Getting the Most Out of Your Therapy Sessions

Has this happened to you? You're sitting on the couch talking to your therapist. You look up at the clock and see that you've got only five minutes left. How did that happen? You've got so much more to talk about! You leave feeling frustrated that you derailed from something really important.

What to do?

Check out PsychScamp's helpful suggestions for better time management during your therapy sessions by clicking here.

I would add to PsychScamp's list a therapy tool I often suggest:

Keep a therapy notebook.

This can be any kind of bound (spiral or otherwise) paper on which to write down your important thoughts, feelings, ideas to discuss at your next therapy session, attempts at change, areas where you are struggling, questions for your therapist, the list goes on. It's especially helpful if your therapy notebook has a pocket of some sort to keep handouts and worksheets.

You can shop for a fun, fanciful notebook or, for the recyclers among us, dig up an old college or school notebook that's buried in your office or bedroom closet. Make use of all that empty paper.

The type of notebook is not important. What matters is that you have a space on which to write.

Some people like to keep the notebook by their bed. Jot down thoughts right before going to sleep. Keeping note of worries and to-do lists right before bed can be a helpful tool when struggling to overcome bouts of insomnia. Two birds with one stone?

A note about the length of your entries: Keep it short.

Lengthy, paragraphs-long or pages-long entries can be tiring, prevent you from getting enough sleep, and lead to a dread or avoidance of your notebook. Concise reminders or bullet items are often adequate for therapy material.

Some people prefer to log their thoughts into their handheld devices, smartphones, or computers, etc., rather than use a paper-and-pencil format. Electronic gadgets of this nature can work, too, but not so convenient for keeping track of the paper handouts.

Whatever you do, be an active manager of your therapy time. In many cases, the more involved you are in contributing to the agenda, the more likely you'll get your therapy needs addressed.

A Happy To Do List for the New Year

A list of twenty-one simple to-dos and to-don'ts for the New Year that I found mostly simple and a lot inspiring.  Some are big steps but more are little.  Because sometimes it's the little things that makes the difference between a life of regrets and a life fully lived.

The very first to-do:  Click here.

-Sandy Andrews, Ph.D.

CBT Cognitive Behavioral Psychologist 

Austin, Texas

  

See the Stars

When it gets dark enough, you can see the stars.

Charles A. Beard

It may come as a surprise to few that many people present for therapy during the darkest of times.  New patients may feel powerless to change their circumstances, hopeless to overcome their problems.  We clinicians like to point out that, through therapy, people often gain the tools necessary to first cope and then to feel stronger, maybe stronger than ever, and then ultimately to overcome the difficult obstacles they face.   

It can help to believe that dark points in our lives may be fulcrum moments, the very point at which we gain the help we need to make substantial life changes.  To find the power within ourselves to take action and change.   

It would be foolish to suggest that we should look forward to low moods and hardship.  But it is worthy to suggest that when they arrive we can learn to accept them  as temporary turning points.  Maybe even necessary turning points.  To embrace the potential adversity presents.  As an end to stagnation.  The pivotal shift we need to grow.   Stronger.  To learn. To succeed.  To  flourish. 

As this quote suggests, we can learn to look beyond the clouds.  Look into that darkness.  Look for the stars.  We might just find incredible, life fulfilling opportunity.  

Say No To Drugs - What Helps for Depression

It is more and more common for clients to tell me they want to work on their mental health symptoms without the use of medications, especially in light of recent findings questioning the efficacy of several commonly prescribed antidepressants.  I like to support the goal of avoiding psychotropic medications in some situations.  While it is true that some disorders typically require medication (bipolar disorder, schizophrenia), especially those where the symptoms have reached severe levels (persistent suicidal thoughts, planning or intent), it is often a welcome sign that a person is interested in doing all they can, on their own, to feel better. 

So when I read this review on PsychCentral, written by Therese Borchard, I wanted to share a summary here for those of you who want to know what are some of the most effective ways to manage your depression without medication.  Although, I want to add, these are excellent suggestions for people taking medications as well.

Six Steps for Beating Depression

From 
“The Depression Cure: 6-Step Program to Beat Depression without Drugs,”

by Stephen Ilardi

1. Omega-3 Fatty Acids   Seafood, oils (flaxseed oil -unheated; canola or soybean oil for cooking), beans (kidney, pinto, mungo), nuts, seeds, spinach, winter squash, broccoli, cauliflower, dietary supplements (fish oil, flaxseed oil).



2. Engaged Activity  keeps us from ruminating, and ruminating causes depression.
Socializing, reading, hobbies, creating art, exercise of all kinds.


3. Physical Exercise    Research suggests 30 minutes  of brisk walking three times a week can be as effective as some medications AND exercisers are less likely to become depressed again later.    

