Taking risks in therapy

   

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We all have something that we don’t like to talk about. While therapy is an appropriate setting to explore these issues, we sometimes hold back on certain things — even in that context — out of fear. “Will I sound crazy?” “Will I be believed?” “What will my therapist think of me?” “What are the consequences of saying this?” “Will my therapist think less of me?“ These questions and more prevent us from being completely open in our treatment. 

But if you never take risks, you won’t progress when it comes to those issues. In fact, they may become worse as feelings of shame, embarrassment, guilt, hostility and unworthiness fester inside of you. The fact that you won’t talk about the topic becomes an issue in and of itself. 

The first obstacle you need to pass is trusting your therapist. You can read more about that here. In short, developing a strong therapeutic alliance in a safe relationship allow you to be more open. Keep in mind the ways in which your therapist has been trustworthy in the past. If you remind yourself of these things, opening up might not seem quite as impossible.

Still, even with trust, it can be hard to explore certain topics. I spent a lot of time trying to figure out how to talk about a series of events that happened a few years ago. I had been seeing the same therapist I’m seeing now at the time these things happened and my irrational fear was that I’d remember things wrong and become discredited. But I have yet to find a way around those fears. So what could I do?

It got to a point where my only options seemed to be to keep quiet and never heal or to take a risk and see what happened. After years of deliberation, I decided to just go for it and see what would happen. For me, that meant telling the story regardless of my fears. So I did. 

I was not prepared for how well that went. At first, I addressed my concerns about how he might remember things differently than I did. I asked my therapist to not go back and read his notes from the time in question and he agreed to follow my request. This removed a lot of pressure. 

It’s going to take a while to get through everything. And that’s okay. Breaking the larger story into smaller segments allows me to do a little each week. This way I get insight into each part, which helps me understand the larger context at play. While the content is very difficult and, at times, triggering, I’m feeling better about myself and am more realistic about my role in those events.

Jumping in is not always the solution, but I’m pretty sure that at this point in the post, you have a specific issue or situation in mind. Test the waters. See what happens. Be honest about your concerns. You can discuss them before you get to the actual content. But when you’re ready, opening up despite fear can be extremely healing. I know it has been for me.

What risks have you taken in therapy? How did it work out? Tell us about it in the comments.

A case for family treatment

We cannot escape family. Their presence or absence will always impact us on some level because family is interconnected in a way that nothing else is. It’s foundational to who we are. A family can be composed in many ways – with blood being only one possible tie – and we will all have different “families” throughout our lifetimes. Sometimes we may be more alone than others, but we all started in a family and that is paramount to the people we become.

There’s an analogy that compares a family to a mobile or a wind chime. There are independent units, but you can’t move one without moving the others. Everything we do impacts our families – and everything they do impacts us. For instance, if a child graduates high school and moves out to go to college, the family has to readjust to the environment without that person. This can mean practical changes, such as redistributing chores, or emotional ones, like when the sibling closest to the one who moved feels left out and has to form new bonds with the remaining family.

  

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There’s a concept in psychology called the “identified patient” (IP). The IP is the family member who has a “problem.” This could be an alcoholic parent, a child failing out of school or someone struggling with physical or mental illness. Everyone else in the family can convince themselves that they are okay because they are not the IP. In this way, all the problems of the entire family get shifted on to one person. 

This isn’t done with bad intentions. Often, the family has benevolent or fond feelings for the IP. A wife will make excuses for her partner’s absences due to a drug problem in order to save face or get him off the hook. A parent gives a child lots of attention because she’s acting out at school. A teenager is happy to have an ill brother because he distracts the parents so she can rebel. This isn’t the family being mean. It’s the family adjusting.

These adjustments that are made for the IP do, however, have consequences. The wife is saving the husband from the repercussions of his drug problem, enabling him to continue to use. The siblings of the “problem child” feel like their parents don’t care about them. The sister gets in trouble because the parents were busy caring for the sick brother. Trying to cover up the problem is just creating more problems, but because they aren’t the IP, the other family members eschew their own troubles in favor of those of the IP.

