Organizational Fragmentation is Hurting Us

Mental health professionals are like cats. We are hard to herd. Perhaps this is due to our independent and autonomous nature, at which most of us seem to arrive after years of study and work as strong advocates of the individual. Perhaps this is an example of western philosophy taken to an extreme.

Whatever the source this has resulted in an unfortunate situation in which we have created a seemingly endless array of professional organizations with which we affiliate. These organizations appeal to narrow sensibilities or professional pursuits. Here are a few examples from the college mental health profession alone:

• AUCCCD
• ACCA
• ACCTA
• ACCCCS
• AUCCCO
• APA's Division 17 and its Commission on College Counseling
• NASPA and its programs on mental health
• ACPA and its programs on mental health
• And professional organizations representing several disciplines within college mental health, such as APA, ACA, NASW, AMFTA, and those for psychiatry.

This is just a partial list. Other professions may have multiple associations as well, but often rely on a single one to speak on their behalf, such as ACHA or AMA for those in medical fields.

This degree of fragmentation is a major obstacle to advancing our specialty, which I believe it is. Due to all the voices, all the principles and customs on which these organizations were founded, it is next to impossible to form meaningful and potent alliances, position statements, and agenda for advocacy at any level. Attempts have been made, such as through HEMHA, but these may be limited in scope due to funding and staffing realities. Without appropriate funds and executive staff to carry out its goals, such efforts will always be quite limited in spite of the very best intentions behind them.

It is past time for us to correct this situation. Due to forces in the economics and politics of health care in the United States, some organizations are pursuing an agenda which often does not incorporate respect for other professions or their core philosophies, especially regarding youth and young adults. Trends toward pathologizing normal life experiences, such as bereavement, so that intrusive interventions may be deployed are but one example. Take note of the buzzwords associated with these efforts: evidence-based care, best practices, integrated care, and so on. As I covered in a previous post, these buzzwords mask another reality, which is integration without true integration, and selective review of research to support whatever may be called a best practice.

The professional organizations representing college mental health need to be consolidated in order to form a more active and potent and focused association. It is an irony that in our appreciation for diversity, we may have neglected the greatest diversity of all: the full range of our professional philosophies and service models. Without such a consolidation and re-calibrating of our efforts, this diversity will continue to suffer and may disappear altogether.

7 ways to manage change

Like the saying goes, change is the only constant in life. Sometimes it’s for the better, other times it’s not. But no matter what, it will come at you every day of your life. With some transitions, it might be hard to adjust. Fortunately, there are things you can do to make change more manageable.

  

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1. Try something new

Prepare for future changes by getting used to the process. Try new things on a regular basis so that variety become a natural part of your life. Take chances and open yourself up to what’s outside your comfort zone. New foods, sports, friends, classes, hobbies and so on make you more able to adapt to the changes you will later encounter. Besides, novel forms of stimulation are great for your brain!

2. Prepare

Not all change is foreseeable, but you can make life a lot easier if you prepare when you can. Make decisions that are consistent with what you will be facing. If you need a new outfit in the winter, you’re not going to buy shorts (unless you’re lucky enough to live somewhere warm). Now is a good time to look at the year ahead. What changes are you making and what challenges do you face? If you take the time to examine those things, you can make a plan to better handle the changes.

3. Establish comfort

When you are faced with something new and unknown, find something familiar to hold on to. There is always a way to bring in something you treasure. Often, it’s the little things. You might have a new job, but you can put the same pictures on your desk and listen to the same radio station on your drive to work. Not only is this a chance for you to make things more comfortable, but you might find that your old experiences can add something valuable to your new ones. 

4. Learn to both hold on and let go

When faced with change, we are given the question of what to keep and when to let go. Take some time to consciously think about this. What lets you progress and what is holding you back? You might also find that some things can remain, but in a different form. For instance, you might move somewhere new. You can’t go to your favorite restaurant anymore, but you can find other similar ones. Alternately, you could adapt skills you used in one setting to fit another. 

5. Be flexible and resilient

In terms of psychological health, flexibility and resilience are essential. When you are flexible, you can roll with the punches and take things as they come. This makes change less difficult and upsetting. Resilience helps you get back on track when things don’t go your way, which cuts out a lot of confusion and wasted time. Practice using these qualities in your everyday life. When things don’t go as expected, don’t let it get to you and find ways to adapt.

6. Ask for help and advice

You don’t have to go through change alone. Other people can be a great resource. Seek out both people you trust and people who have gone through changes similar to yours. If you are having trouble adjusting to a pregnancy, talk to other moms and see what helped them. If you are switching schools, see if there’s another new student you can befriend. If nothing else, it can be great to have someone to vent to and use as a sounding board.

7. Find opportunities

You can look at change either as taking something away from you or as something giving you a chance to grow. As they say, when one door closes, another opens. If the change is not one you enjoy, there can be good things that come out of it, even if it’s simply personal growth. You always have a choice in how you react to the changes in your life and if you seek out the best parts, negativity won’t get to you as easily.

What has helped you during times of change? Sound off in the comments. 

Some thoughts on recovery

Today I’m going to get a little more personal than I normally do. I’ve been thinking about where I’m at in my recovery, where I’m heading and what I’ve learned. From this, I have a few things I’d like to say.

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We all know life isn’t fair. Mental illness is one of those unfair things. Whether it’s caused by nature, nurture or something else, mental illness infringes on our lives in a way that is disruptive and even paralyzing. The things we want to experience and accomplish can seem so far out of reach. Hope can be elusive, but it’s important to believe it’s there.

There are times when I’ve spent months in bed. Other times, I only spent long mornings in bed. Now, I can get up just fine most days. What changed? A million little things. I have had a lot of therapy. I got on the right medications. I have done work on trauma I’ve experienced. I regulated my sleep cycle. I make sure to eat enough. I actively seek out things that keep my interest. I slowed down with school. I cut out negative influences in my life. I’ve worked to better my
relationships. I even got cats. 

So is recovery easy? By no means. All that had to happen simply for me to get out of bed before lunch. If that much and more was required to make that one change, how long is it going to take to do other things? 

The truth is, my whole life. Mental illness can and does go into remission, but you still have to work to stay as healthy as you can. I could say that things are “good enough,” but I think that would be selling myself short. To be honest, I’m not happy with myself unless I am working to heal and become a better person. 

And that is one thing I think mental illness can do: It can make you more motivated to grow and become strong. Recovery teaches you the skills to be healthier, which can be applied beyond reaching a baseline “okay.” As much as not having mental illness would have changed my life for the better in many ways, it would also rob me of some of my strengths. I wouldn’t be as resilient. I wouldn’t place such a high value on good relationships. I wouldn’t know how to handle a crisis. I wouldn’t be as grateful. I wouldn’t be able to run this blog and try to make treatment easier for someone else. 