Activities such as walking, biking, jogging, and weight lifting.  Exercise changes the brain. It increases the activity level of important brain chemicals such as dopamine and serotonin and a key growth hormone called BDNF. Because levels of this hormone plummet in depression, some parts of the brain start to shrink over time, and learning and memory are impaired. But exercise reverses this trend, protecting the brain in a way nothing else can.


4. Sunlight Exposure Important for keeping the body’s internal clock working properly. Without light exposure, the body clock gets out of sync, throwing off important circadian rhythms that regulate energy, sleep, appetite, and hormone levels. On average – a half hour of sunlight is enough to reset your body clock, even on gray, cloudy days.


5. Social Support   Relationships matter. The more satisfying the connections, the better. Think about ways to increase the number of people in your social network especially those you can confide in.


6. Sleep    Disrupted sleep is one of the most potent triggers of depression, and there’s evidence that most episodes of mood disorder are preceded by at least several weeks of subpar slumber.   Keep a sleep log.  Each morning write the estimated number of hours you slept the night before to include approximately how many times you woke up throughout the night and couldn’t get back to sleep for more than ~ten minutes.  

15 Steps to Better Mental Health

Walking in the Rain

by L C Neill

Yet another excellent post by Dr. Deb -- A list of 15 Tips for Mental Fitness that she found on a University of Washington publication. It's such a great list, in fact, I had to post it here:

1. Learn to Relax
Allow yourself to let go of inner tensions by giving yourself a “mini vacation.” Give your mind a break by becoming engrossed in a good book, watching a movie, listening to music, taking a walk, working on a hobby, meditating or similar activity that is relaxing for you.

2. Be Kind To YourselfPeople are frequently too hard on themselves when things don’t go right. Tune into your self talk, and counteract your negative thoughts about yourself with positive statements.

3. Eat ProperlyNutrition has a direct impact on feeling mentally positive. Limit your intake of sugar, fat, salt, caffeine and alcohol and help yourself stay mentally fit.

4. Find A Friend
Friendships are very important to mental fitness. Working on developing and maintaining friendships is one of the best ways to continue growing as a person. Expressing feelings and ideas to another person can help us clarify what’s truly important to ourselves.

5. Learn to Say “No”Often people feel the need to respond immediately when a friend or family member make a request. Help yourself set limits by avoiding the quick “knee jerk” response in the affirmative. Instead, let them know you will get back to them shortly. Then do a check of your schedule; ask yourself if you really want to add to your load. Give yourself permission to say “No” when you are too busy to take on additional commitments of your time or energy.

6. ExerciseCheck with your doctor about what level is best for you. Even a brisk 15-minute walk, three times a week does wonders for how you think and feel.

7. Do It NowProcrastination can lead to negative feelings about yourself. One doesn’t have to go to extremes, but it can feel very satisfying at the end of the day to have accomplished a hard task or met a difficult situation head-on.

8. Adapt To Rather Than Resist ChangeChange is inevitable and is a necessary part of life. The important thing is to be patient with yourself when you are going through change, and to give yourself time to go through the phases of transition. Realize it takes time to let go of the old and embrace the new.

9. Test Your Assumptions
Sometimes in our interactions with other people, we make the most incredible assumptions and act as if they are true. Rather than assuming, it might be worth the risk to ask directly what was meant.

10. Express Your Feelings
Emotions are a natural response to life. It is important to find ways to express your feelings. Journaling your thoughts is one way that can help you clarify what you are feeling. Once you have identified your feelings, you may find it easier to share them with others.

11. Grieve Losses
Sadness and grief are natural and appropriate responses to the losses which we all experience. Grief over the loss of a love one can be very painful and may last for some time. By being kind and allowing ourselves the time to grieve, we have the potential to be stronger than ever

12. Rest
Get a good night’s sleep. Not everyone needs the same amount of sleep, but it should be restful sleep. There are many techniques available to help promote relaxation; or, you might want to check with your doctor rather than assuming your restless sleep is simply something you have to live with.

13. Review Your “Shoulds”If you feel stuck by some things you “should” be doing and aren’t, set a time limit by which you will either have them done or get rid of them. Staying stuck in the middle is a good way to punish yourself and cause mental anguish and stress.

14. Have A Laugh
Nurture your sense of humor, especially about yourself. Trying to see the humorous side of things makes even the most difficult situations easier to bear. Laughter is good medicine. Being too serious limits your ability to enjoy life.

15. Ask For HelpIf you need emotional support or just someone to talk to, don’t be afraid to ask for it. There are times in life when everyone must look outside themselves for comfort and advice. If friends can do the job, ask them to help. If not, be assured that professional help is available through your employee assistance program.

