Can You Fix Me?

Oh you silly, silly person you! Of course not! Am I magic? Do you expect to ride out of my office on a unicorn with a trail of rainbow glitter and happiness flowing behind you?! Though that would be amazing, I can't promise that. I am certain that the way you handle stressors, the way you think about events that happen in your life, your personality, the way you interact with others, etc did not develop over just a few weeks time so please don't expect me to "fix" you in just a few weeks time. Therapy can be hard work. Several sessions in the beginning will focus solely on gathering your history and identifying patterns in your life. After that, we can begin to work on identifying ways to help you. When you take a car in for repair you typically know something is broken or wrong, but not quite sure WHAT it is yet. Diagnostics are run to determine the problem and then repairs can start. Those first few sessions can be considered diagnostics. When we pinpoint the problem it is easier to zero in on the solution. I have had people report they don't feel any different after a few sessions and therapy isn't helping. Well.... no kidding! Can we give it some time? Please!

In addition to managing expectations for progress, I ask that people do their homework. Yes, I assign homework and good therapists should do that. If the skills we talk about and learn in session don't translate outside of the office it's just a waste of time. If we practice reframing negative thoughts in session-I expect you to do it outside of session. Many people with depression and anxiety get stuck in a rut in their thinking styles-going over and over the same negative self talk loop in their minds. In order to create a new pathway of thinking in your brain to improve your mood you have to begin to lay the foundation for a new road. Each time you reframe or challenge a negative thought you are laying down bricks for your new road. You can build a nice new strong path with 100 bricks (or 100 times challenging negative thoughts outside of session) compared to maybe 6 bricks (or 6 thoughts identified and challenged during a 1 hour session of therapy). If you need a little guidance, Google is a wonderful thing. If you have therapy homework about journaling about your feelings and you get stuck you can Google journal prompts to get the juices flowing. If you have therapy about reframing negative thoughts and need guidance, there are a variety of free worksheets on the internet. If we make an anger management plan and you lose yours and need to create another one there are plenty of templates online. Remember that the reason for doing this homework is to ensure that you are grasping the skills from sessions, using the skills frequently, and that use of skills is actually impacting your life in a good way. Are you actually feeling better after reframing negative thoughts? We wont know if you aren't trying! Anyone interested in doing a little homework check out these sites online with free worksheets for anger management, anxiety, depression, etc. They are great resources and I actually encourage clients to use some of the worksheets in my practice. http://www.dbtselfhelp.com/SelfHelpCourse.pdf and http://www.getselfhelp.co.uk/freedownloads2.htm

Do I Need Medication?

Many people who seek counseling have tried medication before or are currently taking medication to manage mood and symptoms. I find that people usually come to counseling because they realize that medication alone is not a cure all. Medication can alleviate some symptoms, but it can't help you process your feelings, address negative thinking styles, create an anger management plan, etc. Medication combined with therapy can be very beneficial if you decide that you need medication. In Kentucky, psychologists, therapists, and counselors do not prescribe medications. Psychiatrists and physicians prescribe medications and you will need to be assessed by one to get medication. I encourage people to keep an open mind concerning expectations about medication, just as I do concerning therapy. Medications will likely need to be tweaked over several months time. Most people who come to my office have tried between 3-5 medications and had several dosage changes in addition to that. I highly recommend you choose a psychiatrist or doctor you are very comfortable with and who listens to you and who schedules regular medication checks to monitor your progress and for potential side effects. Being comfortable with your psychiatrist or doctor will allow you to speak openly about your symptoms, side effects, and advocate for your needs. No one should feel pressured to take certain medications they are not ok with simply because a doctor tells them to and no one should feel like their concerns aren't being heard. Taking medication is serious. Also, please notify your therapist if you are taking medications. Your therapist can also help you communicate problems to your psychiatrist or doctor.

Do I Need to Tell My Therapist Everything?

