I see. Thanks for the advice.

@spartyon:

It's a Masters in Clinical Psychology (as opposed to a Masters in Counseling). In my state that means I have a Licensed Mental Health Counselor (LMHC) license. The main difference between my degree and a counselor degree is that I had more training in assessments and more severe disorders whereas they had more training in group and family therapy.

@jasonr86: So I am a Master's student in I/O Psych right now so I majored in everything you wrote about, nice job. You say you're a therapist, but, as I'm sure you know, that's incredibly vague. What exactly is your degree in, what type of degree is it, etc? Just curious.

@herbiebug:

In the therapy I run, unless it is with a young kid, a couple, family, or group, I do more conversational therapy with a big focus on the therapy relationship. So my therapy might look like that show (though I still haven't watched it yet).

Okay, i first before I answer I should that I have spent about ten months in cognitive behavioural therapy (CBT) for primarily OCD issues in the past. I am also autistic and have a history of depression.

In my experience, the answer to your question would be no. But I realize there is a difference between CBT and the sort of, i don't know how to best describe, umm conversational therapy depicted on that program. In the case of CBT, the sessions are a great deal more structured, with specific long and short term goals. For instance, let's say a person wants to be able to walk away from their car without having to repeatedly turn around and come back to check and see if the door locks actually locked. You would do exercises and learn mind games that help in decreasing both the fear of what might happen if you don't check several times and increasing confidence that one check, as opposed to five or whatever it is, is enough to be certain. Like that. Goal and problem specific.

It really depends. One of the things I tell clients is that, no matter how hard one might try, it is really difficult to look at yourself objectively. There's probably something about your life that is leading to the sadness you are experiencing but it is hard to come to figure that out because we are all to close to ourselves to see what might be clear to someone other then ourselves.

What I would guess is that either there's something that is causing you to feel unfulfilled or there's something that is missing from your life that is causing you to feel this way. What I would probably try to do is ask questions about your life currently and in the past and try to gauge your overall satisfaction with these things. Then try to see what you would like to do that would make you feel more fulfilled. It could be anything that is causing or missing. Your job, your relationships, your hobbies, or anything else.

The basic thing is that there's something about your current situation in life that is making you feel unfulfilled. Probably. Again, it depends. But that would be where I would look first.

Mirroring, it's damn handy even in everyday life.

Not to turn this into a "Ask Shirley" column, but from someone who has experience, what would you do to combat melancholy? The not-quite depression, but still pretty shitty thing of feeling down, usually for no reason. I know there's some generic responses like "talk to someone about it", or "do something that makes you happy" but I'd still like to hear your opinion on it.

Yeah, that makes sense. Mine has found very quickly that it's sometimes best to allow me to talk and talk and talk because I eventually reach a conclusion I wouldn't have before. She almost acts like an idea board for me, just having something or someone to bounce words off of makes it easier for me to think and approach things differently. Not that she doesn't say anything back...

As it turns out I knew more then I thought. I also came into therapy thinking I was going to be the type of therapist that focuses on symptoms, giving out homework, and be task-oriented. I had no plans to focus on relationships. Turns out I focus primarily on relationships and most of all the therapeutic relationship which I never thought I would do.

The task-oriented, homework thing felt forced and didn't feel like it was focusing on what I was seeing with my clients. When I instead turned to relationships and the dynamic in the therapy room everything changed. All the sudden the therapy felt easier and more productive and my clients were more successful.

DID you fool everybody?

Nervous. The first time I did therapy I thought that I had no idea what I was doing and that I had just fooled everyone to get that master's because I didn't actually know a single thing.

How did you feel on your very first day of work?

To the people looking into getting into the field, Just a heads up you can't really do much of anything with a BA, I mean you can but in the same way that a holistic priestess or what have you can give counselling, not saying there's not a place for it but it's a very different world from having a Phd or Masters as Jason has mentioned earlier.

