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Posted by JasonR86 (9611 posts) -

So I'm therapist, everyone, and am biased in a lot of ways. That said, I do think that I have something to offer to people who wonder what the mental health service field is like, what it is to be a client, how I would like a client to view themselves, and so on. So I thought I might make a short FAQ about what I do. Remember, I'M BIASED, and not every person in my position will agree with what I said. But fuck those guys and gals. Also if you guys want to ask me some questions go ahead and I'll try my best.

What's a mental health diagnosis?

A mental health diagnosis is a label created to describe a list of symptoms which all signify an underlying problem. There are two primary types; Axis I and Axis II diagnoses. An axis I diagnosis is usually a short term problem. Axis II is reserved for more long term, persistent problems (this is where personality disorders go). Every assessment that leads to a diagnosis, whether the diagnosis is Axis I or II, is supposed to be a snapshot in time. This is why they can change and why some people think they have 5-10 disorders. People most likely don't have 5-10 disorders. They've had 5-10 different diagnoses at different times in their lives. Here are all the disorders I can diagnosis. There are also v-codes I can diagnosis which are sort of adjuncts to other diagnoses.

What's a case formulation?

A case formulation is where a therapist's theoretical perspective meets the mental health diagnosis. A theoretical perspective is how a therapist views the development of psychological problems, personality, and, without sounding too whimsical, the world at large. Every theory has things in common. But each has their own take on things as well. There's all sorts of lists out there on the different theories but no complete one that I can link to. Just google 'psychological theoretical perspectives' and read a few of the articles if you're interested. So a case formulation is when the diagnosis and symptoms associated with that diagnosis is described and treated from the theoretical perspective of the therapist (hence, symptoms meet theory to create a case formulation).

Why's this shit so dry?

Because this shit's science son!

What does therapy look like?

This all depends on the case formulation and the therapist. Most therapist will say that the relationship between the client and therapist is key. Some therapist will give homework to be done between sessions (not me). Some will say that the therapy sessions are a safe setting to prepare for the rest of the client's life both in how to interact with others, through the therapist, and through the client making decisions (that's more like it!). For kids it can be based on play therapy (basically a child's play represents innermost emotions, their perspectives on the past, and how they interact with others). It all depends.

Who needs therapy?

Whoever wants to have it.

Who shouldn't be in therapy?

People who don't want to be there, especially if they are forced, and people who simply want to be fixed without putting in the effort to work alongside the therapist to reach a common goal.

What's the goal of therapy?

Is it shitty if I say 'it depends' again? Because it does. It depends on what the client wants. But rest assured, there needs be an ending to therapy (this is a contentious thing among therapist though depending on the diagnosis). I would add that I the goal of therapy is that the client would no longer require therapy anymore. That they would be so well off and self-assured that therapy would no longer be a necessity.

What do you think about medication for psychological treatment?

I think my view is way less important then the client's. If they client wants medication then I need to find a way to meet that request. That said, I worry that medication will become a crutch. That people won't reach that goal I mentioned above (being fully self-reliant) and instead will think that they are only as healthy as they have medications. But I do know that there are people who require medication and will need to take it all their life. I just don't think there's as many people out there as there are currently. But I'm biased so there's that.

Are therapist as perfect as they seem in session?

Not even remotely.

Is it ok to show strong emotion in session?

It's preferred. Most of the time (there are some exceptions).

What do you do with client's who lie?

Client's don't have to necessarily tell me the truth. I'm not a cop. And, at times, the way speech is delivered is more important than the content. Also, it's really easy to tell when people lie. Trust me.

Can I ask you more questions in the comments below?

Yep. Go ahead. Ask away.

Can I tell you that you're full of shit and that therapy is bullshit and you suck and nener nener?

You can do that too. If you want. You jerk.

#1 Posted by MariachiMacabre (7056 posts) -

MENTAL HEALTH THERAPY IS SLAVERY.

#2 Posted by JasonR86 (9611 posts) -
#3 Edited by Yummylee (21295 posts) -

You're full of shit and therapy is bullshit and you suck and nener nener... Gosh, I'm witty.

