FAQ About Mental Health From A Biased Source...ME! Part 4!!! It's Political Now (kinda)!

As always, you can leave comments asking me anything including about what I bring up. But remember, I'm not the be-all end-all on this topic. Even if I think I am.

So what's up with Obama-care, affordable care, whatever?

Well, that's hard to say. I know what the new healthcare is supposed to be; affordable healthcare for everyone and whatnot. But I work primarily with people who are on Medicaid which is state funded health care. Now I'm no expert on how exactly this system works but I know enough for my job and just enough to be dangerous. Here's my take on Medicaid generally speaking; it is affordable health care. From what I understand the new healthcare is supposed to be more all encompassing and cheaper but a lot of my client's get the Medicaid for free so you can't get much cheaper then that. So, basically, the new healthcare seems more all-encompassing. I think.

Ok. But, we still don't know how it'll work in real, paying agencies terms. As far as I know no one in my clinic, including our financial people, have heard how it works. We don't really know anything really about how it is supposed to pay us. As it stands now all of our established and new clients have Medicaid, or 'other' insurance (we'll discuss that in a second), and still do. But we also heard that the new healthcare will either change or be an adjunct to medicaid. But we don't know how that really works either just that something is going to happen at some point. So we are taking on clients and keeping clients and doing therapy work without knowing if next week or month or whatever we'll have to let them go because they don't have benefits or their benefits don't cover our therapy. For that fact, we don't know how much the new healthcare will cover our sessions (basically how much money do we get in return for services rendered) or even if our services will be covered. Or if chemical dependency will be covered. We don't really know anything! Which makes this whole change real frustrating to plan for both financially and therapeutically. Do we prepare client's for ending sessions? Do we handle things as if nothing will change because, for our purposes, they won't? WHO KNOWS!

Wait, paid for services rendered?

Yep. We get paid for our work. And how much we get paid depends on things like insurance. So I work for an agency that is non-profit and serves more lower-income individuals. In our circumstance, we get paid the most from medicaid insurance. Private insurance is next (which will cover in a second). Then medicare if it is covered by our agency (I'll cover that later too). Then sliding fee scale which is waaaaaay less then medicaid. Basically, the lowest end on our sliding fee scare results in about 10% money back of what we get from medicaid. So as a businesses, even a non-profit businesses, need to keep things like payroll, budget, etc. on the mind. We have financial goals we have to keep to stay open. So we can only take so much medicare, private pay, and sliding fee scale. Which is an issue because we may have to implement things like a wait-list that can last for months on end. There are more too. Keep reading.

So lets pretend the new healthcare system doesn't exist. Which insurance is better; medicaid, medicare, or private insurance?

Well, all have their benefits and drawbacks. Medicare is the exception really for mental healthcare. There are types of medicare that cover counseling and more that cover psychiatry. But those types of medicare are rare. So we have very few medicare clients.

Medicaid pays kid. It pays us well. So we like medicaid. Plus there are systems in place where I live that makes getting into services when you have medicaid pretty simple. Which I think is pretty cool. With medicaid there's no fuss, no muss, no legwork. Here's the drawback; as you improve, if your getting medicaid for free, you'll lose that medicaid. Basically, medicaid is conceived as a way to help people to better themselves when they are low so they can improve, rejoin the workforce, and live productive and happy lives. Then medicaid benefits go away (which not only cover mental health but dental, medical, eye-care, etc.). Most jobs these clients would get would be low paying and wouldn't have insurance (which hopefully the new healthcare system would fix). So clients are conditioned to be unhealthy to have more. It makes therapy really frustrating sometimes because you're helping someone so they can improve and consequently have less in the hopes that way later they'll have more. It's a hard arrangement.

Private insurance is nice because there's freedom. Client's dictate their insurance fully as long as they pay. Pay more and you get more. It's like other insurances. Pay more for car insurance you get better coverage. Same thing with medical, mental health, dental, etc. insurance. It is also there for you when you get better (you know, as long as you keep paying for it). The drawback is that you have to do leg work.

