Category: Therapy

Glee and OCD

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Did you see last night’s Glee? As you know I am a huge Gleek, so I think all episodes are awesome, but this one was particularly good. I especially liked the way they addressed Emma Pillsbury’s Obsessive-Compulsive Disorder (OCD).

OCD is an easy disorder to make fun of. Furious hand washing, repeated checking of light switches, constant organizing of canned goods – the possibilities for showing the disorder in a “humorous” light are endless. Thankfully, Glee has chosen not to take the easy path of humor, but has instead chosen to seriously discuss the disorder.

OCD is a type of anxiety disorder (which was nicely pointed out on the show) that can affect people in many ways. Obsessive, constant thoughts and worries; Compulsions to engage in certain behaviors over and over; A combination of both; OCD is expressed in many ways. However one’s OCD is expressed, a common point is that it is disruptive to life in some way. OCD can make performing one’s job difficult, maintaining relationships a struggle (as in the case of Ms. Pillsbury), or simply enjoying things you used to impossible.

Luckily, there is treatment for OCD. As the psychiatrist on Glee pointed out: a combination of medication therapy and psychotherapy are typically the best bet for effective treatment. It takes work and time to enjoy a relief in symptoms, but it is possible – and in fact likely – that with consistent treatment the disorder will become less severe.

Some resources:

International OCD Foundation

American Psychological Association

Your First Session with a Psychologist – Is There a Good Fit?

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I have written on this topic before, including posts on how to set up your first session with a psychologist, and what to bring with you when you go.  But for today’s post I am going to focus on “fit.”  There has been quite a bit written on the topic of whether or not one has a good “fit” with their psychologist, and how goodness-of-fit affects progress and positive outcomes of treatment.  For this post I am going to focus on how to assess fit in the first session.

First contact. Different things are important to different people.  For me, prompt, courteous customer service is key.  Whatever your priorities, you can likely tell a lot about a prospective psychologist by the very first contact.  Do they use email? Have an answering service? Take phone calls only at certain times of the day and week? Offer online scheduling?  How do the logistics of their practice fit with your needs?

The waiting game. Some psychologists can see new people within a day or two, while others have weeks or months-long waiting lists.  What is going to fit with you? Can you safely wait to see someone until next month, or would you prefer to get started right away?  What about after the first appointment: will you have to wait another month for the next session?

The office. Once you have made the first appointment, and you are in the office – how does it feel to you?  Does the location feel safe? Is it convenient to your home or office? Is it a place where you want to spend time?  I don’t mean to imply that all psychologists’ offices should be perfectly decorated, but when assessing fit, it is helpful to keep the physical surroundings in mind.

The face to face. OK, now to the tough stuff.  Certainly not all psychologists are going to be a good match to every client.  Just like not all of your neighbors could be your best friends.  It doesn’t mean they are bad people or unqualified, it’s just that for this type of relationship it is important to have a connection that allows for honesty and vulnerability.  Do you feel comfortable with them?  Do you feel as though you are being treated with respect? Do you feel as though you could trust them with personal information? Do you feel like you are being heard?  These are just a few of the things to keep in mind during, and after, your first session as you are trying to determine whether or not you would like to continue treatment.

With all of the above said, it is important to note that psychologist’s are not there to always say what you want to hear.  Their job is not to make you happy at any cost, or be a “yes man” in your life.  Their job is to help you reach your mental health goals, whether they be to learn to communicate in new ways, deal with stress more effectively, or gain new parenting tools.  In the course of treatment, your psychologist may need to say some things that are tough to hear, or may challenge your ideas and beliefs.  And that’s OK.  If there is a good fit and an adequate level of trust, you will be able to hear these things, make some changes, and progress in your treatment.

Is It Time to Seek Therapy?

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I often hear the question: “How do I know when it’s time for me to start therapy?”

It’s a good question.  For most of us, it is tough to know when to make the call to get help.  And it’s not only mental health help I’m talking about – but financial help, medical help, automotive help, real estate help – it’s a difficult thing to know.  Most of us want to believe we can do things on our own, or that our problem “really isn’t that bad,” or that if we ignore it, it will go away.  But, in the end our problems don’t always go away, and we may need  a little (or a lot) of assistance to stay on the right path.