Anywhoo cheers for this, it was an informative read. So do you specialise for a certain age group? I went through therapy sessions when I was about 17, but if it were to continue whence I hit 18, I would have had to move on to a different therapist. Just curious if there's then different training provided for specifically seeing children, or people of old age ect.

Also, if you don't mind me asking, how come you prefer not to hand out homework inbetween sessions?

And finally, have you ever had any clients that suffer from sociopathic tendencies and the like?

#4 Edited by Wrighteous86 (3748 posts) -

You're glib. You're being glib.

#5 Edited by MariachiMacabre (7056 posts) -

All dumb comments making fun of dumb Tom Cruise and his dumb anti-mental therapy cult aside, you do good work, sir! And this was an informative read.

#6 Posted by Demoskinos (14585 posts) -

You're glib. You're being glib.

I wonder if ANYONE is going to get that reference. I got a chuckle out of it though.

#7 Posted by Blu3V3nom07 (4164 posts) -

How about I just PM something?

#8 Posted by MariachiMacabre (7056 posts) -

@wrighteous86 said:

You're glib. You're being glib.

I wonder if ANYONE is going to get that reference. I got a chuckle out of it though.

I got it! I best be getting a prize, motherfucker.

#9 Posted by TheHumanDove (2523 posts) -
#10 Edited by JasonR86 (9611 posts) -

@yummylee said:

You're full of shit and therapy is bullshit and you suck and nener nener... Gosh, I'm witty.

Anywhoo cheers for this, it was an informative read. So do you specialise for a certain age group? I went through therapy sessions when I was about 17, but if it were to continue whence I hit 18, I would have had to move on to a different therapist. Just curious if there's then different training provided for specifically seeing children, or people of old age ect.

Also, if you don't mind me asking, how come you prefer not to hand out homework inbetween sessions?

And finally, have you ever had any clients that suffer from sociopathic tendencies and the like?

Thanks man. I prefer working with adults 18 and up. But I've worked with kids as young as 8 and have done assessments with kids as young as two. There's a different set of skills when working with kids versus adults just like there's different skills working with psychotic disorders versus mood disorders. And some agencies only have therapist who specialize in only working with kids or adults. I do both.

I don't like giving homework because I can't think of a way of doing it without it feeling forced. Plus it feels like me telling the client what to do to get better. I would prefer that people create their own homework on their own naturally through our conversations. Which is usually what happens. So we get the same effect but I don't have to be a teacher.

I have worked with client who have had pretty big criminal records with all ranges of crimes. Pretty violent ones. Ones I can't get into. I also don't like using words like 'sociopath' because it feels blaming to me. It also sort of ignores context rather focusing on what is 'wrong' with a person and why they are broken and whatnot. But if I were to use that word, then yes I've worked with people like that.

You're glib. You're being glib.

Glib is my middle name.

All dumb comments making fun of dumb Tom Cruise and his dumb anti-mental therapy cult aside, you do good work, sir! And this was an informative read.

Thanks man!

#11 Posted by MariachiMacabre (7056 posts) -

@jasonr86 said:
@mariachimacabre said:

All dumb comments making fun of dumb Tom Cruise and his dumb anti-mental therapy cult aside, you do good work, sir! And this was an informative read.

Thanks man!

D...don't make this weird.

#12 Posted by JasonR86 (9611 posts) -

@wrighteous86 said:

You're glib. You're being glib.

I wonder if ANYONE is going to get that reference. I got a chuckle out of it though.

I totally didn't get it.

How about I just PM something?

Go ahead dude.

#13 Posted by JasonR86 (9611 posts) -

@jasonr86 said:
@mariachimacabre said:

All dumb comments making fun of dumb Tom Cruise and his dumb anti-mental therapy cult aside, you do good work, sir! And this was an informative read.

Thanks man!

D...don't make this weird.

Take off your pants. You know, for therapy.

#14 Posted by DarthOrange (3852 posts) -

lol

#15 Posted by JasonR86 (9611 posts) -

lol

I'm kind of like the Citizen Kane of mental health.

#16 Posted by believer258 (11682 posts) -

Yes. Why are you such a dick?

A more serious question: What seems to be the most common thing you treat?

Another: Is depression something that people fall into and out of all the time, or can people just get rid of it completely and never have to deal with it again? My understanding of mental health issues is limited at best, so forgive me if this one sounds dumb.

