Archives for Psychotherapy


Germanwings: A Wake-up Call for Mental Health Professionals

I have no insider knowledge of the specific mental health treatment that co-pilot Andreas Lubitz did or did not receive, or what valiant efforts those professionals may (or may not) have made to avoid the tragedy that occurred. But the unsuccessful treatment that Lubitz underwent can serve as a wake-up call to all of us in the field.

Mental health work can have significant and far-reaching consequences. When we enter into other people's psyches, we must do so with full awareness that it can be perilous work. We have to recognize the responsibility we hold.

In any profession, it's easy to become complacent, or burnt out. This is a reminder of what could be at stake if we phone it in. Because I'm fairly certain Lubitz's doctors didn't foresee this. You never know what people are truly capable of. But as a clinician, you have to stay focused on your own capabilities--your strengths, your weaknesses, your blind spots.

Here are some thoughts on how to do that.
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Diagnosis: A Self-Fulfilling Prophecy?

With a new diagnostic manual out (the DSM-5 replacing the DSM-4TR), I've been thinking more about the dangers of diagnosis.  It's just human nature that if you're holding a hammer, everything looks like a nail.

So the way a therapist sees a client is shaped by the diagnostic criteria available, and that can influence how clients see themselves ("I'm a depressive borderline," one new client informed me.)

Given this, therapists have to diagnose with care.  And clients have to take their diagnoses with a grain of salt: The diagnosis you're given is not the sum total of who you are.
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Can a Narcissist Change?

Many of us are involved with narcissists (people who have difficulty empathizing with others, and behave accordingly, often manipulatively.)  The narcissist may be your parent, your significant other, even your child.  In order to decide what your options are in this relationship, you're wondering: Can a narcissist change?

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When to Seek Couples Therapy

Most people treat couples therapy as a measure of last resort: Your relationship is completely on the rocks, one or both of you is considering calling it quits.   It's like dialing 911.

But as I've said before, that's the worst time to start therapy--when you're feeling hopeless, when one or both of you has little investment in the relationship.  Seeking professional help sooner can make all the difference.

So what is the best time?

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Couples Counseling in the Eleventh Hour

There are a lot of reasons couples might procrastinate about entering therapy.  It might feel shameful, like an admission they can't do it on their own.  They might be afraid of what will come out in the room, and more comfortable maintaining some level of denial about just how distressed their relationship is.  They might feel overloaded and overwhelmed with all they have to do in their week, between jobs and kids and other commitments.

They might also hold the belief that if things get really bad, they can just do therapy then.  They might as well wait, they reason.  What difference could it make?

A lot.  And here's why.

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Social Media: When to Stop Clicking

I am finally on Facebook.  It's a strange declaration for 2013, I know, but it's time to start thinking about promoting my novel, which comes out in July.  Time to bite the bullet and enter contemporary life.

Weirder still: My novel is about a woman who embarks on a social media campaign to find her runaway daughter.   Art does not always imitate life.

Part of my reticence has been the time-suck of it.  I fear going down into the rabbit hole of everyone's musings and links and never being seen again.  But the other part has been witnessing the negative impact social media has had on some of my clients.

So in this post, I'll ask: How do you know, from a mental health perspective, when to stop clicking?
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To Medicate or Not to Medicate

In certain cases, it's obvious that medication is needed.  It can even be a prerequisite for therapy (when people are too severely depressed, suicidal or hopeless to engage; when they're floridly psychotic.)  But for others with, say, mild depression or non-debilitating anxiety, then the answer is not so obvious.

Of course, suffering is in the eye of the beholder (well, the experiencer, if I can coin a term.)  And it's relatively easy to get psychotropic medication.  The vast majority of prescriptions for psychotropic meds are written by primary care physicians, often at the patients' request.

But the decision of whether to seek medication can feel downright existential, and is extremely personal.

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The Isolation Dilemma

When faced with adversity, many of us find ourselves daunted.  We might feel depressed and hopeless.  And when we feel that way, we certainly aren't in the mood for company.

But the more we isolate, the harder it is to pull out of the negative spiral in which we've find ourselves, and the harder it is to generate solutions.  There, in a nutshell, is the isolation dilemma.
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High Stakes Clients

I recently got a new client--a very young mom with an addiction and domestic violence history, trying her best to stay away from her abuser and to stay clean, bouncing a four-month-old baby on her knee.

She belongs to a class of clients that I'm calling "high stakes", because when they show up in my office, I feel intense empathy, sympathy, and a desire to make it all turn out all right.  I looked at her thin shoulders and that baby she's holding, and thought, "I really have to pull this off, for her and her daughter."

But does that pressure actually make for good therapy, or do the reverse?

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