Hello, I'm Jenny, licensed psychologist and PhD working in mental health. Ask me anything!

How do you let your psychologist know you won’t be returning for therapy? Is it impolite to just not return. It’s only been one session and I felt the fit wasn’t good

Thanks for a nice question!
If you haven't made another appointment, you don't need to do anything. However, I really appreciate when clients tell me they won't be returning instead of ghosting me. That gives me the opportunity to leran and grow, and hopefully be a better psychologist for the next person seeking help.
But sometimes that is too hard, and we get that too.

I have a theory that the huge decline in mental health in teenagers is more due to social media than pandemic related issues. What are your thoughts on this?

Interesting!
We do not have any conclusive answers to this yet, but there is some data on what youngsters may miss out on when spending a lot of time on social media:

- less practising social skills IRL -> more anxiety in IRL social situations

- less physical exercise -> lowered general mental health

- no boring time -> less opportunities to explore and be creative

What are some ways to prevent degradation of mental health?

Taking care of yourself can be done in different ways, but a nice way of doing it can look like this:
Self-care can be divided into five categories.
- Caring for your body
- Nourishing relationships
- Describing and expressing feelings
- Finding meaning in life
- Learning new things
1. Set a number for how much you agree with the following statements on a scale of one to five (1 = not at all, 5 = exactly the way I want).
For the past week...
- I took care of my body
- I nourished my relationships
- I noticed and expressed my feelings
- I did meaningful activities
- I learned new things
2. Look at your answers and choose a category that hasn't received much attention in the past week.
3. Now, think of something small you can do within the category you've chosen. It doesn't have to be expensive or grand — it's just about being there for yourself.
4. Write down the behavior you're going to do.
For example: take a short walk, call a friend, explain how you feel, shut off your phone for an hour, help someone, or work out.

Do this check-in with yourself at least once a week, and explore if you can find a way to take care of yourself that suits you.

For someone who is clinically depressed do you have suggestions for activities that are meaningful? Its been 3 years....

What's a meaningful activity to you is probably very different from what's meaningful to me. But on a group level, humans tend to find the following aspects of life meaningful:

1. Relationships. Not necessarily romantic relationships, but long term, loving and caring relationships where we feel seen, understood and trust each other is a common meaningful ingredients.
2. Doing something that matters. This aspect can be very broad, from caring for our own children every day, to doing voluntary work in a difficult setting or protesting on the streets. The important thing is engaging in something that engages you.
3. Taking care of yourself. Having a daily routine like getting up, eating breakfast, taking a walk, read up on something interesting, do a short mindfulness exercise, getting to bed in reasonable time is often underestimated. Human brains like knowing what's coming, and not having to decide whether we feel like doing stuff all the time.
4. When we have depression, our minds and bodies have a harder time enjoying stuff. That means that being persistent and doing things that we used to enjoy, even when they do not bring joy right now, can be meaningful.

Take care <3

How to convince someone whith chronical depression who doesn't believe in therapy to seek help?

Copying from another similar question here:
Well, it is very hard to make any changes with someone not believing in the benefits of treatment or in me as their treatment provider. But, I would start with exploring how satisfied they are with their current situation, what they think they would need in order to make a change in their lives and what is stopping them from pursuing change. Also some questions around what life would look like if they continued to live their life exactly as they do now.

So, some exploring to see if we can find any common grounds and a trusting relationship to continue.

And just to add the ongoing discussion related to this question:

Talking won't help anyone. Changing behaviors in real life can however make a difference. And if therapy can help you explore new behaviors - then it can make a difference. Therapy should be experiential as much as possible, but some reasoning is often needed to find a way forward.

How do you get help for a suspected mental disorder when there are few resources in your country? Do you know any online resources to check diagnosis for adhd

There are a few international organisations of psychologists that try to increase access to therapy, ACBS, is one, organising acceptance and commitment therapists all over the world.

You can also try the free app I'm working with, 29k, where you can practice skills and get peer-to-peer support - but not professional help.

One online resource checklist for adhd that is pretty ok is this:
PsychCentral ADHD quiz
Taking that quiz - or any other - can never replace seeing a professional person, but may assist you to explore if what you experience is within this region, sort of.

