#counseling

[defleftist]

May you live an existence that doesn’t require constant resilience.

[waterlikequotes]

source: @/JunoCounseling

[thejakeformerlyknownasprince]

Genuine question, what’s wrong with the DSM?

[OP refers to the Diagnostic and Statistical Manual of Mental Disorders, which I mentioned being unpopular among mental health professionals.] Disclaimer: I'm not a psychiatrist, I'm not a therapist, and I'm not trained in counseling. I'm a social psychology researcher. If a therapist contradicts me, listen to the therapist.

The problem with the DSM as I understand it: a lot of counselors/ psychiatrists/ etc. want to move away from a category- and source-based diagnostic system, toward a symptom-based treatment system. For example, think about Pepto Bismol: you feel nauseous, you chew pink tablets, it ends your nausea. It doesn't matter if your nausea is indigestion or seasickness or lactose intolerance. You match a treatment (pink bismuth) to a symptom (nausea) and don't waste time or money on diagnosis unless that treatment proves ineffective.

A large percent of counselors etc. would like to take the same approach to mental health. So we'd be researching treatments for nightmares (neurofeedback? MDMA?) in the long-term, and giving clients treatments for nightmares (meditation! Ambien!) in the short-term. All without worrying too much about whether the nightmares are caused by General Anxiety Disorder or a phobia or Seasonal Affective Disorder. There are many strengths to that approach.

Only, see, there's this big purple dinosaur holding us back.

[Image ID: Hardcover copy of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5, American Psychiatric Association; the title is white text on a purple background.]

So if everyone who uses the DSM also hates the DSM, why does it still exist and why do we keep buying it every time a $100 text revision gets published? Two reasons, in order of importance:

Insurance

Communication

Insurance is, I kid you not, the DSM's #1 reason for existence. American insurance companies won't cover treatment unless it's for a diagnosed illness, and so therapists put diagnosed illnesses on what they'd often be more comfortable describing as "bro, this dude is hella distressed and I'm trying to help undistress him." Note the word American on the cover; other countries have other manuals, and no other country's counselors are as chained to theirs as we are to ours. This means that the DSM helps — yay, affordable therapy! It means the DSM hurts — sets of symptoms get grouped artificially, spectra get split into categories, and diagnosis happens way too early in the therapeutic process.

Another comparison to unmental health: I don't have carpal tunnel syndrome, but my insurance provider thinks I do. I only announce that I don't because I haven't told you who I am or where I live. (If the insurance companies find us... Well, we just won't let them find us. The thing you should know is everyone is getting screwed by health insurance. Yeah, even you.) I have wrist pain and tingling. It has the wrong antecedents for carpal tunnel, and it has weird manifestations — pressure on the base of my thumb causes pain in my pinky — but my OT wrote down "Carpal Tunnel" on the forms because the alternative was a $500+ round of diagnostic scans. No one cares whether my median nerve is inflamed or not; occupational therapy still looks like "try this stretch, that stretch, this brace, that brace, and these activity changes; keep whichever combination makes the pain and tingling go away."

This kind of thing also happens in mental health all the time. Many therapists don't care — and neither should you — if your serotonin levels are low; if you're miserable and an SSRI prevents the misery, take the dang SSRI. If your mother was harshly critical and now you feel panic at any hint of criticism, it doesn't matter whether that better fits C-PTSD or NPD; it matters whether you cope with soothing self-talk or if you cope with alcohol. Put something from the DSM on the forms, and focus on finding which stretches (breathing exercises) make the tingling (panic) go away.

Communication is the biggest strength of the DSM. It means that clients can benefit from labels ("I'm not lazy, I'm ADHD") and consistent standards of treatment can be applied across different clients in different states. The DSM has huge lists of things like "if your client shows memory problems, be sure to check for alcohol abuse" or "if they have self-harm, make sure it's non-suicidal before you do anything else" that are tremendously helpful. It can help therapists who encounter a set of behaviors they've never seen before to go "client is rigid, rule-bound, and lacks insight... huh, looks like I'd better refer them to an OCPD specialist." (It's also the source of a lot of toxic misinformation on social media when symptom lists get taken out of context without that all-important differential diagnosis information, but I digress.)