Yet another: Are there any mental health problems that some people mistake for depression?

Finally: You say that some people ask for medication. Do you ever have anyone that specifically wants to avoid any sort of medication?

#17 Posted by MariachiMacabre (7056 posts) -

@jasonr86 said:

@mariachimacabre said:

@jasonr86 said:
@mariachimacabre said:

All dumb comments making fun of dumb Tom Cruise and his dumb anti-mental therapy cult aside, you do good work, sir! And this was an informative read.

Thanks man!

D...don't make this weird.

Take off your pants. You know, for therapy.

Okay. I'm trusting you, here, Doc. Don't make me regret this.

#18 Posted by Example1013 (4834 posts) -

A lot of therapists suck. Don't take it personally though, I have the same feeling for psychiatrists. Haven't spent much time with psychologists so I can't really give an opinion on them, but I have an unfortunate suspicion that if I did, it would match the other two.

#19 Edited by Video_Game_King (36090 posts) -

@wrighteous86 said:

You're glib. You're being glib.

I wonder if ANYONE is going to get that reference. I got a chuckle out of it though.

#20 Posted by DarthOrange (3852 posts) -
#21 Edited by shivermetimbers (763 posts) -

Another: Is depression something that people fall into and out of all the time, or can people just get rid of it completely and never have to deal with it again? My understanding of mental health issues is limited at best, so forgive me if this one sounds dumb.

I can answer this as a life long sufferer of depression and say that depression is different for everyone. Symptoms are different, people react differently to external stimuli, etc. It's pretty much a life long mental illness, it never just goes away. But there are ways to treat it and mask it so that the suffer can lead a normal life and symptoms can leave, even if the illness itself isn't...If that makes any sense.

#22 Posted by MariachiMacabre (7056 posts) -
#23 Edited by Rick_Fingers (524 posts) -

Ever had someone tell you something that just made you scream in horror internally while keeping your professional face on?

#24 Edited by believer258 (11682 posts) -

@video_game_king said:

@demoskinos said:

@wrighteous86 said:

You're glib. You're being glib.

I wonder if ANYONE is going to get that reference. I got a chuckle out of it though.

Wait, is it a Yogscast reference? EDIT Nevermind. I was confusing that with this.

#25 Posted by Yummylee (21295 posts) -

@jasonr86: Alritey, thanks for the reply.

Oh, so how do you feel about how therapy is portrayed in movies and stuff? Actually, just what are the differences between a therapist and a psychiatrist? Because if Hollywood would have its way then therapists apparently don't exist and psychiatrists reign supreme. Do you at least have one of those sleek, leather couches for patients to lie down on?

Also on that note, have you ever considered moving on from your old drinking hole and starting up your own radio show based in Seattle? It's what all the cool therapists/psychiatrists do.

#26 Posted by JasonR86 (9611 posts) -

Yes. Why are you such a dick?

A more serious question: What seems to be the most common thing you treat?

Another: Is depression something that people fall into and out of all the time, or can people just get rid of it completely and never have to deal with it again? My understanding of mental health issues is limited at best, so forgive me if this one sounds dumb.

Yet another: Are there any mental health problems that some people mistake for depression?

Finally: You say that some people ask for medication. Do you ever have anyone that specifically wants to avoid any sort of medication?

I'm a dick because...

The most common issue are mood disorders (depression being huge) and anxiety disorders. Though psychosis is becoming more common as of late.

Depression often comes in episodes. What I see most commonly is a persistent low mood with big drops from time to time. For any disorder, what I try to say is that the person learn what might have lead the current symptoms and how to best deal with them. If that leads to the client feeling like they no longer have depression then that's great! But I aim kind of low and see where the client goes with our work.

Practically anything can be mistaken for depression. Hyperthyroidism can lead to depressive symptoms for example. Also practically anything can be mistaken for mania. So many people think they have bipolar disorder because they go from states of being depressed versus not depressed and the not depressed part equals 'mania'. It doesn't.

If people have a history with a medication and didn't like it they'll want to avoid it. Also if they've had a drug problem in the past or currently they may want, but won't get, some medications. For example, a person with a methamphetamine problem won't get prescribed ADHD medications and a person an alcohol problem won't get prescribed most anti-anxiety medications (like benzodiazepines).

