National Resources

  • Emergency: 911
  • National Domestic Violence Hotline: 1- 800-799-7233
  • National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
  • National Hopeline Network: 1-800-SUICIDE (800-784-2433)
  • Lifeline Crisis Chat
  • Crisis Text Line: Text “START” TO 741-741
  • Self-Harm Hotline: 1-800-DONT CUT (1-800-366-8288)
  • Family Violence Helpline: 1-800-996-6228
  • Planned Parenthood Hotline: 1-800-230-PLAN (7526)
  • American Association of Poison Control Centers: 1-800-222-1222
  • National Council on Alcoholism & Drug Dependency Hope Line: 1-800-622-2255
  • National Crisis Line – Anorexia and Bulimia: 1-800-233-4357
  • GLBT Hotline: 1-888-843-4564
  • TREVOR Crisis Hotline: 1-866-488-7386
  • AIDS Crisis Line: 1-800-221-7044

Local Resources

  • Emergency: 911
  • White Bird Crisis Clinic, 541-687-4000. White Bird’s Crisis Center provides 24-hour emergency response for anyone dealing with a mental health crisis, including thoughts of suicide or self-harm.
  • Sexual Assault Support Services of Lane County (SASS), 541-343-7277. Crisis and support lines are available 24 hours a day to those who have recently experienced a sexual assault, survivors of past sexual violence, and for friends, families or partners of those victimized by sexual assault or abuse.
  • Womenspace, 541-485-6513. 24-hour Help Line for issues of domestic violence/relationship abuse.
  • PeaceHealth University District ER: 1255 Hilyard St., Eugene 541-686-7300
  • PeaceHealth RiverBend ER: 3333 RiverBend Dr., Springfield 541-222-6931

Grief & Growing Through Difficult Times

Grief

Feel to Heal

It takes an enormous amount of energy to remain stuck in chronic grief, resentment or sadness. Often, we try to resist these genuine emotions by keeping a stiff upper lip or a cheerful demeanor when we’re really seething inside. This is especially true during the times of the year when subconscious beliefs or difficult emotions surface, such as the anniversary of a death, loss, tragedy, or divorce. It can be made worse by worries we have ‘pushed back’ in our mind, old traumas and unresolved past issues. However, the present journey of grief can offer us lessons we can grow from.

What we Resist Persists

Instead of trying to talk yourself out of how you feel, harness the courage to acknowledge uncomfortable emotions. Accept your regrets, anger or sadness without remorse. Just let it be. Then let it go. Not only will your energy resurface, but you also will find sensible solutions to many of the to many dilemmas in your life your discomfort will evaporate like mist in the sun.

Look for the Positive

Every thought in our heads is accompanied by a cascade of biochemicals called neurotransmitters. In general, thoughts that are optimistic, grateful and loving result in “feel good” neurotransmitters called endorphins. The same “feel good” chemicals are produced during exercise, love making and meditation. By contrast, thoughts that are fearful, angry or hopeless increase levels of stress hormones, which make us feel tired, anxious, sad, overwhelmed, and irritable.

Fatigue, even depression, is a physical ailment. Yet changing the way you think can help restore energy.

Learning to focus on the positive can do wonders for energy levels as well as improve health and longevity. Research by Dr. Becca Levy, Ph.D., of Yale University shows that positive thoughts energize the body to walk faster. Furthermore, Levy found that an upbeat attitude toward aging extends life expectancy. It can provide the same kind of benefit as exercise, not smoking and having a healthy blood pressure, cholesterol and weight. Other research suggests that when people train themselves to feel love and gratitude regularly, their blood pressure normalizes, their heart function stabilizes and they have more energy. Learn to look at life challenges and struggles as challenges that will positively strengthen us over time. Avoid thinking that problems, or difficult and unfair situations, are useless and make no sense. Focus instead on how this can lead one to growing and developing emotional, physical, and spiritual strength over time.

Gratitude

One way to practice a positive attitude is by keeping a “gratitude journal”: Every day, write down three to five things for which you are grateful. Another strategy is simply to take notice when you fall into a “poor me” or martyred state of mind. Then do all you can to turn those thoughts around. Avoid thinking about the dramatic negative traumas/situations; focus instead on how these are normal learning experiences that will strengthen us. Seeing it as a positive gives one excitement and hope that is focused on the future rather than on the suffering of the present times.