@artelinarose: If you want to look into supporting others in situations like yours, There are lots of LGBT support networks out there, at schools, via community outreach programs, support centres, etc. It's a good place to start, will be a huge help later in life connection wise if you decide to get really involved and make a career out of it. Those places are always looking for help that actually understands the issues personally, I know my organization actively recruits volunteers that live with mental health issues themselves (directly or just in their lives) to help run programs in order to really help people open up. Somebody familiar with both trans and mental health issues could be very helpful/versatile.

I actually had a friend like this. He tried to deal with his multiple personalities by ignoring them, and one would threaten his life like that. He ended up killing himself.

thanks it will probably kill me

@jasonr86: Thank you for making this thread. I want to go into something psych-related as well, and it's good to have someone on hand to explain the area to those that might not know much about it.

I did my History of Psych final on gamification. I wanted to show the positive aspects of gaming, and how it can help people bond together and learn. Unfortunately, a lot of the research I found didn't go into specific games, or the researchers had a very poor understanding of gaming in general. I tried my best with what I had, though.

@artelinarose: I wish you the best of luck in your transition!

Okay, I'm gonna trust you. You're the expert, I suppose. He's screaming that he's gonna cut out my voice box but he's probably just foolin'. Good thing I left my box cutter at home...no wait here it is. Ha! Have a good one, doc.

EDIT: I'm proud that this stupid, stupid post was my 6000th.

You're probably fine.

Whenever I ignore him and makes me pick up a knife and hold it to my throat...

He just wants attention. Ignore him and you'll be fine.

Quick "Q" here, Doc. How do I, politely as possible, tell the worm in my head to stop mimicking the voice of my seventh grade Home Ec. teacher whenever he tells me to light something on fire? His name is Francis, by the way.

Yeah, I have been considering it. It seems like something I'd be good at considering how naturally it comes to me, and I want to be able to help people improve their lives, especially transgendered people looking to figure themselves out or begin transitioning. I just want to help somebody make a difference for/to themselves.

As someone who's becoming interested in this field and potentially working in it one day, this topic has been very fascinating to me. Awesome work, Jason.

PUNISHED THERAPIST

A FALLEN LEGEND

I think everything in life is best take in moderation, whether it is violent media or anything else. That said, I have no right to put my own values on to a client. If that client wants to do anything of any sort, as long as they don't put themselves or others in immediate harm, then I think it's fine. But I would say that if the media is making you feel a way you don't like or if it is interfering with other areas of your life I might focus the therapy on it more then the client might want. But, again, I have no right to make demands of a client (minus the whole putting self or others in danger thing).

Those professionals and advocates typically have red, glowing eyes and horns coming out of their foreheads.

Question: How do I know mental health advocates and professionals aren't really trying to deteriorate my mental health instead?

How do you feel about clients that enjoy playing violent video games?

I diagnose when I do assessments. A mental health disorder is a type of diagnosis. Multiple disorders signify multiple diagnoses.

In all my replies, if I used the wrong term, then sue me.

@jasonr86: you diagnOSE you dont dignosis, its not a verb.

They just make everyone a doctor these days.

I would imagine that a big chunk of that therapy would be on working with that person to admit to the crime him/herself because I could only imagine how that would fuck with someone's head. I could only imagine admitting to the crime, no matter the punishment, would be a relief.

@jasonr86: That is odd, I can't imagine someone confessing to an unsolved murder after the fact and just having to live with that information. That'd fuck me up big time.

Awwww.

Here's when I can break confidentiality and when client information has to be released. But I can redact information that would go to a court or if a client were to ask for their records if I feel harm would come if that particularly information was disclosed. Just a quick thing, a court ordered released needs to be signed by a judge or a representative of a judge. A cop can't get those records without a court order and lawyers, try as they might, can't get records without a judge's order.

In terms of illegal activity, I can't release any information unless there's a likelihood of immediate harm as listed in that link I offered. Here's an odd issue. If a client reports past harm, like a murder that they committed, I can't tell the police or anyone about that crime because it already happened. I can only break confidentiality for immediate, future harm. Odd huh?