Remember that mobile? One person “moves” by having a problem and everyone else shifts their problems somewhere else. 

This brings up the question of where the real problem lies. Is the identified patient of concern, or is it the family as a whole? What starts out as an obstacle for one family member can set off a chain reaction wherein everyone becomes involved.

So what happens when the IP gets better? First of all, the family often stands in the way of the IP improving. If her problems are resolved, then theirs become real again. While the family wants what’s best for the IP, they also want to retain the balance they have established. They might even fear becoming the next IP because the family doesn’t know how to function without one. 

This is why family treatment is so important. It allows all the cards to be put on the table, making it easier to notice connections between family members and their various problems. Sometimes, having a mental health professional take a look at your family unit as a whole can help all of the family better understand what is going on and how to make the family healthier. Everyone’s problems get a chance to be addressed, not just the IP. A good therapist will know not to blame the IP for everything.

   

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Family treatment can cause upset, though. It’s a time of change as new habits and coping skills need to be put in place. It will bring out all sorts of things that no one knew were there and things might even feel worse for a while. But having the family unit heal both individually and as a whole is worth it. There is no price for having stronger, healthier bonds and better problem management. 

When each family member learns to see what he contributes to the problem, he can learn valuable information about how he relates to others, which will be useful in any type of relationship. As she examines her real issues and how she displaces them, she can learn to take more responsibility and thereby have more control over her life. None of us exist in isolation and none of us can heal that way.
                                                                                                                   Individual and common concerns are intricately
                                                                                                                   interwoven.

Even if all the family members aren’t struggling, consider getting treatment together anyway. If nothing else, the love and support shown by joining the treatment is irreplaceable. There is work that simply cannot be done in individual therapy. Besides, by learning healthier patterns, you can improve the lives of the generations to come by having and teaching the skills necessary to have a healthy and happy family.

Have you had any experiences with family treatment? Post your experience 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.

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. 

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.

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.

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.

Are you in (too much) control?

The issue of control is highly related to mental health. Having control makes us feel safe in the world. A lack of it leads to fear and a sense of helplessness. Mental illness can sometimes be traced back to a need to feel more in control, whether it’s in a rational way or not. Here are just a few examples:

   
• Someone with obsessive-compulsive disorder might engage in unusual behaviors because she is under the belief that this will lead to certain outcomes. 
• An eating disorder can be a response to a lack of control of one’s environment, making the body a battleground instead.
• Sometimes, certain personality disorders include attempts to control other people through manipulation or harmful actions, which may or may not be a conscious decision.
• Self-injury can be a way of decreasing distress or other symptoms through taking charge of the pain.
• Depression can worsen when a                                                                                                                                               person believes he has no control  
                                                                                                                                    over his future. 

The question is, how do you learn to control your control? There are no easy answers to that. Trying to do so can create a cycle that can spiral out of control, so to speak, and make things worse. 

So instead of trying to use one controlling action to stop another, look at the original issue. Let’s imagine, for instance, that the root of your control issues is that someone you love has a dangerous physical illness. It’s scary, but you can’t change it. You can’t even really help with the treatment because you’re not her medical team. Lacking control might cause you to attempt to regain it in another area. You might become obsessed about your own health in an attempt to avoid getting ill as well. This can lead into dangerous territory with problems like a severely restricted diet, excessive exercise or taking a large amount of supplements without a doctor’s supervision. 

But the truth is, you can’t control your body completely. You can’t guarantee you will never get sick. Sometimes, it’s unavoidable. So step back and look at what you actually can control. You can decrease your risk of illness by living a healthy lifestyle. This should, however, be done with moderation and a regimen set up with the help of a health care professional.

You might also want to look even further back and think of your loved one. While you can’t provide a cure, you can find other ways of being of assistance. Ask him if he needs someone to drive him to medical appointments. Offer to clean her house. Keep him company while he is bedridden. This is a much healthier and more productive way of managing the emotions her illness have brought up for you. It’s important to recognize that this is actually helping him, whereas you going down a dangerous path with a health obsession does not. 

