7 things to talk about in therapy

Anyone who’s been in therapy a while knows that some weeks flow better than others. Sometimes important topics just come out and you get a lot of work done. Other weeks, you have no idea of what to say. So for those weeks, here are seven things that can be helpful to talk about in therapy.

1. Things you have strong emotional reactions to

Sometimes we don’t know how powerful something is until it throws us off guard. If you are having a disproportionately large reaction to something, it is probably worth talking about. The other day a relative asked me something seemingly benign, but I was fuming about it hours later. That indicates to me that it’s a topic that should be given attention in therapy.

Ambro/FreeDigitalPhotos.net

2. Whatever has a significant impact on your daily life

It seems very basic, but talk about the things that are important to you on an everyday basis. It could be arguments with roommates about chores or the fact that you can’t fall asleep at night. Evaluate your basic routine and look at what impacts how your day goes. Who knows, maybe skipping breakfast is what’s making you irritable.

3. Insights you have between sessions

Therapy is work that continues outside of your scheduled appointments. Thoughts will roam around your head and when something clicks, write it down. By sharing with your therapist the connections you make, he can build on that with additional insights. Keep a journal or just a note on your phone where you put keywords to help you remember your thoughts.

4. Upcoming decisions

Think about your upcoming decisions. Sometimes you think you know what you want, but talking about it makes you realize that you’re actually looking for something else. It can be as big as retirement plans or as small as what to do next weekend. A few well-thought out questions can help you see what you really want and how to obtain it.

5. Whatever you are avoiding

If you are avoiding something, there’s a reason for it. It might be a friend, a specific assignment at work or buying groceries. It can be very hard to actively initiate a conversation about something you are deliberately trying to get away from, but it’s important to understand why you have your aversions. You don’t always have to approach what you are avoiding, but you need to know why it’s happening.

6. Dreams and daydreams

When we’re not forcing our minds to do deliberate tasks, it frees up room to let deeper thoughts and feelings emerge. Perhaps the best example is dreams. Not all therapists work with dreams and some are better at it than others. But it’s worth asking about and if there is very obviously something there, she should be willing to look at it. Daydreams are also worth exploring. 

7. Questions

As you go about your week, you might suddenly have questions about something related to therapy. When you have a new diagnosis, lots of questions emerge as you strive to understand what you are dealing with. Write a list of things you are wondering about and give it to your therapist so he can answer what he knows and look into what he doesn’t know.

What topics do you bring up in therapy when nothing pressing is going on? Answer in the comments.

Healthy distress management

Life is never completely free of things that bring us sorrow, scare us or make us stressed. There will always be a cause for distress. Finding healthy ways to manage this is essential for mental health. Repressing your distress instead of dealing with it can lead to or exasperate mental illness. This can range from being less productive at work because something is nagging at you to developing PTSD and dissociative symptoms from not confronting a trauma. It is easy to turn to bad habits for comfort. Drinking, overeating or self-injury can temporarily create a sense of peace. They all have negative consequences, though. Following are some healthy ways of managing distress.

Naypong/FreeDigitalPhotos.net

Express yourself through the arts
Art can heal. Since the early days of human existence, people have created art. It is just as powerful today. In fact, there is an entire field of art and movement therapies. Expressing your thoughts and feelings in art is a way of making your experience "real." So write a poem about the heartache you are feeling. Dance to express that feeling of reaching for something you will never have. Paint what the inside of your mind looks like. The possibilities are endless. Even if you don't consider yourself an artist, art is something everyone can participate in. Try different mediums until you find something that works for you.

Photostock/FreeDigitalPhotos.net

Talk about your experience
The brain doesn't like secrets. Research by James W. Pennebaker suggests that keeping secrets can have adverse effects on your physical health, including your blood pressure, sleep, and immune function. Disclosing those secrets, however, reduces stress and improves overall physical health. In other words, bottling up everything you are feeling doesn't work. It will literally make you sick. Confiding in someone is healthy for your mind and your body. Therapy is an excellent outlet, but even talking to family and friends about what is worrying you can have a positive effect. The important part is that you get it out there.

 

Feelart/FreeDigitalPhotos.net

Keep a journal
Pennebaker's research also states that writing in a journal can have similar favorable consequences to those of talking to someone. For some, a journal is less intimidating than a conversation. It is a safe place to say anything. If you are worried about someone reading what you wrote, you can destroy the content after you write it. Tear it into little pieces or burn it. You can also write in a way that others won't understand. Some people like writing in a foreign language. When writing about one particular topic, I use a code that only I know how to solve. This takes more effort, but if it is what makes you feel safe, go for it.