@jasonr86 said:

@mariachimacabre said:

@jasonr86 said:
@mariachimacabre said:

All dumb comments making fun of dumb Tom Cruise and his dumb anti-mental therapy cult aside, you do good work, sir! And this was an informative read.

Thanks man!

D...don't make this weird.

Take off your pants. You know, for therapy.

Okay. I'm trusting you, here, Doc. Don't make me regret this.

*zip*

A lot of therapists suck. Don't take it personally though, I have the same feeling for psychiatrists. Haven't spent much time with psychologists so I can't really give an opinion on them, but I have an unfortunate suspicion that if I did, it would match the other two.

We haven't met personally so you might think I suck too! But there's often two sides to these things and there might have been a reason why it felt like the people you've worked with suck. But there's always going to be people in all fields that are not as good as others. We do try our best though.

#27 Posted by falserelic (5334 posts) -

Quick Question from falserelic..


What made you want to become a therapist?

#28 Posted by Video_Game_King (36090 posts) -

It's pretty much a life long mental illness, it never just goes away.

As somebody who suffers from depression with regularity, this is all kinds of terrifying.

#29 Posted by mrfluke (5102 posts) -

lol

but for reals,

so ok lets say a scenario is that the client says he needs medication, but you know based on your diagnosis/gut that its not that serious to where said client needs it.

would you push back against the clients demands for medication and insist on something more low key like natural supplements. or do you ultimately have to give in to the clients demands for prescription medication?

(good post by the way, pretty informative)

#30 Edited by JasonR86 (9611 posts) -

Ever had someone tell you something that just made you scream in horror internally while keeping your professional face on?

Absolutely.

@yummylee said:

@jasonr86: Alritey, thanks for the reply.

Oh, so how do you feel about how therapy is portrayed in movies and stuff? Actually, just what are the differences between a therapist and a psychiatrist? Because if Hollywood would have its way then therapists apparently don't exist and psychiatrists reign supreme. Do you at least have one of those sleek, leather couches for patients to lie down on?

Also on that note, have you ever considered moving on from your old drinking hole and starting up your own radio show based in Seattle? It's what all the cool therapists/psychiatrists do.

So a therapist like me has a master's degree in clinical psychology and can do assessments for mental health diagnoses and run therapy. A psychologist has a doctorate and can do a few more assessments that I can't (like the rorschach tests). A psychiatrist has doctorate like a psychologist but also a medical degree as well. They can prescribe medications and, most often then not, focus on medication management rather then psychotherapy.

I do have a couch in my office! And a sweet office chair. Shortly I'm going to start my own practice and leave the community health life behind me.

#31 Posted by Jay_Ray (1071 posts) -

@jasonr86: Have you ever seen the HBO show In Treatment? Is that a good recreation of what therapy is like?

#32 Edited by ArtelinaRose (1845 posts) -

boy you would just have a field day with me wouldnt you

#33 Posted by Zeik (2260 posts) -

@jasonr86 said:

So a therapist like me has a master's degree in clinical psychology and can do assessments for mental health diagnoses and run therapy. A psychologist has a doctorate and can do a few more assessments that I can't (like the rorschach tests).

You can't do Rorschach tests?! Sorry man, I think you chose the wrong profession.

#34 Posted by JasonR86 (9611 posts) -

Quick Question from falserelic..

What made you want to become a therapist?

I took a few philosophy classes in undergrad and the professor in the classes thought that I was more interested in behavior and people then philosophy. So he told me to take a psychology 101 class and see what I thought. And he was right.

@mrfluke said:

lol

but for reals,

so ok lets say a scenario is that the client says he needs medication, but you know based on your diagnosis/gut that its not that serious to where said client needs it.

would you push back against the clients demands for medication and insist on something more low key like natural supplements. or do you ultimately have to give in to the clients demands for prescription medication?

(good post by the way, pretty informative)

I wouldn't because, with my training, I have no place to make such a claim. I would refer the client to a prescriber I trust and explain to that prescriber what concerns me before they see them. But I would have to put my trust in that prescriber because they are the experts with medications and I'm not.