I wish I knew a better way to express how much each and every good choice you make is significant progress. I don’t know that I’d listen to myself a few years ago. But it ended up adding up. It took a long time, but my life is on track to be what I want it to be. Not all my aspirations will come true, but I’ve made new ones that are realistic to me and my condition. 

I’ve been reflecting about why I run this blog at all. I really, really want my readers to believe that recovery is possible. Not only is it possible, but it’s something you can do. There will come a day when you’ll say, “It was worth it to keep trying.” It might even happen when you least expect it. You are meant to live a good and happy life. You have a right to achieve that. If you do ten things wrong today, the one thing you did right still matters. Those “one thing”s add up eventually.

Have you made progress? Do you have hope you will? Give us your thoughts in the comments.

Wants and Needs

As higher education institutions have adopted business models a customer service orientation toward students has taken root. This is not always a bad thing. It helps faculty and staff stay on their toes and work hard to address legitimate needs of our consumers. It can serve to market the school well and also to advance its image and brand.

As with most things, however, there is a pernicious shadow to these trends, one that is anathema to college mental health which is all about addressing the needs of students. But customer service many times becomes more about satisfying wants. This in turn has created a phenomenon in which those around a student, such as parents, faculty, staff, administrators, and other stakeholders, have taken on a positively entitled, demanding posture concerning something they think should be done for a student. Sometimes there may be a positive basis for the expressed want, sometimes not.

Counseling and psychotherapy is about an individual's need to change something about themselves, something that is contributing to their own unhappiness. The things which need changing are determined by a trained professional, working collaboratively, who evaluates the individual's needs. Many times, early in therapy, clients focus on their wants and not their needs, but this is what may have led to the cultivation of life problems in the first place. Wants are often about being comfortable, while counseling, at least in the beginning, will entail a degree of discomfort. Lasting change is rarely if ever a comfortable process.

So we may face scenarios in which insisting on wants may actually lead to harm for a student, and therefore represent an abuse of counseling services. This we are obligated to prevent or stop altogether. Just as no one can dictate how a physician treats your ailing kidney, no one can dictate how psychotherapy is to be conducted (though insurance companies try to do this all the time). It is unhealthy for anyone to attempt to control what ought to be a collaborative working relationship between client and therapist. Counselors are obligated to uphold standards around this issue, so don't be surprised when they say "No." Of course, folks can seek other opinions elsewhere, where it it will be less convenient and more costly, if they like. Or they could give it several sessions first, say five or six, and then make judgements about the effectiveness of therapy after the discomfort begins to wane.

7 alternatives to harmful behavior

Mental illness does not just affect our minds and our thoughts. It affects our behavior. There are things that people struggling with mental health will do that helps them feel better, but are actually more damaging in the long run. These include self-injury, substance abuse, eating disordered behaviors, acting out obsessions, lashing out at others and more.

 

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It can be difficult to stay away from harmful behaviors, especially during times of great distress. This is why it is important to have alternate ways of coping. It can take a long time to change harmful behaviors, as they do serve a purpose. As a starting point, though, here are some ideas of what you could do instead of engaging in harmful behavior.

1. Replacement behaviors
If you don't want to engage in a destructive behavior, replace it with something else. People use this strategy all the time to quit smoking by sucking on hard candy, chewing gum or playing with putty to give their hands something to do. In other cases, this could mean drawing on yourself with a red marker instead of cutting or drinking tasty non-alcoholic beverages when you feel the urge to drink. The point is to put something less harmful in the place of the old behavior.

2. Creative expression
You can engage the emotions you are feeling without engaging in the behavior that usually
accompanies it. Try to take that energy that is pushing you towards self-destruction and let it live out another way through using it as fuel for creativity. What does your drug use look like when painted as an animal? What would your eating disorder say if it were a character in a novel about your life? Looking at your behavior from a creative perspective can also help you see things differently, which is a good start for more permanent change.

3. Talk to someone
You don't have to go through tough times alone. If you are worried that you'll engage in harmful behavior, see if you can spend time with someone else. You can talk about what is triggering your desire to engage in the behavior or you can just try to focus on something else now that you're not alone. If you don't have someone to spend time with, see if you can call someone. If there's no one to call, try writing an email to someone you trust. Involving another person can make it easier to resist.

4. Write it out
Written expression can help calm down feelings that surround destructive behaviors. There are many ways you can do this. You can try to process what you are feeling through journaling. You can vent out everything that's causing you distress and tear the paper into as many pieces as you'd like. You can write a letter to bring to your therapist the next session. The point is to communicate instead of act.

5. Distraction
Sometimes, it is better to get your mind on something else. My mother would say that if you're feeling miserable, you might as well clean. If you're able to, you can use the stress you are under to accomplish another task. Not all of us can do that, though, and self-care is an excellent way of distracting. You can use this activity in advance to come up with things to do.

6. Take out your frustration on something inanimate
At times, people feel so much tension, pain, anger and frustration that they can't slow down and do something else. In this case, let the damage be something inanimate, not your body or another person. Sit in your parked car with loud music on and yell at whoever or whatever is causing you problems. Punch a pillow or even your whole mattress. Destry things that won't harm you in a disassembled state (yes on tearing up a pillow; no on breaking glass). Redirecting your emotions allows you to feel catharsis without causing any actual harm.

7. Reward yourself
For some people, having a reward system helps keep dangerous behaviors in check. This can have as much or as little structure as you'd like. It might be a system set up in advance where you have a list of rewards for making it X amount of days without engaging in harmful behavior. It could also be having a secret snack stash or video game that you gain access to only when you are actively controlling your impulses. Some people like having a visual reminder of how long they've made it without those behaviors. You know yourself best, so find what motivates you and use it to stop yourself from doing further harm.


What do you find helps when you feel like engaging in harmful behaviors? Trade tips in the comments.

Lapse, relapse and recovery

Part of recovery is relapse. It's almost expected. At some point, after things have gotten better, they'll probably get worse again. The truth is, though, that your attitude towards relapses will have a big impact on how you handle them and whether you can use them to grow.

   

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First of all, a relapse can be many things. It might be returning to substance abuse or self-injurious behaviors. It can also be falling into another depressive episode or having obsessive thoughts again. It is an increase in symptoms that you have previously managed to reduce.

Then there's the definition of relapse. Some people think that any step backwards is a "relapse." The thing is, there is a difference between a lapse and a relapse. A lapse is engaging in a behavior or experiencing an increase in symptoms. Lapses happen to the best of us. They are not the same as a relapse, which is a series of lapses that put you back into the state of illness you were in before.