Here's how it works. Clients call their insurance companies and they give clients a list of providers. Some of these providers are in private practice and some are in agencies. Private providers are nice because there are only the providers to deal with and no politics (for lack of a better term). The problem being they only have so many hours to fill with sessions and can only take so many clients. An agency has a ton of therapists with all sorts of hours to be filled with therapy sessions. Unless their are full with clients (which happens).

The problem with agencies is that, for private insurance, likely only a few therapists are on the boards of a few insurance companies and they need to be on the board of those companies to be reimbursed for services rendered. But then you have to make sure those therapists have free slots for clients. Or that the agencies can be paid for their services by the private insurance (which isn't a ton) while still meeting their budget. It's all a lot of work for everyone.

It all sounds confusing and frustrating.

It is.

So the new healthcare will fix it?

Cross your fingers. I have a feeling though that it'll be nearly exactly the same with just different, new headaches to deal with. Call me a cynic I guess.

That's it for this blog. Ask away dudes. And correct me if I'm wrong because there's a good change I might be in some of this information. It's all very complicated.

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FAQ About Mental Health From A Biased Source...ME! Part 3!!!

So in your most recent blog you called out an article written by a psychologist who said that men aren't maturing into men. You said that he was breaking the #1 rule of therapy; defining what a person should be. But isn't psychology based on standardized norms? Don't you diagnose 'abnormal behaviors' suggesting that you believe there are 'normal behaviors'? Are you just a gigantic hypocrite?

Well, I'm kind of a hypocrite. A mental health disorder is technically supposed to describe 'abnormal' behaviors and after treatment you would hope that the person's behaviors would change or reach some made up idea for 'normal'. So, technically speaking, as a therapist I'm peddling norms.

BUT, I will say that I personally see disorders as a snapshot of present, current symptoms and, in assessments, I ask clients to define their own symptoms. If they are unable to I help them do so. But I don't announce to them what their symptoms are. I don't look at a client and say 'you have a, b, and c wrong with you and we need to turn them into x, y, and z'. People bring their own definitions for their disorders, I give them a name.

While we're on the topic, what is 'normal'?

I have no idea.

What about those people who I just know need to be in therapy. You know, like celebrities, or my friend, or my parents. Just that person who you just know needs to be fixed right up. What do you do with them?

I hate getting asked about the people who everyone seems to know just needs to get into therapy. Like they expect a therapist to do something magical inside the therapy room and these people will be fixed. You should have seen how many people asked me what would need to be done to fix Britney Spears when she was having some issues way back when. I had no idea what needed to be done if anything at all needed to be done.

The thing is, as I mentioned in the first FAQ, client's do better when they want to be there. They can't be forced into changing. It's sort of like trying to force someone to drop a drug problem. Just because other people want something to happen to a person doesn't mean that that will happen and there's next to nothing a therapist or medication therapy can do to help a person who doesn't want help. And in the end, every person is entirely unique from everyone else so I can't just look at someone and develop a therapy. A therapy needs to be created together between client and therapist.

Do you care about your clients?

I do. An awful lot. Even when I don't necessarily like them. I want the best for my clients and they stay with me for a very long time. I can remember my first client and I'll probably never forget that person.

Can relationships between client and therapist foster after, or during, therapy?

Technically speaking, after a certain amount of time (I don't recall how long) a client and therapist can have a romantic relationship after the therapy ends. But it's like a time frame of like years and I would never, ever recommend it. The issue is that, no matter what that relationship looks like, the therapist has an influence over the client. Any relationship that fosters outside of that therapeutic relationship is always going to be marred by that influence no matter how much client and therapist think it wouldn't.

I don't remember if there is any issue with a friendship. But, again, I wouldn't recommend it. Because of the influence a therapist has. But also, with both of these types of relationships, the therapy helps serve as a model for future relationships. And like many future relationships, therapeutic relationships end. The last piece of therapy done in therapy occurs when that therapy ends. Because rarely do people get the opportunity to learn how to end things well. Having some relationship after therapy ends undermines that effect.

How do you work with people you don't like? In the extreme version of this, how do you work with perpetrators of awful crimes of things like murder, rape, or other terrible things?

