Concerns entering therapy, part 2 of 2

Part 1

As promised, here's the continuation of Thursday's post covering concerns you might have entering therapy.

Will you tell anyone what I tell you?

The short answer is no, not unless absolutely necessary. If you are a danger to yourself or other or disclose child or elder abuse, the therapist might have to step in. Additionally, he can disclose some information if given a court order, but he will only give the least amount of information necessary. The only other time is as a part of medical records, but those are confidential anyway. For a more thorough look at this subject, read this.

Will you understand me?

Ambro / FreeDigitalPhotos.net

We all long to be understood, but ultimately, we're the only ones who will understand ourselves. That doesn't mean that it's not worth trying to know someone. More or less by definition, a therapist is trying to understand you. She won't get everything, but she'll know what questions to ask to help get a better idea of what you're going through.

It can also be a good thing that your therapist doesn't understand you completely. If you were going off of your own insights and it worked, you wouldn't be seeking therapy in the first place. We go to get a different perspective. Your therapist will notice things about you that you never saw. Through a shared process, the two of you can work together to form a more complete picture of who you are.

Will you respect my values and worldview?

What you believe is a huge part of who you are. This means that it's going to come up as part of your therapy. But this is where it is especially important to find a therapist who is a good fit. When assessing a potential therapist, let him know what's important to you in life. Ask about any specific concerns you might have regarding your therapist's openness to your particular beliefs. Therapists are trained to work with clients of varying backgrounds without letting their own values interfere. Of course, everyone is human, but it's something therapists stay aware of and check in with themselves on.

If you don't feel comfortable with someone, it's going to impair your work together. But remember to be open. If you feel like your therapist is disrespecting your values and beliefs, say something. Having a therapist is a relationship. Relationships have ruptures sometimes. It is good to learn how to work through those in a healthy way and therapy is an excellent opportunity to do so. Research has consistently shown that therapeutic alliance is one of the biggest factors in accounting for change in therapy.


It can be overwhelming to start telling a stranger about the most intimate parts of your life. Remember that you don't have to dump everything out in the first session. Find someone you can trust and learn how to work with that person. If you are worried about something, it's always okay (and maybe even helpful) to ask.

What have been your concerns regarding going into therapy? How did you resolve them? Please share your story.

Late Night Smartphone Use Affects Productivity

Research suggests that you should put away your smartphone at the end of the work day in order to be more productive the following day.

Michigan State University business scholar, Russell Johnson and colleagues discovered that workers that tried to continue working on their smartphone past 9:00 p.m. were more worn out and less engaged during the following work day.

"Smartphones are almost perfectly designed to disrupt sleep," said Johnson, MSU assistant professor of management who acknowledges keeping his smartphone at his bedside at night. "Because they keep us mentally engaged late into the evening, they make it hard to detach from work so we can relax and fall asleep."

According to research, at least 50% of U.S. adults own a smartphone.  Many of them consider their phones to be critical workforce productivity tools; however the National Sleep Foundation indicates that only 40% of Americans get enough sleep on most nights.  Likewise, much of the self-reported data suggests that the lack of sleep can be attributed to smartphone usage for work. 

To study this phenomenon, researchers asked 82 upper-level managers to complete multiple surveys daily for two weeks.  They also surveyed 161 employees daily in a variety of occupations, such as nursing, manufacturing and dentistry etc.

All workers from all occupations indicated in their surveys that smartphone use for business purposes affected their sleep and drained their energy the following work day. The study also noted that smartphones more negatively impacted workers than watching television or using laptops and tablet computers.

“In addition to keeping people mentally engaged at night, smartphones emit "blue light" that seems to be the most disruptive of all colors of light. Blue light is known to hinder melatonin, a chemical in the body that promotes sleep.”

It seems that smartphone use late at night impacts the amount and quality of sleep we get, which affects our attention and abilities the following day.  That being said, this small study may be reason enough to turn that phone off after 9:00 p.m. to see how it might benefit us physiologically and psychologically.