Some mindsets, such as that of Alcoholics Anonymous and other groups in that tradition, say that a lapse means you're back at day one. This can be very discouraging. But it's not the only way to view it. A lapse can be a learning experience. It tells you about what triggers your symptoms and what your areas of weakness are. This allows you to become stronger in your recovery.

If you experience a lapse, don't give up and give in. Messing up once or having a bad day doesn't mean you have to start over. It doesn't mean you're having a relapse. It just means that you now know what you need to work on. Resist the urge to fall back into old patterns. Take the time to think and maybe journal about what happened and why. Share these thoughts with your therapist, who can help you come up with strategies to avoid similar pitfalls in the future.

Sometimes lapses do add up, though, and become a relapse. While not ideal, this is perfectly normal. But if you could become better once, you can do it again. Stay open and honest with your therapist and support system. If you are struggling, let someone know. It is easier to get back on track with someone cheering you on. Keeping secrets is a sign of trouble.

Every day you spend free of destructive behaviors or symptoms of illness should be celebrated. Whether or not all of those days are in a row is secondary. Each time you make the choice to be healthy, you are right to be proud of yourself. Whether you had a single lapse or are in a full relapse, recovery is still an option. Life has lots of ups and downs. It's what you do with them that matters.


What has your experience been with lapses and relapses? What keeps you on track towards recovery? Share your thoughts in the comments. 

10 commonly used psychological assessments

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Sometimes, meeting with a client in therapy isn’t enough for a therapist to know what is going on. You are seeing someone out of her regular context, moved into a intrusive (though supportive) environment. You aren’t the same self in therapy as you are the rest of the time, so it can be good to get a closer look at traits and symptoms. If your therapist needs more insight into your situation, he might request that you take one or a series of assessments. Following are some of the most widely used ones.

1. Clinical interviews

Clinical interviews are a series of set questions that focus on any symptoms you may have, helping the clinician better assess if you have a diagnosable disorder. During the interview, you will be asked open-ended questions. The interviews generally last between 30 minutes and two hours. Sometimes, the clinician that is administering the test will assess 

attitudes, appearances and behaviors in order to 

supplement the verbal answers given.

2. Screening inventories 

A screening inventory is an assessment that is looking at client symptoms and distress. They can be used both to diagnose mental illnesses and to look at therapy progress and outcomes, depending on the test and context you are taking it in. For instance, the Outcome Questionnaire-45 (OQ-45) can be used before each session to check in on where the client is at. The Beck Depression Inventory (BDI) might be used to get a better handle on a client’s depression symptoms. The Symptom Checklist-90-R (SCL-90-R) might be used to look at a number of symptom clusters while conducting a psychological study. There are a wide variety of tests to suit many purposes.

3. Rorschach test

The Rorschach test (also known as the inkblot test) is perhaps the most famous psychological test of all time. It is a projective assessment wherein the subject is shown a series of symmetrical images created by ink on paper. The subject says what she sees in the images and the test administrator will write down everything, no matter how trivial it may seem. These statements are later interpreted in regards to personality, emotional functioning and to detect thought disorders. 

4. Thematic Apperception Test (TAT)

The TAT is another projective assessment. In this one, the subject is shown ambiguous images of people. The client will tell the proctor stories about the individuals the pictures, which can be interpreted in a multitude of ways. This test is considered a glimpse into the subconscious and the way people see the world. It has been used to study a variety of items, such as motives, concerns, personality and emotional stability. 

5. Rotter Incomplete Sentence Blank (RISB)

A third commonly used projective test is the RISB. In this assessment, the subject is given a list of 40 sentence stems, or incomplete sentences. These are deliberately vague and encompass such phrases as, “I need…,” “Other people…” and “My greatest fear…”. The subject simply completes the sentences however he wants. There is not much in terms of standardized scoring, but themes will emerge, such as a preoccupation with ones appearance or social anxiety. These can help the therapist better tailor treatment to areas of concern. 

                                                                                                                   6. Wechsler Adult Intelligence Scale (WAIS)

   

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The WAIS, currently in its fourth edition, is an intelligence test. It measures raw intelligence and gives you an IQ score. The average IQ is 100. It focuses on a variety of areas, including working memory, processing speed, arithmetic and vocabulary. It has questions ranging from picture completion to finding similarities between words. This test measures your aptitude, not how well you are actually doing in the areas tested.

7. Woodcock-Johnson Tests of Cognitive Abilities

The Woodcock-Johnson, in contrast to the WAIS, is made to measure cognitive performance. It shows how well you actually do in the areas of math, reading and writing. You may score higher or lower than your actual IQ would indicate; for this reason, it can be useful in identifying learning disorders. 

8. Minnesota Multiphasic Personality Inventory (MMPI)

The MMPI is the most commonly used psychological test. It is used to assess personality and psychopathology. Depending on the version of the test you take, you answer either 338 or 567 true or false questions about yourself. This is used to gauge your level of pathology in areas such as depression, hysteria and paranoia. Based on the areas you have the highest scores in, a portrait of your personality and psychological issues can be made. There is also an adolescent version of this assessment, the MMPI-A, which is 478 items long.

9. Millon Clinical Multiaxial Inventory (MCMI)

Used strictly to assess psychopathology, the MCMI does not tell you about personality in the same way the MMPI does. It has a clear focus on psychological symptoms, as it identifies personality disorders and clinical syndromes. It is, however, much shorter than the MMPI, only having 175 true or false questions that can generally be answered in 25-30 minutes. The adolescent version of this assessment is called the Millon Adolescent Clinical Inventory (MACI) and is 160 items long.

10. Child Behavior Checklist (CBCL)

This test is designed to be used with minors, starting as young as 18 months of age. A parent or caregiver takes the test and reports social, behavioral and emotional observations of the subject. There are also versions of the test that can be filled out by teachers or the youth themselves. The assessment asks how true certain statements are, such as “talks or walks in sleep” or “acts too young for his/her age.” Because parents and teachers have higher access to the youth than the therapist does, it can be helpful to get input from someone used to seeing the child in other settings. 

Have you taken any psychological assessments? Did you learn anything interesting about yourself? Talk about it in the comments. 

Supporting the Role of Psychotherapy in Modern Life

Psychotherapy has proven over and over to be effective. In some cases its has proven superior to other interventions, including medication. And yet, over the last 20-30 years there has also been a variety of factors which has limited access to these services.  From the time of the rise of accountable care or health maintenance organizations, many of which have limited its approval and duration, psychotherapy has been struggling to stay alive much less to thrive.

