Healthy Habits available for adoption

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

Would you like to adopt some healthy habits?

One sign of mental illness or substance use disorders is living an unhealthy lifestyle. People with depression do not have the energy to take care of themselves. People who are ill do not have the strength to maintain healthy habits.

Even those who don’t consider themselves “in recovery” find that adopting healthier habits can increase the happiness of their life and reduce the risk of becoming emotionally unhealthy.

One thing I have noticed from my time around the tables and the therapy rooms is that illnesses and diseases take a back seat to discussions of healthy habits. People who are really struggling talk about how hard, impossible it is to take care of themselves. As people recover then begin to talk increasingly about self-care.

Some will say that better self-care promotes recovery and others say that as you recover you begin to pay more attention to your self-care. I suspect there is some of both.

So what things are you doing to take better care of yourself?

Some people feel so responsible for others that they find it hard to spend time, money or effort on self-care.

Taking good care of yourself is not being selfish!

Here are some major areas of self-care that I see clients engaging in as their recovery progresses.

A better, healthier diet is part of self-care.

When you are in your disorder preparing food and eating can be a chore. Depressed people either eat nothing or they eat most everything. Often their food choices are unhealthy. Substance abusers have similar disruptions in their eating. As people begin to recover they pay more attention to what they are eating and how this is affecting them. How is your diet supporting your emotional health and recovery?

Exercise and health maintenance are parts of recovery.

Recovering people often begin an exercise program. They think about seeing a doctor. They get their physical health problems treated.

After years of failure to take care of your body, working on your health can become a priority. Recovering people need to balance their physical recovery with their emotional and spiritual recoveries. It is easy to turn an exercise program or being health conscious into a new addiction. This may be a “better addiction” but it can take you down a wrong path and away from real lasting recovery.

It is important to tell yourself that no matter how much damage to your body your old lifestyle has caused, you are worth taking care of. Depression and inactivity take their toll. So do anxiety and addiction. See to it that you get the health part of your recovery in balance with the other portions.

Setting boundaries with others safeguards recovery.

Part of recovery is learning to say no, set healthy boundaries. As you treat yourself better you will no longer be able to abide by others treating you poorly.

You will also find that you are more able to treat others as they should be treated. You will begin to recognize and respect other’s boundaries.

Safe and comfortable housing promotes recovery.

When you are down and discouraged you stay where you can. Once in recovery, you home becomes important.

You may need help finding a safe place to stay, do not hesitate to use public programs and private resources. Be sure that you make your nest in a place that is supportive of your recovery, not a place of settling for something less than you deserve.

Do what you can to make where ever you stay “your place.”

Improving relationships promotes recovery.

Recovering people want a healthy relationship with their children, parents, and significant others. They also may need to reexamine friendships and try to strengthen healthy supportive relationships, mending breaches where possible, and sometimes they find that there are former associates that need to be let go.

Even if you do not think of yourself as a recovering person, adopting healthy lifestyle practices can improve the quality of your life.

What healthy lifestyle practices are you ready to adopt and take home?

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

Recommended self-help & Counseling books

Recommended Books.

AA big book

Alcoholics Anonymous big book.

We have had some trouble with the links to counselorfresno.com so here is a re-post of the books on self-help, counseling, and therapy. This is a work in progress so if you think of something else that warrants a listing here let me know.

Links to suggested self-help books.

Here are some books that I have found useful or that have been recommended by clients and colleagues. No book is a substitute for professional therapy but many of the things we talk about in therapy are explained in more detail in self-help books. The links will take you to the Amazon.com listing for the books.

More titles will be added as time permits. If you have suggestions for this list send them along. Leave a comment or there is a contact form available.

Self Help books

Broken Open: How Difficult Times Can Help Us Grow – Elizabeth Lesser

The story of how painful events can be the impetus for personal growth

Relationships

Men Are From Mars, Women Are From Venus

Some interesting observations about how men and women understand relationships differently. Not everything applies to everyone but you may well see large parts of your relationship behaviors depicted in this book.

Children

Windows to Our Children: A Gestalt Therapy Approach to Children and Adolescents by Violet Oaklander

Raising Good Children: From Birth Through The Teenage Years By Thomas Lickona

The Healing Power of Play: Working with Abused Children by Eliana Gill

How do people learn the difference between right and wrong and why do some people stay stuck at low levels of moral reasoning.