C'mon...show some respect to the therapist. Joke posts clutter up an otherwise valiant effort into helping/informing others with mental problems. I only have to open the first page of OT and there already is an depressing topic about someone possibily wanting to commit suicide.

So I've been watching a lot of The Sopranos lately and it made me wonder how disclosure of illegal activities holds up against doctor patient confidentiality?

You're a good egg, Noonan Jason.

Although I would probably have to be a dick and make some argument about the 'softness' of the science of psychology, if only because it lacks the absolute precision of math or physics or chemistry. Seemingly identical patients/symptoms may respond differently to identical treatment and that would make me ... well, insane. I suppose that's what neurology is for. My lazy comparison is Darwinian evolution, psychology was predictive of neuroscience in the same way Darwinian biology was predictive of gene theory.

I think that rely on any crutch, whether it is medication or psychotherapy, can be unhealthy. Like I said, my goal is that therapy of all types becomes redundant for all clients who seek it. It's an odd thing but my hope is that people don't need me or medications.

But some people look at medications as the only thing that can keep them sane and that just worries me. I don't think that such a set-up builds people up so that they can be self-reliant. It is also very expensive (or can be). But I'm not so far against these medications to say that people shouldn't be prescribed them. There are therapist out there that think that way. I don't. I just want to work with prescribers who don't view a medication as a set-in-stone, clients will take this forever thing. Unless it's an extreme case and that has to happen (which I've only seen a few times in my relatively short career).

What is your particular stance on prescribing medication? Are you one of those therapists that believes taking medicine is kind of a cop out and just avoiding the issue, or do you think that there are some problems that can only be solved through OTC drug use?

The Elbow Drop syndrome is a difficult one to pin down. We'd need to go through a 2 hour assessment to figure it out.

Is it a mental illness to think that every issue can be solved with sick elbow drops? Because that's kinda been a thing with me for a couple of months now.

@atlas:

I'm glad you're doing well dude and have had such good experiences. It's always nice when I hear the good stories because I'm so used to hearing the bad ones. I think the bad experiences stick with people much longer which is kind of a bummer for me to think about.

I think in the US people are becoming more sensitive to mental health issues but there's a lot of confusion about what these disorders actually mean. There's often a lot of blaming of clients for their diagnosed disorder(s). It doesn't help that there are some people who go on national TV and say really inflammatory things like 'borderlines don't know this or that and they can't be trusted because of x, y, and z' (I'm looking at you Dr. Drew!).

Thank you! I kind of look at 'applied behavior analysis' as a fancy way of saying 'behaviorism' which has been around since the '50s. Every once in a while psychology likes to develop 'new' things that aren't actually that new. That said, I think that behaviorism is a fantastic, well-proven therapy. I've used it with children and it is my main technique when teaching parents about parenting.

I'm mostly psychodynamic from the theory perspective but I use CBT techniques often. I'm a fan of look at the past and relationships and using the therapeutic relationship as the gateway to psychological change. When I'm working with kids or am teaching parents, I use behaviorism.

I've talked to some of my clients of all ages about video games and have talked to a younger kid about dubstep. Yeah, I'm hip.

@jasonr86: And you always told me to be careful what I said around here, granted you're actually a professional and I'm still a student... Going and making an AMA about it! Good read man, It still always amazes me how little the general populace knows about mental health, therapy and human psychology, but I guess an accountant would say the same thing about people and finances. It's always good to spread information.

@belegorm: You said it man, the diversity in how people handle various psychological disorders is huge, even reading up on it really wouldn't give the full picture, I've seen paranoid schizophrenics who live perfectly normal lives and people with fairly straight forward anxiety who can barely communicate with the world. I guess it shouldn't surprise me that people don't fully understand it, but the stigma involved with a mental health issue (even if it is improving) is definitely sad and surprising.