Sometimes, the best answer is to give the issue some space. Work with your therapist to find ways to manage the anxieties that uncertainty and lacking control bring up. You don’t have to act upon them. Some people find mindfulness and meditation helpful in this regard. Others might think through the situation logically and find some peace that way. Whatever you need to do, decrease the importance of having control. Accept what you cannot change and focus on the things you can do. Again, your therapist can be very helpful in this process.

You don’t have to let your need for control end up controlling you. It’s easier said than done, but gradually working at it one issue at a time will lead to progress. As time passes, it will become easier. You will master the skills you need to respond appropriately to uncertainty. This will lead to a reduction in symptoms and, more importantly, help you become a happier and healthier person.

Have you learned to let go of the need for control? What helped you? Share what worked in the comments.

Learning to trust your therapist

  

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It’s hard to make progress in therapy if you don’t trust your therapist. Trust is essential to the therapeutic relationship, which in turn is essential to recovery. But for many people, it’s by no means easy to open up to a complete stranger and talk about the most personal parts of their lives. This is where trust building comes in.

Your therapist has a responsibility to act in a way that makes you trust her. He has to do his part of the work to create a safe environment. But it’s not entirely up to her. There are things that you can do to build that trust, too. 

To start with, don’t be afraid to ask questions. Get to know your therapist. They have varying levels of comfort when it comes to discussing personal matters, but some questions are entirely appropriate. Asking him about his education, how he approaches treatment and what his experience has been in treating people with similar concerns. A more complete list of questions to ask your therapist can be found here. If your therapist is open to it, ask a little about her family or hobbies. This makes him more relatable, which can help build trust.

This goes the other way, too. Not everything you talk about should be symptoms and problems. Let her get to know you as a person. Tell him what you like to do and what brings you joy in your life. If something good happened to you since last time, talk about it. Therapy is not meant to be entirely depressing. You’ll feel better if you believe your therapist
                                                                                  understands you as a person, not just a problem.

Another important factor is giving feedback to your therapist. She is not a mind reader and won’t catch everything. You can let that fester into decreased trust, or you can address it as it happens. If you were upset by something he said or didn’t like how she responded to your concern, bring it up. If something was important and your therapist minimized or didn’t catch it, emphasize how much it matters to you. Talk about why you’re in treatment so it is clear that you are on the same page.

Sometimes, not trusting your therapist actually has very little to do with her. If you have other people in your life that haven’t been trustworthy, you can project your feelings about them onto him. Step back and remind yourself that they are not the same person. If this is the problem, acknowledge that the distrust comes from your end, not from something he did. Remind yourself of how your therapist has been trustworthy in the past. And by all means, talk about why you don’t trust people.

Trust is a difficult issue. Your therapist doesn’t expect it to be easy for you to establish it. Recognize your feelings about trust in your therapeutic relationship and accept that it’s normal for it to take time to build it. But believe it can change. You have to trust yourself as well. Go at your own pace and make note of when your therapist is being trustworthy. Remember those times when you find it difficult to trust her. You can even keep an ongoing list. 

Because trust is an essential part of therapy, developing it is crucial. But it’s okay if it’s something your therapist has to earn over time. Just make sure you are doing your part to move forward. Take small risks in telling him things you are concerned about his reaction to. Take bigger chances as time goes on. When you actively and openly work together on building a relationship based on trust, your progress will be worth it.

Have you found it difficult to trust your therapist? What has helped you work through that? Tell your story in the comments. 

Young adults getting help

I was recently interviewed for an article by Nicole Pasulka on takepart.com. She’s done a great job covering the challenges that young adults today face in getting help with mental health concerns. This is an important topic because, as she writes,

“People between the ages of 18 and 30, often known as millennials, are more likely to be diagnosed with mental illnesses like depression, schizophrenia, or bipolar disorder, and less likely to seek treatment. Three quarters of all mental health conditions have emerged by the time the person is 24 years old.”

She touches on a lot of relevant issues concerning seeking treatment, so I recommend checking it out. The article is called “How These Millennials Realized It Was Time to Get Help” and you can read it here.