Alcoholism, addiction, and recovery   

The Big Book of Alcoholics Anonymous

The classic text on Alcoholism, recovery this is the book that started off the whole 12 step phenomenon.

Alcoholics Anonymous from The Anonymous Press

At 99 cents this is such a bargain. This edition needed a separate listing. No Kindle reader? No Problem, if you have a computer you can download a free Kindle reader.

Theory and counseling techniques

These books are recommended for professionals, interns, and students. They may also be of interest to some clients or consumers.

Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward

Schizophrenia: Cognitive Theory, Research, and Therapy – Aaron Beck

Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D.– Jay Halley

The story of Milton Erickson’s very unusual and very effective way of conducting therapy.

Need a Kindle? Here is one for $69

Kindle, 6″ E Ink Display, Wi-Fi – Includes Special Offers (Black)

“Counselorssoapbox and counselorfresno.com are participants in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.” We recommend only books we think are good and maybe occasionally make a buck.

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 only two must-have things

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

Happy children

Happy.
Photo courtesy of Pixabay.com

What two things are “must-haves?”

From my time as a counselor I find that there are two things, clients must have to create a happy, fulfilled life. Those two must-have things are not the things we have been led to believe are must-haves for happiness.

Whatever their challenge in life, my clients all seem to be missing two important ingredients to create a happy successful life. People who hear voices and see things and people who thought they were perfectly normal until life took a wrong turn both need those same things.

Humans as biological organisms need some minimal intakes to sustain their biology. We need some food, some water, air to breathe, and a small amount of clothing or shelter. Mostly though, as warm-blooded vertebrates, we adapt. Not having those things risks your health and life but having them does not automatically make you happy.

Happiness is not things.

America is blessed and cursed with an abundance of things. So many things we have to haul tons of them to the landfill each week just to keep our things from choking off our access to the remaining things and still – will all those things, we are not happy.

We live in a land of plenty and more people here suffer from excesses than from shortages. There is too much food and the result is obesity and diabetes. We have plenty of vehicles and we consume humongous quantities of energy in our pursuit of happiness and still, amid all those excesses we can’t find happiness. Americans consume the lion’s share of drugs and alcohol and still, we can’t arrive at happiness.

What then are those two things that appear vital in the creation of happiness whether you are rich or poor? Despite our unending search for therapies to help people with their depression two things consistently improve the depressed person’s mood, a healthy relationship, and a purpose in life. Both of these things while simple, are harder to do than they sound.

Humans need healthy relationships.

By this, I do not necessarily mean romantic or sexual relationships, though having a close romantic partner seems to make most warm-blooded vertebrates happy.

We need a relationship with other humans and we need relationships with those higher powers most of us call God or a Deity.

It is a difficult task to have a healthy relationship when you are emotionally sick. Many people find they need to develop a healthy relationship with themselves before they can have a healthy relationship with another. Falling in love is intoxication but the stupor soon wears off and you begin to see with clear eyes that not all love relationships are healthy.

You do need a meaningful purpose in life.

For most of us, this is some form of work. We have come to recognize that many people who we used to think were not capable of work, can despite those challenges we call disabilities, engage in meaningful work.

All work does not need to be paid employment. Having a task that brings meaning to your life gives you a reason to get up in the morning. So paid or volunteer, of someone else’s choosing or of our own, having something to do each day that aligns with a purpose or goal gives us hope and happiness.

You may not be rich but if your daily tasks have a higher purpose, doing God’s will or giving to others, you are most likely to find happiness in living those life purposes.

Finding a job is difficult sometimes. Finding a career that gives you more than just money is more complicated. The more you like your work, the more you are doing what you feel called to do the greater your happiness. No amount of money can compensate you for doing something that is not worth the effort.

We all may need to do something from time to time to pay the bills and keep the body and soul together but in the long haul we call life, those who can find a purpose and then find a way to earn a living at that purpose are well along the road of happiness.

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

3 ways to Cut Down on Stress

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

Stressed

Feeling stressed out?
Photo courtesy of Pixabay.com

Trim away the worries and live a healthier life.

Want a reduced stress diet? Try trimming out some of the stress. Just as weight loss programs tell you to trim the fat out of your diet there are three ways to trim excess stress out of your life.