Nighttime Smartphone Use Zaps Workers' Energy

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Concerns entering therapy, part 1 of 2

It’s normal to feel some anxiety about starting therapy. Whether you starting the process for the first time or switching clinicians, a lot of concerns can come up. You should not let this get in the way of seeking treatment, but you should not ignore it, either. It’s perfectly okay and valid to be apprehensive. Let’s take a look at some of the questions that might come up.

Will you believe me?

The people in our lives, as well-intentioned as they may be, don’t always respond positively and supportively to everything we tell them. That’s where therapy comes in. We go to talk about things we might not otherwise discuss. It’s a safe environment where you should not be afraid to bring up anything.

But doing your homework is certainly warranted. Look for someone who has experience with your particular concerns. If the therapist specializes in your area, you’re probably not going to tell him something he hasn’t already heard. Even if you do, he will have the background to understand what you are communicating. For instance, if you are having hallucinations, you might want to see someone who works with schizophrenia and psychosis.

This question is of particular concern to trauma survivors. Trauma touches on some of the most horrific and extreme aspects of human existence. Sadly, there are no limits to what is possible and, by extension, to what you might ask your therapist to believe. Know that sometimes, the trauma was planned out to deliberately be “unbelievable.” Some abusers set up situations that seem impossible in order to discredit victims should they say something in the future. So don’t be afraid to talk to someone just because your story is “out there.”

For more information about choosing the right therapist, visit here and here.

Will I be diagnosed as "crazy"?

"Crazy" is a societal concept, not a diagnosis. Everyone has a slightly different definition and there is no standard for craziness. Your therapist will not, however, call you crazy. Yes, you might be diagnosed with something. That's okay. With about one in four American adults struggling with a mental illness in any given year, you're not alone.

Some people are actually relieved that there is a name for what they are going through. It gives them something they can look to in order to better understand themselves and what they are going through. If you don't want to know what your diagnosis is, though, just say so to your therapist. Explain that you'd rather not be told what you have and that wish should be respected. As long as the therapist knows what is going on, she should be able to treat you just as effectively whether or not you know your diagnosis.

Will I be hospitalized?

There are very few circumstances in which you would be hospitalized. The standard is that you must be a danger to yourself or others. Examples include being suicidal, psychotic or delirious. But don't think that the thought of killing yourself or the presence of some hallucinations automatically get you committed. Hospitalization is taken very seriously and is a last resort. Other options, like staying with a family member or friend, are usually considered first.


I will post again on Sunday going over a few more concerns you might have. If there is anything you would like me to cover, please leave a comment.

Part 2

Judgment, Inhibition and the Emerging Self

In 1994 Steve Jobs was interviewed on PBS for its One Last Thing documentary.  Speaking about insights which resulted in his life's work, he said:

"When you grow up you tend to get told the world is the way it is and your life is just to live your life inside the world. Try not to bash into the walls too much. Try to have a nice family life, have fun, save a little money.

That’s a very limited life. Life can be much broader once you discover one simple fact, and that is - everything around you that you call life, was made up by people that were no smarter than you.  And you can change it, you can influence it, you can build your own things that other people can use."

These are profound words, and not just for building things.  They describe key aspects for identity development and processes which limit it.  In my work and personal life I am too often struck by how much judgment we humans seem to deliver...to ourselves, to others, to ideas, to thought, to dreams.  I and those with whom I work encounter it daily, and many times a day.  In my middle age I have come to ignore most of it, but this defense was hard won and took too long for me to develop.

So I work to help mostly younger adults to spot judgment which inhibits the genuine trajectory of the self.  There is no growth without risk-taking, without "bashing into the walls" on occasion.  We must all learn to manage unnecessary and harmful inhibition in order to become who we have always been.

There is of course a place in life for social feedback, for learning from others what we are and are not doing well or effectively.  But we ought to critically examine all feedback and determine for ourselves what is "true" and healthy for us and the world around us.  This takes time and practice, and the earlier one starts the better.  It is not easy figuring out where the world's great institutions of family, ethics or faith, school and government have gone astray.  Certainly each has something to offer, to help us reduce chaos and create meaning.  Institutions are made of people so there will not be perfection in these pursuits.  It is up to us to sort that out.