A lot of people try to self-diagnose. What percentage of those people (who actually seek professional help) would you estimate are at least in the right ballpark?

Hard to say any percentage, but self-diagnosing online is a very tricky business. Just from my personal experience I'd say that most of the clients I meet who have tried to self-diagnose are not in the right ballpark. The reason for that is that disorders have somewhat arbitrary boundaries, and many symptoms are overlapping between different disorders, and self-assessment instruments online are often misleading.

We go to general practitioners, optometrist, and dentists for check ups as a matter of course. Should we normalise mental health check ups as a way to perform preventive medicine, or does it not work that way?

Nice idea, and I think it is even more important to make room for regularly taking care of our own mental health. In my experience it is not very common for people to be a lot worse off mentally than they perceive – a lot of times it is the other way around. So most people who's mental health is declining notice that in a different way than noticing that your blood is low on iron.

But I would love for it to be as obvious that we regularly need to take care of our mental health as it is obvious that we need to exercise regularly to take care of our physical health.

Is there an actual decline in overall mental health lately, or are we just actually seeing and identifying an issue that has always been there?

There are signs of a general decline in mental health in the parts of the world where we have reliable data, but whether people are more likely to report or seek help, or if there is an actual decrease is not entirely clear. For young adults and teenagers there seem to be a n actual increase in number of people suffering from mental health problem, at least in the Swedish data, and probably in Europe at large.
The pandemic has also affected people's general mental health negatively in some groups (i. e. university students, young adults, persons previously suffering from mental health issues), but actually also positively for some groups (for example parents and middle aged workers have experienced less stress symptoms during the past two years).
The short answer is that the general interpretation of data at the moment is that there seem to be an actual decline in mental health overall, but not for all groups in society.

Is there a confidentiality therapists and people under 18? For example if someone under 18 asked a therapist to not tell their parents about their mental health will therapists still do it?

This depends on in which country you reside. In Sweden it works like this:

With younger children you need both parents approval to start treatment.

If a child (under 18) tells me something that makes me very concerned (suicidal thoughts or ongoing abuse for example) I'm sometimes obliged to tell the parents, even when the child does not want to. But I always try to get the child's approval for telling the parents, it is always better if we can face it together.
For other things, I try to keep the conversation between me and the child as private as possible. But for any child up to 13 the parents are allowed to see the medical journal, so anything I write in there is available for parents upon request.

hi jenny! thank you for doing this AmA.

seeing as you are working with a foundation to provide a free app for people to work on their mental health... what can i (26m) do for my own mental health?

i currently live in a country where mental health talk is taboo, my parents don't really seem to understand, and my siblings and friends are good for support but i feel guilty constantly going to them for help (i feel like a burden).

i have a good job but i cant afford a psychologist, i stay relatively active and do hobbies i enjoy, but i somehow can't seem to shake this feeling... i feel like i have anxiety (never been officially diagnosed) and with my mood changes i feel like potentially bipolar (but i dont want to claim to have a mental health issue without diagnosis) it just feels that way and its something ive dealt with for the past 10 years.

saw a therapist for a bit whilst i was under my parents insurance but after a few sessions i was sort of coaxed (by my parents) to say i was ok and didnt need it anymore (i suspect it wasnt actually part of their insurance and was too expensive for them).

what else is there to do?

thank you for taking the time and apologies for the long message, i just wanted to provide context.

Thanks for your question. It is very hard to answer in a good way, not knowing the system where you live and this is not a well-suited forum for giving personal advice.

Still, you could definitely try engaging in the 29k app (see homepage for details), where you can learn some skills related to your problems and talk to others in similar situations. But there is no diagnosing, and no professional help in there.

Also, you say you feel like a burden to your family. Our thoughts are just thoughts, and not reality. Ask them how they feel, and ask them for honest answers to help yourself stop guessing. And remember that any relationships (except therapy) involves giving and taking, so make sure to also make room for your friends and family to talk to you about how they feel.

Good luck and take care.