1. Cut off the future

Learn to be mindful and stay in the present. Yes, of course, you should make plans for the future and take the steps needed to get there, but stressing over things that may or may not happen adds a lot of stress to your diet for events you haven’t even tasted yet.

Worrying that you may not get what you want can add a lot of stress to your life today when what you should really be doing is the required work to get where you are going. Stressing over the uncertainty of the future can keep you from enjoying the taste of the present.

2. Cut down on the past

A steady diet of regrets and recriminations about the past can keep you stressed out and unable to live in the present.

The work of grieving over losses and letting go of guilt and shame may require seeing a therapist or counselor. Make the effort to process those old hurts and let them go.

Many of us have resentments towards people who have harmed or wronged us in the past. Holding onto those old wounds keeps us living in the stress of events that have long since ended.

Let the past live in the past and spend your time having the best possible present to enjoy your low-stress diet.

3. Stop trying to eat other people’s dinner – worrying about problems others need to solve

That you care about others is wonderful, but if you are finding your life overrun by stressors then you need to send some of them back where they came from.

You can’t solve problems for others and the more you stress yourself out over their issues the fewer resources you have for your life in the here and now.

If you chose to worry and stress there will always be negative news from around the globe twenty-four-seven. Some people believe that worrying and stressing over what might happen somehow keeps the safe from an unwanted future. It doesn’t work that way.

Prepare for the worst but live in the now. Limit your worrying to the things that you really may be able to influence and practice your acceptance of those things that are out of your control.

Is a reduced stress diet for you?

Try one for a while and see if you are not healthier and happier. If reduced stress does not work for you then you can always go back to worrying about the problems that are out of your control.

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

Mentally Ill Die Younger?

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

Could you be mentally ill?

What Causes Mental Illness?

Do the Mentally ill have shorter life spans?

– Morning Question #22 –

Yes. Lots of disadvantages come with having a mental illness.

You are more likely to be a victim of crime. In fact, a mentally ill person is far more likely to be a victim than a perpetrator of a crime.

You have a larger chance of developing other physical illnesses. Some of these, like weight gain and obesity, can be the result of medications that the mentally ill need to take.

They are more likely to be unemployed, not have or lose medical care, become homeless, and all sorts of other life problems.

They are more likely to divorce or have children with partners who are no longer around and they are at extra risk to have families that cut them off and want nothing to do with them.

You are more likely to die young after a life full of illness.

No, the pity they may get does not compensate for the loneliness and hardship. Most clients I know would gladly give up the handful of dollars they get every month for being mentally ill and disabled if only they could be “normal” and work again.

Those who do recover and work again don’t always talk about their struggles because of the stigma.

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

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

Should you tell that to a friend or a therapist? – Part 2

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

Therapist

Therapist.
Photo courtesy of Pixabay.com

Talking to a Friend or therapist – part 2.

I think I misread this question the first time. My first thought after reading the question was:

“Why should a client go to a therapist they have to pay rather than just talking to a friend?” That is from the client’s point of view and describes why a client would be better off getting a professional therapist rather than relying on a friend.

I wrote a blog post about “Therapist of Friend” which is up at counselorssoapbox.com. That post got some really good comments from readers and they suggested some additional reasons they found going to a professional therapist helpful.

After rereading the question I think they were asking:

“What if your friend is also a therapist? Or as a therapist what do I say, to my friend. Do I set boundaries and keep my roles as friend and therapist separate?”

Remember some of the readers of this blog are consumers but some of the readers are professionals or aspiring professionals.

Here is my opinion of what an ethical therapist should do.

The law’s that created LMFT’s and some other therapist and counselor professions defined what professionals do as “applied psychotherapy.” We are able to bill for services provided to a client’s medical insurance. We have to keep the practice of our medical specialty separate from what we do on a non-professional friend basis.

Consider a doctor and his wife, a therapist; who go to dinner at the house of a couple who are casual friends. The friends proceed to describe some chest pains the husband has been having.

The doctor could ask a couple of follow-up questions, make a diagnosis, and whip out his prescription pad and write out a prescription. But should he? Most likely he will tell his friend you should see a doctor. That needs to be checked out and you need some tests and lab work.