However, diagnosis should never be the beginning point for therapy — it's impossible to know your client's mind without first building trust and transference — but reliance on the DSM for insurance often forces it to be. Diagnosis should never be the end point for therapy — knowing your perceptions don't match others' because of Bipolar I won't stop you hearing the dang hallucinations — but home use of the DSM often acts that way. Categorical diagnosis is limiting if your therapist is primarily interested in how depressed you are but the Beck Depression Inventory uses an absolute cutoff point for "depressed" or "non-depressed." Categorical diagnosis is useless if over 50% of people diagnosed with a depression are later diagnosed with an anxiety disorder, and vice versa. So it's an imperfect book that does a lot of things well and a few things badly, and many of its heaviest users would argue that it shouldn't exist at all.

For further reading, I recommend The Body Keeps the Score by Bessel van der Kolk. I don't agree with all the axes he grinds or all the ways he grinds them, but he's got decades of psychiatry experience and is (I hope) predicting the next paradigm shift in mental health.

For instance, van der Kolk argues that it doesn't matter if at intake your client has long blond hair and is named Linda, only to show up the next time with no hair and the name Gerald, only to come next time with short red hair and the name Taylor. The therapist should only be asking "how does the client feel about these changes?" and "what are these changes doing for the client?" If Linda can't remember what Gerald did, then focus on the terrible memory gaps that alter identities create. If Taylor became Gerald to try and please you, then focus on teaching mindfulness and self-compassion. If this is a happily genderqueer person, then figure out why they're seeking help and don't worry about the appearance changes. If this is someone who thinks in absolutes and regards their personality as constantly changing, then work on teaching them to see the world and themself with moral complexity. It doesn't matter whether Dissociative Identity Disorder exists or not; just ask your client what they need and how you can help, then go from there.

Anyway, the DSM is an imperfect solution to a complex problem, and a lot of mental health practitioners view it as a relic of a more paternalizing era. No one has come up with a really good solution for how to remove and replace it, so for now it's the least-bad option.

[dreaminginthedeepsouth]

’ s y m b i o s i s ’ “Talking face to face”  © Nadya Ploschenko (Kharkiv, Ukraine), 2013 @ArtLify

* * * *

"When you counsel someone, you should appear to be reminding him of something he had forgotten, not of the light he was unable to see."

~ Baltasar Gracian, writer and philosopher (8 Jan 1601-1658)

[h/t Ian Sanders]

[unusual-unicorn]

Therapist: What do you like about yourself?

Me: I really like my blog, man.

[twloha]

i love you mental health care i love you counseling i love you safe spaces to talk about hard things i love you medication that allows me to function and stay alive i love you art therapy i love you boundaries i love you healing

[seidigardensystem]

Your Words Matter

Dear Therapists,

I had just logged into a Zoom session for my Diagnosing Pathology class and my cohort was in deep discussion with one particular student as we all waited for our professor. This student in particular was already working in some sort of clinical setting, not yet giving therapy, but a new client profile had come across her desk with a diagnosis of borderline personality disorder. She didn’t know much about the diagnosis herself, but she was concerned because her boss said, “Whoa, good luck with that one. Borderlines are very difficult to work with.”

Difficult. It’s not the first time I’ve heard that word. Every time I hear a professional utter the word, “difficult” when referencing a client it stings. Is that how you really see us? As patients/clients that are stuck in a downward spiral whose struggles are too much for you to handle? Don’t you believe in what you do and that there is hope for us?

My heart breaks for whoever this person is that has borderline personality disorder because the cards have been stacked against them before they’ve even gotten started. One of my school assignments required me to write about working with a difficult population and this was my response:

“If we get the idea that a particular diagnosis or population is difficult to work with it feels like we are setting ourselves up for failure. Maybe we will treat them differently or have lower expectations or refuse to work with them because we have a negative perception.”

In 2022, I attended the Healing Together conference hosted by An Infinite Mind in Orlando, Florida. I was sitting in a session where I could hear and learn about lived experiences with dissociation and an excerpt from a book was read aloud as an example of how some clinicians view dissociative identity disorder. The presenter who read the excerpt was sad, the audience was sad, and I felt infuriated. The gist of the excerpt talked about how a clinician should be wary because clients with dissociative identity disorder are difficult to work with and that they bring unsolvable problems to therapy.

Unsolvable problems? Listen, if a client’s problem was easy to solve, they wouldn’t need therapy! Of course we are bringing our unsolvable problems to you. We believe in your ability to help us. We were trusting you enough to share our struggles. When we hear you call us difficult, challenging, resistant, and a myriad of other words, you break our trust and confidence.

