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Mental Health Issue

12 Weeks to Feeling Better: Try Psychotherapy Today

by John M. Grohol, Psy.D. 12/7/2023

12 Weeks to Feeling Better: Try Psychotherapy Today It’s time for psychotherapy to stop beating around in the bushes and get a new marketing campaign going for itself. It’s time for organizations like our own, the American Psychological Association, the American Counseling Association and others to join together and have people understand a simple, basic message — 12 weeks is all most people need to start feeling better when faced with a mental health issue.

Psychotherapy still gets a bad rap because of a basic misunderstanding of the process it entails, or prejudice around thinking that if you need to see a therapist, something’s really wrong with you.

It doesn’t have to be this way. Just like the endless pharmaceutical commercials on TV for antidepressants and ADHD medications, psychotherapy could be reminding people that it’s not like you’re making a forever-commitment to Freudian analysis. It’s simply 12 weeks to feeling better.

12/7/2023 3 comments

Ways People Help One Another with Mental Health Issues

by John M. Grohol, Psy.D. 7/8/2023

By John M. Grohol, Psy.D.

I often write about the latest research findings in mental health or psychology here, but most of the day-to-day work of helping people with a mental health issue falls onto people in one’s local community. Sure, psychologists, psychiatrists and other mental health professionals do the bulk of the work — individually or in small groups — but always in private and with little notice or recognition.

Beyond these front-line professionals, there are hundreds of small organizations, loosely-knit groups, and other advocates who expend constant effort to try and help people learn more about mental health concerns and reach others with their message.

At the University of Wisconsin-Milwaukee (UWM), a group of students is being trained to help recognize the signs and symptoms of depression and other serious mental health concerns. Because who better to help a fellow student in need than another student or one of their friends?

7/8/2023 2 comments

Mental Health Care at Harvard

by John M. Grohol, Psy.D. 5/18/2023

By John M. Grohol, Psy.D.

Mental Health Care at Harvard The Harvard Crimson published a remarkable article last week detailing the obstacles students increasingly face when they want to take a break from Harvard University, especially for mental health reasons. It describes the stories of a number of Harvard students who have taken a leave of absence from the university and their labyrinth journey in rejoining the school.

One would think that at one of the leading academic institutions in the world, Harvard would take an open-minded, flexible and personalized approach to helping their young charges navigate the new world set out before them. Especially those most vulnerable.

One would be wrong, of course. Harvard seemingly takes a bureaucratic, miserly approach to helping their students, forcing them to “voluntarily” take a leave of absence and then navigating a rigid set of rules to be let back in once they’ve undergone mental health treatment away from the university.

5/18/2023 18 comments

10 Secrets Your Therapist Won’t Tell You

by John M. Grohol, Psy.D. 1/21/2023

By John M. Grohol, Psy.D.

10 Secrets Your Therapist Won't Tell You Psychotherapists are a unique profession in the world because they are paid to listen and help people improve aspects of their lives or combat a mental health issue that’s affecting them. But there’s some stuff that goes on in the therapy office that you should know about before you decide to take the plunge (or if you’ve already taken it, well, better late than never!). Here’s a few…

1. I honestly don’t know whether I can help you or not.

Most therapists honestly believe they can help most people with most problems. However, until you get in there and start working with a therapist, a therapist can’t really predict whether they’ll be able to help you or not. Most therapists believe they can help anyone who comes to them with a specific problem they’re trained or experienced to handle. However, every single individual is unique and there are few reliable predictors of any given therapist’s success with any given client.

2. I’m not your friend, but I want you to open up to me anyway.

As I’ve written about previously, the therapeutic relationship is not a natural one. Nowhere else in our lives do we have this kind of professional relationship that demands openness, honesty and intimacy (not of the sexual kind). Without those components, your therapy isn’t likely to be as beneficial. It feels like a close friendship sometimes, but it isn’t.