Numerous other societal influences have contributed to this problem.  These include:

• The reduction of time in psychological services provided in medical settings, which have claimed to integrate such services but have only cursorily done so.
• Shifting emphases away from psychotherapy in training programs.  It is now not uncommon to meet trainees with only a handful of therapy contacts under their belts. This is partly due to the sources of grant funding, an orientation toward other health care activities and settings, and the development of manualized treatment programs which place less value on the relationship dyad.
• Burdensome issues relating to overhead costs and below market-pricing for those in private practice, a disincentive to engage in this work.
• Clear valuing of medication delivery in the medico-pharma-insurance conglomerate, to the exclusion of other approaches.  (This may change as pharmaceutical development for mental health slows down due its reaching a ceiling in benefit to humans.)
• A public which has been encouraged to seek quick, effortless relief from life's ordinary challenges.
• A parallel trend in which the public has been convinced that ordinary challenges, such as bereavement, are mental illnesses requiring a biological intervention.
• A reduction in mental health funding at the state level, which actually releases the hospitalized back into the community where they will face long waits just to talk to someone.
• The erosion of privacy in healthcare settings.
• The digital age, which has directed the attention of individuals to devices and away from the support of each other.
• A lack of humanizing development in psychotherapy itself.  All recent "innovations" I can think of actually reduce human contact, as in the cases of online therapy and telemental health services.

In an era in which humans crave and need human contact and community, psychotherapy has a role which is more relevant than ever.  But on top of that, IT WORKS!  There is an ample base of evidence for this.  When you or yours need assistance with one of life's many challenges, seek out a competently trained therapist first.  Look for those trained in accredited, residential programs, who are fully licensed in their jurisdiction, and who will meet you face to face for no less than a full 50-minute session per week, just to start. Insist on a high degree of privacy such that only you and your therapist know your concerns, so that you may experience trust.  (As stated in a previous post, confidentiality is the magic behind therapy.)  When dozens have access to your record, this is lost.

Life-changing therapy relationships are possible.  Don't settle for inferior or illusory "interventions".  Seek out the best psychotherapy possible.  College counseling services are one of the last true preserves of psychotherapy; encourage your student to take advantage of this opportunity which may never be as cost-effective or convenient during their lifetimes.

The importance of self-care

   

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Therapy is hard work. It takes a lot out of you to spend extended periods of time focusing on the most difficult aspects of your life on a regular basis. It’s not hard to burn out while working on particularly intense issues. This is why self-care is essential to recovery. You need to make sure you are in the best place possible in order to move forward in your treatment. 

Self-care is maintaining your health and general well-being. It can take many forms and will be specific to each individual. What matters is that the activity promotes your welfare. If taking a walk in nature makes you feel better, do it. If self-care means the occasional binge-marathon on Netflix, that’s okay, too. There is no right or wrong way to engage in self-care; the only thing that matters is that it works for you.

While you might think that self-care for mental health is only about taking care of your mind, that is not true at all. Taking care of your body is essential, too. Physical health and mental health are very interconnected, so what’s good for one is good for the other. Make sure to exercise, eat healthy foods and get plenty of sleep. Follow your treatment regimens for any physical illnesses you have. 

Make a list of self-care activities so that when you are feeling exhausted, you don’t have to try to come up with something. Keep it on your phone, in your purse, on your refrigerator – wherever you have easy access to it. Make an effort to do something on the list every day. Try new activities, too. You never know when you’ll discover something helpful. 

By regularly practicing self-care, you can avoid future mental health crises. Taking care of yourself as stressors come up means that you won’t have a reservoir of unresolved emotions that flood you all at once when the buildup is too strong. If you are having trouble coming up with self-care ideas, you can talk to your therapist. Together you can come up with a plan for how to take care of you both daily and when a stressor comes up.

Do you practice self-care? How has it helped you? Tell us in the comments.

10 journal prompts to improve relationships

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In the past, we have looked at journal prompts to increase self-reflection. It is a very powerful way to explore yourself and come to a better understanding of who you are. Because this is currently my most popular post of all time, I thought we’d look at some other ideas to write about. This time, we’ll take a look at questions that can help you improve your relationships.

Remember, journaling can also be done visually through drawing, painting, collage and so on. For some examples of art therapy exercises, check this out. You can modify them to fit these prompts.

1. Make a list of the most important people in your life. What do you admire about each of them? 
2. What are nice things that others have done for you? Can you do any of these things for someone else?
3. Pick a relationship you cherish. Write a letter to this person explaining why this relationship is especially important to you. (Sending it is optional.)
4. Think about couple you feel have a loving relationship. What have you observed them doing that you’d like to see in your own relationships?
5. Write about childhood friendships. What positive things did you do as a child that you have lost over the years? 
6. Make a list of traits you have. Next to each of them, list who else in your life has those traits. You might find some new common ground.
7. Who has had the greatest influence on you? Why have these people mattered so much?
8. How can the examples of others help you improve yourself?
9. Have you had a special relationship with a pet? What have you learned from this that can help you be better in your human relationships?
10. What kind of person do you want to be in the context of your relationships (sister, boyfriend, student, etc.)?

What did you discover using these prompts? Do you have any other ones you’d like to share? The comments are open!

Diagnosis spotlight: anorexia nervosa

   

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When most people hear the word “anorexia,” they think of really skinny people. There is, however, a lot more to this disorder than ones weight. Anorexia nervosa is a disorder of both the body and the mind. It can have adverse effects in many areas of one’s life and should always be taken seriously.

First of all, it’s important to acknowledge that anorexia can happen to anyone, regardless of gender, age or race. A college boy could develop anorexia in response to athletic pressures, or transitioning out of independent living could instigate it for a senior citizen. The stressors that can lead to eating disorders are in all our lives and while young females are more at risk, it is important to acknowledge that that isn’t the whole population.

A hallmark trait of anorexia is the restriction of food intake. Someone with anorexia might create unhealthy diet plans, not giving the body the calories and nutrients it needs. Certain foods are avoided completely, leading to a very restricted diet of what has been called “safe foods.” 

For anorexia to be diagnosed, as opposed to another eating disorder, this restriction should lead to a low body weight. The DSM-V diagnostic criteria used by mental health professionals defines this as “less than minimally normal” for adults and “less than that minimally expected” for children and adolescents. 

Another criteria for anorexia is an intense fear of gaining weight or interfering with weight gain despite being at a low weight. This is often related to the final criteria. One of the following needs to be present: disturbance in how you perceive your body (thinking you’re fat when you’re not, for instance), your self-esteem being excessively influenced by the way you see your body or a failure to acknowledge the seriousness of the low body weight. 