Please be honest in sessions. Try to report as honestly as you possibly can about symptoms and your life in general. If you are too depressed to shower and haven’t changed your underwear in 2 weeks-say so! If you are mean to your spouse and call names when you are in a bad mood-say so. If you drink a 12 pack of beer every night-say so. The great part about therapy is you can say what you want and it’s against the law for me to tell anyone unless you are threatening to harm yourself or someone else. Being honest to your therapist allows the therapist to understand how to better help you and to understand how severe the issue is which guides treatment. Being honest also allows the therapist to assess progress that you may not always be aware of. For example, if you go from showering every two weeks to every few days that’s progress and you may not be aware of it because you view it as something you SHOULD be doing anyway. However, it speaks volumes about increased level of functioning and improvement in mood and energy level if you are depressed. If your anger affects your relationship, but you tell me everything in your relationship is fine and I suggest that you turn to your partner for support that’s just ludicrous! Your partner will probably not be in the space to help you take a deep breath and walk away if you routinely cuss them out while angry. The anger AND the interactions in the relationship will need to be addressed. In the event I have to disclose information to someone outside of session it will be for safety reasons. If you are talking about killing yourself or someone else I can't expect you to be rational and just talk it out with me. I have to keep everyone safe first and talk it out later.

How Can I Prepare for My Sessions?

Please think about what you hope to achieve in therapy and try to create some goals to discuss with your therapist prior to coming in and throughout the therapeutic process. What you want to get out of therapy will change throughout the weeks depending on new/old stressors affecting your life, fluctuations in mood, and increase/decrease in symptoms. As much as therapists would love to climb into your pocket and hang out with you all day, silently observing what is important to you and identifying how various issues are impacting your life and functioning-We Can't and in fact it may not matter! Personal experience is subjective. What is important to me may not be important to you. What I think is a problem you may be totally ok with. You are the expert in your life. You will guide what happens in sessions and that is simply to ensure that YOU are getting what You need and not getting what I THINK you need. Do you want a place to vent? Do you want to learn self relaxation skills? Are you looking to improve communication skills? What is it that you need? Think about it and then come in and tell me! Got it? Great!

What If I Want to Hurt Myself or Someone Else?

Thoughts of wanting to harm yourself or another person are called suicidal or homicidal ideation in the therapy world. These thoughts should be taken very seriously. I understand that it is never easy to tell someone you have thoughts about hurting yourself or someone else. However, it is immensely important to do just that-TELL SOMEONE. Then praise yourself for being so brave. Your therapist needs to know in order to help you safety plan. Placing someone in the hospital or alerting police is not always the first step. If I can safety plan with a client experiencing suicidal ideation, meaning we agree to a plan of the person being monitored by family/friends, adhering to scheduled check ins via phone calls, and coming in to the office for face to face sessions in the midst of a crisis I don’t always suggest hospitalization. When someone is suicidal or homicidal it is obvious the person is not thinking clearly and the immediate thing to be managed is safety. Addressing homicidal ideation is addressed differently in that if there is the threat of imminent harm to another person and a plan to harm the individual has been identified, I will have to call the police and warn the person being threatened. Please keep in mind that disclosing information to family, the police, etc. is not meant to punish or shame anyone, but to MAINTAIN SAFETY. If you know anyone experiencing suicidal or homicidal ideation please tell someone or alert the police. If you are not comfortable identifying yourself, please choose to report it anonymously to 1-800-273-TALK (8255) or visit this website http://www.suicidepreventionlifeline.org

What Is Wrong with My Kid?

Why would I know?! Joking! There is rarely a clear cut answer to this question. There are no clear answers as to why some people get depression or anxiety or other mental health issues. There are no clear answers why some people who face stressors or experience trauma seem to be inherently resilient. Genetics, environment, personality, support systems, and several other factors seem to all play a role in how likely people are to experience mental health issues. I encourage parents to keep an open mind when dealing with children who they believe have something "wrong" with them. Sometimes the "wrong" lies in a parent not completely understanding what is developmentally appropriate for a child or a teen. Young children tend to be hyper and impulsive. They do silly things like jump off of chairs, run in circles, scream for no reason, and yell and throw fits when upset. These are all very "normal" behaviors and don't always suggest symptoms of ADHD are present or that something is wrong. Teens are defiant, rude, moody, and push boundaries. These behaviors are age appropriate and don't always mean your teen is heading down the wrong road or a lost cause. Some children and teens are shy and quiet and introverted which some parents may perceive as them being depressed. Many behaviors we adults perceive as abnormal are very important in the developmental process for kids and teens. For example, children need to learn things like how to self soothe and regulate uncomfortable emotions (tantrums) and teens are learning to be independent and set limits with others and stick up for themselves(defiance). Children and teens are also sponges. It is important to recognize that they often emulate what they see and hear. If your child is hitting, cussing, losing control, etc and it's obviously out of proportion to what is developmentally appropriate ask yourself- How do I handle problems? If you blow up, cuss, hit people or break things when you are upset you are modeling that that behavior is ok.