Use entertainment for catharsis

Photostock/FreeDigitalPhotos.net

Sometimes, all we need to feel better is to find a story we relate to. One of the reasons entertainment is so popular is that it allows us to feel less alone. I can't count the number of times I have listened to certain songs to get through the night. Some of my favorite movies contain themes that resonate in my own life. And books can be a more prolonged way of identifying with characters and their circumstances. Finding entertainment that speaks to you and your situation can be incredibly healing. Make playlists for different emotions. Own copies of movies that make you feel better. Read books that deal with what you're going through, either literally or metaphorically. You don't have to be alone.


You can read more about Pennebaker's work here.

What helps you deal with overwhelming thoughts and emotions? Let us know in the comments.

Women's mental health concerns

Happy International Women’s Day! In honor of this worldwide celebration of women, let’s take a look at mental health issues that are of special concern to females.

Mood disorders

According to Columbia University Medical Center, women are twice as likely as men to have a mood disorder. In addition, the WHO reports that depressive disorders account for 42% of neuropsychiatric disability among women, compared to 29% of men. Mood disorders can cause serious impairment in all areas of functioning. Report any serious or unusual changes in mood to your doctor so you can be screened for mood disorders.

Female biology

Women have a host of medical concerns that don’t affect men. The menstrual cycle – both monthly and across the lifetime – can cause significant symptoms. Premenstrual dysphoric disorder became an official diagnosis is the latest psychiatric manual and menopause can trigger new mental health issues in previously healthy women. Fertility (or lack thereof) also has huge implications for mental health and there are mental health services that exist specifically to deal with these concerns.

Jomphong/FreeDigitalPhotos.net

Postpartum conditions

The physical changes associated with pregnancy and childbirth have psychological implications as well. The most common way this is seen is with postpartum depression. For up to a year following child birth, the mother can enter a depressive state much like what is seen in major depressive disorder. This might include a focus on the child, such as obsessing over her newborn’s health or even thoughts of hurting the baby. Less common is postpartum psychosis, wherein women experience delusions and hallucinations that affect their behavior. This may require hospitalization. A final condition associated with child birth is birth-related post traumatic stress disorder. This comes from a dangerous birth experience that threatened death or serious harm for mother and/or child. For more about PTSD symptoms, read this.

Violence against women

Women are more susceptible to physical and sexual violence than men. The WHO estimates that violence against women has a lifetime prevalence rate ranging from 16-50%. They have also found that at least one in five women experience rape or attempted rape in her lifetime. Other estimates are higher. Women generally have a physical disadvantage compared to men and can also be bound by the gender roles of their societies. This leads women to be more vulnerable to dating violence, sexual assault and domestic violence. 

The unique mental health concerns facing women mean that we should pay careful attention to these areas of life. All of these issues can be addressed with appropriate intervention, but it requires getting help. Talk to your doctor or mental health professional if you believe you are struggling with any of these concerns. In the U.S., you can also call any of the following hotlines:

Depression and Bipolar Support Alliance: 1-800-826-3632

Postpartum Support International: 1-800-994-4773

National Center for Posttraumatic Stress Disorder: 1-802-296-6300

National Domestic Violence Hotline: 1-800-799-7233

National Sexual Assault Hotline: 1-800-656-4673

National Suicide Prevention Hotline: 1-800-273-8255

A note on productivity

A lot of our sense of self comes from what we do. Our jobs, our skills, our hobbies – they all make up a big part of who we are. That is why mental illness’s interference with productivity can be so devastating. 

Stockimages/FreeDigitalPhotos.net

It’s tough to keep up with everything in our lives and mental illness makes it that much harder. It’s difficult to be a good employee when you can’t even get out of bed. When leaving the house is terrifying, you are restricted to what you can do at home. This toll on productivity can really affect self-confidence, which in turn can further damage mental health. This is why it’s important to reassess how much productivity is worth.

I’m currently in school. I started the semester with what I thought was a manageable class load – and I did keep up. I was doing well in all my classes, but it was very stressful. It started making my symptoms worse. I decided to withdraw from half of my courses. It was a difficult decision and it made me feel incompetent. Instead of letting my limitations get to me, I try to focus on the fact that I saw what I needed
                                                                                                                and chose to take care of myself. My health (both
                                                                                                                mental and physical) is more important than how soon
                                                                                                                I graduate.

