Thursday, March 23, 2017

Why I Want To Know Your Mental Health Diagnosis; And Why That's Not A Bad Thing

Why I Want To Know Your Diagnosis; And Why That's Not A Bad Thing -
Recovery Empowerment Tips For 5 Mental Health Diagnoses - A Two-Part Series

Part One: Rationale For Using Diagnosis In Recovery And Empowering People With Depression

Don't assume all mental health workers use diagnosis to put a label on you and treat you like a label. I'm sorry if that happened in the past.  That does not mean that all workers do this all the time.

We work in a medical system and diagnosis is part of that system. People are people and there are always going to be someone who does not treat you right.

I come from a standpoint that consumers aren't  victims of the system, even if the system is seen as 'bad'. Even if the system is "bad", that does not means all workers are uncaring and hold you back in life with a label because they use your diagnosis.

Give your worker a chance. Don't presume to know what a mental health worker thinks about your Diagnosis. What I think about is, "What is the best way to give this client hope and empowerment so they won't need me as much?"

I'm a consumer too and so are two  of my family members. I feel I have a right to express my viewpoints on the topic. I'm with you. I'm on your side. But sometimes I get passionate about things that may seem controversial. Give me a minute to explain and I think you'll agree that I'm doing my best to help you, and I can help you best when I have an accurate diagnosis.

I have a Masters degree in counseling psychology. I worked hard to get an education to be able to help people in and out of the 'system'. I'm one of those people who grew up in the system and went off to college to figure it all out.  I came back with my knowledge and experience to help others because I know what it's like.

I Never Felt My Diagnosis Was A Label. My Diagnosis Was My Ticket To Freedom.

Finally I had a name to make sense of chaos and figure out what baffled me for decades. So I'm a big believer in having a (correct) Diagnosis.

It's only a bad thing if you assume that your Diagnosis label makes me think automatic thoughts about you. Some workers may have those thoughts, society may have those thoughts, but I don't.
Remember that's "all-or-none" thinking and "generalizing" a bad experience to all new experiences. That might even be your depression talking.

Keep in mind also that things have changed. The system has evolved. There's more consumers "out of the closet" and we're normalizing mental health in general and blasting through stereotypes and stigmas on a large scale these last few years. So don't be a hater of Diagnosis.

Respect The Care And Years Of Research That Has Gone Into Trying To Help People By Organizing Symptoms Into Diagnoses. Embrace It All.

The director of one of our mental health community centers said, "The diagnosis framework  should be used as a starting point, and not as a label", and I agree with that.

Think of diagnosis as a constant and everything else is a variable. Meaning that diagnosis stays the same although the workers and the consumers and the circumstances and society are always in a state of change. Diagnosis may be the one thing we can lean on as a constant in a sea of change.

As individuals, we're are all unique and constantly evolving. Time is always going by. The System appears to be outdated at times, but over time it catches up and integrates the wisdom and experience of all its workers and consumers and offers up some of the best wisdom and insight into the Human being as you can find.

Your Dx does not limit you in my mind or box you into a category. It empowers me to help you the best I can in the shortest amount of time available, which is critical in the system. I don't have one hour a week to devote to you and your case like a therapist would.

I have a short amount of time to develop rapport, get a feel for your Dx and Sx and then decide what will best help you today and for the 30 minutes every 2 months I get to see you. (And remember, the doctor sees you for 15 minutes every 3 or 4 months, so s/he has to rely on the Dx framework to know how to treat his/her patients.)

Those 30 Minutes You Have With Me Should Be Packed With 2 Months Of Information To Work On So That You're Already Starting To Recover.

You should leave with a sense of hope, and a real plan of action. Maybe for the first time, the opportunity to change your life around.

When is the best time to start introducing a recovery plan? At intake, at the first introduction and always in your mind. What's important is how you go about it.

I will validate you, empathize with you, support you, be interested in you, and listen to you, until you able to listen to me and the personalized, empowering, psycho-education I'm about to give you that will change your life for the better.