Do you ever get interested in your patients' lives? By which I mean - do you ever get excited to hear what a patient will say this week as far their progress goes or big life events? I know it must be important to keep that emotional separation, but my psychologist seems really stoked and happy for me and my progress - just wondering how you manage that.

Yes!

For me, that is what keeps me going.
I think that it is important to remember that the relationship is not friendship. Is not the normal taking and giving-pattern, but one where I'm supposed to lead the conversation and the conversation should be about the other person.
With experience and help form others you invent strategies to be both emotionally present and engaged when with a client, and to leave that investment at work when you go home. Some clients I get a little extra emotionally invested in, and sometimes those ones are hard to not think about when being home with family and friends or when it is time to fall asleep. But then I try to practice being present and not so much up in my head and in my thoughts.

But not being emotionally engaged in my clients - for me that would be the end of it. If I don't care about them and their progress, they won't either.

Just out of curiosity. If someone really needed help but didn't believe/trust in the abilities of mental health psychologists, what would you tell them?

Well, it is very hard to make any changes with someone not believing in the benefits of treatment or in me as their treatment provider. But, I would start with exploring how satisfied they are with their current situation, what they think they would need in order to make a change in their lives and what is stopping them from pursuing change. Also some questions around what life would look like if they continued to live their life exactly as they do now.
So, some exploring to see if we can find any common grounds and a trusting relationship to continue.

Wow, so happy to see all your questions here.
Thanks!
I need to take a break now, but will be back later, so keep 'em coming and I'll do my best to answer.

Take care <3

I have tried many strategies for depression/anxiety and maybe adhd. Mindfulness, exercise, therapy, meds, religion... nothing seems to stick past 3 months. Any other advice for making these strategies work?

It is hard to form new habits, especially if you are in a vulnerable position. I have two simple tricks (that you may have already tried but they are still good):

1. Make small changes. Make the behavior you want to do as small as possible - better to have it happen than for it to be too big of a commitment.
2. Attach it to an existing habit. After brushing your teeth, every time you come home after school, before bedtime...

And, when you manage to get something going for more than three months, you may be ready to add something more.

Do you have tips for how to deal with OCD-related perfectionism?

The most effective form of therapy for OCD according to research is ERP - exposure with response prevention. That means exposing yourself to the things that you are afraid of, in this case not being perfect, or deliver an im-perfect report, and then refrain from doing behaviors aimed at reducing the anxiety that follows, in this case, maybe quadruple-check spelling, re-send an updated version or apologizing to others in advance for delivering non-perfect things.

Doing this is hard, and spotting your own small behaviors aimed at reducing anxiety can be difficult, so engaging in ERP is best done together with a professional.

Do you find it hard to be fully engaged in your own therapy sessions?

I imagine that receiving therapy might be difficult as you might be too aware of the method/approach of your colleague. You might be suddenly pulled out of the conversation when you realise "oh, they just used _____", or "ah yes, I forgot about analysing myself with this technique".

Sometimes, yeah. I've been giving therapy to other psychologists, and received as well. It is somewhat special and when giving, I always have this self awareness showing up in a way that is not present with other clients...
And when in therapy myself, I can sometimes reflect on what the other person is trying to do, but when it is good it does not matter. When it is not working, the analytic side of me takes over and no emotional connection is there...

What are some recommended therapies for helping with the physical manifestations of trauma? I feel like having an overactive sympathetic nervous system or irregular release of stress hormones - it wouldn't be a stretch to say that there could be and may likely be immediate and long lasting ripple effects in other body systems, but I feel this and treatment is not talked enough in or often even considered at all in general medicine or in mental health.

Thanks for the question!

Traumatic memories have a way to engage your body and mind in a constant state of looking out for dangers - this is called hypervigilance and can be thought of as a constant stress arousal in your entire system.

The therapy with best documented effect for previous trauma is called PE - prolonged exposure for adults, and TFC - trauma-focused-cognitive behavioral therapy for children.

In both the approach involves engaging with traumatic memories in full (body and mind), and by doing so the positive effects seen in treatment may be due to un-fragmentizing traumatic memories.