3. If you ask to see your chart, I’ll probably give you a hard time about it.

Despite the rights of patients to be able to view and have a copy of their own medical records and data, most mental health professionals still resist attempts for a patient to view their own mental health chart. They’ll ask you why you’d like to see it. They may hem and haw a bit, and ask that you pay for copies of it rather than just look at the chart itself while in the office. Your chart likely contains little eye-opening information, as it’s probably just full of short progress notes that describe very generally your progress in therapy from week to week.

4. I’m not supposed to give you advice, but I will anyway.

The first thing a young therapist in training learns is that psychotherapy is, Do not give advice to your clients. “If a person needs advice, they should talk to a friend,” one of my professors said in class. And yet, most therapists end up doling out advice as though their client’s lives depended upon it. Even cognitive-behavioral therapists will give advice, disguising it in the form of “homework” — “Why don’t you try keeping a journal of your irrational thoughts?” It’s a successful strategy for most to try, but it’s still advice.

5. This is probably going to hurt, but I may not tell you that up-front.

Most medical professionals rarely are up-front about the extent of how painful an operation or procedure is going to be. Why would they be? The more painful you hear it is, the more you tense up, become anxious, and the more it does end up hurting. (Ah, the joys of the mind-body connection!) The same is true of good therapy. Good psychotherapy requires you to make changes in your life — in your thinking, in your behavior, and how you interact with the world around you. This isn’t easy, and it usually takes most people a lot of hard work, effort and energy. And if you start digging around in your past (as some, but not all, therapies do), you may find it very painful indeed.

6. My graduate degree probably doesn’t matter much; neither does where I graduated from.

There’s little research to demonstrate that one degree will produce better patient outcomes than another. A “patient outcome” is you feeling better, faster. Because, after all, time itself does indeed heal most wounds. As long as the mental health professional has a Master’s or better in education, it’s likely they will all be equally just as helpful. There’s no evidence to support the idea that a graduate degree from one psychology program is better than another, or that a Ph.D. is better than a Psy.D. for your feeling better, sooner. Find a therapist that you feel comfortable in working with. As long as they are licensed (or registered) and paid for by your health insurance, you’re good to go.

7. If I’m pushing a particular brand of medication, you can likely thank a pharmaceutical company.

You can’t throw a Google keyword without hitting a blog that talks about how various pharmaceutical companies have influenced physicians’ prescribing practices (including psychiatrists’) over the past few decades. Pharmaceutical companies, for instance, love to give doctors free samples of their newest and most expensive medications. Doctors then prescribe these to their patients, who get the free samples as a starter. But the free samples aren’t forever, and then the patient (or their insurance company) winds up paying an arm and a leg for the medication when an older, less expensive medication will work usually just as well.

8. I work for you, but battle your insurance company to get paid.

Yes, you pay your $10 or $20 co-pay to see a therapist, but the majority of their fee will often come from your insurance company. And what your therapist will rarely tell you is how much work it can take to actually get themselves paid from your insurance company. There’s not a lot you can do to help this process along, but it can be a time-consuming and frustrating process — especially in the past when patients would bump up against their maximum-allowed sessions for the year. Or the insurance company denies payment for a certain diagnosis. It’s a mess, and many therapists end up spending more of their time on paperwork for reimbursement than they’d like. Although most therapists won’t admit it (or may not even be aware of it), if your insurance company is giving them a hard time, it may impact their relationship with you.

9. I will give you a diagnosis whether you need one or not.

Nobody likes to admit this, but without a diagnosis, the therapist won’t get paid by your insurance company. And it can’t just be any diagnosis (despite the mental health parity law passed last year). It has to be a “covered” disorder. Which means that if you come in with something that isn’t quite clinical depression, your therapist may diagnose you with it anyway, just so they can get reimbursed. (That’s one of the many reasons why you shouldn’t put too much faith into your diagnosis in the first place.)

10. I love my job, but hate the long hours, client’s often-slow progress, and the difficulty in being understood as a profession.

