Friday, August 29, 2014

What to expect when you start therapy

Making the decision to go to therapy can be intimidating for some, and downright scary for others. If you have never been to therapy, you may have no idea what to expect. And even if you have been to therapy, starting over with someone new... they may have a completely different style from other therapists.

You may be surprised to find that I, and many other therapists I know, take the first couple of sessions not just to get to know you, but to "get back to basics". Many people who struggle with anxiety, depression or any other mental health difficulties have let go of the things that we KNOW we should be doing, but lack the energy or motivation to do. Part of my job is to help get that back on track before diving into deeper emotional concerns, like trauma or emotions.

The top four:

Sleep:  Anxiety and depression can really impact your sleep. You may find that you can't sleep, or are waking up at 2-3 am and toss and turn until the sun comes up. You may find that all you want to DO is sleep, and struggle to get out of bed, or nap several times a day. Or you may find that staying up late is the answer to getting things done around the house, catching up on Breaking Bad episodes, or playing Words With Friends on the iPad.
Why this matters: Sleep deficiency can cause many issues- poor driving, poor decision making, difficulty losing weight, mental deficiencies... and just feeling tired and crabby. This makes you not only uncomfortable in your own skin, but usually not very fun to be around. It also means that you likely don't have energy for exercise, relationships, or hobbies (the other important self-care items).
What to do: Create a sleep schedule, committing to be in bed by a certain time, and that time should be relatively consistent. Cut out the use of screens before bed, and stop using caffeine after 2 pm in the afternoon. Consider meditation or deep breathing/relaxation to help ease you into sleep. If your pets or kids sleep with you, and this is interfering with sleep, consider a new plan.

Can't... stay... awake....




Exercise: Before you think I am sadistic, I refer you to a previous blog post where I talk about how much I HATE exercise. There. Now we are on the same team.
The reality is that many of us are not getting enough activity, whether that is because we are overtired, we work full time, the kids take too much of our time, etc. etc. etc. Or we just hate to exercise, and nothing sounds fun. Again, small amounts can make a big difference. Start with a ten minute walk around the block. Park your car farther away when you work or shop. Take the stairs. Play in the yard with your kids. You don't need to be able to afford exercise equipment or a gym membership in order to get exercise.
Depression, especially, takes away any motivation or interest in exercising. So you will have to make yourself do it. There is no simple answer, unfortunately... I'm sorry. However, you will likely feel better after you do something, and that I know is true.

Exercising with a friend is always more fun


Diet: Please don't hate me. When  I use the word "diet", I do not necessarily mean "going on a diet". Although sometimes that is the case, the healthier approach is making small changes in the daily ways that you eat, or don't eat. Drinking more water. Not skipping breakfast. Eating less carbs.
Depression and anxiety can make people crave carbs and junky foods. Then they have an energy crash which does not help anything. Or it can completely rob you of your appetite, leading you to skip meals and either lose weight or binge/make poor choices later in the day.
So again, start small. If you are skipping breakfast, have a hard boiled egg, a piece of fruit or a smoothie for breakfast. If you go several hours without eating, have healthy snacks available that you can reach for rather than something processed from the vending machine. Or keep a full water bottle nearby so that you remember to drink more water. Cut out one serving of caffeine, particularly if it is the afternoon. Focus more on how you feel rather than the number on the scale.
Nom nom nom....


Socializing/Hobbies: Finally, a big one. When you work full time, or are a new parent, or have young kids... friends and hobbies seem to be the first thing to go. Then, add a mental illness that can either sap you of any motivation to socialize, or cause you a lot of anxiety or panic attack to think of engaging in. Often, this are seems to take more time for me to get clients to buy into. They say, "Nobody wants to be around me right now" or "Everyone will think I'm stupid/fat/weird". "I don't have time/money/space to engage in my hobbies".
There are many approaches we can take in counseling to address these thoughts or low motivation, and also find some ways around any concerns to help you get reinvolved in your life. I promise, you will feel better when you do.
Again, start small. Think of something that used to bring you pleasure, and do it for 10 minutes. Go to the library and get a book. Go to an art museum. Grab your camera and go outside and take pictures. Call up a friend and commit to talking for a short period of time, or send an email to someone you haven't connected with recently but would really like to. Ask a co-worker to join you for lunch. As daunting as some of these things feel, you are in control of what you do and for how long.

This looks fun, right?


I share this information in the hopes that it will encourage you to reach out for help if you are struggling. Don't try to figure things out alone. Have a professional who is non-judgmental and is there to offer support and encouragement as you get back on your feet. Ultimately, when you are struggling with anxiety or depression (or any other of it's close friends), you feel very out of control. Self care is something that you do have control over, and small changes can add up. Pick one small thing to try, and start doing it.