Now the wife changes the subject and tells this couple all about the problems they have been having with their teenage son. What should the therapist do? Listen empathically? Ask more questions to define a diagnosis? Suggest some interventions that the parents could try? Or should this therapist, for the same reasons as the doctor, suggest politely that lots of kids these days have problems and the family might want to consider getting him some counseling? Counseling doesn’t mean he is crazy, just he may need help with some of the growing up tasks that he needs to do. And often it is hard to listen to suggestions from family members whom you want to please and you have a history with.

But wait a minute, aren’t those also reasons why the couple may not be totally honest with their therapist friend? And could you make things worse if you suggested interventions or treatment and you had an incomplete diagnosis because your “friend” left out some embarrassing details in front of their spouse and guests?

Once you learn a skill it is hard to unlearn it or know when to put it aside. If the friend had a heart attack the doctor would most likely intervene and do some emergency procedure or he might call an ambulance. The therapist would do the same if the person was suicidal. But beyond emergency situations, therapists need to put their therapist hats by the door and just be friends.

Remember no one likes a car salesman who comes to your house for dinner and spends the whole meal trying to sell them a car. No one likes a psychotherapist who is trying to psychoanalyze everyone they meet.

The difference in the relationship between a friend and a professional therapist lies in the professional’s ability to diagnose or define the problem and then institute interventions to make a change. Even professional coaches are allowed to make criticisms of the client that a friend would not be permitted.

In a past blog post, I wrote about reasons a client might want to see a professional for therapy rather than just talk to a friend. Now, look at those same reasons from the therapist’s point of view. Your liability insurance won’t cover you. They get no confidentiality or privilege. You may need to make a child protective service report on your friend. And most importantly because of dual relationships, you lose a friend.

Here is what I suggest you tell your friends who bring up problems that are in a therapist’s scope of practice.

1. This sounds like something that a counselor could help you with.

2 I make it a rule not to do therapy with friends.

3. We are not supposed to have a second relationship like a friend, with our clients and I would hate to lose you as a friend.

4. I can give you the names of some therapists who could see you if you like.

If you do other things such as coaching or teaching there is no problem in having a friend attend your class or coaching them on more effective communication but be sure that this is a separate activity from your therapy or counseling practice. And remember, in coaching or teaching you never ever give a diagnosis or conduct an intervention designed to treat a mental, emotional, or behavioral problem.

Hope that clarified the issue from the therapist’s perspective.

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

Why research is not about your problems – co-occurring diagnoses

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

White mouse

Sometimes the mice get it wrong.
Photo courtesy of Pixabay.com

Feeling left out? You probably have been.

Have you had difficulty finding information that applies to the problems you are facing? You are not alone. The latest research usually doesn’t apply to your condition and should you find a relevant article it may end with the statement, this treatment has not been studied in patients with X, Y, or Z.  In the mental health field, this issue is especially acute, “acute” meaning sharp and painful not “a cute” as in nice to look at.

Most people don’t have only one problem. We have many, many problems. So when we look for treatment we want something that might help us. When people have multiple problems we call that dual diagnosis or co-occurring disorders. You may have two mental health diagnoses, maybe more. Sometimes this is called multi-occurring or even “complex.”

Most people with a mental illness will meet the criteria for two or more conditions. The overlap between substance abuse and mental illness is the rule, not the exception. People with mental illnesses are more likely to develop an addiction or substance abuse disorder than those without mental illness.

People with a mental illness often have a physical illness. People with an earlier physical illness are more likely to develop a mental illness. If you are seriously and chronically ill you might be a little depressed and anxious wouldn’t you?

As a therapist and a blog writer, I am always looking for the latest in research, things that might help my client. There are some new things, but frankly, there are a lot of studies that are not very helpful.

Most studies exclude from their population anyone who had a substance abuse problem until they are clean and sober for at least 6 months or more. They also exclude from studies those who have had a psychosis such as schizophrenia.

Most of my career has been spent in substance abuse facilities, crisis units, and psychiatric hospitals. Clients there have the greatest need for new effective treatments. They also have the most co-occurring disorders.  The newest treatments have not been tested on the people who need the help the most.

Drug companies would love to play this game. Many psychiatric meds cause weight gain. This excess weight gain can result in obesity and diabetes. So if I am a drug manufacturer and want to minimize side effects which I need to report to the government I would want to exclude a person who had diabetes, better yet let’s leave out anyone who is overweight. When it comes to drug companies there are regulatory agencies that keep an eye out for this sort of thing, with psychotherapy not so much.