Like most people, a therapist isn’t always going to be in love with their jobs. There are a lot of daily frustrations a therapist faces, including those mentioned above. Unless the therapist is well-established and successful, many therapists work 10 hour days, or up to 6 days a week. Sometimes clients aren’t committed to the process of changing as much as they say they are, which can be frustrating. And many people still believe that therapists listen to you talk about your dreams as you lay on a couch. It’s hard to be respected as a profession (psychiatrists are often looked down upon by their physician peers), and everyone believes that it’s one of the easiest professions in the world that just about anyone could do (“You just sit there and listen to people’s problems all day?! Sign me up!”).

1/21/2023 154 comments

Bremner’s False Claims about Postpartum Depression

by John M. Grohol, Psy.D. 12/2/2022

By John M. Grohol, Psy.D.

Bremner's False Claims about Postpartum Depression Psychiatrist J. Douglas Bremner has weighed in on the Melanie Blocker Stokes MOTHERS Act, an effort to provide voluntary screenings to pregnant women to help identify postpartum depression before it becomes overwhelming. I’ll let Bremner speak for himself:

The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous.

My BS alert goes off whenever someone tries to change the argument from a reasonable effort to help increase education and information about a stigmatized mental health issue, to hyperbole, suggesting that a piece of legislation is trying to turn motherhood into a psychiatric disorder. It goes off again when a professional makes an extraordinary claim like, “there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum [sic] depression.” Really? Absolutely no evidence? That’s quite a strong statement, and easily proven false with a literature review.

Where shall we begin? (I have limited space and you have a limited attention span, so I’ll just highlight a few studies…)

Ross & Dennis (2009), for instance, in a literature review found that both substance use and current or past experiences of abuse are associated with increased risk for postpartum depression (PPD).

In urban South African women, Ramchandani and colleagues (2009) found the strongest predictors of postnatal depression were exposure to extreme societal stressors (e.g., witnessing a violent crime/danger of being killed) and reporting difficulties with their partner.

Robertson et al. (2004), in a large meta-analysis of research to-date, found that a previous history of depression and anxiety (not just during pregnancy) was predictive of postpartum depression. But they also found that simply experiencing a stressful life event during pregnancy or low levels of social support (e.g., not having any emotional support from your friends or family) could also lead to postpartum depression.

Beck’s (2001) meta-analysis of 84 studies found:

13 significant predictors of postpartum depression: prenatal depression, self-esteem, childcare stress, prenatal anxiety, life stress, social support, marital relationships, depression history, infant temperament, maternity blues, marital status, SES, and unplanned/unwanted pregnancy. 10 of the 13 risk factors had moderate effect sizes while 3 predictors had small effect sizes.

Look at all of those factors which are not depression or anxiety — I count 9. Even if 3 of those are small-effect size factors, that still leaves 6 factors which are not depression or anxiety.

What about the argument that if depressed women are the most at-risk, we should simply focus on them?

Ingram & Taylor (2007) found it wasn’t just a woman’s pre-birth depression severity that was important — poor emotional support and women who had more negative descriptions of their own childhood were additional risk factors that played a role in increased risk for postpartum depression. Who’s going to screen for these things, the obstetrician?

Well, no, because the obstetrician is already not doing a good job at screening for postpartum depression, even in high-risk women. Hatton et al. (2007) found that, among high-risk women, obstetric care providers may be overlooking up to one fifth of women with current major depression. Not exactly great numbers there. If obstetric care providers can’t deal with the obvious cases, I can only imagine how well they do with the more complex or less obvious ones.

Monk et al. (2008) sums the state of our knowledge on PPD:

Depression is relatively common during the perinatal period (Gavin et al. 2005; Ross and McLean 2006). Approximately 8.5 — 11% of women experience either a major or minor depression during pregnancy (Gaynes et al. 2005). Nearly 20% of women have a minor or major depression in the first 3 months following delivery (Gavin et al. 2005).

So up to 1 in 5 women have depression after giving birth, and this isn’t something worth noting or screening for? (For comparison’s sake, 1 in 10 men and women in the general population might have depression at any given time.) Giving birth doubles your risk of depression, and this isn’t an issue? Amazing.

But don’t just take my word for it. Zajicek-Farber’s (2009) study conducted on high-risk women for postpartum depression concluded that:

These findings provide additional supportive evidence that more efforts are needed to identify and assess women’s depressive symptoms to promote health and safety of young children.