So when people ask me this question, I have a few questions for them in return:

How long has your issue been going on? If you’ve been feeling worried, depressed, anxious for a day or two, that’s very different than if it has been going on for many weeks, months, or even years.

How is it affecting your life? By this I mean: Have you stopped doing things you used to enjoy because of your emotional struggles? Have your relationships suffered (with colleagues, friends, partners, family, kids) Has your ability to work suffered or changed?

What else have you tried? Therapy doesn’t have to be the first resort for dealing with emotional struggles.  Have you read any books, tried  changing your physical activities (yoga, walking, etc), talked to a trusted friend, family member, or clergy about the issue?  Any other strategies you have used to feel better? What, if anything, has helped?

How do you think therapy might help? It’s important to have a realistic idea about therapy can do for you.  It can’t change your boss, but it can help you learn better coping strategies for job stress.  It can’t change the fact that your spouse has had an affair, but it can help you (or both of you) learn different communication techniques and provide a safe forum for discussing your feelings about the breach of trust.

With the above questions in mind, it might help you be better able to decide if now is the time to seek therapy.  And if you do decide to start looking for a psychologist, check out first steps here.

What is a Psychologist Anyway?

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One of the coolest things about my career as a psychologist, is that I often get a chance to talk to reporters and other media folks about psychology and mental health.  I typically get asked questions like “What can people do to reduce their stress?” and “What can parents do to raise psychologically-healthy kids?”  These are great questions and each time I get asked them, I try to come up with interesting, unique, and useful responses.

Today I am preparing for another interview, but this time the question is a little different.  It is: “What is a psychologist anyway?”  I love this question because lots of people ask me, and I know even more people wonder about the answer to this – and related questions.  So here are my answers to questions I often hear about who we psychologists are anyway.

How much schooling do psychologists get? After graduating with a bachelor’s degree from college, the psychologist-to-be (PTB – my term, for simplicity’s sake) applies to a graduate program in psychology.  This process often includes writing essays, going through interviews, taking the GRE, obtaining recommendations, and proving an interest in (and usually experience in) working with people.  Once in the graduate program, our PTB takes lots of classes on psychology, neuroscience, statistics, etc.  The PTB also does clinical work (working with patients under close supervision) in the community and possibly within their school at a counseling center.  After 2-3 years of full time study, our PTB is eligible to earn their master’s degree – which usually means writing a thesis and/or completing super-anxiety-provoking oral and written exams.  Once that hurdle has been jumped over, the PTB can start working on their doctorate – often in the same program/school – and sometimes at a different school.  The doctoral program is similar to the master’s program, but typically involves more research, more advanced clinical work, and intense coursework.  Another 2-4 years are spent in this process until the PTB is ready to apply for their year-long clinical internship.  This is grueling process, as there are many fewer internship slots than candidates.  If our PTB is lucky enough to secure a position (at a medical center, community mental health center, or state hospital for example) they will spend the next 12 months there doing even more intensive clinical work.  After that year is completed (and all other research and academic requirements have been filled) our PTB can graduate with their doctorate (PsyD or PhD)!  Yahoo!  But it’s not over yet!  After graduation, our PTB still has to complete one year of supervised practice and only once that is completed can they sit for the licensing examination.  States vary in exactly what they require for this process, but it often includes a written or multiple choice examination, and an oral examination.  Once all that is done (5-8 years AFTER college) our PTB is officially a psychologist! Finally!

Is a psychologist a real doctor? Yes.  Psychologists really earned a real doctorate.  If by real doctor you mean a medical doctor (someone who went to medical school), then no – we aren’t real doctors by that standard.

Can psychologists prescribe medication? In a few states psychologists can earn prescriptive authority (meaning they can prescribed medication) after more intensive schoolwork, clinical work, and supervision.  Most of us do not prescribe medication, however most of us are happy to refer you to someone who can.

Is the psychologist the same thing as a counselor? No. Some psychologists might call themselves counselors, and some counselors might be psychologists, but the terms are not the same.  The term “counselor,” like “therapist,” is a pretty general term.  Social workers, marriage and family therapists, and other non-licensed folks might call themselves counselors or therapists.  “Psychologist” is a term reserved for people who have undergone the above training and licensing process and represents a much smaller group.