Furthermore, there are two types of anorexia: binge-eating/purging type and restricting type. The former involves episodes of binge eating and/or purging behavior. Purging refers to expelling food from your body, like self-induced vomiting or misuse of laxatives or diuretics. The restricting type does not binge and/or purge, but loses weight through dieting, fasting and/or excessive exercise.

Anorexia also often accompanies other psychiatric illnesses. Depression, bipolar disorder, obsessive-compulsive disorder, personality disorders and self-injury are some of the more common comorbid conditions. This can make the anorexia even worse, as there is more internal turmoil. Getting treatment for other mental health – and physical – disorders can help in the recovery from anorexia.

If you or someone you love is experiencing these symptoms, it’s imperative that you seek out help from a qualified professional. Anorexia nervosa is the most deadly mental health disorder. It will wreak havoc on your body until it literally eats itself. You cannot survive without nutrition. But it’s not just your body. Suicide causes one in five anorexia deaths. It is so important to get help.

Find someone who specializes in eating disorders. They have their own specific challenges and your best shot at recovery is with someone experienced. There might also be local support groups you could join in addition to therapy. If the anorexia is severe or treatment-resistant, consider finding a treatment center. If serious physical symptoms develop, call 911 or get to an emergency room. Look out for fainting, seizures, irregular pulse and other symptoms that could be considered serious. Recovery from anorexia is essential, so don’t hesitate to get whatever help you need.

To learn more about supporting loved ones with eating disorders, read this.

What has been your experience with anorexia? What helped you or a loved one get better? Share your thoughts in the comments.

7 reasons to enter individual therapy

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Therapy can be helpful for lots of different concerns. While we have discussed when it is appropriate to enter treatment, we haven’t had a good look at the reasons for doing so. If you or someone you love is having problems in any of these areas, you should consider contacting a therapist to commence treatment.

1. Relationship problems

Relationships are, perhaps, the most important aspect of life. While there are a few hermits out there, people aren’t generally meant to go it on their own. We need others, whether that means a farmer who grows your food or a friend that offers a shoulder to cry on. Relationship impairment is, therefore, very significant. If you are having a hard time with your relationships in general or are struggling with an important relationship, a therapist might be able to help you figure
out your part in it and how you can improve those bonds.

2. Support during transitions

Change can be hard. Change is even harder if you go it alone. As well-meaning as friends and family may be, they are not always enough to guide you through major adjustments. For instance, if you have been diagnosed with a major illness, are going through a divorce or can’t quite get in the groove with a new job, it might be a good idea to talk to a therapist. He is removed from the situation and doesn’t have anything but your best interest in mind, whereas others – while wanting to help – might have their own agendas. 

3. Impulsive behaviors 

Everyone does something on impulse from time to time. Whether it’s as simple as trying a new place for lunch or as complex as quitting school to travel the world, sometimes we just want to do something. At times, however, impulses can get the best of us. Doing things without thinking can damage the lives of us and the people around us. It is especially important to get professional support if you are having problems with addiction or sudden aggression. If you wake up the next day regretting your decisions, consider contacting a therapist.

4. Difficulties in school

Education is a very important part of life. Struggling with it is definitely a cause for concern. You could have a learning disability, or something might just be in the way of you completing your work efficiently. Therapists are trained to identify what is causing your problems and can even offer assessments to see where your challenges lie in order to help you get through them. They can also make recommendations to your school about accommodations for any conditions you might have.

5. Vocational issues

What you do for work is one of the most important life decisions you will make. Whether you are struggling to find out what you want to do or not doing well in your current occupation, therapists are a great resource for working through work issues. Because employment is essential to supporting oneself and one’s family, entering therapy when you are struggling is a good investment. As with school, therapists can sometimes make recommendations for accommodations in your workplace to help you succeed in your job.

6. Sexual concerns

Sex is a significant part of intimacy; therefore, difficulties in that area of life can be particularly distressing. Luckily, therapists are not there to judge you and can help you work through any concerns you have in this area. Whether you are struggling with people accepting your sexual orientation, learning to be intimate after sexual assault or curious whether your sexual quirks and kinks are healthy, a therapist is a good sounding board to help you work through such personal and important questions.

7. Self-improvement

Therapy isn’t only for those who are unhealthy. Sometimes, people go to therapy just to become better people. You might have some meaning-of-life questions, or you might just want to be a better friend or more comfortable in your own skin. Therapy is a great setting to explore your strengths and weaknesses and find out how to make the most of your life. Therapists can teach you useful skills and techniques, help you work through “the big questions” and explore how you can add more meaning to your life. 

Why did you decide to enter therapy? Tell us in the comments. 

What to expect your first session

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The first session with a therapist is a unique experience. It is different from all future sessions, which will be dictated by what problems you are facing. But in that first hour, there is lots of important information you and your therapist will be going through. Every therapist is different, but here’s what you might expect in your first session.

First of all, arrive early. There is likely some paperwork for you to fill out. Some of this will be

financial. This would include insurance information, so make sure to bring that with you. If you don’t have insurance, you may have to sign a contract stating that you take financial responsibility for paying for the sessions. You might also be asked to fill out questionnaires about your symptoms and history.

You might also be given a paper stating the limits of confidentiality. Whether or not you get the paper, your therapist should talk to you about it and answer any questions you have. You can also read more about confidentiality in therapy here.

You may have filled out paperwork on it already, but your therapist will likely ask you about your background and what symptoms you are experiencing. Be completely honest. You’re not going to be rejected for telling the truth. Only if you are open can your therapist formulate the best possible treatment plan for you.

There will also probably be questions about your current situation – occupation, relationship status, living situation, family and social relationships, and so on. This is done to get a better idea of the stressors you might face and the support you have. Again, be honest. You’re not trying to impress anyone.

The most important question, though, is what brings you to therapy. Think ahead of time about what you would like to accomplish with your time together. You don’t need to know exactly what the plan is – that’s something your therapist and you will come up with together. But a basic idea of what you want to change in your life is very helpful and an important starting point for treatment.

With all the questions you are being asked, you probably have some of your own. That’s perfectly appropriate. Now’s a great time to learn about your therapist and the process of therapy. Some ideas for questions you might want to ask are here. 

What you shouldn’t expect, however, is for problems to be solved. Some therapists might jump right into the issue and leave some of the questions discussed for later, but even then, remember that therapy is a long-term process. If you have an imminent emergency, make that clear to your therapist early on, but if not, let the first session be what it is. It’s a time for you and your therapist get to know each other and make goals for treatment.

What has your experience been with first sessions? Tell your story in the comments.

25 safety tips

Being the victim of a crime or accident can be traumatizing and, as we know, trauma is bad for your mental health. This is why it’s very important to protect yourself at all times. Following are 25 ways you can be safer in your everyday life.