The reason why I focus on recovery according to your diagnosis or set of symptoms, is that I know, I won't always be there for you, but your diagnosis and your recovery plan will.

Therefore, its best that I equip you with a plan and tools and a pathway - and the confidence - to create your own recovery routine. And it's best that you know what your diagnosis is so you can manage it the best way you can too, so education on your diagnosis is part of accomplishing your recovery goals.

So here are the 5 'acceptable' Dx that Medi-cal will pay for and here is why knowing which one you are will help me help you so much better, rather than wasting months or years of your life just being a 'support person', which is healing in itself and better than nothing. But why stop there when there is so much more you could be doing?

I Can Feed You "Fish" Or I Could Be Teaching You 'How To Fish' So You Are Not Dependent On Me Forever.

You will become aware of how to get support for yourself which is more in line with your real "everyday life",  which in turn helps you not be so dependent on a system.

So,… would you be willing for me to Tx you for your Dx in exchange for empowerment? 

Would you be ok with me using labels for your own good? 

What do you think people would rather have if given a choice: a half hour of venting or a half hour of being empowered?


When people have depression they need to jump right into the wellness & recovery model because they need to get into action, and stop ruminating which means not thinking and talking about problems but doing wellness actions and daily routines .

What depressed person wants to start taking action after months of procrastinating, inactivity and isolating? What depressed person even has the energy to do that? Not many. 

So the first step is finding how to motivate or interest them in recovery. You've got to sell them on the benefits of recovery but you can't do that if you don't have their trust and interest.

So the first step toward that is rapport and acknowledgment. I have to let them know that I know how bad they feel and where they're at or I won't have much of a chance getting them to listen to me on how to change.

I have to say out loud that I know they are depressed.  I let them know I "get it" by saying that I know what it feels like to be depressed. I share and talk about how there's no energy, lack of interest, no joy, flat and then emotional, and fighting with your head and inner critic all the time.  Even though it seems like we're focusing on all the negative stuff.

I'm talking about THEM and no one else understands THEM or their depression, so when someone comes along who does understand, then it gets their attention.

Now They Are Smiling And Nodding Their Head Because They See I Do Get It And Know Exactly What They're Going Through.

I'm also giving them sorely needed answers and explanation of things that they are confused about. I teach them about the symptoms and what they're called.

I make sure to say "The hardest part about depression is battling your own head that's beating you up". And that may be the first time someone has articulated the vague mental imprisonment of the shame and helplessness they've been experiencing.

So they're like, "Oh my god, she gets it, she knows what I'm going through. She understands what I dare not say out loud to anyone. Maybe she's got more answers and knows a way out of this."

I talk about the downward spiral of depression, how you feel bad and do less and feel worse and do even less and down they go deeper into depression. They nod their head a lot.

Then I share what works to help stop the downward spiral and start the upward spiral and this leads into their interests and strengths and talents and what they really want in life. Now I see them paying close attention with a look of curiosity on their face. This is a good sign because  with depression there is a loss of interest.

They see it makes a strange kind of sense but they never thought about it like that. They didn't know there was a spiral and that it could be reversed. Maybe their depression made no sense and there was no rhyme or reason to it, and now they hear their symptoms being organized into a label that may also come with recovery instructions.

Mainly I help them with their inner critic and self-doubt, which gets them interested because again, they thought they were trapped, stuck and a victim of the inner critic and have no way of fighting it because they assume all those thoughts are true.

I Teach Them How To Catch Their Depression In The Act And Say, "Ah Ha, That's My Depression Talking. What Does My Wise/Higher/True/Recovery Mind Say?"

I teach them the art of re-framing negative thoughts.

I still validate and non-judgmentally say that the emotional part they're going through is hard, and yes, it is very hard to start trying something different, but we can start with baby steps,  and I move right into  asking, "So what are you going to do for your recovery this week?"