I would like to add a suggestion of my own to the list: Look at art. Even better, create some yourself.

How about you, reader? Anything you'd like to add to the list?

male or female therapist?

I am often asked by someone who has decided to seek out therapy whether to select a male or female psychologist. Psychologists discuss this very question among themselves because professional opinions vary.

My answer is typically that it's really up to the preferences of the individual. It's a very personal decision. Some people think they would feel more comfortable with one gender or the other.

Women often tell me they prefer to see another woman. They think they would feel more comfortable sharing the frank details of their lives with a woman, particularly when sexual issues or a history of sexual victimization are involved.

Choosing a psychologist or therapist is not unlike choosing an ob-gyn. Some prefer a doctor of the same sex believing she will be more understanding and knowledgeable because she's been there.

Or like choosing a massage therapist. Some people want to avoid any semblance of a sexual vibe. Whether that points to a male or female therapist depends on you and your inclinations.

Many guys prefer female therapists. They find it easier to open up to a woman. There aren't many settings where men allow themselves to be emotionally vulnerable in front of other men. They don't want to start on the couch.  Or maybe that is exactly what they are after.  The ability to relate on a more emotional level with another man.  

Sometimes the preference depends on experiences growing up. I recall one friend who had a particularly critical father. She decided to go with a female psychologist. She didn't want to start out fearing or assuming negative judgements.

Other times our adult experiences shape our preference. An abusive female boss may lead a patient to choose a male therapist. Again, to avoid feeling judged. This is often referred to as "negative transference." When we make assumptions about or react to a therapist in a negative way because she reminds us of someone we don't like.

Sometimes it makes sense to choose a psychologist who is the same gender as the abusive or critical parent. Give yourself a chance to feel accepted, to feel comfortable with and understood by someone of the same gender as the critical parent. Therapy, for many, is often, in part, a re-parenting experience. Where the parent figure, this time around, accepts us for who we are and the decisions we have made.

I've been in the position of conducting psychological evaluations for children in need of therapeutic intervention and asked whether the child should see a male or female therapist. I recall one boy who had repeated negative experiences with various males in his life. I suggested a male therapist to help the child gain a positive, nuturing experience with an adult male. To help undo.

So it really just depends on the preferences and experiences of the patient. Of course, one of the most important considerations in is the expertise of the therapist. How experienced and expert they are at therapy. Feeling comfortable with the therapist is another. Does it feel like a "good fit?" Do we seem to "click" when we're in session? And no one will be a better judge of this than you.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas  

first session: what to expect

Clinician's differ to some degree, of course, but the first session is generally part "getting to know you" and "getting you to sign paperwork."

After the initial forms are signed, very often therapy begins with me explaining a little bit about my practice, my theoretical orientation, as it's called, which means the type of therapy I use in treating patients. I suggest my clients Google "Cognitive Behavioral Therapy" or CBT to learn more about my approach. A well informed client often has a head start in healing. I encourage questions throughout our meetings.

Then I move on to asking for a brief description of the "presenting complaint." What problem area brings the client into therapy?

The moment we've all been waiting for.

Sometimes I get pieces on the phone but will want to hear about the therapy issues in greater detail. This is where the box of tissues might come in handy.

From there I begin an evaluation that could take one to three full sessions.

I like to get the following, give or take:

- a history of previous therapy, counseling and psychiatric visits; what felt helpful; what didn't

- medical history including prescription medications, over the counter, nutritional supplements

- family of origin including history of mental illness

- education and work history

- relationship history: who have been the most significant romantic relationships and friendships

- trauma history

- current symptoms

- expectations and preferences for treatment; for example, individual (one on one), couples or family therapy; this could also include specific therapy expectations, such as a request for dream analysis or stress management skills

Not all mental health clinicians will begin this way. I cannot speak for all therapists, but most psychologists (who must have a Ph.D. in a psychology field as well as a list of other requirements) have been instructed (or should have been) to be thorough in assessment, diagnosis and treatment planning.

If you are contemplating starting therapy and wonder what you can do to help move things along, thinking about your family history can be a plus. Many people prefer to keep their therapy quest private and that's understandable. But filling in the blank spots of the "who's who" in your family of origin can help the therapist in the diagnostic process. Any parents, grandparents, aunts, uncles, siblings, cousins who have been diagnosed with a mental health condition? Someone who has been prescribed psychiatric medications? Antidepressants? "Nerve pills?" Has anyone had a "nervous breakdown," an unofficial term that can range from a depressive episode to a psychotic break? Blank spots are not uncommon and can be worked around.

The important thing is showing up, being yourself, asking questions, thinking about goals, being willing to consider recommendations, and trusting that this can work, that you can find a caring, listening, non-judgemental ear, and ultimately you can feel better.