     

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1. Let someone you trust know where you are going and when you will be back.
2. When walking, be aware of your surroundings at all times. You can check your phone later.
3. Keep your car doors locked both while parked and driving.
4. Do not “check in” on social media when you are out of town. It will alert potential burglars that you are gone.
5. Have your keys out when walking to your car or home so you can enter more quickly.
6. Walk on the side of the street that is facing traffic.
7. Keep any entrances to your home well-lit.
8. Always secure your windows and lock your doors.
9. Never tell anyone that you are home alone.
10. If you receive a call from someone about a problem with your credit card, hang up and call the number on the back of your card to make sure it’s actually them. 
11. Never accept drinks that have already been opened or are given to you by strangers.
12. Do not leave valuable items visible in your car. Store them in the trunk.
13. If someone calls and has the wrong number, do not give them your name or repeat the number back to them.
14. Stay on well-lit streets. If it takes you longer to get somewhere, so be it.
15. Get a copy of your credit report once a year (it’s free) and check for inconsistencies. 
16. When out of town for an extended period, have someone check on your home regularly.
17. Shred all papers that contain personal information.
18. Stay away from bushes and other overgrown areas.
19. Use a headset while driving or, better yet, stay off the phone while on the road.
20. Don’t leave a spare key near your front door. Consider leaving it with a trusted neighbor or family member.
21. Hang up immediately if you receive an obscene or harassing call. If the problem persists, contact law enforcement.
22. Memorize important PINs and passwords; do not write them down.
23. Get sufficient sleep so you are alert, especially if you are driving long distances.
24. If you have a GPS, set “home” as somewhere near where you live, but not your exact location.
25. If you are being followed, don’t stop. Keep walking or driving to the nearest public place.

How do you keep yourself safe? Share your most helpful tips in the comments.

Past vs. present

   

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When in the middle of a stressful or triggering situation, it can be easy to let emotions get the best of you. The thing is, those feelings aren’t always connected to the present circumstances. Luckily, there’s a quick way to calm down and see what’s really going on. It’s called past vs. present.

This technique is pretty much what the name suggests: comparing the past and the present. When you are feeling emotionally overwhelmed, take a minute to look back and consider other times you have felt similarly. Then you can tell yourself what is currently different than the past situation. Here are some examples to help you get the point.

You ask out someone that you met at a party and get rejected. This might make you feel upset or confused and lower your self-esteem. When you think of where you’ve felt those feelings before, you realize that it’s how you felt when your ex left you. But in the present, we’re not talking about someone you had made a commitment with. This concerns a relative stranger. Someone you just met should not be allowed to have the same emotional sway as someone you were deeply connected to. You recognize that the current situation does not carry as much weight as the one in the past, so while it’s not fun being let down, it doesn’t have to ruin your day.

You have to give a presentation at work. No matter how much you prepare, you feel anxious and like you are going to mess up. You are afraid you’re going to be made fun of, so you think back and see if you can remember a time that it actually happened. You remember that in junior high, you had to do a presentation, but forgot and had to go in front of the class unprepared. As you stumbled around a topic you didn’t know much about, you could hear snickering and whispers in the room. In the present, however, you are prepared. You know the material and have been practicing what you will say. You don’t have to feel as nervous as you did back then.

Someone you encounter seems to upset you for no reason. You don’t know why you dislike him; others around you might think he’s great. She may never have said or done a single offensive thing to you, but you can’t get rid of your dislike for her. That is when you look back and see who this person reminds you of. Maybe he looks like a mean coach you once had. Maybe she has the same tone of voice your mom had when she was angry. It can also be a matter of position, such as having a bad experience with a doctor and projecting that onto future doctors. Once you can recognize that the person who upset you is actually in the past, you can move forward with the present person.

It can sometimes be a little tricky to find out who or what you are actually dealing with emotionally, but a little reflection can go a long way. Even if you can’t find a person or reason in your past, looking for it might help you realize that the situation is not as bad as it might feel. 

Do you think this technique could be helpful for you? Try it out and come back to tell us how it went.

Service Models in College Counseling Centers

An earlier post focused on one role and philosophy for campus counseling services based on my professional experiences.  But discussion on this subject would not be complete without an at least a brief overview of various service models already in use across the United States and perhaps other countries as well.

I have been surprised, even dismayed, to repeatedly observe how little literature or direction is available concerning these guiding philosophies or models.  Since very few mental health professionals receive any management training prior to becoming the manager of counseling services, this places new or emerging directors in a vulnerable position.  In the haste to develop services sorely needed by students, we can create a patchwork of disjointed programs and services which may not be rationally related nor focused on any particular values or orientations.  Further, we may also be vulnerable to other influences which are better schooled in business models but which have little to nothing to offer in the area of psychotherapy or relationship-based healing.

A comprehensive view of existing models is beyond the scope of a brief blog post.  Suffice it to say that what is offered here is a sample, a taste if you will, of the choices available to campus leaders.  It is my hope that this may whet appetities to examine this more deeply, and to investigate what models may best suit a particular campus, its culture, and its student body.  The reader will note that definitions are not presented here.  This is partly because the literature is so scanty I am not sure there are agreed upon definitions available, and partly because I do not want to constrain the imaginations of managers working to grow a center (more on that later).

The list below was developed by a convenience email sample of counseling service directors in August of 2014.  It is not to be construed as complete or exhaustive.  Each of the models listed have advantages and disadvantages, and none, in my opinion, is inherently superior to the others in all contexts, though some may claim otherwise.  And context is the key: understand yours first.  Then select the models or models which you think may best suit campus needs.  Then investigate and experiment and evaluate and refine.

A Sample of Service Models

1. Bio-Psycho-Social Model

2. Brief Therapy Models

     a. Brief Intermittent Model

     b. Short Term Episodic Model

     c. Time Attendant Model

3. Building Resiliency and Supporting Personal Success and Goals Model

4. Campus Stakeholder Model

5. Client-Directed, Outcome Informed Model

6. Community Mental Health Model

    a. Brief Campus-wide Services Model

7. Consultation or Organizational and Community Development Model

8. Contextual/Environmental/Ecological/Systemic Models

9. Cube Model

10. Developmental Model

    a. Broad-based Comprehensive Student Development Model

11. Educational Services Model

12. Feminist Model

13. Human Service Model

14. Medical, Health Service or Clinical Model

15. Multicultural and Cross Cultural Models

16. Public Health Model

17. Strengths-based Model

18. Hybrid (of two or more)

Significant Areas of Emphasis in Centers

1. Training Emphasis

2. Evidence-based Therapy

Two-week hiatus

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Right now is a slightly chaotic period for me. I am currently in the process of both moving and starting a new semester at school. Because those two things are taking a lot of my attention right now, I need to give myself a little break from this labor of love. I am hoping that in the next two weeks, I will get settled down enough to come back refreshed and less stressed.

