if together we can notice unconscious patterns you do so we can interrupt those next time.

Once you develop awareness of your self destructive patterns the next step is to plot how you will interfere with the conditions that cause those patterns to happen. We call these counter measures. Begin deploying those when you notice the warning signs of your self sabotage behavior and will avoid your normal mistakes.

Why is therapy not only incredibly expensive but often must be paid out of pocket?

I've read a number of articles by therapists who explain why they don't like working with insurance - plenty of totally good reasons - but almost every therapist in my area is $200+ per hour. I gave up after months of looking for one with my (extremely good) insurance - as soon as I resigned myself to paying out of pocket I had my pick of a million good therapists (and found an excellent one).

But I still resent the cost. I hear their arguments that they go to school for a long time and need to recoup that money, but that's $400,000+ a year. I just don't buy these articles about how that's necessary to "make a living." Makes me think of politicians and other high earners who say "[astronomical salary] isn't that much these days."

Surely you can sense my anger here, but can you speak to this?

Yeah, totally understand your frustration.

I can't speak for every place in the world, but for many therapists it's not that they don't like working with insurance, but that they can't get paneled with insurance. Mental health parity laws state that insurance companies must panel mh providers, but it doesn't say how many in proportion with the population. ABC Insurance company can say "XYZ Mental Health Clinic is our mental health provider. If you are using our insurance, you need to schedule with them." The person calls to make an appointment only to find out it's 4 months before they can get in to see someone. That clinic is overwhelmed and clearly not able to meet the needs of the community. So another mental health provider contacts the insurance company to get on their panel and the insurance company says, "we already have a mental health provider, we're not taking any more." There's no incentive for them to panel more than the minimum. Those therapists will often turn to cash pay because it's the only way they can survive.

$200 an hour seems like a lot. It could be where you're at as well; I know a lot of therapists that charge closer to $100/hr in the Las Vegas area. You also have to factor in whether this therapist is strictly private practice or working in a clinic of private practice clinicians. Those have different costs that the clinician is responsible for.

$400,000 is a lot of money. However, that is assuming that the therapist is seeing 40 clients a week. I don't know any that are able to do that. The busiest therapists I know will be seeing 30, but most are closer to 20 a week. Forty hours of direct care leaves no time for clinical documentation, which is vitally important if you want to protect yourself in a lawsuit. And then we need to factor in professional liability insurance.

Another nice thing about being paneled with insurance is that they will send you clients. If you're cash-pay, you're now in charge of marketing yourself, which has it's expenses. If you have your own office you're paying rent for that, or if you're part of an independent therapy group, you're having to pay into that.

We shouldn't have as many cash-pay providers as we do, but the system is broken.

A few years back I was going through some stuff and I wanted to see a therapist for myself. I ended up paying out of pocket as well. I totally agree, it is expensive and it sucks. However, I see it on the other end too, and I'm just not seeing anyone getting rich doing this. If a high school student asks me about a career that will be financially rewarding, I'd push them into banking, law, or nursing. I've NEVER heard anyone say, "Get your Master's in Social Work, that's where the money's at!"

Don't get me wrong. I'm not complaining that we are suffering and 'poor us.' We all knew what we were getting into. You can make a fine living in this field. But from the inside, I just don't see anyone getting rich doing this.

What would cause a therapy podcast to get an NC-17, PG-13, PG, or G rating?

Podcast world has no ratings besides marking ourselves as "explicit". I only say that in the title so people know what to expect when they listen. Most therapy/mental health podcasts come in two types

1. Stodgy academic therapists who discuss research, use medical jargon, and speak in low calm tones.
2. Amateurs and comedians who want to support mental health, are fun and entertaining, but not very informative because they aren't experts.

We wanted to be a third type and bridge the two. We wanted to be casual and fun while also being technically helpful to the audience. So we are a show that doesn't shy away from F-Bombs and real talk. We are definitely a show for grown ups, don't listen to Pod Therapy while driving your kids to school, lol.