My ask of you is that you reframe your perspective of difficult clients. My therapist always says that behavior is communication, so when you find a client’s behavior particularly difficult, ask yourself, “What is my client trying to tell me?” “What does my client need right now?” Seek out peer consultation or supervision without passing judgment on how difficult a client is for you.

I’ve always carried around my own judgment about myself as a client in therapy. I used to tell my therapist, “Thank you for putting up with me” and her response was, “There’s nothing to put up with.” When I had the opportunity to watch her present at a conference once, I went up to her just before it started to tell her she’d do a great job. She just smiled and said, “Everything I’m presenting today, I learned from you.” I thought about that for a long time. Not once, in our years of therapy had she ever shown any indication of frustration, feeling challenged, or felt I was difficult. She simply adapted her interventions as needed.

The NICABM posted back on June 11, 2022 on their Facebook page a quote from Pat Ogden, PhD; “When we call clients resistant or difficult, it’s because our interventions are not working and we feel incompetent.” As clients, we don’t think you’re incompetent. We think there’s something wrong with us and we believe you when we hear you say we’re difficult. So, please, choose carefully. Your words matter.

Sincerely,

A DID Client

References

NICABM. (2022, June 11). What may at first seem like opposition or resistance can often signal a client’s deepest struggles. [Status Update]. [Image attached]. Facebook. https://www.facebook.com/NICABM/photos/10159170676011314

[crystalsenergy]

'counseling' each placement - for a better life; [Mercury version] part 1

pic not mine

Mercury in Aries - Try to exercise more patience, less sense of urgency. This can generate a lot of anxiety. Look at the other options more openly. Be careful not to impose too much your thinking on others, and this ends up generating several conflicts around you. tips: meditation, breathing exercises.

Mercury in Taurus: Work on adapting to changes in plans, understand that not everything will go the way you planned. Understanding things in a practical and objective way is important, but being open to other ways of interpreting can be great. Don't be inflexible with life itself and with the change of direction. Work your mind to understand points in life that may go unnoticed by your mind, still focused on thinking like years ago.

Mercury in Gemini - Don't push yourself mentally - your mind does a lot of work in an entire day. Try to analyze things before starting them. Know something in more depth before you believe you know them. Take time to rest your mind and do something that relaxes you, that doesn't influences your thoughts. And I say this for the tendency to feel anxiety. Try as much as possible to remove simultaneous stimuli from (study) environments, this will greatly impact your productivity and efficiency.

Mercury in Cancer: Don't analyze things solely on the basis of emotions. This may be how you function and this is who you are, this is your essence, but that doesn't mean that nothing can improve. Emotions are important, but understand that not everything the other does can be based on an emotional issue. Don't hold annoyances, as they can surface in the future, contaminating the interpretation of situations and people. In short: don't take things personally. Talk about your annoyances! this will avoid problems.

Mercury in Leo - Work your acceptance to hear 'No' when you expected 'Yes'. Try to understand when something can't be done. Don't communicate aggressively or defensively after hearing something different from what you expected - such as a criticism. Notice tendencies to demand a lot of attention when it is not the case to receive it. Use your creativity and power of expression in your favor, constructively, taking others into consideration as well. Believe in your potential.

Mercury in Virgo: Try not to see everything in a practical way. exercise the pleasure of looking at what has already been done, and less at what needs to be done. Don't blame yourself so much for the mistakes you make. Try to be less critical and appreciate your time more as a way to relax a little too. Work your creative side, reception for abstract messages is something very important for a healthy psychological, as well as for self-knowledge. Not everything is made of concreteness and objectivity.

Mercury in Libra - Incorporate into your mental activity things that are also related to yourself, purely understanding, without involving anyone else. Learn to communicate sad things as well. Remember your potentials. Doubt less of something you have noticed, decided, said. Depend less on the analysis of others and create internal parameters to decide if what you did was good or bad. Realize the problems around you, stopping to avoid conflicts of ideas all the time - which are sometimes necessary. Understand who you are: take time to yourself and understand your thoughts, the root of your decisions. Don't be such a perfectionist. Take care of your mental health and how much other people's expectations affect you.

Mercury in Scorpio: Work on your mental inflexibility. Understand more the faults of others, from a more comprehensive point of view. Understand more openly the peaks and troughs of life, and even your personality. Don't hold grudge, anger, explain what you think of something - from the beginning, because holding it will generate an accumulation of information that will most likely be distorted by your mind. Beware of extreme views of people or things. Use your ability to be observant.