Engaging in traumatic memories is very painful, and some are hesitant to start therapy for that reason (it is actually common to feel worse for a period of time), but for many the effort pays off in the long run. Less physical sensations, less nightmares, less flashbacks, less hypervigilance, less avoidance can be some of the effects of treatment.

Adhd and autism- I have a pet theory that they’re actually part of the same disorder, because of the incredibly high comorbidity between the two.

What are your thoughts on this?

Resubmitted because my adhd butt forgot the ? Mark at the end 🤣

Well, this is interesting and somewhat politically but here we go:
Most diagnoses are actually just a description of a bunch of symptoms. Where diagnostic manuals draw the line on having a disorder or not having a disorder is sort of based on an agreement made between clinicians and researchers working in that field. So if your problems matches one description and also another description you will get two labels.

For me as a clinical psychologist this has some implications. I can read up on research on treatment for this and that diagnose, but the person in front of me will never be a perfect match and just matching that particular disorder. The combination of problems and how they manifest them in this persons' everyday life often have certain things in common, but at the same time they are unique. So for treatment, I will always try to meet the needs of this particular person, no matter what label the health care system wants me to place on that person.
And as the comorbidity between a lot of diagnoses is super super high, there are an interesting line of research trying to aim at what's called "transdiagnostic factors" (=things that different diagnoses may have in common).

In short – the overlap between ADHD and autism is huge. The labelling we do can be a nice way for clinicians to communicate and do research, but for real people, these boundaries are not real. Symptoms show up in different clusters, and the naming of them can actually be somewhat arbitrary...

How do you know if you're depressed?

The diagnostic criteria of having an actual depression include:
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
In order to fulfil the criteria you need to have at least one of the two first symptoms, and then at least four more for at least two weeks.

Hi Jenny! Thanks for doing this!

What kind of mental illness is the most difficult to diagnose? What kind of people are the most difficult to diagnose?

Hi!

I'm actually not very into diagnosing people, unless I have to in order to follow existing regulations in health care for example. I'm more interested in getting to understand problematic behaviors, what's stopping this patient from doing what he wants to in life, and what's within our power to control and what's not.

do you ever ask the people you treat what they think would help with there mental health? and if so what sort of reactions do you get to that question?

i started getting help 18 months ago after an attempt on my life and every single professional i saw asked me that question and it always infuriated me, if i knew that answer i wouldnt be where i am....

Thanks for your question. Sorry to hear that you've had bad experiences when seeking help.

And, yes, I frequently also ask this question.
The reasoning behind it goes something like this:
- You know yourself best
- Knowing what would help, is not the same thing as doing it. If I know more about your own thoughts, we can figure out what obstacles or barriers there are, and try new ways of overcoming them together.
But that said, if you would come to me and tell me you don't know and you get angry at me for asking, then we would know that exploring your needs ans wishes for the future will be an important part of a successful treatment.

Hi! Is it worth giving kids in the care system automatic psychological help? It doesn't happen in the UK - usually kids are referred to a service if they display serious depression or signs of a disorder, but all young people in care have come from traumatic backgrounds.

Would it be worthwhile? Especially considering that around 70% of those in prison and prostitution have come from the care system.

We know from research that early interventions are the most effective ones, and waiting until the problem has grown out of control is not a good strategy. Nevertheless, this is where many systems taking care of children end up. The resources are not enough to meet the demands from those who are so and so, and are used for the ones in extreme need.

I think it would be awesome to have a system that can catch all youngsters in the beginning of the downwards curve, or teach all of them basic self-care skills, about anxiety and worry, stress and sleep etc in school. That might lead to some changes in the long run.

[removed]

Thanks, I've now updated the post with proof. Let me know if that's good enough:)

Treated anyone whose kink/addiction sounded quite fun?

Haha, that's funny! Well, I usually tell my clients that it is hard to surprise me because I've heard all kinds of thoughts, feelings and experiences that people never talk about with anybody else. But, yeah, I learn a lot from listening and sometimes clients inspire me to do things differently. As trying something that I had not thought about.

Do you think you need psychological help? Also what about the other psychologists, do you think they need? I remember I heard that doctors and/or psychologists needing psychological help is seen as unusual or weird etc. Do/Can psychologists try to treat themselves when they have a problem(How meaningful it is etc)?