Models and Frameworks of Therapy

Cognitive-Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy (CBT) is, perhaps, the most often requested type of therapy for dealing with difficult behaviors and beliefs. Ironically, when it was first introduced, it was ridiculed as being overly simplistic and inappropriate for clinical use. Over time, it has become the de-facto standard of choice for clinical treatment by therapists and insurers alike.

CBT relies heavily on the Socratic method of questioning, does not involve external beliefs by the therapist and often includes homework assignments to assist with change. CBT has been shown to be extremely effective with depression, anxiety and feelings of worthlessness/guilt.

As a therapeutic model, CBT assumes that behavioral variables are specifically influenced by the type of cognitions, or thinking styles, that are utilized by the patient. Dysfunctional cognitions, distorted cognitions, including negative and positive automatic thoughts and attributional styles (attributing negatives events to themselves and their actions), are seen as having a major impact on the ways in which the patient functions and responds.

Negative cognitions, and cognitive distortions, are seen as directly related to depressed functioning. The cognitive-behavioral therapist is more active in assisting, and challenging, the patient to examine the various negative cognitive distortions which impact functioning. The patient is challenged to check out issues in their environment, such as asking others not involved in the problem about how they perceive the situation. The goal is not only to change cognitions, but to make the patient an active participant in their own healing.

It is understood that examining negative cognitions may by itself not be enough to bring about a change. The lack of positive cognitions, and experiences, is seen as influencing maladaptive emotions. The cognitive-behavioral approach also involves issues of Rational Emotive Behavioral Therapy (REBT), relaxation, biofeedback, Eye Movement Desensitization and Reprocessing (EMDR), and similar techniques, all directed at specific active things that the patient can involved in doing and receiving various forms of feedback, or reinforcement, from accomplishing.

Non-depressed patients are seen as having more positive cognitions and autonomic thoughts. Research into the use of cognitive behavioral therapy supports its significant value in treating depression. The results of Cognitive-Behavioral Therapy are initially equal to the results of utilizing anti-depressant medications. However, the long-term results provide for superior sustainable outcomes for the cognitive behavioral approach to therapy.

Cognitive Behavioral Therapy (CBT) has been around since the 1950’s in one form or another and was pioneered by several individuals. Of worthwhile note are the contributions of George Kelly (1905-1967), Albert Ellis (1913-2007) and Aaron Beck (1921-Present). Before this, most psychotherapy consisted of variations on Freud’s Psychoanalysis, wherein past issues were considered to be the root cause of many of our problems.

In 1955, George Kelly proposed that anxiety, depression, anger and paranoia were the result of how we each interpret these feelings. Beck’s position and status in the field of academic medicine gave the additional credibility to CBT. Beck considered that our automatic thoughts often contained what he called cognitive distortions where our misguided interpretation of our own feelings and events were the primary cause of our issues. CBT continues to be developed and refined, however it is very popular with both clinicians and health insurance companies.

Ego Psychology Model of Therapy

This model of therapy admits that the patient does have pathology. However, this model looks to the Ego Strengths possessed by the patient. The focus is on how to build on these strengths. It avoids focusing on the pathology and the many problems that would be nice to solve. The focuses is on how to help in the here and now. It is a psychodynamic model of treatment that encourages, supports, directs and reinforces strength development. It focuses on behavioral shaping of even minor approximations of positive behaviors in order to increase their occurrence and frequency.

Managed Care Model of Therapy

The idea of a managed care provider focuses on the need to direct and focus the type of care provided. It includes the idea that only the most appropriate care is provided. It is concerned with cost-efficient, cost- effective, limited services. It has as its center a knowledgeable provider who manages and guides the patient in obtaining the desired goals. The provider is suppose to be aware of what may be the most effective way of finding a solution to the patient’s problem without over-utilizing other unnecessary services. The provider’s job is to educate the patient about their condition, the realistic alternatives, what they should expect from treatment, how to realistically obtain their goal, and help the patient make realistic choices about alternatives for treatment and obtaining the desired outcome(s).