7 signs you need a new therapist

Not every therapist is a good match for every client. This means that sometimes, finding someone else is the best thing to do to progress in your recovery. There are, of course, reasons to stay with the one you have. By working through your differences, you develop a stronger bond and learn how to manage relationships outside the therapy room. But if any of the following points are a problem, then it might be time to find someone new.

1. You are not being respected.

One of the great tasks in life is learning to get along and grow with those who are different than us. The variety of people in the world should be celebrated, as it allows humanity to reach its highest potential. But these differences can also be a source of prejudice and unkind behavior. If your therapist is devaluing your experiences, not honoring your belief system, asking you to change culturally appropriate behavior or making you feel inferior in any way, it’s time to switch therapists.

2. You can’t establish trust.

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Sometimes, we just don’t trust people. Maybe they remind us of someone that hurt us in the past or appear similar to a stereotype we have problems with. If this is the case, the first thing you should do is talk to your therapist about it. Working through that mistrust can be huge in terms of personal growth. But if you’ve tried your best and just can’t make yourself trust her, find someone that makes you feel more secure.

3. Your therapist is crossing boundaries.

Your therapist should be your therapist and nothing else. He is not a potential business partner. She is not someone you’ll hang out with at social events. He is not the friend you call at 3:00 a.m. Most importantly, she is not a romantic or sexual partner. If your relationship with your therapist is expanding into these areas, that needs to stop immediately. It’s highly unethical and could even have legal implications for your therapist. If he can’t stick to his job, find someone who can. 

4. Your therapist doesn’t respect your time.

When you go into a session, that is your hour. Your therapist should not be focusing her attention on anything but you. He should not, for example, answer calls when with you. She should also be more or less on time and not frequently canceling sessions. Be understanding that occasionally, something major might be going on. But if you see a pattern of these behaviors, you might want to look into finding someone else.

5. Your therapist breaks confidentiality.

Your therapist has to keep all information about you private. He can’t give your information to anyone, even another therapist or healthcare provider, without your permission in written form. If someone asks, she can’t even acknowledge whether or not she’s seeing you for therapy. The only exceptions are related to major safety concerns and rare legal orders, which can be read about here. But if your therapist is, for instance, chatting with your significant other about your progress without your express permission, that’s an ethical violation and a legitimate reason to dump the therapist. 

6. Your personalities clash. 

We all have certain types of people we just don’t get along with. If your therapist has a personality that is particularly irritating or difficult for you, don’t give up right away. You can become a more open and accepting person by working through those issues with your therapist. If it doesn’t work, though, it doesn’t work. On the other hand, sometimes self-improvement is secondary to an immediate concern, in which case, find someone you get along with.

7. Nothing is happening.

Progress in therapy is not as simple as a line gradually moving upwards. You’ll be all over the place. Sometimes, you’ll have a huge change for the better, while other times you’ll take a few steps back. There is some truth to the “getting worse before it gets better” concept, so don’t jump ship just because you become a bit more symptomatic. It’s part of the healing process. But if everything just stays the same, then something’s wrong and you could be better off working with someone else. 

Have you ever switched therapists? Why did you do so and how did it go? Report your experiences in the comments.

Mental health myths: Am I crazy enough?

Mental health concerns come with a lot of misunderstandings and there is plenty of misinformation out there. That’s why I like to tackle mental health myths from time to time. Today, let’s look at some thoughts about seeking treatment.

Myth: If I see a therapist, I’m crazy.

Fact: There are lots of “non-crazy” reasons to seek help.

   

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Somewhere in their heads, people set an imaginary standard for what the threshold should be for seeking mental health treatment. People come up with an idea of what they think is “bad enough.” One of the unfortunate consequences of this is that it makes people assume that someone who is in treatment meets their criteria for what they believe a mental health patient is. This is often not the case.

An acute crisis or severe symptoms definitely warrant treatment. But these are not the only reasons to seek it. It’s completely normal to go to a therapist if you are experiencing mild or moderate distress. This is, in fact, a good thing. By working on your problems before they get magnified with time saves you a lot of effort in the long run. 