What’s the difference between a psychologist and a psychiatrist? Psychologists have PhD’s or PsyD’s (doctorates in the field of psychology) whereas psychiatrists have gone to medical school and completed a specialization in mental health/psychiatry.  In general (meaning – not always), psychologists do psychotherapy (counseling, talk-therapy) and psychiatrists work with their patients on medication management.

Which questions did I miss?

Study Participants Wanted

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I am posting the following notice from my colleague Dr Keely Kolmes who is conducting a study on therapy, social media, and clients.  Please read on for more information:

Are you a person 18 years old or over, who has been in psychotherapy,
and has sought or found information about your therapist on the
Internet? If so, we would appreciate your taking the time to complete a survey.

Our names are Keely Kolmes and Dan Taube and we are licensed
psychologists who would like to request your participation in our
research on the effects of encountering your past or current
therapist’s information on the Internet. This study has been approved
by the Institutional Review Board of Alliant International University.

As a participant, you will be asked to complete an online survey
covering your basic demographic information and your experiences
regarding seeking or accidentally discovering information about your
therapist on the Internet. We expect the survey to take about 20 to 35
minutes to complete.

Your input may help therapists to better understand if and how this
information affects clients.

No names or personal information will be linked to the study and your
participation will be completely anonymous so long as you do not put
your name in your responses. If you should wish to contact the
researchers directly, your participation may become confidential
rather than anonymous, although your name will not be linked to any of
the data you submit.

To be eligible for the study, you must be 18 or older, currently in
psychotherapy, or have been in psychotherapy in the past, and have
encountered or sought information about your therapist on the Internet.

If you meet the above criteria and are interested in participating in
the study, you can access the survey at:

http://www.surveymonkey.com/s/finalclient

If you do not qualify for the study but you know others who might be
interested in participating, feel free to forward this notice or URL.

Thank you for your interest and participation.

Sincerely,

Keely Kolmes, Psy.D. drkkolmes@hushmail.com

Daniel Taube, Ph.D., J.D. dtaube@alliant.edu

Do My Husband and I Need Therapy?

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I often get phone calls and emails asking me this question. My answer is usually something pretty vague like “well, what do you think?” To which I then get a description of the state of the marriage. Typically the caller is unhappy, not feeling heard and/or appreciated, sick of arguing, or the couple are struggling to overcome a breach of trust (an affair, pornography, financial problems, etc). So, how do couples know when it is time to seek the help of a professional?

You’ve read all the books. Often when couples come to me for therapy they have tried reading self-help books, gone to seminars, tried talking to each other, ignoring each other, and changing each other yet nothing has worked.

You’re looking outside your marriage for relief. Whether it’s complaining to your girlfriends about what a jerk your husband is, or looking online for a new partner – when folks start looking outside their marriage for happiness and fulfillment, it is usually a sign that there are problems.

Your other relationships and roles are suffering. I often hear women say that their relationship with their husband is so bad that it is affecting the way they parent, or their relationship with their friends, or their ability to concentrate at work.

You’re married. Marriage is hard. Kids are hard. Work is hard. Put it all together and it is a recipe for strain on even the most solid, loving marriages.

I think all couples can benefit from therapy at some point in their lives together. Maybe it’s after a baby is born, or after a lay-off, when someone decides to stay home with the kids, or when grandma moves in. Whenever the tough times might come (and they come for every relationship) it can be a relief to know that there is a way to get help.

Stress in America – Stress Tip #7 – Ask for Help

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For the last week I have been posting stress management tips.  But what should you do when you’ve tried them all (and lots of others) and you are still feeling more stressed and overwhelmed than you would like? It might be time to seek a professional.  I’m often asked how one knows when it is time to see a psychologist; here are some ideas:

  • You’ve tried several strategies on your own to manage your stress (or sadness, or worry, or fears) and nothing seems to work
  • Your stress is starting to interfere with your relationships and your work
  • You’re not enjoying life the way you once did (or wish you could)
  • You’re starting to notice physical manifestations of your stress (headaches, muscle aches, stomach aches, problems sleeping, etc)
  • You’re starting to use not-so-healthy behaviors to deal with your stress.  Maybe you’ve started drinking more alcohol, smoking cigarettes, eating to excess, not eating enough, spending too much, etc
  • You just feel like you need a fresh set of eyes to help make sense of the struggles in your life

If the above are happening, try meeting with a psychologist.  Often just a few sessions are enough to gain a new perspective on life, and to learn some new strategies for stress reduction.  Don’t know where to begin?  Check out my post on making your first appointment with a psychologist.