I'm fine without going to therapy in my daily life. There have been occasions when I felt I needed support, and it has not been weird to seek help.

I think psychologists and doctors are like most people, some of us get depressed, some have ADHD, some have bipolar disorder, some have sleeping problems.

In some ways, I can treat myself, sort of. I would probably have sought counselling as a parent on a number of occasions, had I not known what I've learned as a psychologist. As you suggest, also when it comes to work on my own values and feeling meaning in life, I've been helped a lot by the things I'ver learned studying and working.

I have a friend who struggles with depression and anxiety. He doesn’t really do himself any favors in that regard. Drinks like a fish, moved across the country with his gf (who is great), and expressed to me he was feeling lonely and can’t get past the regret of past choices he has made. How do I help him help himself?

I'm glad you want to help your friend, and remember that the responsibility for his choices lies with him. There's only so much you can do from the outside.
It sounds like your friend would benefit from treating himself differently, but you telling him that will most likely not make any difference. He needs to identify his own problems in order for there to be a wish to change.

My basic tip here would be to ask him questions instead of making suggestions.

How does he feel? How would he like his life to be? What would happen if he continued to treat himself this way? If he would dream, what would a good life look like in five years? What would he need to do to get there?

Good luck <3

I have this thing where I'd be in the middle of something and suddenly a random, very old buried memory pops up, with pretty strong imagery? Could be a scenery of a railway track that I used to cross as a child or could be a random street corner!

I literally pause and try to think if it could be traced back but it's always an isolated piece of childhood memory? I don't think it's normal? Is it?

Our brains work in mysterious ways, and yes, it is normal for our minds to constantly produce thoughts and images throughout the day (and night). Sometimes our brains pick up some sort of cue to a memory (and we may not be aware of what that cue might be (a smell, a color, a random association...), sometimes it is just a random thought.

Memories with strong emotions attached seem to be more vivid than memories with low emotional engagement. And memories that are associated with strong fear and trauma, are sometimes more likely to show up years later, especially in situations resembling the traumatic situation. Traumatic memories can also be very fragmented, it is just how our brains deal with memories under certain circumstances.

Do you draw a line as to what you consider a mental health problem? For example, suffering anxiety when you are about to do something stressful is not really a mental health problem is it?

I'd say that all the things we experience as difficult (as anxiety, worry, stress, sadness or whatever) is a natural part of the human existence. It is not a mental health problem to have them, they are a part of life.

At some point you may have a severe enough frequency and intensity of that experience for it to cause problems for you in your everyday life - and maybe fulfil criteria for a diagnose.

I’ve been taking 200mg of Zoloft a day for a few months. A company reached out to me about nasal ketamine for depression. Have you heard anything about depression and ketamine? Btw I like Zoloft, it makes me think rationally

Hi.

Ketamine is usually used as a pain reliever, can be addictive and have some nasty side effects. If you are happy with current medication I don't see any reasons to change, but if you want to know more, discuss this with your prescribing health care personnel.

I want to do something with mental health counseling because I like to help people but my biggest fear with that job is that I will get told some completely horrific stuff by a patient that will stick with me and fck me up mentally myself. Is this a logical fear? Do you get training to help to distance yourself from your patients ailments? I’m a very emotional person and I can see myself getting affected by others stories. TIA

Hi!

I've heard some horrific stuff that I've had a hard time letting go of. But you learn with experience that you will be no good to no one - not the least yourself - if you bring those events home and let them invade your everyday life. When I have junior psychologists in training we often talk about strategies to deal with this.

Where do babies come from?

Ever heard about storks?
Also, can recommend Sex education. Some good knowledge nuggets delivered there for all in need.

Why does it seem that anyone can actually become a psychologist/therapist? Isn't the bar set too low?

There is a difference in being licensed and just calling yourself a psychologist or a therapists, so if the people are not licensed, then I totally agree:).
To get a license is a bit different in different countries but in Sweden, where I work, we have five years of university education and one year of clinical internship before we're allowed to work independently.