So when asking what is wrong with my child-ask these additional questions: Are these behaviors serving a purpose and developmentally appropriate? What is the frequency, duration, and intensity of these behaviors or symptoms? Are the behaviors occurring across several different settings and disrupting child's ability to function in school, home, and social settings? What am I modeling for my child? Do I often lose control? Also ask yourself if you are projecting things onto your child. Does your child do things that remind you of your ex spouse whom you hate? Do you fear that because your child has tantrums they will grow up to be abusive like your ex or your mother or father? In these cases you are projecting your own experiences onto your child and that may be YOUR problem and not your child's problem. It is important a child is treated like their own individual person and that the child is not compared to or told that they are just like someone you make known is a "bad" person. You are then making YOUR problem your child's problem, too, by negatively impacting how they view themselves and their self worth. Ex. I don't like when you call me names and throw toys at me(appropriate) vs. You are a bad kid and just like your no good abusive father (inappropriate) . One way verbalizes dislike for a particular behavior whereas the other way attacks the character of the child. A child can understand working on managing/ changing their behavior, but a child who hears they are a bad person may feel hopeless and truly begin to believe they are bad and can't change who they are.

If your child does end up in therapy, we will try to work with your child from a strength's based perspective.  As previously discussed, some behaviors that may annoy you may be beneficial to the child.  A hyperactive child may be able to channel that energy and excel in sports.  A talkative opinionated child may be great on the speech team and grow up to be an excellent lawyer.  We will work on finding ways to redirect behavior.  Many behaviors can be managed from a strength based perspective.  Praising and rewarding a child for appropriate behavior can have a much greater impact on the child's behavior than shaming and punishing a child into submission.  Positive reinforcement will help a child feel confident as the focus is on pointing out what is going right so they can keep on doing it. Relying solely on punishment can contribute to a child feeling insecure, angry, and resentful and often people using this style only point out what is wrong and forget to mention what the actual expectation for the behavior is so the child has no direction or sense of how they are supposed to be acting.  Telling a child "Hands in your lap" is a short simple directive whereas as "Stop being all crazy or Ill take all your toys away!" can leave a child overwhelmed because they may not understand what "being all crazy" means, there has been no indication of what the desired behavior is, and there is the threat that if they don't figure it out quickly they lose all of their play things.  

Will You Testify In Court on My Behalf or Write a Letter?

So..... the short answer is probably not. Please please please do not assume that a few sessions with your therapist will land you some slam dunk decision in court. Often therapists have people come into their office and think that after 3-4 sessions the therapist can write a letter or even testify on their behalf concerning their fitness as a parent, their ability to manage anger, that their Child's mother/father is crazy, etc. Sometimes therapists get requests from old clients months after their last session to write letters for court or to appear in court. Speaking solely for myself-I WILL NOT DO THIS OR PROVIDE THIS SERVICE. It’s not ethical or good practice. Would you honestly want someone who has talked to you over 3 sessions (the equivalent of 3 hours over 3 weeks) making a decision or weighing in on life altering situations like custody? I really hope not! I am certain that if you visit the grocery store several times a week and chat with the check out person for 5-10 minutes each time and that equals somewhere around 2-3 hours a month you would laugh me out the door for suggesting that check out person knew you well enough to have an opinion about your life. That's an exaggerated comparison, but not too far off! I will only go to court after meeting with a person or family for an extended amount of time doing extensive work. Even then in the event I provide a letter or testify I DO NOT MAKE RECOMMENDATIONS or give my opinion unless explicitly asked to do so by a judge. Judges make decisions. I report my observations, I report facts like number of sessions attended and what was worked on during sessions, I report on compliance meaning did client attend and participate in all scheduled sessions and appear to make progress, etc. These observations and facts allow the judge to do their job which again is to decide what is in the best interest of the individual, child, or family. Plenty of parents get mad at me because I do not “side” with them on an issue or refuse to provide letters for court or appear in court after just a few sessions. That’s fine. I can take it. All I ask is that if children are involved, leave adult issues to adults and child issues to the child. If you want to take issue with how something is handled, please talk to me and do not try to coerce your child into refusing to meet with me, turn your child against me, or process the issue with your child like they are your partner. If contentious court proceedings are happening your child needs a space to feel safe to express their feelings without also feeling they are betraying one of their parents. Therapy can be that place so don't take it from them. I encourage everyone with kids to look over this Bill of Rights for Children. It is a great reminder of how children should be treated and respected.http://www.crckids.org/parents/joint-custody/bill-of-rights/