One problem limit – rationing emotional help

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Can you have too many problems to get help?

Ever feel like you are standing in the wrong line? You go to a place and ask for help only to be told we can’t help you with that problem you need to go someplace else. If you have a few too many problems you might get discouraged and stop trying before you found the place that could help you. You might die while waiting for help.

Systems used to be designed as if people only had one problem. You go to the specialist who handles that one thing. That almost never works, people have multiple problems.

So the system would try to sort people out by their problems. All the people with substance abuse problems go over there. You people with a mental illness you need to stand in that line. We had a line for everything. Lots of places still do.

People with co-occurring disorders, combinations of a substance use disorder and a mental health issue got used to this. You go to a treatment place for substance abuse and they tell you to go see mental health. You go to mental health and they tell you they can’t see you till you stopped using drugs. I would like to do that if only the depression and the voices in my head would shut up. So around and around you go.

So we set up a system where the mentally ill stand in line 1 and the substance abusers you stand in that line over there. The homeless go to another building and the unemployed go somewhere else. If you have a physical illness we send you to this doctor but if it is your heart you see the heart doctor and so on.

Most of us would like to think we are not like those people. We are not homeless or criminals. Until that day when you lose your job and then can’t find a new one.  If you stay out of work too long you might run out of money and have to choose between making the house payment and paying the registration and insurance on your car. But if you get stopped while driving to that job interview with no insurance or registration you might suddenly find yourself as a criminal. That might make you depressed and you might have a drink or two, maybe too many.

See how quickly these problems begin to add up. Multiple problems can be overwhelming to the person with them. They can also be too much to handle for the person who is trying to help them. I would like to help you but the agency I work for has rules and if you don’t do what I say you will not get any help.

One woman told me she was sorry for missing her therapy appointment last week, could I still please see her. Seems she was told by her welfare worker that if she did not come in that day they would cut off her welfare. The same day she got a call from the principal at the school telling her that her son was in trouble at school and if she did not come for a conference this afternoon they would be expelling her son.

Can’t understand why a kid who was sleeping on the floor at a friend of his depressed mother would be grouchy and argue with his teacher or end up in the office after talking back to that principal.

Now I don’t want to sound all negative, though some days that is more likely than others.

Some systems are making strides towards being more helpful and less territorial about controlling the clients. Substance abuse providers are offering mental health treatment and physical health facilities are providing substance abuse and mental health treatment.

Still, we have a long way to go before people who need help can get it wherever they go. As many of us have seen during this last economic downturn, anyone can be closer than they think to a whole list of problems.

SAMHSA talked for a while about the concept of “No wrong door.” That no matter which place you went, they should be able to help you and they should get you connected with the help you needed.

Then came this re-depression and we started locking doors.

Have you and yours been able to get the help you needed?

Care to share? What help have you needed? Has that help been easy to access or have you had to run from place to place and try to meet each program’s differing requirement to get services?

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

Is Dysthymia better in the morning or worse?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Which depression is worse in the morning? – Morning Question #14

Having more depressive symptoms in the morning is a characteristic of “Atypical features” of a mood disorder. Atypical does not mean unusual it means “not melancholy.”

Atypical features include the hibernating-like-a-bear symptoms, overeating, sleeping too much, and being tired and grouchy in the morning. With atypical features, the person may be able to feel better temporarily if something they really like happens, but the happiness does not last long. They may also feel better in the evening but by morning the depression comes back.

Atypical features can occur during episodes of Dysthymia, Bipolar one or two Disorders, and Major Depressive Disorder. In practice, the only time I remember seeing this on a file is as part of the diagnosis of a Major Depressive Disorder but having atypical features increases the risk that this will eventually turn into a Bipolar disorder.

If your mood is customarily worse at a particular time of day, make sure you are eating and sleeping well, that there are not environmental problems like relationship issues that are causing this, and then seriously consider consulting with a medical doctor or psychiatrist. If the doctor rules out any medical problems then some counseling should help.

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

Morning Question # 9 Is Substance abuse or mental illness first?

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

Hands with pills

Addiction.
Photo courtesy of Pixabay

Does Substance abuse or mental illness occur first?

Both can be first, depends on the person. People who have early symptoms of mental illness are at high risk of developing substance abuse disorders. People who begin abusing substances early in life are more likely to develop mental illness. It may be hard for many people to remember a time before they had one or the other so it is hard to tell sometimes. I like to start by asking how old someone was when they first began to use drugs and alcohol and then ask what life was like before the drugs or alcohol. Some people can’t remember a time before one or both.

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

Morning Question #6 – Could a father’s meth use cause Schizoaffective Disorder?

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

Drugs

Stimulant drugs.
Photo courtesy of Pixabay.com

Schizoaffective Disorder and Meth use.

Schizoaffective Disorder is an unusual condition, though I think it is underdiagnosed. Think about traveling through a swamp full of lots of muck but here and there are some small islands of land. Sometimes you have one foot on land, sometimes two, and other times none. People with Schizoaffective Disorder can have episodes of psychosis, episodes of depression, or Bipolar disorder, sometimes both and sometimes neither. Depending on who sees them and when they are seen the diagnosis can change all over the place.

Mental Health conditions do not seem to be caused by any one gene. Most likely they are caused by the interaction of many genes, risk factors, environmental influences, and so on. Dad doing drugs is not likely to have caused that. Sometimes dad was doing drugs because he had a mental illness or there was a history of some disorder in the family that put him at risk.

Mom’s drug use during pregnancy is another matter. The more she uses the bigger the problem. The day she uses can determine what part of the baby was developing that day and what was affected. Mom’s drug use can result in mental retardation or learning disabilities but so far I have not seen any research out there that says the parent’s drug use before the child was born changed the child’s genes and caused a mental illness. If someone has seen that please leave a comment.

