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?
DEPRESSION
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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