It’s hard not to place your worth on how well you do. But self-care and managing your needs is so important. Without it, your productivity is going to suffer further in the long run. Check in with yourself every day and see how you are doing. Assess what your stressors are and how you can reduce them. Know when something becomes too much to handle and back off. Your needs are worth more than your output. When it comes down to it, a lot of the things we think we need to do are actually things we prefer to have done. 

You are more than what you do. You are your beliefs and your aspirations. You are the way you treat the ones you love. You are someone who keeps trying, and that in and of itself is admirable.

5 ways to help a loved one with a mental illness

When someone faces an illness, either physical or mental, it can be very overwhelming to those around him. There’s a lot of new information to take in while at the same time a whole new set of questions that open up. Most people want to be helpful when a loved one is facing difficulties. Here are some guidelines for how to be supportive to someone with a mental illness.

Photostock/FreeDigitalPhotos.net

1. Respect your loved one. Everyone, no matter one’s circumstances, deserves respect. This is especially true of those that society doesn’t overtly value. There is a lot of stigma around mental illness and chances are your loved one has been treated poorly because of it at least once. People say hurtful and uneducated things and have unrealistic expectations. Show your loved one that with or without a mental illness, you value her as a person. Be proud of him for the things he does accomplish, even though they might seem minimal to an outsider. Just remember that respect is not about treating this person exactly like everyone else. It’s about treating others with the consideration they deserve, which is something that varies between individuals.

2.. Educate yourself about your loved one’s condition. It’s hard to help someone when you don’t know what the problem is. That’s why it’s important to learn about the condition(s) your loved one has. You are by no means trying to be this person’s therapist. It’s actually more preventative. If you have a better understanding of your loved one’s challenges, you are less likely to have missteps and offend, hurt or be unhelpful to that person. Talking to someone who is depressed differs markedly from talking to someone with anxiety. It can be hard to find the right information, though. Have your loved one ask her therapist for recommendations of books or websites that appropriately explain the condition. 

3. Talk and listen. Dealing with a mental illness can be very isolating. Take time to have conversations with your loved one. Ask him how he’s doing and listen carefully when he answers. Mental illness presents many unique challenges and sometimes, it feels like no one else understands. That’s why active listening (reflecting back what she’s saying, asking questions, acknowledging emotions) can make a real difference. Make sure you also talk about things other than his mental health. Those with mental illnesses have most of the same needs as everyone else. Talk about the upcoming game, weekend plans and hobbies. Making everything about the mental illness is limiting your relationship. There is so much more to a person than what she is diagnosed with.

David Castillo Dominici/FreeDigitalPhotos.net

4. Help with daily living tasks. Part of what qualifies someone as having a mental illness is that it causes impairment and/or distress in important areas of functioning. That’s why even simple, every-day things liken getting dressed or taking out the garbage can sometimes become overwhelming. Pay attention to your loved one and see what areas he is struggling in. If she is too anxious to leave the house, offer to do her grocery shopping for her. If he’s depressed and can’t take care of his apartment, clean the kitchen. If she is in shock after a traumatic experience, see if you can drive her to her appointments. The important thing to remember is that it can be hard to ask for help or even know what one needs, so saying, “Let me know if I can do anything,” doesn’t always work. Notice the specific needs of your loved one and attend to those. 

5. Take care of yourself. Being a person of significance in a mentally ill individual’s life can take a very real toll. You might experience compassion fatigue, a state in which one becomes more indifferent to the needs of others because of overexposure. Simply put, if you help someone a lot, you get tired. This is why it’s important to take care of yourself. Make sure that you are getting your own needs met, including leisure and self-care. You are not expected to, nor should you, be there 24/7. Take advantage of resources and other people. It is a whole lot easier to make sure someone is getting what he needs when you work as part of a team. If your loved one needs a lot of help, reach out to other family members and friends so you can coordinate how to best help her. When everybody does a little bit, a lot can get done without one person getting too worn out. Sharing responsibility is one aspect of making sure you get what you need, too.

There are other resources to help you find out how to help someone with a mental illness. The American Psychological Association keeps a list of resources for caregivers. A very practical guide for how to help care for your loved one with a mental illness is When Someone You Love Has a Mental Illness by Rebecca Woolis. Remember to also communicate with your loved one. He or she will always be your best resource in terms of determining what you can do.

What have you found that is helpful in terms of giving or receiving help and support during a mental illness? Share your tips in the comments.