It’s kind of like getting a headache. You notice that you’re hurting, but think that it’ll pass. As the day goes on, it gets worse and worse. Finally, you take some ibuprofen. But because the headache has set in more deeply at this point, it might be that no amount of pills makes it go away. You just may not feel better until after you sleep it off. Ultimately, you prolong your pain by not taking preventative action when your discomfort was tolerable. 

The same goes for staying in treatment after you start feeling better. There is no pressure to terminate until you are ready. You don’t have to stop just because you’re mostly doing better. Maintenance is important. My symptoms are not nearly as bad as they have been in the past, but I’m still in treatment because I don’t want to go back there. You might want to reduce the frequency of your sessions when you have made significant progress, but that is something to discuss with your therapist. Together you can make a decision on that.

Some people feel like they have to “earn” the right to be in therapy. They think that they don’t deserve treatment because they aren’t psychotic, don’t have a history of trauma or can cope reasonably well with their lives. The thing is, you don’t have to be a certain way to deserve help. The only prerequisite is a desire to improve your life. 

Honestly, you don’t even have to have problems to be in therapy. Plenty of people go for self-improvement. Some examples include learning to develop better relationships, finding greater fulfillment in your life, learning more about yourself and so on. You just can’t make assumptions about why people are in therapy.

In short, you don’t have to have hallucinations or be so depressed you can’t get out of bed for months before seeing a therapist. If you feel like therapy is or would be helpful for you, go for it. Likewise, don’t pass judgment on anyone else for seeking help. They don’t know your circumstances and you don’t know theirs. There is no template for what someone in treatment looks like. 

What beliefs have you had about yourself because you’re in treatment? How did you work through them? Talk about it in the comments.

Don’t put a timetable on recovery

Like most people, I entered therapy not knowing what to expect. I had dealt with depression and other mental health symptoms for years, but thought that I could take charge of my problems in a matter of weeks – a few months at the most. Almost eight years later, I’m still at it.

Assuming when I would “get better” was a mistake. The thing is, you never know. You may ask a therapist for an estimate, and they’ll often give you one. 8-12 sessions is a frequently used figure. But really, there are so many factors that influence this. There is no way to calculate how long treatment will take. 

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It is unfair to both yourself and your therapist to set a timetable on recovery. There is nothing wrong with setting goals, but don’t make hard deadlines. The mind is very complex and what’s masquerading as a relatively simple concern might actually be liked to a much larger underlying problem. You just might not see it before you examine the presenting concern. 

On the other hand, sometimes it’s faster than you’d think. I’ve heard of people benefiting from a single session. All your life problems won’t be solved in an hour, but sometimes you luck out and get the insight you need a lot quicker than expected. Really, don’t go in expecting one session to fix everything, but know that what you think might take many months or years may actually not require that much time. 

Unfortunately, insurance companies aren’t nice about letting you take as long as you need. There are often limits on how many sessions they will pay for. This means that you will want to try to make the most of your time with your therapist. Talk to her about what to do. Seeing him every other week instead of weekly can give you slower progress, but it stretches out over a longer period of time. Together you can find out what’s best for you. Also, don’t be afraid to call your insurance company if you have questions. 

Even when therapy is over, it does not mean that your progress ends there. You should not expect to be completely “fixed.” Recovery is a journey, not a destination. For many people, managing one’s mental health is a life-long endeavor. Improving your mental health is a long-term commitment. However long it takes to feel better is how long it takes. Just don’t stop trying. The “do it at home” tag is a great source for exercises to keep up your progress independently of therapy.

I know it’s hard, but don’t stress about how long your recovery will take. That only creates more anxiety and concern. Accept yourself for where you are at and be proud of yourself for any progress, no matter how small. It’s heading in the right direction that matters. Maybe you’ll feel better soon and maybe you won’t. The persistence you put in to your recovery will, however, eventually pay off. 

Are you able to be patient with yourself about the rate you’re progressing at? How did you come to peace with it?  Let us know with a comment.

10-question assessment on recovery progress

Every once in a while, it’s good to check in with ourselves and see where we’re at. Recovery is a long process and it’s not always possible to see progress from day to day. But over time, all the effort you put in does add up. Sometimes, it is nice to be able to look back and say, “Wow, I’ve come a long way!”