In the mean time, you can leave suggestions in the comments for posts you’d like to see. I don’t guarantee that I’ll get to everything, but I’ll try to do at least one idea from when I was gone. 

I hope things are going well for all of you. Keep taking care of yourselves and I’ll see you in two weeks!

Best wishes,

Lindsey

5 ways to support a loved one in inpatient treatment

Sometimes, mental illness or substance abuse requires more intensive treatment than can be provided on an outpatient basis. Situations like being suicidal, the inability to get substance abuse under control, going through a medication change or an eating disorder becoming life-threatening call for inpatient treatment. The amount of time someone is gone varies, too – rehab can take months while most stays at the psychiatric ward of a local hospital are only a few days. The uncertainty of how long it will take can make the situation even more distressing.

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While this is a lot to deal with for the patient, it also leaves loved ones not knowing what they can do. Visiting hours are often very restricted and you might not even know if your loved one wants you to come. Besides, these programs are sometimes pretty involved, with individual counseling, doctor’s visits, group therapy, psychoeducational classes and more. You want to help; it’s just hard to know what to do.

In these times, grand actions are not very viable. It’s the simple shows of support that end up being meaningful. Following is a list of suggestions for showing that you care. Keep in mind, however, that the rules and policies of each treatment center varies. If you are uncertain of whether a specific item is permitted, call the unit your loved one is staying at and ask a staff member. 

1. Let him know you are there for him… 

An in-patient stay cuts someone away from the world, leaving most of society’s currently used methods of communication off limits. She likely won’t have access to her cell phone or the Internet. This brings up the question of the best way to show support. Even if your relationship is close, he might not be ready to accept you reaching out. A card or a letter is a non-threatening way to show support that allows her to decide if she wants to give you a call or invite you over to visit. Include your phone number, as he might not have it memorized.

2. …but respect her privacy. 

Because it is closed off, knowledge of what goes on within the program can seem mysterious to outsiders. Your curiosity might naturally be piqued, however. But unless you are the parent of a minor, you most likely don’t have a right to know what is going on. You have to trust that the treatment team has the situation under control and will make good decisions. If your loved one wants to talk about his treatment, he will. Be nonjudgmental and a good listener. Avoid giving advice at this time. Besides, after a long day of processing issues and psychoeducational material, hearing about the latest game or celebrity gossip might actually be relaxing. 

3. Pictures 

Due to risks of patients harming themselves or others, there are a lot of restricted items in the inpatient setting. Pieces of paper, however, are generally considered benign, so bring pictures. Don’t just stick with family portraits. Go to your loved one’s Facebook page and print out a few of her having fun with her friends or on a vacation. A picture of a beloved pet can also be appreciated. If your loved one has a strong attachment to a particular location, a photograph of a place that soothes her can also be calming. If permitted, bring Blu-Tack so he can hang them up. Frames will not be allowed, at least not with the glass in.

4. Entertainment 

Despite intensive treatment, there is downtime. If left with the facility’s resources, however, your loved one might spend a lot of time coloring pictures with crayons or playing checkers. While often highly regulated, entertainment is appreciated. Some books and magazines are restricted based on the content, but you probably won’t know until you get there, as it is very arbitrary. Less frequently, a center might allow an iPod or MP3 player. They may, however, require a small speaker, as headphones can be a safety risk. With this, it’s especially important to talk to the staff before you bring something over.

5. Something from home

It is normal to get homesick when in an inpatient setting, seeing as one is pulled away from all the comforts one is used to. Bringing something meaningful from home can ease some of that feeling. Take over a favorite stuffed animal, pillow or blanket. A small, unbreakable trinket with personal significance can be a lovely connection to home. Avoid brining valuable or irreplaceable items. Not all inpatient stays are planned, so a fresh change of clothes can be much appreciated. If you are allowed to bring food or treats, a comfort food can also mean a lot. A connection to life outside the treatment center can serve as a lifeline when treatment is at its toughest.

Have you spent time in an inpatient unit? What shows of support did you find helpful? Add to the list in the comments.

Why you should see a student therapist

Every therapist has to start somewhere, so there are plenty of student therapists who are practicing under supervision. They can often be found in university counseling centers and in community clinics. This means that college students and those utilizing community resources may well end up working with a student therapist.

   

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Not everyone is entirely comfortable with this. If you’re a senior citizen, how can you put your trust in someone in her twenties? Does a student feel like he is getting appropriate treatment when his therapist only a couple years ahead? It’s an issue that student therapists have to deal with sometimes. The thing is, they shouldn’t have to.

Research shows that student therapists perform just as well as licensed practitioners. Some even suggests that they might actually be better. The reason for this is unknown, but it could have to do with being regularly supervised, the fact that their education is still present or recent, and the initial zeal that old hands lose. No one knows for sure. What matters is that you shouldn’t be worried about having a student therapist – you might actually be better off that way.

Supervision allows students to have a second pair of eyes on their clients. Supervisors often watch tape of students performing therapy, meaning they can give very detailed and relevant feedback. Students also have someone who can help them conceptualize their clients and give suggestions. It’s kind of like having a second therapist behind the scenes.

By virtue of being in school, students are actively learning. They are dealing with the material both theoretically and practically. They spend a lot of time actually thinking about all the things that lie behind therapy, something a seasoned clinician might not do. Students also have multiple professors at their disposal, meaning that experts are on hand.

Students are also enthusiastic about their work. They are at the very beginning of their careers, following their dreams. You don’t commit to graduate school unless the subject has significant meaning to you. They haven’t been jaded by time and they are excited to learn and grow. It’s a unique period in their lives where there is lots of energy on hand. 

So if you are under the care of a student therapist, you shouldn’t worry about her being inexperienced. There are other factors at play that make up for that. Every therapist, no matter how long he has been practicing, has something unique to offer. If you find someone who’s a good fit, it doesn’t matter whether or not she has “Ph.D.” after her name.

Have you seen a student therapist? How did it go for you? Tell us in the comments.

Best Best Practices

Certain buzzwords appear and fade during the course of a long career in mental health.  Many times such words are reflective of economic trends rather than any scientific breakthrough.  They galvanize groups and can serve as momentum to pursue one avenue or other in the field, on the promise that the folks we serve will have better "outcomes".  The word outcomes itself has spent some time as a buzzword.  While having better blood pressure is a desirable outcome, a host of problematic side effects to blood pressure medicine are also outcomes, though apparently not the outcomes of interest for some.