Sooner or later, everything which comes to us in life will be categorized as "belonging to me" or "not belonging to me".  We simply cannot accept all reflections of us as though we are carrying a mirror around with us at all times.  Attempting this will overwhelm the self and lead to poor mental health outcomes.  We have to be able to turn the mirror around and perceive that judgment is often more about the other or a system which is in need of our gifts and talents.  We don't always have to "live inside the world", but we do have the responsibility of changing that world for ourselves, and possibly for others, if we are to be authentic selves.

3 things to know about mental health parity

With the coming of this year, there is a lot going on around health coverage and insurance plans. While an in-depth analysis is a bit outside the scope of this blog, it's important to touch on some of the major changes that are occurring. Following are three things you should know about the recent changes in laws pertaining to mental health parity.

1. Mental health and substance abuse treatment is "essential"

The Affordable Care Act has identified 10 areas of "essential health benefits" which must be covered under all plans subject to the act. This places mental health treatment on equal footing with emergency services, hospitalization and prescription drugs. In addition to bringing treatment to more people, this equality represents a positive shift in society towards seeing mental health as a part of overall health.

2. Treatment limitations are the same for mental health and medical benefits

There can be no discrimination between medical and mental health benefits. In practice, this means that deductibles, co-pays, annual and lifetime caps, and out-of-network benefits are the same for mental health and substance abuse conditions as they are for medical and surgical needs. Not only does this ease the financial strain of treatment, it also opens up more treatment options, especially in areas that have fewer services.

3. Intermediate treatments are covered

There has been some question about the area that occupies the space between basic care, such as seeing your doctor for a prescription, and intensive care, like involuntary hospitalization when dangerous. The laws going into effect specify that the intermediate treatments, such as intensive outpatient therapy and residential treatment, are covered. This can help avoid escalation of problems and conditions that might otherwise have to spiral out of control for treatment to be authorized. 

2014 should be a great year for mental health parity. If you believe that your insurance company is denying your right to equal coverage, the Parity Implementation Coalition (http://www.parityispersonal.org/) has some great resources.

Dad's Absence Affects Neurobiology of Offspring

Scientists at the Research Institute of the McGill University Health Centre (RI-MUHC) have discovered that an absent father during critical growth periods can lead to social and behavioral impairments in adults. This is the first study of its kind to correlate paternal deprivation and social attributes with physical changes in the brain.

"Although we used mice, the findings are extremely relevant to humans," says senior author Dr. Gabriella Gobbi, a researcher of the Mental Illness and Addiction Axis at the RI-MUHC and an associate professor at the Faculty of Medicine at McGill University. "We used Californiamice which, like in some human populations, are monogamous and raise their offspring together."

Researchers were able to control the environment in which the mice were raised, including the factors among the different groups.  As a result, mice studies may be clearer than human studies claims Francis Bambico, a former student of Dr. Gobbi at McGill and now a post-doc at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Researchers compared the social behaviour and brain structure of mice in different groups; those raised with both parents and those raised by their mothers. Findings show that mice raised by single mothers experienced abnormal social interactions and were more aggressive than those raised with both parents present. In addition, these findings were more prevalent among female mice.  Furthermore, females also experienced an increased sensitivity to amphetamine.

"The behavioral deficits we observed are consistent with human studies of children raised without a father," says Dr. Gobbi, who is also a psychiatrist at the MUHC. "These children have been shown to have an increased risk for deviant behavior and in particular, girls have been shown to be at risk for substance abuse. This suggests that these mice are a good model for understanding how these effects arise in humans."

Further studies may uncover a clearer reasoning for such findings.  Is it merely the presence of a male role model?  Could it be that two parents, regardless of gender, have more influence than one?  Could male mice be more sensitive to amphetamine if raised by fathers alone?  Many questions remain for future studies to uncover, however this research demonstrates that the role of the father and/or the presence of both parents during critical stages of growth appear to be relatively important in children's mental health development. 

Dads: How Important Are They? New Research Highlights Value of Fathers in Both Neurobiology and Behavior of Offspring

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