@jay_ray said:

@jasonr86: Have you ever seen the HBO show In Treatment? Is that a good recreation of what therapy is like?

I haven't but I've heard about it. I should give it a shot.

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

#35 Posted by JasonR86 (9611 posts) -

@zeik said:

@jasonr86 said:

So a therapist like me has a master's degree in clinical psychology and can do assessments for mental health diagnoses and run therapy. A psychologist has a doctorate and can do a few more assessments that I can't (like the rorschach tests).

You can't do Rorschach tests?! Sorry man, I think you chose the wrong profession.

Well, I guess if I took the training I might be able to do it but my analysis wouldn't hold as much weight as a psychologist's would.

#36 Posted by ArtelinaRose (1845 posts) -

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

#37 Edited by JasonR86 (9611 posts) -

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

I'm at an agency. So, technically, my agency could take a lot of money from you. Better?

#38 Posted by MariachiMacabre (7056 posts) -

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

He left me penniless. :'(

Why, Jason? Why? You were my friend...

#39 Edited by ArtelinaRose (1845 posts) -

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

I'm at an agency. So, technically, my agency could take a lot of money from you. Better?

But I already have a therapist...

#40 Posted by JasonR86 (9611 posts) -

@artelinarose said:

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

He left me penniless. :'(

Why, Jason? Why? You were my friend...

BECAUSE YOU TOOK OFF YOUR DAMN PANTS!!!

#41 Posted by JasonR86 (9611 posts) -

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

I'm at an agency. So, technically, my agency could take a lot of money from you. Better?

But I already have a therapist...

*inhales*

Well this is awkward.

#42 Posted by ArtelinaRose (1845 posts) -

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

I'm at an agency. So, technically, my agency could take a lot of money from you. Better?

But I already have a therapist...

*inhales*

Well this is awkward.

I mean, why on earth would I need TWO friends?

#43 Posted by McGhee (6094 posts) -

Since you mentioned it, it made me wonder if psychology is a science. Can human behavior be understood and quantified to that level of dependability/repeatability?

#44 Posted by JasonR86 (9611 posts) -

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

I'm at an agency. So, technically, my agency could take a lot of money from you. Better?

But I already have a therapist...

*inhales*

Well this is awkward.

I mean, why on earth would I need TWO friends?

If we could initiate a transfer...then, you know...

#45 Posted by ArtelinaRose (1845 posts) -

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

I'm at an agency. So, technically, my agency could take a lot of money from you. Better?

But I already have a therapist...

*inhales*

Well this is awkward.

I mean, why on earth would I need TWO friends?

If we could initiate a transfer...then, you know...

M-my word! How unprofessional! Are you TRYING to start a scandal?!

#46 Posted by MariachiMacabre (7056 posts) -

@jasonr86 said:

@mariachimacabre said:

@artelinarose said:

@jasonr86 said:

@artelinarose said:

boy you would just have a field day with me wouldnt you

I only know you from here but from what I've seen I think you'd be a great client.

Cause you'd be able to take a ton of money from me, huh?! You hack!

He left me penniless. :'(

Why, Jason? Why? You were my friend...

BECAUSE YOU TOOK OFF YOUR DAMN PANTS!!!

I DID IT BECAUSE YOU TOLD ME TO. YOU TOLD ME TO TRUST YOU AND HOLD MY BREATH.

#47 Posted by JasonR86 (9611 posts) -

@mcghee said:

Since you mentioned it, it made me wonder if psychology is a science. Can human behavior be understood and quantified to that level of dependability/repeatability?

Yep. There's an entire field of psychological research. One of the most famous was Pavlov's Dog's and him developing the concept of classical conditioning.

#48 Posted by JasonR86 (9611 posts) -
#49 Edited by ArtelinaRose (1845 posts) -

I am curious as to what you meant by you think I would make a good client. You can't just say something like that and expect me to let it go! You don't have to answer it publicly, obviously...

#50 Posted by JasonR86 (9611 posts) -

I am curious as to what you meant by you think I would make a good client. You can't just say something like that and expect me to let it go!

You seem open to differing opinions, are strong, determined, and have a good sense of humor. You seem like you'd be open to hearing the nonsense a therapist like me spews throughout each session. You seem to already have a lot of strengths that you can rely on.