Through therapy I've identified that I've long believed I wasn't deserving of love since childhood. This manifests in relationships with me looking to my partner for validation and recognition, and I realized this isn't good.

Are there any steps/actions I can take to start validating myself? A loop I get stuck in is me not trusting my own judgement if I'm alone, so attempts to find internal validation/acceptance fail.

This question is fantastic. So first off, great self awareness that affirmation must start from within. If we spend our lives relying on our partners, friends or families to tell us we have worth or value we will develop resentments toward them and find that no amount of praise will ever be sufficient.

Positive affirmations are an important technique that you might want to look into. There are many variations of this but it is usually a process of identifying statements about yourself that you say in the mirror every day. Not merely compliments but statements that reflect the things you are doing in life, the areas you are growing, and reminding yourself that you are a good human with value.

I had regular virtual sessions with a therapist for a large part of 2020, and ended them a few months ago because I felt like all the topics I'd wanted to work on had been worked on and I was in a better place.

But also, because I felt like I was developing feelings for her. Which isn't great on many levels, but also because we're both married.

Anyway... How common is that? It seems like the therapist/client relationship is all about opening up emotionally, vulnerability, and the therapist listening to and giving care to the patient. Which all feels very personal and intimate. But of course, it's the job.

Tl;DR: how common is it for clients to develop feelings for therapists? Do therapists develop feelings too? How do you handle that sort of situation best?

Great question! We ended up discussing this on our Instagram Live as well.

Its VERY common to develop some sort of emotional/relational connection with your therapist, and in fact it means that the therapist is doing great work with you because the relationship has become so natural.

Most humans are starved for sincere, genuine attachments. We aren't used to sharing our truth, or to encounter somebody else who is actually interested. To find that attractive and magnetic is perfectly normal.

Just don't ask your therapist out for drinks =)

How does one seek mental help later in life, when they're at their lowest? I never really had motivation, I've just been riding the wave of life since about 2005. Not the healthiest way to go along, but it was all right, I was still depressed but I wasn't unemployed. That's what's important to me. Unfortunately that wave ended last year when I lost my job right before the pandemic was declared. My now former workplace was robbed in March of last year while I was on the clock. It was the first time I ever had a weapon pointed at me with clear intent to fire if I didn't comply, and the company threw me right under the bus afterward. From that point I was socially paralyzed, afraid to go outside for most of the year, I couldn't even motivate myself to collect unemployment - probably the most pathetic thing I've ever done to myself.

I just feel like dead weight now, with only the capacity for self hatred. Finding work again has been a monumentally disheartening struggle since I'm starting back at square one. I never knew how to network or interview for a job in the first place, I was only employed by pure chance. The 'interview' was basically just running me through how they did things because they were desperate for help. I held onto that job with a death grip for seven years because I was sure I'd never find another without a similar miracle. It took me years to notice retail and service jobs are chronically understaffed and that this is by design. When the boss finally told me I was fired I was practically ecstatic, since I never had the balls to quit. All that time I effectively worked as a doormat, and I've vowed to never do it again.

The way I feel now at 35 years old is that I missed the bus. Everybody else I know figured out how to mesh with society before they graduated, they've all had multiple jobs and some even moved onto proper careers. But nobody is coming back for me, I know that and everyone around me knows that - they won't shut up about it, like that's gonna motivate me. My parents only knew tough love and it didn't work for me, just drove me deeper into self hate. The best they could do was question why I didn't just apply myself earlier in life like they did. How can you say that to somebody in good conscience? It's not helpful, it can't possibly be! They'll never drive me in a way that is actually beneficial. Which really sucks because that's who I live with right now.

Even when I was employed, the only positive emotion I felt about it was that of not being a burden. Never felt like I was making much impact, and I always felt out of place. Simply communicating is hard work for me. Even engaging in perfectly banal, time-of-day style conversation drains me when I'm around strangers. I'm a slow thinker, on a typical day of work I'd have more than a few customers deliberately taunting me because I'd take more than a moment to think before I respond. To put this in perspective, I can solve a Rubik's Cube with far less intense thought than meeting a new person and casually talking. I did my job well otherwise, but the fear was ever present of somebody else coming along and doing what I did without breaking a sweat.