Recently I have been doing some reading on the problems related to treating people with PTSD. We need to find better ways to help people with this condition. Right now there are lots of possible treatments but even the big names in therapy don’t seem to agree on the best approach. If therapists don’t agree on the best treatment how is the client to know if the treatment will help or harm them?

Most of the clients I see who have PTSD also have other problems. Substance Abuse is common. With those recurring intrusive memories that keep you from a good night’s sleep for years on end would you be tempted to drink?  Most of the “controlled” studies on PTSD exclude anyone with a substance use disorder or psychosis. These are the clients for whom we most need to find better treatments.

People who have a combination of PTSD and depression or substance abuse are at greater risk. Does it make sense to exclude high-risk clients from efforts to evaluate treatment for high-risk clients?

Recently I came across a study on a new treatment for PTSD. I won’t spoil the fun by telling you whose study this was.

The introduction sounded good until I read further. They excluded from their study anyone with Bipolar Disorder, Psychosis, or a history of addiction. By the time they got done excluding they were down to less than ten subjects. They had excluded more people than they included. To me, this means they should have gone the other way and tried this new treatment on the people with the most problems, the larger group. When they did their study they found out that all but one of their subjects had a history of alcohol abuse. While they had screened out current alcoholics they missed that all the people they serve had at some time or other had an alcohol problem.

A further concern should be mentioned here. Treatment should not make a client worse. Some of the current treatments for PTSD seem to make clients worse off, the treatment can retraumatize them.  Treatments that are too painful result in clients dropping out of treatment. I continue to believe that people do not benefit from the treatment they do not receive, no matter how great the treatment looked in a research study.

I will post more about treatments for PTSD as I wade through the newer studies.

For more blog posts on PTSD, substance abuse, or Co-occurring disorders see the newly revised list by categories to the right.

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

DSM-5 Diagnoses begin to disappear

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

Medical record

Diagnosis.
Photo courtesy of Pixabay.com

UPDATE – changes in the DSM.

You can erase most of this post from your memory. During the process of updating the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the DSM-IV to the DSM-5 a lot of things were proposed. Some of those suggested changes were instituted and others were left out. This post includes mostly ideas that did not make it to the final DSM-5. Because these ideas were included in a lot of research articles and other blog posts, I have left the post up but need to tell you that some of this information is now out of date.

Mental illnesses appear and disappear like magic – More DSM-5.

The effort to improve and refine the Diagnostic and Statistical Manual of Mental Disorders continues. This round of revisions has created a lot of concern about the way in which things we thought we knew about the nature and treatment of mental illness can change dramatically in a short time span.

There has been a lot of opposition to some of the proposed changes from both inside the American Psychiatric Association (APA) and those outside the association who have to work with the manual. The effects for consumers and clients may not be obvious for some time.

Recently the APA posted a notice on their website about changes they are making to the proposals for the new edition of the DSM. Not surprisingly, those revisions in proposals have coincided with the APA’s convention. The pressure to get this worked out is on now as the new edition is due out next year at the May 18-22, 2013 APA convention. That means the decisions need to be made and the book sent to the publishers by the end of 2012. The APA is accepting comments on their website from May 2nd to June 15th, 2012.

Most of these ideas are tested in carefully controlled trials with strict adherence to criteria. Unfortunately in daily practice clients don’t come in with only one problem and clinicians don’t have the time or resources to do extensive testing and diagnosing. The question remains, will this new understanding of mental disorders help or hinder the efforts to get clients the best possible care and still stay inside agency’s budgets?

Here are some of the most recent changes

1. Mixed Anxiety and Depression

This is getting moved to the back of the book under diagnosis for further study. We know that clients often have both of these together but then they also may have diabetes and sore throats but so far we are not creating lots of combo diagnosis. Bottom line if you have two mental illnesses you get two diagnoses, not one “combo,” for now.

2. Attenuated Psychosis

This moves to the back of the book also. We have plenty of psychosis class diagnosis, not sure one more will make any difference.

3. Depression gets a footnote about being careful not to make normal things into mental illnesses.

But that always has needed some judgment. If it is causing you too many problems it gets diagnosed if it is within normal it does not. So we still try to keep categories of illnesses while we also allow for variations in degree.