It's really hard some times. Every professional will have a different take on this issue. For me, I see myself as a speed bump in the way of future crimes by the perpetrator. So I see myself as influencing future behavior and hopefully keeping people from being victimized. But, even with the worst of people who have done the worst of things, there's always something about that person to empathize with. It can be hard to find sometimes. But at some point that person was an innocent child. At some point that person had a future as a very respectable person. There's always something.

As always, don't be afraid to ask me any question and I'll try to answer you as well as I can.

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A Cautionary Tale: People Can Use Psychology In Gross Ways

Psychologytoday is a website that in theory is kind of cool. My blogs where I offer FAQs regarding mental health therapy and the process of it is in a similar category. Basically it provides a resource for clients and those interested in psychology to learn about what is happening in psychology currently (today some might say).

But because this is geared towards a more casual audience I get a little irritated when writers on there do really gross things. Like this blog, linked from an article on the FRONT PAGE OF THE SITE!!!!, where the very important but apparently amazingly out of touch Philip Zimbardo (he created the Stanford Prison Experiment) writes that men and boys are no longer turning into 'guys' or adult men.

So first he's defining what a 'guy/adult male' is. Which is gross. There is no definition. There is no ideal. People can be whatever they want to be. Putting one's own definition of anything relating to another is mistake #1 in working with clients. You don't do that shit. Ever. It's disgusting. People are whoever they wish to be period the end.

Then he explains that men aren't men anymore because of excessive porn and online games. Basically men are falling behind women in regard to social skills, leadership capabilities, emotional availability, you name it men are lacking. So excessive porn use could be an issue in regards to social ability. Though it's probably waaaaay less often then he thinks. But online games? Really? Offline games maybe you could make a case. But online games? Nah son.

Also, just in the nit and gritty of his blog and the article on the front page, he cites none of the sources he claims are scientific fact, claims research conclusions are the same thing as absolute truth which is nonsense, and basically any symposium, which his blog is an overview of his symposium (and a book he's selling), tends to ignore research that disagrees with the point of the symposium/book.

So, just keep in mind, if someone claims to have some sort psychological fact behind it is often biased as shit and often are doing some gross, fucked up shit and using their name and credentials.

27 Comments

FAQ About Mental Health From A Biased Source...ME! Part 2!!!

So my last blog was pretty popular so I thought I'd start fresh with some more common issues, questions, so on that comes up from time to time in mental health therapy. Again, these are my opinions as a therapist and a lot of people in my position my disagree with me. But, again, fuck those dudes and gals.

How long does an assessment take?

It depends. Usually between an hour or two.

Why do therapist keep bugging me about things that I don't want to talk about?

Because, typically, those are the things that are causing clients distress. When one of my first professors who taught me about resistance used to say that social norms are important in all walks of life except in the therapy room. As opposed to in normal conversation, in the therapy room a therapist wants to jump right into resistance and all the things that people hate talking about.

That said, most therapist try not to force the issue either. You can only really go places successfully when a client is ready. But if you're in therapy and you hate your therapist then I'm sorry. But that might be why you do.

Speaking of resistance, why do therapist ask us about our sexual orientations, ethnicity, culture, religious and spiritual beliefs, and what not?

These questions are a big deal for a lot of people. The two biggest complaints is that it makes people feel uncomfortable and that they have nothing to do with mental health. Well, in terms of the uncomfortable feeling...well, sorry. Again, resistance isn't comfortable and breaking social norms aren't either. But there's a reason why we ask these things.

Which brings us to complaint two. Here's the thing; everything relates to mental health. These questions relate to how the client relates to society and how society relates to the client. The neat thing is the stronger the reaction to the question the more likely there's an issue surrounding that topic. Again, resistance y'all. If I ask a client 'how do you define your ethnicity?' and they respond with 'why are you asking that shit's racist' then I know I'm in on a big deal. It's like clockwork.

How do you talk to parent's about video games especially when they relate back to their kids?