Sunday, August 17, 2014

Words matter

With the recent suicide of Robin Williams, discussion about suicide, depression and mental health are at the forefront of everyone's mind. And if there is anything positive that can come out of this terribly sad loss, it is bringing more awareness to the need to feel like we can talk openly about mental health. To feel like we can say, "I am not OK" without fearing shame and stigma from the people around us.

What I have noticed when reading numerous articles that have come from this loss is the way that people stick a diagnosis on people like a label. That it is as if their mental health diagnosis is who they are, rather than a part of them that they struggle with. Fill in the blank: "I am..... " Bipolar. Schizophrenic. Mentally Ill.

The reality is that while we need to be able to talk about these disorders without shame, our label is still not who we are. We are so much more than that as people. How ridiculous would this sound:

"I'm green eyes"

"I'm polycystic ovarian syndrome"

"I'm cancer"

We don't say those things. We say, "I HAVE cancer". "I HAVE green eyes/brown hair/my dad's nose".

Why does this matter? Because it is so easy to become our label. To wear it like a Scarlet Letter of shame, and say that certain parts of us are not acceptable. We are so much more than our labels, in the same way that our physical appearance are not all of who we are.

People first language matters. Be mindful today of how you label people in any way.

"That autistic kid" becomes "That child with autism"
"That depressed/crazy/anxious person" becomes "He has depression" "She struggles/lives with mental illness"

It only takes seconds.

Tuesday, July 15, 2014

The Climb...

Feelings about the twerky Miley Cyrus aside, her song, "The Climb" (which she wrote back when she was sweet and innocent) has played through my head a lot lately. It even randomly popped up on my iPod while I was driving one day, ruminating about my stress level with this whole private practice business. This journey has definitely been a climb, one worth making, and I am hoping that I am heading back down the mountain, but I am sure there is another one somewhere in the distance.

The struggles I'm facing
The chances I'm taking
Sometimes might knock me down, but
No I'm not breaking
I may not know it, but
These are the moments that
I'm gonna remember most, yeah
Just gotta keep goin',
And I, I gotta be strong
Just keep pushing on, 'cause

There's always gonna be another mountain
I'm always gonna wanna make it move
Always gonna be an uphill battle
Sometimes I'm gonna have to lose
Ain't about how fast I get there
Ain't about what's waitin' on the other side
It's the climb


The biggest mountain I have faced so far is transferring all of my credentialing with insurance companies over to my new location. I am very lucky to be part of a large clinic that already had me credentialed with just about every possible carrier. What I wasn't sure of was how that would translate to my new solo practice at Stages. Two carriers denied me initially. I appealed and only one of them overturned. Which means that one (rather large) carrier continues to deny me coverage, and it means saying goodbye to those clients, unless they can afford to use their out-of-network benefits and pay for it... many people cannot do this.

The carrier that continues to deny me is Health Partners. They denied me originally saying they have enough providers in this demographic area (keep in mind, I was already in their network at my current practice). I appealed with a letter very specifically outlining the need for more providers in the south metro that specialize in perinatal mental health. They responded, "we have enough... " When pressed further (through many many back and forth emails with a rep there) I was also told that they rarely credential solo practices, and that there isn't anything I can do.
Pregnancy and Postpartum Support MN (PPSM), of which I am the proud Co-Director, has spent a lot of time (a LOT) interviewing and vetting providers in the Twin Cities metro area that declare a specialty in perinatal mental health, and who have paid an additional membership fee to be part of our resource list. This means something to us within PPSM. It means that they care so much about the area of perinatal mental health, and have had so much training, that they want to be known as having a competency in this very specialized area so that new and expectant parents can find them and be confident they are seeing someone that knows about this specialized area of mental health. We have ALL heard horror stories from clients who have seen providers who do not have a specialty in this area, and how many of them have left feeling ashamed, frightened and misunderstood not because the therapists hearts aren't in the right place, but because they are not adequately educated about working with Perinatal Mood and Anxiety Disorders (or PMADs).
Interestingly enough, my fellow co-director Lisa Cross and I did some research on the providers Health Partners has on their list with a declared specialty in PMADs. And guess what? Not one single one of them is on the PPSM Resource List. Lisa could also not find any that mention on their personal websites that they specifically work with PMADs. Why is that? Likely, it is because when Health Partners does credential someone, they are sent a generic checklist asking what things the provider will work with. A provider can check the box for postpartum depression or maternal mental health (depending on how it's worded on their form) but they do not need to prove their training in these areas. This explains why their list makes it appear that they have an adequate supply of providers who work with this specialty.

I'm still climbing this mountain, and while I have not crested the peak, I have had to stop and get some air. The truth is that we need some reform and education within insurance companies to let them know how specific PMADs are. Lisa and I attended a wonderful breakout at the PSI Conference in June about how Cigna is tackling this issue. We know it is happening (just not at Health Partners), it just needs to spread.