One of the current buzzword phrases is "best practice", or its cousin "evidence-based practice".  Something may make a best practice list through rigorous research, which is great, or it may happen through a rather casual and cursory literature review.  Some times they are based on the opinion of a single individual, well known though he or she may be.  And there are times when it just so happens the list parallels a new product or the marketing of services.  It can be difficult for a trained practitioner to make sense of such lists, much less the ordinary consumer, which is to say all of us.

I have found that addressing the credibility of a "best practice" claim is a bit like being a party pooper.  This occurs even when the party goers are supposed to be trained professionals who are in theory versed in the scientific method.  In fact, I once heard someone say "well, that was a buzzkill" when a colleague disputed such a claim.  A buzzkill of a buzzword.  If it fits, so be it.

Maybe it's out there somewhere and I have missed it, but I don't recall ever seeing a method of evaluating best practice claims in the mental health field.  So here goes.  When you hear this claim being made, ask yourself the following questions.  Better yet, ask the one making the claim.

• What disconfirming evidence was sought prior to the claim, and how was it sought?
• What is the disconfirming evidence?  (Hint: there is always disconfirming evidence.)
• What sources of evidence were examined, and were they as broadly distributed across disciplines as possible?
• What other practices achieve comparable or better results?
• Is the practice accompanied by any risks?
• Can the claim be clearly separated from economic pressures, such as ties to pharmaceutical development, billing incentives, or lobbying from professional guilds?
• Even if the claim stands up to scrutiny, is it possible to offer consumers alternatives better suited to their circumstances, and has this been done?

Many mental health professionals are trained in a scientist-practitioner model, so these questions should not be unfamiliar or treated with disdain.  If that happens, there is something horribly wrong.  Insist on the best of best practices.  Caveat emptor, my friends.

10 signs of mental illness you should never ignore

   

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There are a lot of symptoms of mental illness, more than anyone can list off the top of their heads. But some are more severe than others. Here are a few of the ones where you should immediately seek advice from a mental health professional. 

1. Hallucinations

Hallucinations are experiencing the presence of something that is actually not there. Visual and auditory hallucinations are the most well-known, but they can also be smells, tastes, tactile stimulation and more. Hallucinations are a symptom of several serious mental illnesses, so they should always be taken seriously. It is possible that there is a more benign explanation – it could be a lack of sleep or the side effect of a medication. But it can be difficult to judge what the  cause of a hallucination is,
                                                                                                                   meaning that a professional evaluation is called for.

2. Antisocial behavior

Antisocial behavior is not a reference to being introverted and liking alone time; rather, it’s deviating from the norms and laws of society. This often is expressed through aggressiveness, dishonesty, disregard for safety and criminal behavior. Antisocial actions can have long-lasting consequences for both the person performing them and for others, so it’s important to get it under control. When there’s a pattern of these types of behaviors, it’s important to seek help in order to prevent more permanent damage.

3. Identity confusion

There are times when people start questioning who they really are and what they want their lives to look like. Adolescence and mid-life crises are a couple examples. But if taken too far, this uncertainty is potentially dangerous. If someone suddenly abandons what was previously loved and don’t know what to replace them with, it could be a sign that something more serious is going on. At the extreme, there might be complete blank on who one is, which can be indicative of amnesia. It’s important to talk to a mental health professional to identify the cause of losing one’s sense of self.

4. Mania

Everyone gets worked up and excited sometimes, leading to increased activity in one’s life. But sometimes, it becomes out of control. If someone has persistent and abnormal elevated or irritable moods for over a week, it might be a manic episode. These episodes, a hallmark of bipolar disorder, might present with an inflated sense of self-esteem, a decreased need for sleep, racing thoughts, distractibility, being unusually productive or engaging in behaviors that will have serious negative consequences. Because of the lasting impact these episodes can have on one’s life, professional help is warranted.

5. Learning difficulties

It’s normal to struggle with learning sometimes. We are all better at some things than others. But when someone is, in at least one area, several grade levels below where one should be, it could be a learning disability. This doesn’t mean that someone’s stupid, but rather indicates a lack of the ability to learn in certain areas. Learning difficulties could also be indicative of a high level of distress, which needs to come down before one can resume regular patterns of learning. A sharp change in one’s ability, like suddenly being unable to perform tasks one could do before, should also be looked into.

6. Self-injury

Self-injury is indicative of severe distress. It often means that someone is in a lot of pain and is unable to cope with it in a healthy way. Self-injurious behaviors include cutting, burning, bruising, interfering with wound healing and intentionally sustaining injuries. While most of the time there is no intent to cause lasting damage, it might happen anyway. This is one reason why, when someone engages in self-injury, it’s important to intervene. Talking with a therapist can help in terms of finding healthier alternatives and in understanding what caused the behavior in the first place.

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7. Delusions

Delusions are beliefs that are unique to oneself and that contradict the generally accepted reality. Some examples include believing that one is under surveillance by the government without sufficient reason; thinking a song was written about oneself despite never even having met the artist; and insistence that a partner is cheating despite a complete lack of evidence. Something like believing in alien visitations or prevalent conspiracy theories are not delusions, as they are beliefs shared by lots of people. Delusions can seriously impact quality of life and might even lead to people making dangerous decisions, so talking to a professional is important.

8. Substance abuse

As discussed in an earlier post, substance abuse is highly correlated with mental illness. The two can feed off of each other, with substances being used to mask symptoms which in turn become worse due to the substances. While not all substance abuse is indicative of mental illness, it is a serious problem that should be addressed either way. It can also cause physical health problems or lead to acting impulsively in a risky way. There are lots of professionals that specialize in treating substance abuse, so find someone with experience.

9. Major shifts in personality/goals

People are generally pretty consistent in how they act and what they want. While some variations are normal, like deciding to end a relationship or to take up a new hobby, there are times when changes can be a cause for alarm. These changes are more notable when they occur rapidly. A consistently cheery person might abruptly become frequently cynical or someone may suddenly drop out of school despite indications that things were going well. It is important to take a good look at what caused these types of change, as they can be a sign of distress or mental illness. 

10. Suicidal thoughts

Thoughts of suicide should always be addressed. The risks that come with brushing it off or not seeking help are not worth it. Suicides have permanent impacts on both those who commit them and their loved ones. It’s not a decision that happens and stays in a vacuum. Surviving a suicide attempt can also lead to lasting health problems. If you feel like ending your life or suspect someone else might, talk to a professional. The earlier one gets help, the easier treatment will likely be. To learn about what suicidal people talk about, read this. I have also put together a list of hotlines, which can be found here. 

What symptoms made you seek help? Have you seen these signs in a loved one and encouraged him or her to get help? Let us know in the comments.