The parent’s drug use after the baby is born?

There are all kinds of research that says growing up in the home with a substance abuser can affect a child’s mental health.

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

Morning Question # 5 How often and how long should you see a therapist?

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Short answer: see a therapist as much as you need, no more, no less.

Longer answer: There is nothing special about the once a week, 50-minute hour, therapy session. Psychoanalysts often see clients twice a week or more. If you have a personality disorder, especially Borderline Personality Disorder, at least 2 to 3 times a week is recommended. Once to work on current problems, once to learn skills to avoid having more crisis type problems and more sessions as needed for addressing the past and long-term suffering.

In substance abuse, the preferred method of treatment is lots of sessions and meetings in the beginning, and then less as time goes on. Many programs begin with residential around the clock treatment to make quick gains followed by daily group sessions to consolidate the gains and lastly weekly follow-up sessions.

In Coaching or goal setting situations a single session may be all you need. That first session is sometimes followed by a booster session every so often.

Most of the time the number of sessions, frequency, and duration of treatment is determined by who is paying. Insurance may limit you. So might public funding. Court-ordered treatment may set a minimum. If you need more sessions your provider should be able to advocate for you and help you get what you need.

The more serious the illness the more treatment will be needed. For some conditions you will need to stay on medication for the rest of your life and that medication will need monitoring even when you discontinue therapy.

The question of how much, how often, and for how long are definitely things to discuss with your provider.

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

Morning Question # 4 – Is there a mental illness you can’t recover from?

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

Confused brain

Mental illness.
Photo courtesy of Pixabay.com

That depends on what you mean by recover.

People, in my opinion, can and do recover from a wide range of mental illnesses and substance use disorder problems. Recovery means that you get your hope back and you get your life back. It does not mean that you are cured or can cease your vigilance when it comes to self-care.

Somebody with type-two diabetes can lose some weight; get their blood sugar under control. They may even be able to live without medication. But does that mean they can or should begin to overeat or neglect their health again?

Someone with a serious mental illness may get their condition under control. They may be able to have happy relationships and friends. They get their hope and happiness back. Many people with mental illness are able to work, volunteer, or do productive activities again.

Millions of people have “recovered” from alcoholism, by which they mean they are no longer in a hopeless state of mind or body.”

To me, recovery is a process, not a destination. We can all move from unwell to less well to more well. But recovery only lasts when you continue to do the work to maintain it.

So – NO – I have not seen a mental or emotional illness from which you can’t recover if you are willing to do the work of recovery. Some recovery roads are just longer and more difficult than others.

When a question or comment comes in or someone uses a search term that needs a short answer but not a post. Time permitting; I post answers, like this one to those questions in the early morning.

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

Morning Question # 3. What stimulant drug causes mental illnesses?

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

Drugs

Stimulant drugs.
Photo courtesy of Pixabay.com

What stimulant drug causes mental illnesses?

Morning Question # 3.

ALL. Yes, any stimulant can cause a mental or emotional problem when you are under the influence. Some stimulants, like Methamphetamine, if you do enough of them, can cause permanent damage to the brain. The DSM includes five stimulant-induced disorders that can last after you are detoxed from the drug. Even Caffeine can cause intoxication and can induce anxiety or sleep disorders. The stronger the stimulant and the more you use the bigger the risk.

Sometimes a question or comment comes in or someone uses a search term that needs a short answer but not a post. Time permitting I will post answers to those questions in the early morning.

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

Morning Question # 2 Does Methcathinone help you get big in the gym?

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

Bath salts.
Photo courtesy of Pixabay.com

NO! No stimulant makes you big and strong, you just think you are.

Not even if you consider someone with anorexia to be overweight. Methcathinone is a stimulant just like Methamphetamine. Different chemical formulas but similar results. The people who are telling you this are also pushing the “Jenny Crank” diet. Is losing your teeth your idea of weight loss? The only bulking out you do on powerful stimulants is from the scabs on your face. There is to my knowledge no safe and effective way to get big in the gym other than eating healthy and lots of appropriate exercises. The shortcuts that do work are not safe. The safe shortcuts don’t work.  Want to get big in the gym? Lift more weight, run more miles, and eat a lot of healthy food.

Morning Question # 1 – MFT trainee or MFTT?

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Morning Questions. (Sometimes reader question.)

A new feature for this blog. Sometimes a question or comment comes in or someone uses a search term that needs a short answer but not a post. Occasionally in the early morning, I will post answers to those questions. Here is the first one.

Morning Question # 1 – MFT trainee or MFTT?

ALWAYS – MFT Trainee. MFT Trainees are still in school. They are not yet registered or licensed. They can only work under close supervision. Both at the school they attend and the field placement they are supervised. In California, the rule is one hour of supervision for every 5 hours of client contact. Not spelling out the full word Trainee can be misleading.

For MFT interns –  who have graduated but are still accruing hours for their license the same rule applies. They should always list themselves as MFT Interns NOT MFTI. This is to avoid misrepresenting their credentials to the public.

Both trainees and interns should also tell clients who is supervising them.

Some other professions use different labels for students and unlicensed workers. For example, most social work interns have about the same experience as MFT trainees this leads to all kinds of arguments about the merits of “interns.”  For more on this label, issue see “Therapist, Counselor or Social worker?”

Are people who go for counseling crazy?

Sorry, this post is no longer available.

New post over at counselorfresno.com “If I go for counseling does that mean I am crazy.” If you check it out feel free to leave a comment and let me know what you think.

By David Joel Miller.