Neuro-Linguistic Programming

Neuro-Linguistic Programming (NLP) assumes there is a connection between the mind’s processes (neuro), language (linguistic) and behavioral patterns learned through experience (programming) and that these can be changed to achieve specific goals. A neuro linguistic therapist analyzes the detail of the patient’s words and phrases used to describe their presenting issues in order to understand the underlying cause. The goal is to help remodel the patient’s thoughts and associations in order to re-order their thought process for a better outcomes.

Object-Relation Model of Therapy

The Object-Relation model suggests that the pattern of early parent-child interactions dramatically influences the individual’s capacity for intimacy. Adult relating patterns are established in early childhood. Distortions in relating to other objects (people) early in life results in dysfunctional relating later in life. Understanding early life relating patterns can help the professional understand, and predict, how the patient will relate in the present and future.

The model suggests that the therapist must be aware of the patient’s tendency towards the pathological use of psychological splitting. The tendency is to split good and bad parents in a negative dysfunctional manner. It is understood that this is an expected part of all interactions with the patient. The patient will tend to split one staff member, or therapist, against another, therefore recreating similar dysfunctional childhood relating patterns in the present.

Such splitting can result in one therapist being seen as the good parent and the other as the bad parent. Such splitting can happen in the relationship with just one therapist. It is important for the therapist, or staff members, to be alert to such splitting in order to stay united in their approach to the patient. The model suggests that there are specific stages of therapy which can be seen in the context of short-term or long-term therapy.

The Engagement Stage is the first stage and vital to the establishment of an effective relationship. If the patient is not engaged early and quickly in a relationship of trust, it is doubtful that therapy will continue for long. The Projective Identification Stage suggests that not only are certain feelings projected onto the person of the therapist, but that the patient induces the professional to react behaviorally in specific ways. Therapist have to be aware of vague feelings that something is not right. They may find themselves becoming irritated, angry, rejecting, aroused, overly-caring, or doubt their abilities as therapists. One must use their own countertransference in a positive diagnostic manner to understand the meta-communication presented in the projective identification. The Confrontation Stage is an important stage that can take place within a short period of time. It is important to remember that the goal of therapy is to help the patient to admit to the specific goal of their relational pattern.

Though the patient may not readily admit to their use of projective identification, they need help in understanding how they are impacting others. The therapist also needs to understand, and respond appropriately, to the projective identifications utilized by the patient. It is a time to utilize gentle confrontation techniques whereby the therapist can help the patient realize that there may be better ways of handling the situation in order for them to accomplish their goal. The therapist refuses to respond to the meta-communication demands. It is hard to not rush in to save a needy and dependent patient. The confrontation takes place as part of the interactional process. The therapist must only refuse to give into the patient’s demands, while all the time reaffirming the relationship with the patient. The patient needs to confront what they fear most, i.e., the loss of human contact with others.

The Separation Stage is where the therapist must realize that an important part of the therapeutic process, from the beginning, is to assist the patient in separating and becoming independent. It is a stage where the therapist recognizes that they must be constantly aware of the mixed feelings about separation experienced by the patient. Many times the patient’s angry responses, or relapses, are related to their fears of leaving the therapist and being on their own.

The patient needs help in attaching to social supports and experiences which can allow them to separate and be able to handle their problems in a more competent manner. The therapist must be aware that they need to guide and direct the patient towards this stage of therapy rather than focus on keeping them dependent in treatment too long. It may help to start, toward the end of treatment, to start to stretch out the time intervals between treatment sessions in order to facilitate the patient relying more on themselves before all supports are removed.

It is important to know that in order for the patient to receive the maximum benefit from therapy the therapist must continue the focus on the therapy relationship. Patients are rarely aware of the kind of messages they have conveyed in their projective identifications. The vital goal of this last stage of therapy is for the patient to be provided information about the way they are perceived by others. It is important to remember that the significant issues for the patient revolve around fears of abandonment, rejection, and splits between good and bad people and feelings.

Rational Emotive Behavior Therapy

Rational Emotive Behavior Therapy (REBT) is a subtype of Cognitive-Behavioral Therapy developed by Albert Ellis in 1962. The additional focus is on critical thinking wherein problems were thought to be the result of irrational interpretations of events (e.g., I should be…, This is awful…). This additional refinement to CBT can be an important asset in CBT.