No matter what I say, parents have to dictate what happens to their kids. No matter what I say or how professional I look and sound, the parents' word is the be all end all for their kids. That said, I try to help parents be as reasonable as possible. Often I rely on two things; relating video games to games the parents played as kids and the idea of 'everything in moderation' (because I'm a fan of trite phrases). The 'relating to parents' games' bit is to explain the similarities between video games and those games. Then I bring up the idea of allowing the kids to play in short stints. Usually as a reward for a behavior (which I'm sure kids love me for suggesting).

My last therapist sucked. Also my last medication sucked. So why should I try again?

Every therapist thinks differently. Just like every client thinks differently. So there may be a therapist that just doesn't meld with some clients but is a perfect fit for others. Keep trying. Eventually you'll find one you like. As for medications, I'm no expert. So let me talk about medications for a second. Medications react to everyone differently because of issues like diet, metabolism, heredity, ethnicity (yeah, that concept again), and so. So finding the right medication for the right person is really hard to do. Again, just keep trying and you'll find the right medication and dosage.

That's all I can think of for now. Ask away if you want about anything and I'll try my best to answer your questions as well as I can.

43 Comments

FAQ About Mental Health From A Biased Source...ME! Part 2!!!

So my last blog was pretty popular so I thought I'd start fresh with some more common issues, questions, so on that comes up from time to time in mental health therapy. Again, these are my opinions as a therapist and a lot of people in my position my disagree with me. But, again, fuck those dudes and gals.

How long does an assessment take?

It depends. Usually between an hour or two.

Why do therapist keep bugging me about things that I don't want to talk about?

Because, typically, those are the things that are causing clients distress. When one of my first professors who taught me about resistance used to say that social norms are important in all walks of life except in the therapy room. As opposed to in normal conversation, in the therapy room a therapist wants to jump right into resistance and all the things that people hate talking about.

That said, most therapist try not to force the issue either. You can only really go places successfully when a client is ready. But if you're in therapy and you hate your therapist then I'm sorry. But that might be why you do.

Speaking of resistance, why do therapist ask us about our sexual orientations, ethnicity, culture, religious and spiritual beliefs, and what not?

These questions are a big deal for a lot of people. The two biggest complaints is that it makes people feel uncomfortable and that they have nothing to do with mental health. Well, in terms of the uncomfortable feeling...well, sorry. Again, resistance isn't comfortable and breaking social norms aren't either. But there's a reason why we ask these things.

Which brings us to complaint two. Here's the thing; everything relates to mental health. These questions relate to how the client relates to society and how society relates to the client. The neat thing is the stronger the reaction to the question the more likely there's an issue surrounding that issue. Again, resistance y'all. If I ask a client 'how do you define your ethnicity?' and they respond with 'why are you asking that shit's racist' then I know I'm in on a big deal. It's like clockwork.

How do you talk to parent's about video games especially when they relate back to their kids?

No matter what I say, parents have to dictate what happens to their kids. No matter what I say or how professional I look and sound, the parents' word is the be all end all for their kids. That said, I try to help parents be as reasonable as possible. Often I rely on two things; relating video games to games the parents played as kids and the idea of 'everything in moderation' (because I'm a fan of trite phrases). The 'relating to parents' games' bit is to explain the similarities between video games and those games. Then I bring up the idea of allowing the kids to play in short stints. Usually as a reward for a behavior (which I'm sure kids love me for suggesting).

My last therapist sucked. Also my last medication sucked. So why should I try again?

Every therapist thinks differently. Just like every client thinks differently. So there may be a therapist that just doesn't meld with some clients but is a perfect fit for others. Keep trying. Eventually you'll find one you like. As for medications, I'm no expert. So let me talk about medications for a second. Medications react to everyone differently because of issues like diet, metabolism, heredity, ethnicity (yeah, that concept again), and so. So finding the right medication for the right person is really hard to do. Again, just keep trying and you'll find the right medication and dosage.

That's all I can think of for now. Ask away if you want about anything and I'll try my best to answer your questions as well as I can.

Start the Conversation

FAQ About Mental Health From A Biased Source...ME!

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.