I'm just sick of acting the way people expect me to, it feels like living a lie. Everything about society at large feels fake to me. I can barely handle living just my regular life where I'm not trying to impress, say, one person who's reading a hundred other job applications. I can only see it as building oneself atop a hill of lies. Maybe the best example is writing out a resume - it just feels gross, like I'm overselling myself for no reason except to compete against other applicants who are overselling themselves. That's the chief concern in my life now though, finding a job, preferably far away from customers. Then getting serious, professional mental help. And maybe after I get that squared away I can go about finding somebody who can bear to be with me. That's another issue I've noticed in the past few years, maybe my second greatest fear is being alone, and that manifests in my dreams a lot. Nothing quite like waking up from a dream in which you've found happiness with somebody else, it really ruins the whole day afterward.

My only saving grace, I feel, is that I have a pair of friends who refuse to give up on me, regardless of how hard I push back. I wish I would be more open to their suggestions, because they have been helpful in small doses, but I've been awful to them the last few weeks. I feel too stuck in my own broken ways to commit myself to positive change. One of them even tried to low key play matchmaker for me, and thinking about it as I type this I really appreciate it in retrospect, but in the moment I casually brushed it aside because I've never remotely considered myself on the table, if you know what I mean. Plus... they've got their own mental health issues, and I don't feel it's fair to impose mine on them when the root of my poor mental health is self sabotage.

Sometimes I just want to mind-meld with somebody, because otherwise I don't think they'll truly understand how little hope I feel, or how I think in the first place. Or maybe it could go the other way around, I might understand what it's like to have hope, because I just don't right now.

Reading this was profound. I can tell you have been through a lot of betrayal and now struggle with personal doubt and self destructive patterns. I want to thank you for sharing this, and I hope you will continue to open up on forums like this, or in therapy. You deserve to feel better, you deserve to feel healthy, and you deserve to discover your path forward.

Rooting for you friend.

Hello :)

So I've been in a relationship for over 10 years now which has sadly ended although we're still on good terms. Throughout that time my other half has been suffering mentally with depression and anxiety. Over the years we've tried multiple different things from pills to therapy, which I don't think shes really ever opened up and unfortunately things just haven't worked out. I'm still in contact with this person and still want to help them get better. What can you suggest for someone who's basically tried everything. Ive been trying to push her to back to therapy but its so difficult to convince her at times to do this. Could you suggest the best way to go about having these conversations as I've found theres always a fine line between offending people and trying to give them useful advice. Unfortunately I'm not a licensed professional so I don't really want to make things worse but wanted to know how I could go about helping?

Thanks for everything you do

This is a tough one. We get this question a lot, actually. I've worked with a lot of intern therapists, and they express a lot of the same concerns you have. "I'm not sure what to do, and I don't want to do anything to make the situation worse." I always say that when you don't know what to do, your fall-back position is to be a cheerleader. You acknowledge something positive they're doing, tell them you're proud of them and be there for support. You'll never hurt anyone that way.

Continue to talk to them about giving talk therapy another shot. One thing I've heard from countless people who write in to our show is how they had tried therapy multiple times and "it never worked," but they give it one more shot and end up with a therapist they really click with and they've had great results. Sometimes that's what it takes. Sometimes it's about having a therapist that you click with, and sometimes it's just that we're in a different place mentally and emotionally when we go back to therapy and that's what makes the difference.

Talk to a therapist, build a support system, seek medication if you need it, and physical activity. Staying physically active has an amazing effect on the brain. Check out the book "Spark: The Revolutionary New Science of Exercise and the Brain" by John J. Ratey, MD.

But again, most importantly be a support and continue to encourage therapy.