These are objective researchers calling for more screenings. Not politicians. And not people (or professionals) with a political agenda.

Now, I understand Bremner’s point — let’s not medicalize and catastrophize ordinary motherhood. I agree. And of course a woman’s pre-birth depression or anxiety is strongly correlated to postpartum depression. But not exclusively, as Bremner claims.

Bremner claims, with no evidence, that all mental health screenings are simply pharmaceutical sales tactics to help increase prescriptions. That’s ridiculous. When I worked in community mental health, we ran annual mental health screenings in the clinic — with no funding from any pharmaceutical company — because it reduces stigma, decreases misinformation and increases education about mental health issues in the general population.

Sorry, but most people don’t have time to keep up with a dozen blogs or read monthly journals on the latest research in mental health. Most people know what they know about mental health largely through mainstream media, or their own first-hand experiences with an issue. How is the promotion of more information and education about mental health issues a bad thing?

Bremner uses teens as an example of screening gone wrong, but conveniently fails to mention the facts about teenagers and mental health. Teens are an “at-risk” population, hence the reason they are sometimes targeted for screenings. Teens are notorious for being limited in their treatment options (especially in the U.S., where their treatment may be covered by their family’s health insurance, meaning a talk with their parents about their mental health issues), and for peer pressure limiting their ability to accept or seek help. (Yes, sorry, if you’re seeing a therapist for depression as a teen, you’re typically not seen as a “cool” kid.)

Sadly, whether people want to admit it or not, mothers are another “at risk” population. Why? Because society has told mothers time and time again that giving birth is supposed to be a joyous, happy occasion. If you’re depressed after giving birth to a child, there must be something wrong with you. Don’t draw attention to yourself or your problems. Just try and deal with it, try and take care of the baby, and make it through each day. Mothers don’t know they might have something recognized as postpartum depression, much less that they can talk to someone about these feelings or that there’s treatment — psychotherapy or medication — readily available for it.

So respectfully, I disagree with Bremner’s assessment of the MOTHERS act and its need in today’s society. And if you’re not going to bother to do the legwork and just make general (false) pronouncements about what the research actually shows (or worse, suggest the all research that disagrees with you must be in pharma’s pocket), then that’s a lazy person’s argument. There are too many logical fallacies at work here to list, so I’ll just suggest that I expect more reasoned and professional arguments –based upon the actual research — about such important legislation.

Psych Central continues to support the Melanie Blocker Stokes MOTHERS Act because the research shows it would help in the efforts to increase education and correct mis-information about postpartum depression.

References:

Beck, C.T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275-285.

Hatton, D. C., Harrison-Hohner, J., Matarazzo, J., E.P., Lewy, A. & Davis .L. (2007). Missed antenatal depression among high risk women: A secondary analysis. Archives of Women’s Mental Health, 10(3), 121-123.

Ingram, J. & Taylor, J. (2007). Predictors of postnatal depression: Using an antenatal needs assessment discussion tool. Journal of Reproductive and Infant Psychology, 25(3), 210-222.

Monk, C., Leight, K.L. & Fang, Y. (2008). The relationship between women’s attachment style and perinatal mood disturbance: Implications for screening and treatment. Archives of Women’s Mental Health, 11(2), 117-129.

Ramchandani, P.G., Richter, L.M., Stein, A. & Norris, S.A. (2009). Predictors of postnatal depression in an urban South African cohort. Journal of Affective Disorders, 113(3), 279-284.

Robertson, E., Grace, S., Wallington, T., Stewart, D.E. (2004). Antenatal risk factors for postpartum depression: a synthesis of recent literature. General Hospital Psychiatry, 26(4), 289-295.

Ross, L. E. & Dennis, C-L. (2009). The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: A systematic review (PDF). Journal of Women’s Health, 18(4), 475-486.

Zajicek-Farber, M.L. (2009). Postnatal depression and infant health practices among high-risk women. Journal of Child and Family Studies, 18(2), 236-245.

12/2/2022 202 comments