School Counselors – Stars On and Off TV

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There was so much I could have written after this week’s airing of Glee: the controversy about its appropriateness for young viewers, the sexualization of girls and women, the psychology of Rocky Horror Picture Show, the list goes on and on.  But instead, I’m going to keep it simple.

Ms. Pillsbury from Glee (Fox TV)

I love Emma Pillsbury, the school counselor on Glee. There are lots of reasons I like her: she loves cardigans as I do, she’s a redhead, she’s a quirky character.  But perhaps what I like best is that she is the school counselor – and I LOVE school counselors.

In my work with children and families, one of the first things I recommend is that parents make contact with the counselor at their children’s schools.  It has been my experience that these professionals offer some things that I – as a private psychologist -  never could.  Below are some of the things that make school counselors stars – and an awesome resource for families:

  • They see your child in a different light. School counselors get the opportunity to be flies on the wall at school and observe children in their natural state.  They are able to see who really started the fight, if your child is really the bully you think she might be, and what is really behind all those tardies in math.
  • Their services are included. At least in my area, school counselors’ services are free to students.  This can be a super opportunity for families who are pinching pennies and can’t afford outside services.
  • The hours are great. Since counselors’ offices are right there in the school, their schedules match beautifully with the kids’.  Often kids can zip into the counselor’s office for a quick chat between classes, during lunch, or at recess.  No need to miss parts of the school day, cut into family time, or rush through homework in order to make an appointment with an outside practitioner.
  • The kids are in charge. In many of the schools with which I work, the kids themselves are in charge (to a large degree) of deciding when they see their school counselor.  I love the degree of responsibility and independence this affords them.  It helps teach kids at an early age to find appropriate help and resources when needed.

While your school counselor might not sing and dance like Ms. Pillsbury, she/he is still worth checking out!

Photo: Glee on Fox TV

Should I Use My Health Insurance for Mental Health Treatment?

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This is one of the first questions I am asked by perspective clients.  Most people would like to use their insurance if they can (“I’m already paying so much for the coverage, I want to be able to take advantage of it!”) but are sometimes hesitant to do so.  What are some of the pros and cons?

Reasons to use your insurance:

  • You can. Thanks to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act many of us can now use our health insurance for mental health treatment.  This law insures that mental health treatment is covered in the same way as physical health treatment.
  • It’s cheaper. Because treatment is covered by insurance, it ends up being cheaper for most folks.  Instead of being responsible for the entire fee, you may only need to pay a co-pay, just like when you go to your primary care physician.
  • Makes finding a provider easy. Want to use you insurance but don’t know what provider to see? Simply call your insurance company and ask which psychologists in your area participate in their panels.  They will provide you with several names, numbers, and in some cases even help you set up the appointment.

Reasons to pay for treatment yourself:

  • Confidentiality. When you use your health insurance to pay for your psychological care, you allow the insurer access to all of your records.  Though they may not always request the information from your provider, they can.  And this information can be used in the future to  determine whether other services are covered, or if you are even eligible to be covered by health insurance at all.
  • Freedom. Even though insurance coverage for mental health treatment has improved over the years, there are still limits to the number of sessions and the types of treatments and conditions that are covered.  In order to have maximum control and freedom in your treatment, it may be best to pay for it yourself.
  • It’s easier. If you have the money to do it, paying for your own treatment is easier.  When patients use insurance to see me, we have to spend at least some of our time dealing with the administrative tasks required by insurance companies.  For some this is worth it, but for others it becomes a distraction to the more important tasks at hand.

Still not sure what to do?  Talk to your provider and see what s/he suggests.