I recommend writing down your answers to these questions and then doing it over again in a few months. You can keep doing this and have a record of your progress. The insights gained over time can be shared with your therapist, who can give you additional feedback on how you’re doing. He or she can also give you standardized assessments, such as ones measuring depression or anxiety, to use in addition to this self-assessment.

    

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1. What did I use to be like?

Think back a year, six months or since you last answered these questions. Describe what you were doing and what your struggles were.

2. What am I like now? 

Describe your daily functioning, both where you excel and where you could do better. Note any major changes that have happened, such as starting a new relationship or quitting a job. 

3. What coping mechanisms did I use in the past?

Make note of what you did when you were symptomatic. Point out which strategies worked, which ones didn’t and whether or not you now believe they were healthy ways of handling things.

4. What coping mechanisms do I use now?

State what helps you cope right now. Consider whether you have found healthier and more effective ways of handling your symptoms. If you haven’t, what might you do to improve?

5. Where am I at with my goals?

Think about any goals you have made and whether or not you’re making progress on them. Also make plans for the next step in each one and feel free to set new ones.

6. What areas can I improve in?

Consider all facets of your life and pick one or two areas you feel like aren’t quite up to par. Think of ways to make progress with those things.

7. What makes me proud?

Go through all the changes you have made and identify what makes you the most proud. Staying positive and acknowledging the good can give you motivation to keep doing the things that work.

8. Am I getting the support I need?

Take inventory of the people in your life and ask yourself if they are helping or hindering your progress. Also note if there is anything that specific individuals can do and don’t be afraid to ask for help.

9. Is my treatment working?

List the different components of your treatment (therapy, medications, self-care, etc.) and consider if they are actually helpful. If one isn’t, can it be changed or should it be replaced by something else?

10. Where would I like to be by the next time I self-assess? 

Envision what you would like to see happen in the coming months. Be realistic, but don’t underestimate yourself either.

How do you measure your progress? Make suggestions in the comments.

Diagnosis spotlight: depersonalization/derealization disorder

We all experience dissociation in some way or another. It can be as simple as highway hypnosis, where you suddenly realize you’ve driven for miles without noticing, and as complicated as dissociative identity disorder, formerly known as multiple personality disorder. Somewhere in-between, there is depersonalization/derealization disorder.

First of all, what are depersonalization and derealization?

Depersonalization refers to a distortion in self-awareness. You are, in a sense, unfamiliar with yourself. One typically experiences detachment from the body or the sense that it is unreal. It can even mean watching yourself from outside your body. The self just doesn’t feel real and things might seem like a part of a dream. It can also be watching yourself go about your day and making decisions, but not really feeling in control. Time might also be distorted and there can be physical and/or emotional numbing. 

Derealization is when everything else doesn’t feel real. Your surroundings might feel foggy, distorted, unreal or, again, like a dream. People, places and things that may be familiar seem strange or surreal. It’s hard to fully perceive the world around yourself and it might seem like you are watching everything through a filter of sorts. It can be like living in a bubble. What is around you is very separate from you and it can be hard to fully engage in life. 

Depersonalization/derealization disorder means having episodes of one or both of these. It can be accompanied with a feeling that you’re “going crazy.” There might also be vague physical symptoms, like tingling or lightheadedness. It is often associated with anxiety and/or depression. 

Approximately one-half of adults have had an episode of depersonalization or derealization. It happens. But when it is recurring or even constant, it can become pathological. Onset is almost always before age 25, so it’s something that can be experienced from a very young age. Childhood trauma is considered one of the causes of depersonalization and derealization, but it can happen without it. Symptoms can also be caused by physical conditions or substance use, so those need to be ruled out. Episodes are often preceded by high levels of stress, anxiety, depression, traumatic events (or reminders of them) and/or drug use.

Both therapy and medication are used to treat depersonalization/derealization disorder. In particular, cognitive behavioral therapy allows people to reinterpret the symptoms and psychodynamic therapy can look at unresolved and suppressed internal conflicts. Medication-wise, nothing has been approved specifically for the treatment of this disorder, but anxiety medication and anti-depressants have shown some success. There is also research supporting the use of lamotrigine, an anti-convulsant typically used to treat epilepsy. Using grounding techniques can also be very helpful.