Best of luck to you friend

I have a strangely specific question. How can I tell what behaviors of mine cause people to ignore me? All of my friends never respond to calls or texts but they also make no indications that they want to end the relationship or that they're angry with me, and they're usually normal in person. I feel unimportant and disrespected but it's a common theme with almost all of my relationships outside family. What could I be doing that's causing this commonality. Thank you.

Great question. I've had people ask me this in the past. It's a really tough thing to navigate. The first thing I would do is get a therapist. Work with your therapist on how you process your emotions and coping skills (and/or anything else your therapist determines as appropriate). Next, if you really want to know, ask the friends for their honest assessment. But you need to be emotionally stable and have some healthy coping skills before you do this (that's why step 1 was "get a therapist"). If you can't say "thank you for your feedback, I really appreciate it" and mean it no matter how painful it was to hear, then you're not ready for step 2. Go back to step 1.

Step 3, should you get to that point is to take the info you gathered from step 2 and process that with your therapist.

...Or you may get into therapy and your therapist tells you that everything we've told you is crap, in which case, listen to your therapist. They've met you personally and have assessed the situation in way more detail. They know better than we do.

It also may have nothing to do with you. We have a tendency to personalize things. In either case, you're a good person. This is a bump in the road and you can find a way through this.

Thank you for this AmA, what's Major depressive disorder !? Can we treat it without medecines !?

Hi!

Major Depressive Disorder can be characterized by having a combination of some or all of these symptoms; depressed mood, diminished interest or pleasure in activities, significant weight loss, insomnia, psychomotor agitation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to concentrate, and/or recurrent thoughts of death. ***IMPORTANT: This information should not be considered a diagnosis. This is a VERY abbreviated summary of symptoms and should not be used to diagnose yourself or anyone else. There are many important details I left out to keep this short. If you feel like you have any of these symptoms, seek out a qualified mental health professional who can assess you personally. This information is just for education.

The most effective treatment seems to be a mixture of psychotropic medication and talk therapy.

I haven’t had a psychological evaluation since I was a teenager. I am now an adult. How would I go about getting a new one?

So a Psychological Evaluation can mean a lot of things. If you want a long workup with batteries of tests you could contact a Clinical Psychologist in your area and request an evaluation. If you want a basic assessment, like checking with a therapist and just giving them a run down of your reality and see if they notice anything worth commenting on you can schedule with any therapist and tell them you want to do an intake assessment and see if therapy might be beneficial.

I'm asking because of me, who easily passed subjects when tests were almost the entire grade relying on crazy good memory and somewhat understanding the principles, letting me get away with not doing homework at all. But of course, grades got progressively worse when doing the work started to be as important as the tests. I never learned to sit still and do the work without having my mind wander, even when it's easy, even when i know the answers or where to find them, only focusing when deadlines are right on top of me. Any suggestions?

And on more general terms, are there any trends you've noticed from people that were "the smart kid in class"?

Great questions!

We are fans of doing short tasks rather than trying for long slogs. Taking a project or task and splitting it into sections, milestones, then splitting those down into individual tasks. Putting all of that on a list and structuring your efforts into 15 minute bursts of action. That can help people who struggle with focus to zero in on their objectives and get results.

As far as the smart kid issue, I haven't seen much research on it but anecdotally I'll say its common that for kids who easily get through the system they don't learn rigor. That doesn't mean they aren't successful, it just means they learn those lessons later in life.

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So first, I absolutely get what you're talking about. I've had many patients over the years with these symptoms, and they are actually quite common with OCD.

Second, if you aren't already working with a therapist, that of course is a key recommendation. OCD, tics, and Intrusive Thoughts can be really frustrating but they get better with good help and good theory.

Third, I encourage you to look into the book "Overcoming Unwanted Intrusive Thoughts" as I think you will find it really helpful for the thoughts. Remember that with OCD its about delaying the behavior after we have the thought, the longer we can delay our reaction the more our brain gains control over breaking the cycle. Using CBT methods and good self talk can be a key ingredient to long term success. I also recommend the OCD Workbook, its a great resource.

Why do you guys think people ask for advice just to do the complete opposite then.