Action in the now and the in the near future, is always the focus. Sometimes they balk and resist and doubt they can do anything. That's when I ask them to just spend 5 minutes this week doing one easy thing.

I give them my list of 81 easy, gentle, no-cost, self-nurturing activities, like star gaze, paint, day dream, bubble bath, walk in nature, listen to your favorite music, play with animals - things that make them feel good just reading about. I tell them to circle all the ones they like, used to like, or would like to try.

Pleasant Activities That They Might Not Have Done In Years That Brings Up Old Memories And Feelings Of Well-Being As They Read The List.

While reading the list, it starts to feel easy. It starts to bring up memories of good times and reminds them that these things are not gone, they were  just forgotten for awhile. The brain is already starting to heal as a result of seeing these soothing activities on paper because as they read each one, they are seeing them with their mind's eye.

This gives then a good feeling. That may motivate them to do some activities which will give them an even better feeling when they do them in real life.

I teach them how to pause and really take in those pleasant experiences, and let the good feeling linger for a few moments. Feelings of well-being strengthens the neural pathways in the brain, which in turns brings some relief from depression.

So the healing and recovery have already begun without them having to do a thing but listen, read a list, and see themselves in their mind's eye doing some nurturing things that feel light and easy and not  impossible like huge list of things- to-do would feel.

Next is social support. Isn't it great talking to someone who gets it who does recovery? Yes, they love talking to me about it, but they instantly resist the thought of showing up to a group where more people like us are talking about it. If they went, they could get more support, more validation and more recovery ideas.

But their depression and negative self talk takes over again and say "no, I can't do groups".
If I could get every depressed client in a room who says they hate groups, we'd have a huge group! 
They'd all have one thing in common and it would be an excellent support group for depression. 

So I did just that. I created a depression art group so my depressed clients can get social support while relaxing and coloring and talking about what they're doing for their recovery. It's once a week and they can drop in anytime and it counts as a visit if they want it to.

This Is When They Discover They Are Not Alone And They Are Not The Only One.

I focus on where they can find people who understand depression and how to connect with them. I avoid focusing  on people that don't understand them or don't have recovery. No matter what negative thought they throw at me, I accept it, even agree, but in moving forward I'm focused on planting seeds for them to have a better experience with people.

This also lets them know that there are others out there. Most depressed people like other people, they enjoy talking to someone knowledgeable and who understand and have recovery

"Just think what it would be like if you could talk to more people like me who have recovering from their depression."

Most still won't go to group and that's OK. I've planted a seed that I am not the only one who "gets" depression. There are others out there. Millions in fact.

This opens their mind and expands their limited often negative view of the world. Most people suffering from depression are criticized, neglected or rejected because of it. They don't feel like dealing with people or forcing a smile or dealing with social anxiety. They don't feel like dealing with people who might trigger them into irritability either.

I let them know I have confidence and faith in them and their abilities to be able to get there, however slow, because even though most people don't get them, like-minded people who understand - like me - are cool and they tend to agree because I've been demonstrating it this whole time.

Even If They Have To Take Baby Steps, They Got To Do Some Recovery Actions If They Want To Crawl Out Of The Black Hole They've Been Stuck In.

Or they can do nothing, let their head take over and go deeper in the hole.  I don't have to tell them, 'if you don't do recovery, things will likely get worse' because they already can infer that from the up and downward spirals I educate them about. They can see the downward spiral operating in their life already and now they know how to get that spiral to move upward, if they want, because I've explained to them that the more you do, the better you feel, which inspires you to do more and you feel proud of yourself for doing it and having happy moments enjoying life again from doing so which inspires them to do more. Do less feel worse. Do more and feel better.

I'm Giving Them A Choice They May Not Have Had Before. I'm In No Hurry For Them To Make It.

There's never any pressure to do anything, only encouragement . I just present the information so  they can clearly see the two paths that lay before them; keep doing the same things and get worse or start doing recovery and feel better.

