Monthly Archives: December 2012

How do the mentally ill feel? About feelings.

Posted on by
5

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Man with feelings

Managing feelings.
Photo courtesy of Pixabay.com

Can you describe how the mentally ill feel?

This question actually comes up, both in-person and as search terms. Despite the difficulty of answering such a general question, I will take a stab at this.

Speaking for any group of people is always problematic. I am an old white guy. So I should be able to tell you how old white guys feel right? Trying to speak for any group is beyond difficult. How old white guys feel would depend on whether that old white guy was a homeless veteran living alone under a bridge or a Wall Street executive who was paid millions for running a company last year that lost billions. I really can’t describe how all old white men might feel about anything.

But I will try to tell you how the mentally ill feel.

It might be easier to describe how the mentally ill do NOT feel, though that begs the question of how they do feel.

The mentally ill don’t feel happy. Occasionally they may feel mania. They may run without stopping and not need to sleep but even then they will probably tell you they are not really happy.

It is hard for positive emotions like happiness, contentment, and peace to co-exist with active symptoms of a mental illness.

One reason I feel so sure that I can describe the way the mentally ill feel is that they are so much like those of us who would like to think we are not suffering from a mental illness – not at this moment anyway.

In the course of any one year, 25 % of Americans will have symptoms of a mental illness so severe they should be diagnosed. Over half of all Americans will have at least one episode of a mental illness during their lifetime. So they will feel a lot like the rest of us – only more so.

The rest of the world has similar prevalences of mental illness. What you call it may vary from place to place. What symptoms people may exhibit may vary from culture to culture, but most any of us can tell when people are not happy and when they are suffering from dis-happiness.

Most people with a mental illness feel flooded, overwhelmed with negative emotions. When they are anxious they feel really, really anxious. When they are sad they are down in the bottom of the hole sad. Their depression does not go away when they watch a sitcom. Their night of dark feelings is really, really black.

It would be reassuring to think that somehow the mentally ill are different from the rest of us. If only they somehow have a different temperament or had done something so wrong they deserved their misery.  But the truth be told, bad things can happen to good people and we all are at risk to have an experience that overwhelms us.

Sure once they develop mental illness they may act differently from the way they did when they were well. They will smoke more and maybe drink and drug more. They may lose the ability to care for themselves or to show up for work.

But tell the truth, if tomorrow you were to lose your job and your home, if your family and friends turned their back on you – wouldn’t you feel depressed, anxious, and like giving up?

So for those of you who wonder how the mentally ill feel, take a look at how you feel when things go wrong, and then you will know how you might feel if one day you woke up and discovered you had contracted a mental illness.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How does my therapist know that? Isn’t counseling confidential?

Posted on by
5

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Is counseling confidential?
Picture courtesy of pixabay.

Did my last therapist tell?

This comes up a lot when people move from provider to provider. It especially happens when you see multiple people in the same agency. No not everything you told your old therapist will be kept secret from your new one. WHY?

Laws about confidentiality make a distinction between “Use” and “Disclosure” of information. If you are in the hospital anyone who is treating you needs to be able to look at your record and see what medications you are on, what procedures you have had, and what allergies you may have. Anyone who treats you in the future at that agency probably has the right to look at your old record and see what was done to you. The same applies to psychotherapy.

Everyone at the hospital does not get to look at anyone’s medical record just because they want to see it. The only reason to access a medical record should be for the purpose of treatment. People have gotten fired for looking up someone’s medical record just because they were curious. Even looking in medical records to see if a famous or infamous person was treated at your hospital can get you fired. But if you are treating a client you may need to know what is in their record.

Psychotherapists do and can share records and that is considered “use” not “disclosure.” Laws about confidentiality primarily relate to disclosure. Some of this has to do with law, for that see a lawyer. As a therapist though, I find this is an important issue to many of my clients and they need to understand how our system works.

It is considered good practice to separate psychotherapy notes from your general medical file. Everyone who treats you in the emergency room for an accident does not need to know about your marital problems.

We also don’t need a list of the names you or your spouse call each other. What the counselor wants to know is that you two are having conflicts and that you resort to name-calling with each other rather than problem-solving. One or two examples will suffice here. Long transcripts of the argument might be interesting in a movie script but they don’t need to be in psychotherapy notes.

Clients sometimes move from therapist to therapist. Sometimes clients want a new counselor, some therapists are known to “fire” clients for a variety of reasons. Ethically we should suggest a change of provider if we feel that we are not able to help a client. If your counselor retires, you may be assigned a new one.

When the client changes therapist, we do not, as a rule, start a new file. Would you want to go through all those tests and lab work every time you saw a different doctor? Same with taking a life history. It should be in your chart. The new provider should review your chart so they should have some knowledge of what your last therapist was treating you for and why.

Charts are needed to provide continuity of care as well as other reasons. Clients have told me they resent that the new therapist knows things they had not told them. They probably read this in the chart though they may have been briefed on the case by the last provider also. If the file moved to a new agency there probably was a release of information but at the same agency, the old paperwork still applies.

Personally, I like to meet the client first and form my own opinion about them, then review the chart. The risk is that the client will have to tell me something they just told the other counselor last week. The benefit is that in telling me again they may say something they did not say last time or I may ask a different question. A fresh set of eyes can sometimes see something new.