I find it annoying that people ask for advice from someone who is well versed in the field (for example: technology) they get their tips and tricks and advice and whatnot, turn around and do a complete 180 from what was recommended.

Do they think we want to screw them over?

Interesting question. :)

I can't speak to technology. Maybe the human behavior is similar in your case as with ours, but maybe there are some differences as well. I know from our perspective, when people ask a therapist for advice they usually already have an idea of what they are going to do. What they are really asking for is approval to do the thing they're going to do anyway. I typically deal with this by first asking them "what solutions to this problem are you already considering?" They will usually offer them up. "Well, I was thinking about....". This is a good position to be in because the idea the person comes up with on their own is the idea they are most committed to. "Self-guided Persuasion" as psychologist Kurt Lewin called it.

Once they've listed off a few options, I can help them navigate the pros and cons of each, they get to make their own decision, and they get to take full credit for it's success. ...and we come off looking smart even though we didn't do anything. It's a win/win. :)

What do you think of Howard Stern?

He's actually extremely pro therapy. He tries to talk Jerry Seinfeld into it during his episode of Comedians in Cars Getting Coffee.

If you could go back and talk to yourselves when you were just starting your journey toward becoming therapists, what would you tell your younger selves?

This is Jim, I'll give it a go, Nick might answer this one also.

First I would tell myself what a great profession this ends up being, and try to salve the anxiety I felt at the time. I was a school teacher for 8 years before I decided to get my Masters degree and enter mental health, the whole effort was extremely risky financially and I had every reason to believe I was destroying my life by training to become a therapist. So Id like younger me to know it worked out.

I'd also tell myself to invest in bitcoin.

What is your opinion on people who preach "mental health awareness" but willfully ignore any mental health issues other than their own?

Edit: correct spelling errors.

Its a pet peeve. We talk on the show about how glad we are that mental health as a topic is now so destigmatized that everybody can talk about it, but the dark side of that is there is very little accountability against weaponizing mental illness (diagnosing other people) or pathologizing all behaviors as mental illness (everything I don't do well in life is because X, not my fault). These can have a chilling effect on people getting real help and making real progress.

QUESTION: how often do autistic adults and ADHD adults not get their diagnosis until adulthood? Is this common? I wasn’t diagnosed until my 30’s and my life has been so much different since.

Its hard to say how common it is statistically, but I'll say that Autism and ADD/ADHD have a complicated history with diagnosis. They've traditionally suffered being over diagnosed in children (every energetic child has ADHD, every stoic child has autism) to the point where the reaction started being to under diagnose these issues. There are a generation of adults who are now discovering these realities and it is very helpful for them to have a name to describe what they experience, especially because it also opens up tool kits they didn't know where there.

Hi, and thank you for doing this.

I lost my younger brother to suicide less than 3 weeks ago, and have my first counseling session tonight. I'm finding that aside from all of the sadness, guilt, shame, regret and myriad of other emotions I've been experiencing since it happened, I'm also feeling a sort of bubbling up of a lot of the issues that I feel have been rooted in my family dynamic for years that I have just been stuffing down in what I now realize has been an effort to keep the peace. It just feels like so much to tackle all at once, and I am not sure where to start when it comes to therapy. I feel scared and overwhelmed and sort of hopeless. I understand that my counselor will hopefully help guide me through this process, but do you have any suggestions about where to start or what to focus on in the short-term?

Another issue I'm having is that other members of my family are already proving to be resistant to the idea of grief counseling, particularly my dad. He and my mom were with my brother while he actually died, and it's become pretty clear in the way that they seem to be coping that they must be suffering from PTSD, not least of all from what they saw (he used a gun). How can I help convince them that counseling is necessary? Do you recommend group therapy right away for something like this? Should my parents go to counseling together to start?

Again, thank you for reading. I look forward to tuning in to your podcast.

I am so sorry for your loss. I really hope you see this before your therapy session, but even if you don't, you're going to be okay. Your therapist is trained to handle this, so don't feel like you need to go into therapy with a game plan. Just try to be the most honest version of yourself that you can be and let the therapist do their thing. I've heard people express similar concerns; that you can feel it bubbling up and you're worried that it's all going to rush to the surface the moment you walk into that office. That can be a scary feeling, but where better to have that happen than a therapist's office, right?

Grief sometimes feels like a heavy backpack that you carry around with you all day, every day. If you get nothing else from therapy, you at least get 1 hour that you can take that backpack off, set it on the floor, and give yourself a break. Even if you end up picking it back up when you leave, you get that little bit of respite. As you continue in therapy, you'll start taking small items out of the backpack and leaving it there when you leave. Sometimes you may even pick up some items you left there the week before, but over time, that backpack gets lighter. You may never be without it, but you can make it lighter and learn to co-exist with it.

Your concerns with your family are valid. I would love to see everyone get some help. That is unimaginable to have to go through. I think the best thing you can do is get healthy yourself and set an example. Like they say on airplanes, "put your mask on first before assisting others."

As far as group or individual, honestly, whatever is more likely to get them involved is what's best. This would be a good question to ask your therapist tonight, but my guess is that their advice would be, "let's start with you first."

Good for you for taking the first steps. That's amazing.

Wishing the best for you and your family.

Hey guys, thanks for doing this AMA :)
Long story short I've been on benzos since I was 16 (topped out at 2mg Klonopin last year) and have slowly managed to reduce my dosage to roughly 1.5mg. I've got huge anxiety about how or if my personality will change when I am eventually off them completely; will I be the same person? Will there be any lasting effects to my personality/mentality? I have BPD and I struggle a lot with my identity so it kind of terrifies me

Howdy! Thanks for writing in! A few thoughts:

1. Re: Fear itself - First off, its perfectly normal to have anxiety about your anxiety meds. I call it being scared of your scared pills. But in this case I dont think there is much to worry about here.
2. Re: Personality Change - No, I don't think your personality will change. First, benzos effect you by mostly turning off your emergency response system which causes acute anxiety. They are temporary medication that doesn't do much a day after you've used it. If you have used it for years (you didn't mention how old you are currently) I'm not so much concerned about your personality as I am your stress tolerance. When we start using narcotics (even for medical reasons) at a younger age it can sometimes stunt our emotional capacity to deal with hard things. Stress tolerance is something humans build up through exposure to frustration and finding organic ways to cope with it. You might find yourself a bit more irritable or easily frustrated in the first months after discontinuing benzos, but that will pass and you need to be gracious with yourself.
3. Re: Identity - Remember that medicine exists for a reason, and its ok if your health care providers believe you should use benzos from time to time to assist you. Sometimes your doctor will recommend you use them on an as needed (PRN) basis, and then maybe still cut them in half. That could be a great long term tool if it helps you. But you don't need to fear that your personality will change. You should expect to have to adapt and cope with stress and difficulty in the first year after stopping, that is a good thing, but you might not exactly be thrilled about it for a while. But above all, know that you are going to be ok. This gets better, and good for you that you take your mental health seriously and have been accessing helpers since being 16.

Hi! Thanks for doing this AMA.

I wanted to ask you how common it is that people resolve severe mental health problems on their own?

I was extremely suicidal on and off for years. My first reaction to any amount of stress was ‘fuck it I’m gonna kill myself’. I was on different meds, had hours of therapy and they even got me to attend group DBT but nothing helped me.

The only thing that did was change (in my life situation - moving back home), time, and doing DBT on my own through a workbook/listening to podcasts.

I’m sorry to say but the bad experiences I’ve had have left me with a rather cynical view of the mental health treatment available. Particularly the group: it felt super patronising.

Not sure what my question really is, I just wanted to share this and see if this resonates with you or with any of the clients you’ve seen in therapy?

Howdy, thanks for this. I really like this question because its true that humans can heal all on their own. Humanity is a resilient species, we have dealing with the burdens of consciousness for a long long time, and we have invented all sorts of non-clinical ways to chip away at the problem. Podcasts gave you healthy thoughts and probably connected you with a community. Workbooks gave you personalized tools that you put to good use. You found resources that worked for you, which is absolutely awesome. Therapy is one tool, not the only tool, great job friend!