Mercury in Sagittarius - Watch out for a tendency to over-imagine things, idealizing them and seeing life in a very different way than it is: a life that will tend to work out even if you don't do something. We always have to do something. Pay attention to indiscipline and try to be more realistic. Beware of promises you make to others and a tendency to be mentally irresponsible.

Mercury in Capricorn: Don't try to control every detail. Accept that things will get out of your control. Beware of a possible habit of forgetting to consider other needs because yours are involved. Planning is important, but understanding unforeseen events too. Let go more, let things flow. Don't analyze everything as if it needed to have an end goal. People and emotions don't need earthly and concrete filters - not always.

Mercury in Aquarius - It's extremely important to understand your flow of thoughts. You tend to think a lot, reflect on different points of the same question, starting at one point and ending at another. This can be great for analyzing problems, finding solutions, understanding issues. But it can also complicate your life a lot, especially when dealing with matters that need to be externalized, talked about. Therefore, be very careful with a tendency to always want to understand a subject from the inside and forget about exchanges, conversations, to externalize. Work on practicality: making thoughts useful, which is certainly possible to do, as you tend to be deep mentally speaking. Beware of anxiety. The more you empty the "mental cup" somehow before it fills up, the better it will be for your mental health. If practicality is difficult, as Aquarius is a much more "aerial" sign, work on your creative side! Use music, for example, as a way to lighten the mental load. Dialogue.

Mercury in Pisces: Try not to be so impacted by everything around you, whether visions about you or what happens in general. Or, if this is complicated, try to notice when you are impacted by something that had nothing to do with you, but that you later incorporated into your thoughts. Don't be soooo fickle, use your ability to go in other ways to your advantage. Use this ability to grow in your individuality: Pisces is a great sign for studying things that for others seem difficult and complex to decipher, especially those related to the emotional. Believe in your communication and persuasion potential as long as you move intelligently, working with the knowledge you tend to have / absorb of what others are, want, need.

[amerindianfromcrowntown]

I'm gonna start working on getting out of the field. I can't say certainly, but I think I'm out of the counseling game for good. I'm not mad. I'm not burnt out. I'm just done. It's a bad diet for me.

I've been telling friends lately. Nicely enough, they seem understanding and supportive. I'm just really happy no one's really challenged the conclusion.

Being a counselor made me a far better person, but I'm not enough of a humanitarian to do this consistently. On the private practice end, I think I'd become one of those predatory counselors who is essentially a yes man for wealthy cash clients. I can't enjoy being community based because I feel owed one. If I stepped up into private, I'd try and get every dollar I felt deprived of and a lot more. I'd rather just have a job where I don't have to do any actual psychotherapy. That way, I could just be a normal joe and be good at a title that had no serious emotional work.

[asking-jude]

Do you want free mental health help? What about remote, pay-what-you-want counselling? Visit askingjude.org.

[xanaxlollipop]

Healing Relationships

Things you should navigate with your partner at the beginning of a love story…to have a healing relationship

Do you have any boundaries/limitation about anything? Something that I should know at the start?

What do you need, specifically, in order to feel emotionally safe and secure inside our relationship?

How do I know/recognize if you're getting triggered? What do you think it's the best caring response from me? Any suggestion?

How can I help you feel most confident in the bedroom?

In your opinion, what are the mistakes you tend to make in a relationship, and you want to avoid in this one?

What's your biggest relationship fear? How do you think we should adress it?

Do you feel comfortable with the pace of our relationship? You think we're going too fast/too slowthe right pace?

What makes it hard for you to be your authentic self inside a relationship, and how can I contribute to make it easier for you?

What did you not hear enough in your last relationship and you want to hear more?

[defleftist]

The joyous convergence of my leftist politics and my job as a therapist is when I get to help a client research local tenants’ rights laws to help them get out from under a shoddy landlord.

[waterlikequotes]

reasons to end a relationship by @/millennial.therapist | Sara Kuburic

[dahackedaccount]

If you're located in Illinois or Minnesota & you're been thinking about taking your Mental Health seriously, Becoming Behavioral Health & Wellness has immediate openings!

https://www.becoming-well.org/

[lalocreativity]

Here's how to quickly identify what you might need in your emotional and mental health journey.

[twloha]

“When I first started seeing a counselor, I would never have shared that information with anyone. I didn’t want them to think I couldn’t handle life. Now I am proud to say I seek help.” – Amanda L.