133 Comments

How Ryan Yelling About Mario Led Me to Giant Bomb

So, despite my insane post count, I wasn't one of the first GB users on the site. I came to the site about two years following its creation. I came here from a link that was posted on GoNintendo that led to this video...

...and I found it really entertaining. So I promptly watched the rest of the videos in the TANG series and then moved over to Quick Looks which, at first, I really didn't like (I was young and naive).

Through these three years, though that doesn't seem like a long time looking back, a lot has changed in my life and Giant Bomb has been a constant support. From my time in school where I constantly wondered if I was throwing my life away to the beginnings of my career and my overcoming alcoholism (with a ton of support from @wrighteous86). To my idea to lose 70+ pounds to help cope with the drinking cravings to just a distraction when life was getting hard. Quick Looks, Endurance Runs, and Bombcasts have been my go to along with these forums and in PMs (you fuckers know who you are).

And it all started with Ryan Davis yelling about Mario and me thinking that that was entertaining. I really appreciate this site and the people on it. I appreciate the staff entertaining me for as long and often as they have. They, and you all, have turned me from a student that had no idea what he was doing in life to a more confident and self-assured adult who is still not really sure what he's doing quite yet but he's getting there. I just thought that in light of the news today it would be worth it for you all, and the staff and any of Ryan's family and friends who just happen to stumble on to this blog, to know that I personally have found you all important to me and I thank you for everything.

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Countertransference and Alcohol: The Match Made In Heaven

Easter this year marked my year of attempting to be clean from alcohol. Officially I have been clean for about 7-8 months. My use started during high school, escalated during college, but sky-rocked during graduate school and especially my first year as a full-time mental health therapist. You might think that someone in the health profession, especially the mental health profession, wouldn't fall victim to bad habits. But as it turns out the health profession is stressful. More so then I ever imagined. But my use was a little more complex then just a reaction to stress. In this blog I'll try to explain my use and the rationale and nature of me quitting. This blog is about me developing into a more mature person. It's also about mental health. It's about a lot of stuff and is also mind-numbingly huge. It also may not lead to much community discussion. But I'm linking it to the 'off-topic' section of our forums anyway with the hope that maybe someone might get something out of it.

So I'm 26 right now and will be turning 27 in November. Every age range is weird developmentally and the 20s are no exception. The 20s represented a time when I was both maturing into an adult but also feeling stuck because, into mid-20s, I was still in school. That's a long time. Friends around me were getting married, having kids, and developing their careers. I was still a lowly student. It was frustrating. Add that to the fact that when I was in graduate school I didn't have a lot of time to hang out with people and still do well in school. Then there were was the internship which was my introduction to therapy work and trying to find my place and my view of therapy in a real, tangible, practical way. Also my part-time job had a way of sucking up all my free time too. All of these things lead to me not have a lot of downtime to recuperate.

Then there came alcohol. I was living with people who worked at the time and we all drank pretty heavily spending the majority of our money on alcohol. But unlike them, I started to drink non-stop. I didn't have a sober time. There wasn't a point where I didn't have alcohol going through my veins. At school, at my internship, at work. I had moments when I wasn't drunk. But I never had moments where I was sober. So I suppose I became a functional alcoholic. I was always in a hazy state. This lead to a feeling of just being out of it. Of being lethargic and depressed. Which lead me to drink more. So my functional alcoholism quickly turned into heavy, dysfunctional alcoholism. I would show up to work at 8 AM still drunk. I would see clients with a hangover still pounding my skull at 3 PM. Then I would go back home and drink another fifth.

It all culminated during one fateful party on Easter. I went to my parents' house with all my extended family with three fifths in the back of my car. By two or three hours into the party all of the liquor I had had was drunk and when I sat down to eat some dessert I passed out for a moment and spilled cake all over myself. Embarrassed, but too drunk to play off what had happened, I went upstairs to a spare bedroom in my parents' house and passed out up there. It was on that day I decided to stop drinking.