More than once after doing a new assessment I looked at the file and can see why the last counselor came up with the diagnosis they did, but having new facts I don’t necessarily agree with that opinion.

So yes, the new therapist may know something you did not tell them. That they were filled in by your previous provider is not a violation of confidentiality. Did you really want to have to retell your whole life history to a new person before getting down to the work of solving life’s problems?

The bigger question is why you would want to hide things from the therapist you are seeing now?  They will have trouble helping you if you don’t tell them what the situation really is.

The most important person for you to trust and get honest with is you. Some clients hide things from their counselor because they don’t want to face the fact that they have a particular problem.

The results of counseling are mostly about the relationship. We try to spend time upfront getting to know clients and building trust. Some clients have more trust issues than others. If you are not sure you trust your therapist, ask them questions. The names of their kids and their spouse are not important but their views on how to raise a child or have a good relationship might matter to you.

You should be able to rely on your provider to maintaining your confidentiality and not disclosing your information to someone who has no reason to know. Don’t expect one doctor or therapist to try to hide your symptoms from another professional who is treating you.

The bottom line? If you want help in recovering from your issues, whatever they are, you need to get honest with yourself and your counselor or find a provider you feel you can trust.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

The question why? – In therapy

Posted on by
1

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

The question why in therapy.
Photo courtesy of Pixabay.com

Does it help to know why?

More than half the time in most therapy sessions is spent on the question why? Most of the time the focus of the why question, is not on the client but on some other person in their life. Clients spend a good deal of time asking me why their partner did this or that, why did their parents do something, and so on.

It would be reassuring to know why. Most of us think if we just knew why then we could prevent something bad from happening. The great illusion of most relationships is that we can somehow control the behavior of others. Most of the time we can’t control the others in our life, and except for teaching our children good behavior, controlling others is probably not healthy.

The questions we should be asking are not about others. More helpful questions are the ones we ask about ourselves. What do I really want out of life, what are my values? How much am I willing to invest in reaching my goals? Can I accept this situation? What am I willing to do to change?

Sometimes we focus on others to avoid looking at ourselves. It is easy to upset yourself about things happening in the next apartment, across the street, or across the country. Looking at what is happening in your own life is more productive. It is also more challenging.

People like to vent about their partner, their boss, or their children. It would be easy to devote a lot of therapy time to talking about others. Conversations between friends often turn to talking about others. We call that practice gossiping. It is easy to do. We may even think that by discussing others we can gain some insight into the situation, some way to improve our outcomes.

One thing we tell clients in therapy is that it is not productive to talk about people who are not in the room. Taking about your conflicts with your partner may make you feel better, temporarily, but it won’t change the situation. There are two ways to improve this relationship situation, get the other person in the therapy room, or change yourself.

Marriage, Child, and Family Therapist’s work from a “systems” perspective, to change a family situation it helps to get all the people involved in the room. Often the “identified patient” is not the one with the problem. Let’s look at some examples of this situation.

Mother comes in with her teenage child. The child has a severe weight problem. The child has become depressed as a result of being overweight. Despite mom’s best efforts to put this teen on a diet, make them exercise; the teen continues to gain weight. The teen comes to therapy; they don’t want to talk about their weight. What is on their mind is the way their parents have been fighting and every time they go to visit grandma, she runs mom down the whole visit.

Turns out that because of the marital conflict, every time dad takes this teen out they stop somewhere for something to eat. Dad always says “don’t tell your mother, she is way too hard on you,” which the teen tries to respect.

When the teen visits grandma she does the same thing, makes excuses for why the teen does not need to lose weight, and rewards the teen with food treats. Grandma does not like her daughter-in-law and gets even with her by being the teens “friend” and sabotaging the mother’s plans for the teen to lose weight.

Working with the teen around weight loss may not be very effective. One approach is to get the whole family together at once and talk about how they are all colluding to use the teen’s weight as a way to try to control or get even with other family members.

Sometimes we can’t get the whole family to therapy. We have to work with the teen on what they really want. If the teen is impacted by this weight issue we may need to help them to learn how to say no to dad and grandma’s efforts to sabotage their diet. Some teens can’t resist the family dance and are stuck.

Boys escape this family dance by joining the military or running away from home. Girls try to escape by getting pregnant, moving in with a man, or some other way of having to leave the family. Both genders may also use drugs and alcohol to escape the intolerable conflicts.

Another situation that results in a lot of talk about a person who is not in the room is the spouse of the alcoholic or addict. They are likely to want to spend a lot of time on how to make their partner stop or on what they did to make them drink and use.

The spouse did nothing to make their partner abuse substances.  A bad relationship may have contributed but it is not the cause. People drink and use to change the way they feel, eventually they lose the ability to cope without the substances. Some people can use and drink a little or even drink a lot and then stop when they want. Other people find that when they try to stop they can’t. We consider this an example of the disease of addiction.

There is not much the non-using partner can do to stop the other person’s substance abuse.  They have a choice. End the relationship, say that this is more than they signed on for and they are done, or they can accept that the other person is the way they are and go on from there. Spending time talking about the person who is not in the room is not helpful here either.

Do you spend a lot of time asking why others do what they do? How much time have you spent in looking at yourself? What do you really want? What can you accept or not accept?

Don’t waste time on the why; work on the “what and how” of the changes you need to make to have a happy future.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel