Tag: depression

Posted in psychology, Therapy

Let’s Talk About Therapy

Posted on by alidware

For those of you unfamiliar with the mental health system or are unsure about therapy or whether or not a psychiatrist is a good idea, this post is for you.

For the rest of us, it’s also a good post for you. It’s a good post for everyone.

Anyone (with a degree and some version of licensing of course) can be a therapist. That could be a LCSW (Licensed Clinical Social Worker), a MFT (Marriage & Family Therapist/Master’s of Family Therapy), a clinical psychologist (Ph.D) or Psy.D (Doctorate of Psychology). A psychiatrist (MD) could as well, but many of them have zero background in psychology other than your average level of undergraduate study.

An LCSW and MFT will indeed make less than a Clinical Psychologist or Psy.D. Those two will generally make less than any Psychiatrist depending on where you live and what clinics each individual works. If you feel that someone with a Ph.D will be much more knowledgeable and better trained than an LCSW, you would be terribly, terribly wrong. In fact, the main difference between them is the amount of money they make.

Studies (and the lecture in my research course) have shown that credentials have no effect on success rate; that is, just because you have a Ph.D doesn’t mean your “clients” do better than an LCSW’s clients. That includes the M.D’s.

This might seem obvious: it depends on the clinician, right?

Wrong.

It depends on the techniques. If a clinical psychologist with a Ph.D is certified as an International Board of Repression Therapist (a non-scientific therapy) and their colleague in the office next to them is an MFT certified in Cognitive Behavioral Therapy (a scientific therapy) and one client experiences IBRT and the other experiences CBT, chances are CBT will provide a hefty affect over the IBRT. Yes, there are other factors which play into this, some important ones being what the client is seeking support with and their drive level. Connection to the provider plays a role as well. However, speaking from a technical point, there is no solid (well-done) research supporting IBRT, and plenty of well-done research supporting CBT.

That doesn’t mean IBRT is useless. One day perhaps someone will come up with some verifiable, testable, and reliable data. But until then, I won’t be seeing anyone specializing in IBRT. The Inner Child exploration therapy is another “non-scientific therapy” and I’ll have a post on that later, as I have experienced it and have mixed reviews.

There are three basic differences between a Psy.D and a Ph.D.

  1. Scientific training.
  2. Clinical training.
  3. Cost

Colleges which offer Psy.D programs are by far much easier to get into and much less regulated. They also cost thousands of dollars more (unless you’re trying to get Ivy league training in which case good luck paying out of pocket for your Ph.D from Yale. I suspect school type also doesn’t correlate with client success rate) compared to your average Ph.D training.

There is a school which I had planned on attending back when I was ready to transfer for a Psy.D until I realized their training isn’t really based in any science. And psychology is supposed to be a science of the mind, right? (More on THIS in tomorrow’s post). The success rate was large, in the 80 percent or so, the school was still working on its accreditation, and the classes they required were scant. In fact, they didn’t really require anything other than a couple of psychology classes. They claimed integrated, client-centered approaches, which is great. And I’m sure once we have more actual data on the effectiveness of their techniques, that school will be booming.

I believe they got accreditation some months after I learned they weren’t yet accredited.

I have seen MFT’s, LCSW’s, Psy.D’s, M.D’s, and now my first Ph.D therapist.

And so how do you pick?There’s all these choices, all this research you have no access to, all these articles online pulling you this way and that and are probably based more in opinion than actuality.

I used to choose my therapists by their profile picture and their degree level. If they looked friendly and had a high degree from a reputable school, I’d try them. And every time I left them.

This time I tried a different approach. I searched for therapists in town at all degree levels. If they didn’t have a website explaining their practice methods, mission, and specialties, I did not consider them. If their picture seemed unfriendly or strict, I also did not consider them (and that’s a totally unscientific, personal preference). If they did have a website but didn’t meet my specialty requirements, I crossed them off too. If their website wasn’t fully developed or seemed unprofessionally dull or full of metaphysical intuitive opinions about nature and life, I also crossed them off.

I love philosophy and enjoy metaphysics. But I’m also aware that people with that mindset are more inclined to tell me “if you believe it, you can achieve it” and I don’t need cliche sayings. Believing the demons will go away will not make them go away. I need to learn how to work with them, not shove them off a metaphorical cliff that I created in my mind and watch as they tumble helplessly into the locked drawer which I also created in my mind. Not my type of therapy.

Now, if someone had a decent, updated website that laid out their specialties which coincided with my needs, what insurance they accepted (if any), their location, phone number, and a blurb about their practice and themselves, I’d investigate further.

I eventually came down to three people: two women and one man.

I eventually crossed off the man because he had been in practice for many years, thirty or forty, and while that’s not a bad thing there is also no notable effect between years of experience and better rate of client success. I’ll explain why in tomorrow’s post as well. The reason the years influenced my decision is because many still maintain old views of specific “disorders” and treatment methods. I refuse to see a psychiatrist who graduated in 1979 and below.

The two women: one was a LSCW and the other a Ph.D. Both had well defined websites and structure to their treatment methods. I went for the LSCW because the Ph.D had listed their G.P.A and grades and I considered that rather conceited.

The LCSW was on vacation and when she got back she called me to let me know she wasn’t accepting new patients.

As disappointing as that was, my last choice was the Ph.D. I was nervous because of her degree and her listing of her G.P.As. I predicted she’d have an arrogance about her and see me as less than. I was indeed very wrong. This will be relevant in tomorrow’s post as well, how intuition can lead us far astray.

This particular therapist and I connected immediately. I have only connected in such a way with two other people in my life, one girl when I was in first grade and a guy when I was 14 in high school.

She is attentive and didn’t seem to mind that I hadn’t mentioned on our phone consultation that I hear voices and have experienced psychosis. She did believe that voices went away with medication (which isn’t the case for most of us, and I filled her in on my experience) and that schizoaffective can only be diagnosed under the condition that psychosis appears alongside depression (I didn’t correct that because I felt awkward doing so; it’s in the DSM-5, she can check it out if she wants. I have a DSM-5 PDF copy if she needs it) but overall she validates my feelings but also challenges me when something doesn’t seem quite right.

She will help me see alternatives and consider alternatives. She is full of humor, and gets my humor, and I’ve never laughed as much with a psychologist as I have this woman. I don’t feel judged usually, and have felt free talking about my voices with her. I have not talked in depth with anyone else about my voices, and I certainly haven’t told anyone else that I hear both internal and external.

Why did she work out? Because I didn’t follow my intuition, I followed a set of criteria I set for myself that weeded out those who were specializing in what I needed support with versus what I didn’t. And her listing her G.P.A has nothing to do with that.

And so what it comes down to is:

  1. Test the waters. See what kind of people you like. Don’t get disappointed if some don’t work out. You don’t make friends with every person you meet, do you?
  2. Don’t choose solely on degree level: you’re disgracing science and ignoring data.
  3. Take your time. You might not pick the right person on the first try, but you want to get as close as you can so you don’t have to go through 20 different people. That can happy very easily.
  4. Do your research. See what others say, but also recognize people can be picky about things you might not care about.
  5. Come up with your own criteria for the qualities that would be helpful for you. Make your stance clear at your first appointment.
  6. Get ready to work and be open to opinions that don’t match yours. Don’t assume CBT will work just because it’s a proven technique. Put some effort into it. Cry. Feel things. Process things. Think about things. Get frustrated and angry and annoyed. That’s literally the whole point.
  7. Don’t rely on your intuition solely.

And most importantly? Remember you have a say in your treatment. Make the therapy and partnership and it could become one of the better relationships you’ll establish in your life.

Posted in Peer Support, psychology

Pros and Cons of Working at a Peer Respite House

Posted on by alidware

Did you enjoy the totally unrelated photo I took of the Hollywood sign some years ago?

This August celebrated my third year anniversary at my job. I may have mentioned briefly in passing on one other post that I work in peer support, or maybe I didn’t. I think maybe I didn’t, because I talked so much about it on my old blog. I’ve only posted a few times there this year. Ultimately, it’s abandoned.

So I figured I’d talk a bit about it today. Not the job itself really, but the pros and cons I’ve come across with working with other people with lived experience at a respite house. There are ten times more pros than there are cons, but I think anyone would say that if they work a job they actually care about.

Pros

  • People understand you.
    • I’d say this is really what separates a retail job or even another professional career from peer support. There’s no need to hide who you are or how you think and there’s encouragement to express your feelings. It’s difficult to do that in other jobs because most other jobs aren’t centered on your feelings or your comfort. When you are struggling, you’re free to say so and good chances are you’ll receive support from not only your coworkers but the people who are receiving the peer services. When was the last time a customer gave a shit about why you were in a bad mood? (Not saying it doesn’t happen, there are some nice customers out there, but most people just get offended by your shitty mood and therefore act more shitty toward you because how dare you ruin their good mood).
  • You can take literal mental health days (and get paid).
    • The way it works for us, people either use their sick time or vacation time, or a mix of both, depending on if they work full time (which is four 8 hour shifts a week, or a mix of overnights and day shifts) or part time (which is what I do). There is no limit on the amount of sick days or vacation days you can use in a given year, as far as I’m aware. I accumulated weeks worth of sick days and used them all at once (for that hospitalization period) and a couple weeks later I used some more. It may be different at different peer places, but for us that’s how it works, and I’m sure other places have a similar sense of leniency.
  • Transformations are amazing.
    • Even if you don’t jive with a particular person coming in for services, chances are they’ll connect really well with at least one other person, be it another person receiving services or a peer worker, and you get to see people come out of their shells or make revelations about themselves. You see their perspectives shift. Some people become less helpless as they realize they really can do things (like cook for themselves, navigate bus lines, search for housing, create a resume, e.t.c). Some people express their feelings for the first time (like me) and other people learn how to pull back on their sharing and give other people the space to share.
  • Uncomfortable situations are uncomfortable and kind of cool.
    • Sometimes you’re presented with abrupt shit. It can catch you off guard, especially at 2 in the morning. The cool thing is that you learn how to work with the uncomfortable-ness instead of against it, and you learn more of how to do that everyday. Eventually all this shit you learn rolls over into everyday life and you’ll find yourself learning a stranger’s life story when all they’d said was hi to you, and you said hi back and asked how they were and they shrugged and rather than walk away you just had to comment: “that seems as if you’re not satisfied with today” and there you go, you’ve opened Pandora’s box full of reflections and open ended questions. Just roll with it. You’ve become your ultimate self.
  • You’re apart of a community, not just a workplace.
    • And not only are you apart of it, you get to help build and maintain the atmosphere and contribute to people’s lives and they contribute to your life and it’s never just “coming to work”. You go places with people mentally and physically (we take people on outings to the beach and such). The more you get to know certain people, the more they trust you and the more you trust them and it’s not some weird hierarchical “I’m the worker, you’re the guest (we call people guests, not clients or whatever), do what I say”. Or, “This is what worked for me so it’s going to work for you, you just need to listen to me”. Or “You’re not complying with my orders and that makes me insecure and therefore you’re a problem guest”.

Cons

  • There are A LOT of different personalities. You won’t jive with them all.
    • No one jives with all of their coworkers at any kind of job, or the people they interact with. But at most jobs you just knuckle through it and the drama is kind of hovering in the background, the elephant in the room. You don’t go after a customer and say “you know, your kid didn’t put that toy back on the shelf and that hurts because my next hour I have to stock and there are so many toys misplaced that I can’t even get my actual stocking job done and I just feel it’s disrespectful to the store and to us workers when people throw things around. How do you feel about that?” No. You do your job, you go home, you gossip on social media or whatever. At this job the drama can blow up fairly quickly and some of it is a bit under the rug but most of it is in the open. This isn’t really a con. But it can become extremely stressful, which is why I put it on this list. Everyone deals with separate mental health stuff, so some people’s anxiety can really up your anxiety. Other’s paranoia can really, really up your paranoia, I’ve noticed personally.
  • You don’t always make enough to live on.
    • At least, not where I live. With two overnight shifts and one day shift, I bring in an average of $1500 a month before taxes (+ or – $500). Now, if I lived in Cheyboygan, Michigan, that would be a lot. Here, it’s not even enough for one month’s rent for a studio half the time. And if you find a studio less than that, don’t expect to eat or have electricity or soap to wash your ass. The addition of one night shift (10 hrs) was enough to push me 100 dollars over the Medi-Cal welfare limit and so my insurance was ripped away and all the Health services I received. Some people purposefully keep their hours low so they don’t lose insurance and social security and subsidized housing. You get trapped in this web of “I want to work, and I can work, but I can’t work enough to make a living because I still get overwhelmed and the government doesn’t want me to work but they do want me to work so what the fuck?”
  • It’s easy to get burnt out.
    • If I worked more than I do, especially right now, I would (majorly) break down at least twice a year. There’s a lot of emotions to deal with. There’s a lot of stuff you might accidentally bring home with you.

There are a lot more positives and probably some more negatives too, but I’m not trying to go on into infinity. Overall, this is the most comfortable and rewarding job I’ve had. They hired me a month before my 21st birthday and I’m still the youngest worker there by one year. I always joke they’re not allowed to hire anyone younger than me because I’ve always been the baby they’ve had to cradle; I feel like I was raised there and it’s only been three years. That should say something about growth. I think maybe I was mentally raised there.

There are a bunch of different types of peer services out there. Walk-in/Drop-in centers, Warmlines (which are phone lines manned by peers. Some are better than others. We offer a Warmline at the house.) NAMI is a version of family and peer services; some people find them useful and rewarding. There are more respite houses popping up across the U.S. There may be 40 or so now. There was 30-something when I first got hired. Sometimes there are peers working in the hospitals.

If you’re curious about a peer respite near you, check this directory This is the U.S list. There are peer services in other countries as well, it just takes a quick google search.

If you want to learn more about what a Peer Respite actually is, read this description here.

Posted in Freedom

You’re Not Allowed to Die

Posted on by alidware

Jumping from the physical sciences (biology, physics, chemistry) and into psychological research methods is quite a leap. I am no expert in biology, physics and certainly not chemistry, and I never finished a degree in any of them, but I’ve taken enough to get a general understanding of proper research principals. Applying that mindset to people, however, is quite strange.

My professor quoted determinism as the most distinctive philosophical quality of all science. He also went on to (proudly) mention psychological research has 20% more accounts of replicated studies than physics and I resisted raising my hand and snapping back with a “well, no one in physics fraudulently fabricates a picture of a black hole the way psychological researchers fake prescription medication research for their own profit.”

But, that’s beside the point.

It’s not the first time I’ve heard this, and the further you go in science the more determinism becomes a question. It’s nestled deeply in psychology as well, which is probably the most terrifying place it can rest.

In a very basic sense, determinism is the thought that everything, every event/state of affairs/decision we make has been determined by events previous to that state. Some hard-lined determinists argue this is reason to scrap free will, while others insist free will exists within the parameters of determinism.

There’s thought that Quantum Mechanics has solid foundation for undermining determinism, and while it does present issues determinism cannot provide answers for, it’s been pointed out there are a few ways it could in fact support the idea of determinism.

I haven’t spent years studying Quantum theory, I can only know what I’ve learned from friends who went further than me in physics, and from research articles I’ve read in some journals. But, the Stanford Encylopedia of Philosophy has a great, short section on the multiple ways QM supports and doesn’t support determinism. (No, there isn’t a ton of incomprehensible math or professional jargon you can’t decipher). If you are also skeptical, I’d take a look at that link. There’s also discussion of naked singularities and probability.

That article concludes there can be no definitive conclusion–not in the way of empirical, mathematical support for determinism as a way of the universe. Instead, it postulates the universe be made up of both deterministic and indeterministic variables (i.e, proper randomness, proper chance).

This is one philosophical topic we can actually gather data for. But what does this have to do with psychology? Fucking everything, as it turns out. Let me reiterate some of B.F Skinner’s words and warnings from an excerpt of his (deterministic) book Beyond Freedom and Dignity:

“The appeal to reason has certain advantages over the authoritative command. A threat of punishment, no matter how subtle, generates emotional reactions and tendencies to escape or revolt. Perhaps the controllee merely ‘feels resentment’ at being made to act in a given way, but even that is to be avoided. When we ‘appeal to reason’, he ‘feels freer to do as he pleases’.”

In terms of the behavioral sciences, he’s referencing controlling unwanted/unruly behavior not with threats or anger or obvious statements (i.e, you’re going to hurt yourself jumping off that curb like that), but appealing to reason (look at how likely you are to get in an accident drunk driving! You could kill someone, or yourself!), disguising the control so that the person believes they have a sense of freedom. Skinner is not too fond of freedom. He insists “we must accept the fact that some kind of control of human behavior is inevitable . . . we are all controlled by the world in which we live, and part of the world has been and will be constructed by men”.

Appealing to reason is considered more compassionate than threats, but it can become unnecessarily coercive as it has within America’s mental health system. For example, if someone tells a professional “I can’t take it anymore, I want to end my life”. Often fear triggers a response of “how would your family feel? Would you want to do that to them? Think about how much you’d hurt them.”

And while on the surface that seems logical and effective, it’s shaming (how dare you consider doing this to your family). It’s refusing someone a decision and leading them into your preferred decision. And it’s also is a quick tactic to believe you have removed the crisis, to feel good for removing that crisis, to fulfill your quite well-intentioned need to save someone. It also often doesn’t allow us to explore the feelings behind the crisis in that deep, profound moment. But, it offers the question that is often debated of whether we have the right to tell someone “you have to live.”

This, of course, is rooted in the idea that if the benefit outweighs the risk, the benefit is worthy. The risk here would be removing someone’s freedom; the benefit, that someone continues to live. This, then, presents the question: is living chained (without knowing you’re chained) better than dying free?

It’s where the APA comes up with their experiment guidelines: if the scientific benefit is substantial, pain (human participants) or death (animal subjects) is warranted.

It makes us feel weird to think about all of this. It makes us feel bad too, for all the families who have lost someone to suicide, all the pain and horror that causes. As someone who was frequently suicidal, and attempted once, it makes me feel extra weird. We don’t want our friends or families or ourselves to feel that pain. But philosophically, that doesn’t remove the question of whether it’s our right to tell someone when they can live and when they can die.

And so, Skinner foreshadows many things really, with “The danger of the misuse of power is possibly greater than ever”.

The summary of his book, offered by one of my first philosophy texts, says he lectures on this idea that “behavioral scientists can and should be given the power to ‘engineer’ human behavior in accordance with an agreed-upon set of ideals (social harmony, individual happiness, and productivity)”.

Some form of control does seem inevitable. Is it because we like order and organization? Is it because we’re all power hungry? Is it because we can only see the world from our perspective and so absorb things personally/take them to heart? Or do we control out of fear of no control and therefore will never know if there is a version of constructive chaos?

I don’t have the answers. But, if we’ve created our mental healthcare system based on the idea that behaviorists should engineer human behavior into what they believe is the proper standard behavior, than I dare say we’ve actually lost some control.