Definitely checking out your podcast in 3, 2, 1...

I am interested in learning more about personality disorders, and specifically histrionic personality disorder. Any recommendations?

Hi! Great question.

I'd want to first know why you're interested in learning more about this because that would impact the direction I'd point you toward. The reason I say that is because the majority of the time people want to know more about personality disorders is to diagnose their significant other. Please don't take that as an accusation. It's just something we hear a lot on our show. :) If that happens to be you (I'm sure it's not, but incase anyone else is reading this), tread lightly down that path.

In one episode of the podcast I told a story about an intro to psych course I took in my undergrad when the professor sent us home for Thanksgiving Break with an assignment to use the DSM-IV to diagnose as many of our family members as we could. When we came back he was quick to tell us that ALL of us were 100% wrong on every diagnosis we made. His point being that there is A LOT of nuisance and details that need to be looked at in making a diagnosis, and without proper training it is easy to mis-diagnose. Almost like how every horoscope seems to fit, any diagnosis can fit if you want it and you're not trained in differential diagnosing. I will add that according to the DSM 5, "Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions suggest a prevalence of histrionic personality of 1.84%." So, pretty rare. There are a lot of people on Earth who are "dramatic," but very few people will be diagnosed with Histrionic Personality Disorder.

If it's just something you're curious about and want to learn more, there are many books online on the subject matter. Just go to Amazon and there will be no shortage. I haven't ready many, so I don't have a specific recommendation for you, but I'm sure any of them would be a good place to start.

Lastly, if you are curious just for yourself, the best place to get more information would be from talking to a licensed mental health provider. If you feel like you suffer from histrionic personality disorder, talk to someone about it. It may be the case that you don't meet criteria for that diagnosis, but talking to a therapist is a good idea anyway.

I really hope that helps. :)

Are there instances where a patient referred to you was incorrectly suspected of schizophrenia? When in fact, the voices were real and turned out to be something spiritual? Like a guide, or angel, or clairvoyance...ect..

Good question. A complex question, for sure.

The complicated part of this question is the word "real." What we're really talking about with schizophrenia is "perception-like experiences that occur without an external stimulus." (to quote the DSM 5). Whether they be from the diagnosis of schizophrenia or a guide, angel or clairvoyance, they are perceived as "real" to the individual. The biggest difference is that we haven't been able to scientifically prove the existence of the supernatural. Our scientific understanding of schizophrenia is much more comprehensive.

However, this is an interesting discussion because (in America, at least) thousands of people will claim to hear the voice of god telling them to do something; they can't all be schizophrenic. But to deal with this, mental health professions have gotten very good at being able to distinguish between true schizophrenia and someone who is speaking poetically about their religious or spiritual beliefs. The latter we find is almost always something that already fits within their religious/spiritual schema. In contrast, when the voice is telling the person that the shower faucet is the sexual organ of Jesus Christ and that's why they haven't showered in two weeks (true story from a former client of mine), then it because easy to distinguish. If someone is saying that God is telling them that something good is going to happen to them this week, we find that that seems to fit more inline with what they already believe, so that "voice" can more easily be explained by an internal dialogue than from an external source.

Another interesting distinction is that when people are crediting their existing beliefs to hearing it from an external source, the messages are almost always positive. Makes sense, our beliefs form what we want. When we're talking about schizophrenia, the voices are typically negative. This in not ALWAYS the case, but generally speaking, it is.

To answer the question, has there every been a person who was diagnosed with schizophrenia that was later discovered that they didn't have schizophrenia, but truly had a supernatural being talking to them or achieved clairvoyance, no. It has not happened to me or any mental health professional I know. I'd add that had it ever happened, it would have been a scientific breakthrough that would have fundamentally changed everything we know about the natural world, and we all would have heard about it.

This was a great question. Thanks for asking it.