4. The Non-Suicidal Self-Injury Diagnosis (often called cutting)

So far has not worked the way they thought it would. Some have proposed adding Suicidal Behavior Disorder also. Currently, neither of these is considered a mental illness. They are symptoms of something but we are not all agreed on what they are symptoms of. These two are likely to end up in the back of the book along with that complex grief thing.

So the announced changes in the draft move us back closer to where we were before – except that to this point the APA is staying with their proposed changes in Autism and Substance Use Disorders. Only time will tell.

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

Put the head back on!

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

Confused brain

Mental illness.
Photo courtesy of Pixabay.com

Mental illness versus physical illness.

For a very long time, physical health practitioners have ignored the connection between mental and physical illness. When someone suggested that the way in which we think can cause physical illness they have been disregarded, or worse. Traditional western medical practice has looked for the cause of physical illnesses everywhere but in our thoughts. That may be about to change.

As I write these words I am getting very nervous. The pictures in my head of cancer patients giving up their meds to participate in some sort of thought workshop scare me. I am not suggesting that some “psychic energy transfer” ought to replace conventional treatment.

But the research, good scientific research, by reputable researchers, keeps pointing to the connections between physical illness and mental illness. No less an authority than the Robert Wood Johnson Foundation has published a report on the subject.

Their conclusion is that the connection between mental health and physical illness is overwhelming and it has huge implications for the direction and cost of healthcare in the future.

Why?

Among those with a diagnosed mental illness in the U.S, almost 70% have a chronic long-term physical illness. That might not sound so significant until we notice that in any given year about 25% of the U. S. population has a mental illness. Their conclusion is clear. Those people with a mental illness are not just faking things. The problems are not just all in their heads. The mentally ill are much more likely to develop chronic long-term diseases. But that is only the beginning of the problem.

Almost a third of those people who have a chronic long-term physical illness develop a mental illness. The connection between physical and mental health and illness runs in both directions.

In typical scientific fashion they tell us so far we can’t be sure if mental illness causes physical illness or physical illness causes mental illness. There may even be a third thing that is causing both. What we do know for sure is that very often the two exist at the same time in the same person.

There is a circle or maybe a spiral of risk going on here.

A medical condition with a “high symptom burden” such as migraine headaches or back pain is a risk factor for, which means it is likely to lead to, depression. But the spiral does not end there. Depression is a high-risk factor for heart disease. See how mental illness and physical illness are intertwined?

There is a bigger societal problem in the making here. There are extremely high rates of “uninsurance” among the mentally ill. We also know that many people with chronic medical conditions may lose their coverage if they are unable to work.

Treatment for one problem can make the other worse. Medication for a psychiatric illness like depression or psychosis can result in weight gain making the person’s diabetes worse. Medications for many physical symptoms can make a person’s mental health conditions worse.

In the elderly, and these are the people where we would expect chronic physical conditions to be at their worse, we also have the problem of multiple meds. One hospital study found that among patients who are taking 8 or more meds there was a 100% chance two of these meds were interacting and producing unwanted results. In assessing for cognitive decline in the elderly, a therapist always wants the prescribing doctor to take another look and tell us if part of the problem might be the medications not the client’s loss of mental ability.

Now regardless of how you swing politically, the bottom line here is that those people with mental illness or chronic physical illnesses are at high risk to develop the other condition and then to be unable to work. One way or the other this group of people will end up in hospital emergency rooms and those who can’t pay – well those of us who are still working – we get to pay that bill. This will only get worse as time goes on.

I suppose we could just stop paying for those who are too sick or old to work and pay for their own medical care. It sounds like some are advocating that approach these days. I for one would not care to live in a society that was unwilling to provide care for those who are least able to care for themselves. I also have enough faith in my fellow Americans to think it will not come to that.

But there is another option and support for this option is growing not just in treating the uninsured but also in treating those with the best of insurance coverage. This other option which is growing in popularity is to integrate the treatment of physical and mental health.

Consumers who are less depressed take their heart meds more often and end up in the emergency room less. The reintegration of the two specialties is overdue.

We need to stop treating medical patients as headless bodies and but the head and the feelings back in the equation when it comes to treating the whole person.

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