Posted in Emotions

To Process Emotions

Posted on by alidware

When I stopped seriously blogging about two years ago, it was abrupt and painful. Painful because I missed the writing community of almost five years which had enjoyed stories and laughs and tears and memories and traumas alongside me. They were there when I got my first car. They were there when I quit each job I got. They were there when I became employed at a Peer Respite house. They were there in my largest transformations of self.

Also painful because I was cracking up. Breaking down. In the hospital, confused and somewhat oddly satisfied in my terror of life. I felt alive again in a twisted way. I felt targeted and special and immortal and genius and connected to something greater than myself.

I posted every once in a while, but lost my follower’s attention. I created a slough of new sites, but WordPress changed so much of their format that I got frustrated trying to adapt. So, I went dark.

I told myself I’d be back only when I felt secure in myself. I’d be back only when I knew I had something important to say. I have something important to say.

This journey through depression and delusion and anxiety has given me new insights on darkness. Its introduced me to the true duality of nature so described in daoism. It’s roughly coddled me into accepting not only myself but all of life.

At the beginning of the pain, before I even worked at the respite house, a voice kept telling me “dead man walking”. Considering I’m a woman, it kind of cracked me up and also simultaneously terrified me; someone, something, was coming to kill me I thought. But I don’t think he predicted my future. I think he commented on my present. I was dead. I enjoyed nothing. I faked smiles. I practiced expert avoidance. I ignored myself and my inner processes because they scared me and because of that fear those inner processes found a way to express themselves for the first time in both of our lives. That way was voices, beliefs, depressions, a mania, panic attacks, and the underlying feeling of being broken.

I could talk about childhood stuff here. I could talk about medication and homelessness and the trauma of school. But I spent years reiterating that on my previous blog. I’ve spent time reiterating it to friends and therapists. And now, I can sum it all up in one word: fear.

I feared everything, for many reasons. I feared life. I feared being sad. I feared being happy because sadness came after. I feared anxiety, I feared death, I feared fear.

I think many of us go into therapy or other treatments confused on what “processing emotions” means. I think some therapists and psychiatrists who have never really gone through that heavy process are also confused on what it means. So they blurt it because they’re supposed to, it’s part of the script.

Processing emotions for me meant more than just talking about them and feeling them. It meant not telling myself “tomorrow will be better” or “this is temporary” or “I’ll be happy some day”. It meant not telling myself “you need to get up”. It meant greeting darkness with a handshake and respecting the space it needed within me. The darkness is lonely, too.

It meant sharing my body and my mind with panic and voices and fear and setting boundaries with them; if we all have to live in here together, we need to communicate and I can’t hold the power. But neither can you.

It meant getting comfortable with uncertainty. There is no standard “life”. My experiences don’t make life worse than what life should be, they don’t make life better than what life should be because life doesn’t have a designated “should”. It doesn’t have a designated “have to”. It’s just there.

It meant veering from my psychology degree and studying philosophy, a bit of physics, and leafing through neuroscience articles. It meant studying research. It meant, for me, getting off medication, and really feeling ALL of myself.

I’m sure most people have heard of the double-slit experiment in physics. I remember hearing about it for the first time as I sat high as a kite in High School chemistry. You learn the conclusion is that photons (and other particles) behave as both a wave and a particle, given the observed interference pattern. What high school teachers don’t talk much about is that the reason we come to that conclusion and label it as a reasonable consensus is because, as of right now, we’ll never know if we’re wrong.

We can’t see a single photon pass through anything with the naked eye. And so when we don’t observe it with a camera, when we can’t see what’s happening, the photon behaves as a single photon. The camera we use to observe this particle has a tiny light. That tiny light is a confounding variable–it could be affecting the particle’s behavior. Or maybe it isn’t. But, because we can never see for ourselves with a naked eye, we’ll never know. That’s the paradox, and part of the foundation of the Uncertainty Principal.

We’ll never know. We’re limited in this life we have, and when we’re not okay with that, we run ourselves exhausted trying to fix what isn’t broken.

I’m not scared of darkness anymore. What is there to be scared of?