@artelinarose Glad to see you're doing not awful, keep on trucking.

It's definetly science, but a significantly younger one than pretty much every other field, Think about the thousands of years of history of medical treatment compared to around a hundred years of therapy, and even less of understanding the chemical nature of the mind. Something to keep in mind is that all of the medical sciences, most of the natural sciences in general are about formulating a hypothesis, playing the odds, and peoples interpretations of the data. An Oncologist never says you're gonna beat cancer, they can only tell you if you have a good or bad chance of beating it. Same goes for everything all the way down to the flu, and mental health is no different, add in the relative infancy of the field, the personalities of the clients, the therapists, and you begin to see why it might seem people can have bad experiences with it so frequently. Human behaviour is shockingly predictable though, the data is simple, it's just how people use it.

@punkxblaze: If you meant it as "I would trust a therapist without reservations if they liked Giant Bomb", then using "implicitly" like that was quite fine. Certainly made sense to me.

@jasonr86 Thanks for sharing, Jason. You should make this a regular blog.

I think it's interesting how different mental health professionals are from how people often expect them to be. They're really just varied individuals like anyone else with an extensive knowledge of psychological science. They provide a much-needed service. :)

Now, since you're answering questions both personal and professional, what are your thoughts on applied behavior analysis?

Therapists like the OP are doing damn good work. Most of them are helping make life better for people, and some even save lives.

I've been fortunate enough to work with some great therapists during my life. I'm a more specific case because I suffer from anxiety issues and depression, and I also have Asperger syndrome and ADHD. As an adolescent, I saw a psychotherapist and an occupational therapist, and they were both very helpful, especially the OT - we did a lot of practical work developing skills, and although one of the hallmarks of Aspergers is poor communication skills (eye contact, body language, interpreting social cues etc.), I'm much better at these things than many others on the spectrum are due to my OT spending the time basically teaching me these skills.

But my most rewarding therapeutic experience was the work I did with an autism specialist/psychologist who developed a program of cognitive behavioural therapy tailored to people with Aspergers. We ended up having over 40 sessions, which is a LOT for CBT, but he had an intuitive understanding of a lot of the thought processes and patterns that I went through and didn't fully understand myself, and he was a great mentor who taught me a lot of valuable things about myself.

For some people, therapy won't "cure" you of depression, and neither will medication. But that's not the point; it's about managing your depression levels, and developing strategies for coping with depressive episodes or challenges presented by the mood destabilisation. At my present point of life, I'm not an entirely "functional" human being, but I'd be waaay worse without the people who took the time to help me develop the skills I needed to help myself.

Another thing worth mentioning; I'm English, and therefore my treatment was "free" (higher taxes pays for national health service). I feel like there is a strong difference in attitude between Americans and most Europeans as regards therapy and medication, with greater dismissal and superstition from Americans and greater, I dunno, sympathy or understanding from Euros. Maybe that's just a misconception, but if it's true then I wonder if the difference in attitude is partly due to the cost involved in procuring them in the States. Obviously, in extreme or highly acute cases intensive private therapy is available, and my sister has had private therapy in the past, but I never take for granted that I got to work with someone who is at the very top of his field for free for nearly two years.

For some reason I feel like I would implicitly trust a therapist more knowing they're a Giant Bomb fan. I figure Giant Bomb = good people.

Usually.

EDIT: Also, I don't think 'implicitly' is the word I'm actually looking for here, but it's 12:30 in the morning and my vocabulary is maybe not what it is in daytime hours.

At $50 an appointment that is a long term relationship, and I'm just not ready for that kind of commitment. I am only twenty two for gosh sake.

So what psych perspectives are you a bigger fan of? I'm guessing you'd have to use multiple perspectives when trying to approach a diagnosis so do you have some "go-to's" for that?

@jasonr86: I wasn't making much progress anyways. I could probably see if I could get stuff done now, but I'm getting along ok, and I don't feel like breaking in a new therapist :p