Well it didn't happen quite that easily. A week went by and I had more drinks in my hands. Then a week dry. Then a few weeks hammered. It went back and forth like this for about a month. This all coincided with the fact that I was going to have to end the therapy of four of my clients because either we were done with our therapy or they ran out of funding.

So, with all of that in mind, here's where I had my revelation. It was when I had been about two weeks clean. This was the longest I had ever been without a drink since high school. Not a drop. And I was dying. Alcohol was my elephant in the room. The more I tried to not think about it the more I seemed to think about it. Eventually it became an ever present thing on my mind that I couldn't shake. I went outside to our garage, grabbed a beer, opened it, and held it to my lips. Then I thought of my four clients and I got anxious. The need to drink escalated even higher. But this link was more important to me then the drink. So I thought about it.

One of the things that a therapist, at least in my opinion, tries to do when ending therapy with a client is express to that client what that therapy meant to the therapist and also to ask the client what the therapy meant to him/her. A big part of this is discussing the nature of the relationship between the therapist and client and moving the conversations from the abstract and cognitive to the emotional. I'm not good at this as it turns out. It's because I like to keep people at a distance. I'm not good at dealing with emotions when they are about me or me in relation to another person (I sure picked the right profession didn't I?). It stresses me out. My normal defense is to be sarcastic and aloof to show everyone that I'm not bothered by all this emotional stuff. Those emotions can't touch me.

But at the time I also knew that I couldn't do that. I couldn't avoid the emotions and I couldn't be aloof when I was with my clients ending our relationship. Rather I had to face those emotions head on. Most importantly I had to lead by example. That scared me. That made me anxious. That realization lowered my anxiety. It lowered my desire to drink.

Looking back what I had realized was my immaturity. This immaturity led to these maladaptive behaviors. My fear of emotion whether it be from a relationship, from my reaction to work, school, being stuck in school rather then starting the rest of my life, all of it. It was all immature reactions leading to extreme emotions that I didn't want to experience and it was all coming to a head when my way of coping with those emotions, drinking, was causing me to ruin more then just my liver but also my reputation with my family, my ability to be a professional, and my own evaluation of myself as a person. And the kicker was that my solution to extreme emotion couldn't be used when I ended therapy with my clients because it would have meant that I would have to send my clients away while hammered out of my mind (which is not the most ethical thing to do).

So I decided to reassess what I was doing with my life and changed my habits. I started an exercise routine to help me cope with extreme emotions and cravings. I sucked it up and one by one got through all of the therapy terminations unscathed. In fact, every termination was refreshing and made me feel happy and proud. In short, I grew up. I haven't had a drink since.

Man this is a long blog.

33 Comments

A Weird Dream (or Call Me Freud)

So I had a very weird dream that I feel like I should write down so I don't forget it. Just a little set up first. I grew up going to a Protestant church that eventually had a split. Half of the group went and started a new church. My family went with that church. The original church ended up improving itself and is now going strong while the split-off church is trying to revitalize itself. The last time I went to either church was about 5 years ago. But my one set of grandparents, aunt and uncle, and one cousin still goes there. I'm really close to the grandparents but have a really shallow relationship with the aunt, uncle, and cousin. They are nice people, with some odd views of the world (but who doesn't?), but I more or less have no issues with any of them.

So, my dream took place in the original church. Apparently I had been going there for a while and had become an active member. My uncle apparently was at a place of leadership within the church and my cousin was his assistant. I was walking along with my uncle down a hallway and he made a comment along the lines of, "You are doing really well here. Even (some dude's name that I didn't recognize and can't recall) has seen some vast improvements over what you were like when you first came here." I felt irritated that someone had decided to judge me before and had taken it upon himself to judge me again. So I asked my uncle, "So what was I like before then?" My uncle didn't answer, said goodbye to me, and left through some door along the hallway wall.