Diagnosis spotlight: posttraumatic stress disorder

Life isn’t always kind. No one is immune to twisting an ankle or feeling heartbreak. The difficult aspects of life are just normal a part of the experience. Trauma, on the other hand, is something damaging that is outside the realm of normal human experiences. It’s not something that is expected and it can be very difficult to cope with. War, sexual assault, major natural disasters and life-threatening accidents are all examples of this.

David Castillo Dominici/FreeDigitalPhotos.net

Traumatic events can leave anyone shaken for a while, but when symptoms won’t go away, it can become an illness. When the aftereffects of the trauma seriously interfere with major areas of your life for an extended time, it might be post traumatic stress disorder (PTSD). According to the guidelines in DSM-5 (a volume used for mental health diagnosis), this is a psychiatric condition that is the result of “exposure to actual or threatened death, serious injury, or sexual violence.” It can be a result of something that you experienced, witnessed or (in a few cases) heard about. Symptoms have to occur in each of four different areas: reexperiencing, avoidance, cognition/mood alteration and hyperarousal.

Reexperiencing is exactly that: experiencing the trauma over and over again. This can happen in lots of different ways. You might have intrusive memories, nightmares, flashbacks or negative reactions to things that remind you of the event. On the extreme end of the spectrum, you may actually think the trauma is happening right then and there.

Another reaction is to avoid anything that is associated with the event. It could be trying to stay away from external reminders or you might avoid your own thoughts and feelings. If someone was in a serious car accident, he might drive different routes – even when longer – in order to not pass the scene of the accident. An assault victim might go to extreme lengths to distract herself from the memory and associated feelings. It can also include avoiding seemingly benign things, such as teddy bears, frying pans or the rain, if they are somehow reminders of the trauma.

  

Victor Habbick/FreeDigitalPhotos.net

There must also be changes in thoughts and/or feelings as a result of the trauma. It could be being plagued by negative feelings (fear, anger, guilt, etc.) while being unable to experience positive emotions (happiness, calm, love, etc.). Others might be unable to remember an important part of the trauma. Distorted thoughts, such as “it’s my fault that I got mugged” or “nowhere is safe,” can also occur. Feeling detached from others and having a decreased interest in significant activities are also signs.

Hyperarousal refers to having very strong negative reactions to your environment. You can’t feel safe, so you respond as if you are always in danger. An increased startle response or hypervigilance (intense and unwarranted efforts to detect threats) are common reactions. Problems sleeping or concentrating are also potential disruptions. You might also become irritable or angry without being seriously provoked. It can even go as far as engaging in self-destructive behavior. 

Psychotherapy is the most common treatment for PTSD. This can take many forms. Sometimes desensitization to the experience through repeated exposure can reduce symptoms. Other times, processing the event and what it means is called for. Medication might help with individual symptoms, but are not meant to treat the condition as a whole. There are also treatment techniques such as hypnotherapy and what is called EMDR (eye movement desensitization and reprocessing). Talk to your clinician about your treatment options because there might be more than you think. 

PTSD is a normal reaction to an abnormal event. It can seriously interfere with all aspects of living, so it’s very important to seek a professional opinion and subsequent treatment if you are experiencing several of the symptoms described. Recovery might seem unthinkable in the midst of the disorder, but it is possible to overcome extremely difficult parts of your life. It might take a long time, but remember that it can be done and working on it is better than allowing it to take over your life. 

Cut your med costs in half (really)

Vichaya Kiatying-Angsulee/FreeDigitalPhotos.net

Here's a quick tip that can potentially cut the cost of your prescription medications in half! I don't use exclamation points often, so this is cool. I learned this trick from a pharmacist, actually, even though it's not necessarily to their advantage. This saved me when I was on a $100/mo. medication without insurance. 

The next time you visit your health care provider, ask if any of your medications are available in pill (not capsule) form. Then see if there's a pill that's double the dose you need. If there is, ask to have that one prescribed instead and then take half a pill instead. This isn't possible with every med; if you have a time-release prescription, it won't work. Your doctor could say no, but it's definitely worth trying – especially if you don't have adequate insurance. I know that you can do this with a fair amount of medications.  

Outside of that, check if your preferred pharmacy does price matching. In general, at least in my area, Costco has the lowest prices (and you don't have to buy in bulk). You can, of course, switch pharmacies. But there are sometimes reasons to stay with the one you use. Making a few calls around town, though, could be a big saver.

Do you have any other money-saving tips when it comes to meds? Share your tricks in the comments.