Having the experiences of depersonalization and derealization can be very frightening. But it is a recognized mental health condition and a notable amount of people experience it. If you feel like the symptoms described apply to you, please talk to a doctor or therapist. It is possible to gain control over it enough to where it is not interfering with your life, if it doesn’t go away altogether. 

Have you experienced depersonalization or derealization? What was it like for you? Share your experience in the comments.

Have hope – it will change

  

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Mental illness has a way of trapping you into thinking that you are stuck in it forever. A depressed person doesn’t lay in bed for three weeks and say, “Two more and I’m good.” Someone doesn’t think, “I’ll have five more panic attacks and then I’m done.” It’s pervasive. And even if you can logically convince yourself that it isn’t going to last forever, it’s hard to believe it enough to get the accompanying feeling of relief. It’s like a kid the week before Christmas. It drags on forever. 

The point is, though, that it isn’t forever. Like I said, it’s hard to believe. Really hard. But it’s true. There is an end to it. Even if you are suffering from a lifelong condition, the way it manifests will change. There will be variation. The pain you are feeling won’t feel the same way for the rest of your days. 

There is always change. If you aren’t changing, the world around you is. You might not be capable of changing yourself at the moment. That’s okay. Some days/weeks/months/years/decades are like that. But others aren’t. An acquaintance might transform into a good friend. A family member might have a burst of inspiration that results in him being more helpful. Your therapist can learn something new about your diagnosis and apply it to your treatment. You have to believe in change.

Change happens on larger scales, too. Psychologists do studies to find out which treatments are more effective and why. Scientists invent new medications. People learn to become more sensitive to mental health issues. You never know when the next breakthrough is around the corner.

That is why you have to believe that change is possible. It’s happening around you all the time. But it is possible for change to happen to you as well. It might take a really long time, but it does happen. I tried several different medications of a certain class before we found one that worked. Did it suck until we found it? Yeah. Did some of them make me worse? Yes. But when we did find it, it made my life easier. I was in therapy for seven years before I decided to take a chance on a new treatment approach and it transformed my life. I’ve had bad relationships. If I had given up on people, I would not have a boyfriend that makes me better every single day.

You never know how long it will take to change and that’s scary. It really is. I spent over a decade almost constantly fighting with a certain terrible feeling before it subsided. If you’d told me at the start that that’s how long it would take, I might have given up before even trying to get better. That amount of time is overwhelming. But it is a lot shorter than the rest of my life.

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I’ve asked myself if it was worth it. How long can you endure misery before the chance of getting better is no longer worth it? There were times when I would have said not another day. Sometimes, I would have said that ridiculously many days in a row. But part of me didn’t let go. And eventually, things did turn around. 

It seems easy to say that, well, in retrospect it might be worth it. When you’re not in the midst of it, you can say it was possible to overcome. But my life is still affected by mental illness every single day. There are things I want to do that I can’t. Sometimes, I still get set off and have to spend a few days under the covers. But I have also found many things that are worth it. I have found relationships I could not have been healthy enough to manage before. I have come across new interests and started new hobbies that I would not have had the energy or concentration to learn about before. Even running this blog gives my life some sense of meaning. 

No one was more annoyed with the whole, “It gets better,” attitude than me. I felt like an exception. But the fact is that despite feeling hopeless, I still kept trying to get better. That effort pays off eventually. It will be small victories at first. It might be forgetting you’re suicidal for an hour or going a single day without drinking. But every bit of progress is still progress and it’s moving you forward. It might take you a thousand steps to get to somewhere when it takes someone else only 10, but you can still get there. 

With time, those steps do add up. Every day that you do your best matters. Everything is constantly in motion and you are becoming a new person minute by minute. Making the choice to recover helps you become a happier and healthier person. So love yourself for trying. That is one thing I always hold on to: I never stop trying. Knowing that alone has a powerful impact.

What gives you hope? Share stories in the comments.