I then walked up to my cousin who was further down the hall, said 'hello', and asked her what 'dude x' had said about me when I first came to the church. She brushed it off. So I asked, "Is it because I'm sarcastic?" She replied, "Well, actually, yes that was the problem. You may not be aware of it but you're kind of a 'glass half empty' sort of guy." To which I replied, "Well, believe it or not, as a mental health therapist I have to occasionally be a 'glass half full' sort of guy in rare instances." Not taking the bait (I said that last sentence with real dry, bitter tone) she replied, "Well I'm sure the people you help appreciate that." I replied, "Not as often as you might think." She asked, "Why's that?" I replied, "Because people don't like to change." With that she entered the main service area. I took a step towards that door, stopped, turned around, and walked out of the church toward my car.

If I were a psychoanalysis I would probably have all sorts of ideas of what that means. Right now all I can do is make guesses. But it was probably the most articulate dream I've ever had.

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A Small Little Thing From a Mental Health Therapist

So I've said what I'm about to say 10 billion times on this site already but just in case one of the readers of this blog don't know; I'm a mental health therapist. My job involves both running therapy with clients and also running assessments and then putting labels (mental illness diagnoses) on people. I don't like that I have to give people labels and usually don't tell my clients, whether they become my long-term clients or if I only see them for the one assessment, what I've diagnosed them with. I don't do this because I worry that people will feel as if that diagnosis will come to define them. That that label will now dictate how the rest of their life will proceed. It will determine how much success they have in life. How many friends they have. How well their intimate relationships go. Everything will pass through the lens of that new label.

Rather, I give clients a long winded explanation of what the diagnosis means. But I never offer the actual label itself. However if a person isn't happy with my long winded answer and asks, again, for what they were diagnosed with I'll tell them. I'll give the diagnosis, give an explanation for why I picked that (or those) diagnosis(es) and ask if they have any questions. Then I'll give a big long speech that usually goes something like this;

"Though this label fits where you are in your life right now I think it's important for me to say that that label doesn't define you. It is simply an aspect of who you are right now. When I look at you and talk with you I don't see you as that label. I see you as a person who is having some problems and is looking for some help. I feel it is the job of the therapist to offer that help as well as he/she can. This label defines you as much as any other label I might give you. I might say you are kind and intelligent. Those labels are as applicable to you as this diagnosis. Because you, like the rest of us, are complex and unique. You aren't simply a diagnosis and you aren't simply the problems we discuss in here."

I'm saying all of this because I need you all to understand, then, why I get so irritated with what people feel my job is and how we as a society tend to define the mentally ill. At times I feel like I am simply an agent of my society peddling social norms and taking away rights and privileges to those that don't meet those norms as per the bidding of my society.

There was a remark recently that sparked this response from me. It was on my twitter feed following the US Senate not passing the new gun laws. A person I follow, who will remain nameless as I don't want to give the impression that I'm mad at this person, said this in response;

"Thanks a lot US Senate, crazies and criminals can continue to buy guns..."

Now I don't really have a dog in the gun law race. But I guess my ears burn when I hear things like 'crazies' shouldn't being allowed to buy a product while us 'normals' can. The issue I have with this is that there's this stigma associated with all mentally ill that is so widely accepted and it bothers me because, really, I'm one of the people who have created that group that is now stigmatized by 'officially' labeling people in the first place. The stigma being 'All mentally ill are the same. They all have some failing in some way that keeps them from being of the same caliber and of being able to have the same rights, privileges, and responsibilities as us normals.' or something along those lines.

Now the person who I quoted was probably referring to an aggressive 'crazy' and I'm probably being overly sensitive. But I'm seeing mentally ill people who are all, generally speaking, seen by that label, 'mentally ill', alone by our society if they know my clients carry that label. But not all mentally ill are the same. Not all are risks to others. Not all are suicidal. Just like not all 'normals' are the same. Not all 'normals' aren't risks to others or aren't suicidal.

I guess what I hope comes from this very long post is that those who read it take a moment to rethink 'mental illness' and really try to see people under that label as uniquely as they see everyone else and try not to just throw out words like 'crazies' or make the wild assumptions about what mental illness-based labels mean. The world and the people who live on it are not so simple.

NOTE: If you know who I quoted please don't give the name in the comments. I don't want that person's name dragged through the mud because I had a reaction to something he said. If he knew how much it bothered me he would probably be really upset about it.

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