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FAQ
Q. I don't want to take medications for my problems. What are my options?
A. Given bottlenecks and delays in seeing a psychiatrist, the physician most likely to address your
anxiety or depression problems is likely to be your general practitioner. He or she must process patients at
the rate of seven to nine minutes average each. In an efficient practice, the quickest and easiest way for
your physician to address these problems is through medication. Some physicians are willing to suggest other
more time-consuming means, and will refer to another professional. Few physicians are able to take the
necessary time themselves given the constraints of their practice. Psychotherapy and counseling options are
available. Cognitive, rational emotive, skills development, psycho analysis, and existential therapies, among
others, can be used for these problems, but they require client-therapist talk, often homework, and practice
on the client’s part. They often result in significant but incremental improvement. The gains can often be
long-lasting, promote clients self-confidence, and do not result in long-term dependency on medication.
Q. How do I know if I need short-term or long-term therapy?
A. Whether therapy is likely to be short or long term is a function of the nature of the problem
itself, and how effective efforts have been in daily life to clear them up. Some depressions may be
situational and short-term. A grief reaction or adjustment to a loss may be relatively short
term – for example, the loss of a short-term partner, or a job, or a trauma such as a house burning down.
Adjustment to the loss of a child however, or a loved spouse of many years, might take much longer. Therapy
for a frequently dissociating, alcoholic survivor of 10 years of parental sexual abuse will probably take a
very long time, and will likely proceed in stages. Some conditions are chronic, such as biologically based
bipolar and periodically psychotic conditions. These may benefit from long-term ongoing supportive therapy,
frequently combined with physician-supervised medication. Some people come to therapy because they know that
they have had long-standing patterns of self-destructive behaviour which seem to get in their way at work, or
in relationships, or in regard to their health. These sorts of long-term habit patterns are also likely to
take a long time in changing through therapy. The old notion from psychoanalytic therapy that the only true
productive change came not through short term behavioral change, but rather through deep structural resolving
of conflicts and inappropriate primitive defenses, has been called into question during recent years. Much
research has shown that behavioral change itself can be long-lasting, and can affect deeper structures in a
significant way, so even longer term therapy does not have to be interminable. Research indicates that many
short term issues can be substantially resolved in 5 – 10 sessions, and that significant improvements for
some longer term problems can be brought about in 6 months to a year of therapy.
Again, the brief answer to long-term or short-term therapy, is - "it depends".
Q. What are the best approaches for an addiction?
A. There are several levels of treatment for those who suffer from addictive problems. A basic level
of treatment would be seeing an addictions counselor regularly [possibly weekly] along with periodic visits
to a physician with a specialty in treating addictions. Proper assessment of the problem’s severity could
also be done at this level. A more intensive level of treatment would be regular attendance at a 12 Step
program such as Alcoholics Anonymous or Cocaine Anonymous [for specific substance addictions], or a group
such as Gambling Anonymous to treat a nonphysical or "process addiction". These groups often
require attendance a minimum of three times per week, at least at first, to be effective. Another level of
treatment, perhaps the "gold standard", is an inpatient program, often involving a residential stay.
This may last from the traditional 28 days to 60 or 70 days, followed by an outpatient 12 step program. For
seriously addicted individuals who may show considerable denial of their problem, a formal process called an
Intervention may be required. This is an orchestrated and rehearsed procedure, often led by a professional
who coaches the family and friends of the addict, on how to confront the addicted person with his or her
problem, in a way that has maximum impact to convince the addict that he or she needs to enter treatment.
Q. What is optimum mental health anyway? Does anyone have it?
A. A greeting card I once read, said "The only people who are normal are those you don't know
very well yet". Probably not totally true, but it is the case that anyone surviving a trauma or
dysfunctional family, or a normal but severe life event like a breakup or job loss, may benefit from some
counseling or therapy. There are some benchmarks for good mental health, however. Here is a significant but
not exhaustive list: resilience in the face of adversity, the ability to self modulate emotion so one is not
overwhelmed by circumstances, the ability to use information in a rational way and yet retain a balanced
access to one's emotional self, the capacity to sustain some degree of anxiety and not resort to
self-destructive or mood altering avoidance strategies, the ability to maintain goal directed activity and
not be governed by poorly thought out impulsivity, the ability to empathize and connect with other human
beings in a deep and intimate way, the ability to self reflect and self correct decisions and behavior
patterns which are not productive, having a clear set of values or guiding principles and generally adhering
to them through time in such a way as to have personal integrity, allowing oneself the time and inclination
to laugh, play and be creative. This is certainly not an exhaustive list of mental health benchmarks, but
reflects many which allow a person healthy emotional maturity.
Q. How do I know if my relationship is really in trouble? Do I stay quiet and keep the peace, or speak up,
"make trouble" and seek help?
A. there are many opinions on this issue, but Dr. John Gottman, probably the world's foremost
researcher on relationship process in couples, has some clear guidelines. He says that if your relationship
has been characterized by very frequent expressions of criticism, that is, characterological putdowns of the
partner, or by expressions of contempt one for the other, or by consistent defensiveness when issues are
brought up, or by one person simply ignoring the other's concerns [stonewalling], then the emotional
partnership is in severe trouble, and these problems should be attended to, probably with professional help.
There are other more obvious individual issues which will lead to couples problems - addictions, violence,
financial impulsivity, etc. these may very well require individual work by one of the partners, as well as
couples counseling. An evaluation in couples counseling may help open the door to treating these individual
issues. Keeping quiet just allows problems to build, anger to increase, and love to erode.
Q. How do I handle a relative or friend whom I might think may be suicidal?
A. On this issue, and for obvious reasons, seek professional consultation or emergency help quickly.
Call your physician, or mental health person, or the crisis line number in the front of the phone book, or an
emergency room. Serious clinical depression may involve ongoing suicidal risk. The presence of guns in the
house or implements which have been assembled for carbon monoxide asphyxiation, or the hoarding of medication
may present a very high risk to someone who is thinking of suicide, so they should be removed to the police
or a relative’s. Words said or written about suicidal intent should always be taken seriously and discussed,
even if further action is not necessarily taken. People who've been very depressed for some time, who appear
to be tying up loose ends in their lives, and/or appear to be surprisingly calm and satisfied for a change,
sometimes have made up their minds to finish things. Be conservative, on the safe side, take indications
seriously, and see quick help. And remember that if someone is showing you any signs whatever of suicidal
activity or intent, at least part of that person’s ambivalence wants you to notice and take preventive action.
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