Since you can make yourself feel better just by playing your favorite music or taking a daily walk or losing yourself in coloring, or getting a goal accomplished, or reading about recovery or practicing a craft that you're interested in, it doesn't seem so hard anymore to give recovery activities a try.

Already they can feel a relief, their depression has lifted because recovery has already begun in my office.  (Remember they perked up when I spoke their language, understood and validated their depression. They got a hint of hope when I educated them on the upward spiral. While reading a list of self-nurturing activities they remember or can imagine feeling good ).

Sometimes you can see them fighting with themselves about it, because they hate to admit that they can feel better and they can do something about it. They resist change which is why it's so important to get their interest first and validate them.

They're so conditioned to think the worker will counsel them and help them analyze their woes or that a magic pill will be all they have to take. They may not be used to getting empowered to take responsibility for themselves by choosing wellness actions.

They felt better when they imagined themselves doing some of the stuff on the list, and they have someone giving them permission to do things they would otherwise skip, or think was a waste, or self-indulgent or they lost interest. But now someone is giving them homework to do things depressed people like to do, like star gaze, read, color, etc.

 Depressed people love to spend time alone in their heads thinking or dreaming, and now they get to do it for homework. They begin to see a little light at the end of the tunnel, they got a taste of feeling good for a few minutes, and that's enough to feel that recovery may be possible for them if they keep this up.

If I were to let them vent and ruminate the whole time they would have missed all that and went home and did the same routines and would still be stuck in depression.

As soon as they leave, they leave wanting more of what they just experienced which motivates them to go home and do something different, which in turn gives them a good experience which then makes it easier to do the next thing.

The next session is really all about what barriers came up so I can give them tips on dealing with those barriers so they can go try it again. More empowerment.

I'm empowering them to know how to deal with their own inner critic and how to take control of their lives.  I tell them they are doing good and to keep going. I'm their cheerleader and teacher and I don't let them beat themselves up because it's not their fault they have depression and its hard and they failed to do anything.

I simply encourage them to do one item they've circled for five minutes once per week. I don't worry about what they failed to do, I'm always future-pacing to the near future to try it again. Most of them report back that they did some of them and they did enjoy them. I keep encouraging them to keep that up by telling them they're doing good and I'm proud of them.

I ask them about their strengths and their recovery actions at each visit. And it goes from there. The whole point is getting them to play an active role in crafting their life in recovery and reaping the benefits of wellness.

It's like teaching them the controls and now they know how to turn down their depression and turn up their wellness and pleasant feelings.  Officially this is called "behavior activation" which is opposed to traditional "talk therapy" for depression as it exasperates their rumination. They think they need talk therapy, they are dying to sit and talk about their depression.

I always give them some time in the beginning to talk about it, but then I redirect them to what helps all that by re-framing depression as a battle with the inner critic. They didn't know they could do something about it. Heck, they didn't know it was their depression and inner critic even talking when they had all those negative thoughts.

Depressed people are usually creative so when I talk about music or art that sometimes gets them sharing how they write poetry or music or used to paint.

I Encourage Them To Do Their Art Again And Ask Them To Bring It In Next Time So I Can See It.

No one seems this interested in their art and their inner critic certainly beats them up over the idea of doing it for fun and relaxation. Talking about art as recovery motivates them to partake in their crafts again. I love to see their stuff. I always find their strengths in them and make sure to mention them out loud and give them genuine compliments on their work.

They feel good about that so they feel better. They may go home and go back to being depressed for awhile, but  I keep giving them positive recovery experiences when I see them. I'm pointing them over and over again to craft their recovery plan and incorporate all these feel-good activities into it.

Almost every client despite their diagnosis gets most of the tips above. But if they have a diagnosis other than depression I go into the tips in Part Two for Bipolar, Trauma and Schizophrenia.

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 Thank you!
JP Bailey, M.A.

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