Reframe Model of Therapy

This model of therapy does not rely on insight. It is a model that helps the person see the world somewhat differently. It is based on understanding things in the here and now. It is just a different way of looking at things. It’s use is a surprise to the patient, giving them something to think over. It does not look for the individual to acknowledge or admit to the reframe.

The reframe is promoted to fit with the patient’s experience and functioning. The reframe is not meant to change the patient, but only to help the patient see the world differently. The reframe model accepts the patient as they are in the present time, not as they could be. It accepts that patients will get what they want to get from therapy in the end, not what the therapist wants them to get.

This model is designed to assist the patient in seeing things in psychological terms in order to assist them in continuing to find psychological explanations in their daily experiences. The psychological reframe is seen as an early part of the therapeutic process which needs to start in the first session with the patient. If done in the first session it can help the patient to bond to, and be more productive in, therapy.

Reframing is used less and less as therapy continues, with a focus being an encouragement of the patient finding their own psychological reframe of problems they encounter. This helps to empower the patient in dealing with problems in their lives, as long as the therapist is subtle in the encouragement of the patient being able to reframe, and find solutions, to their own problems.

The therapist avoids any hint of criticism, or a well you should know by now response to patients who ask for help in the middle of therapy. The focus is to help the patient feel good about learning to explore solutions. It encourages the excitement of exploration.

Scanning Model of Therapy

As humans mature and develop, the initial tendency is to focus on small details. As one grows, gains experiences, knowledge, and meets more people, the individual slowly becomes aware of a greater horizon to be seen. With maturity and experience the effective therapist learns how to scan the patient’s environment to understand the total bio-psycho-social-cultural- vocational implications that relate to the patient’s current life and reality.

The experienced therapist scans the larger picture asking questions upon questions about the vocational, social, family, marital, motivational, along with the practical here and now issues of what will help to return this patient to total functioning as soon as possible. The experienced therapist is aware of the tendency in therapy for one to focus on small details of the patient’s psychological reality while ignoring the larger picture of reality in which the patient resides.

Scanning the larger patient reality helps to keep the therapy, therapist, and patient, aware of the need to see all aspects of the patient’s functioning and life. Such scanning allows the therapist to comment, push, and point out areas of problems, or avoidance, presented by the patient. The scanning model also requires that the therapist always has an understanding the beginning, middle, and ending points of therapy so that they are constantly aware of where they are going in the treatment process.

Task-Centered/Focused/Outcome Model of Therapy

This model is active, focused and directed. It is concerned with the task at hand. It keeps a focus on the bottom line. It keeps the patient responsible for their own life and their own natural and logical consequence of their actions. It is time-limited, problem-limited, task-centered, and is limited to a specific outcome.

This model keeps the focus of treatment related to the outcome(s) desired and needed. It requires an active, verbal, directing therapist. It keeps a focus on the beginning, middle, and ending phases of therapy within a time-limited framework. It sees the initial Phase of therapy as developing a relationship, defining goals and directions for therapy and establishing an agreement, or contract, for how therapy will proceed within a time-limited period. This helps to focus therapy in a quick active manner.

The second phase of therapy is seen as assisting the patient in self-exploration until an understanding of psychological realities is established. Once this is accomplished the therapy quickly shifts to assisting the patient in finding alternative coping strategies rather than becoming stuck in resolving all problems through in-depth therapy.

The third phase of therapy is designed to assist the patient in disengaging from therapy. There is a realization that symptoms may worsen as the patient moves towards termination. The therapist focuses on the patient taking risks, becoming more assertive, dealing, and managing, the realities of their world. The goal of therapy is to assist the patient in learning how to manage their world, and others, rather than having the patient wish that the others will change on their own. This step empowers the patient in dealing with their fears of the world. In all of this the therapist is very active, directive, and focused on moving the treatment process forward.

Separation-Individuation Model of Therapy

This model understands that the organism is always growing, dividing and changing into a distinct human being. The model suggests that the therapist searches for experiences that will help the individual move from a dependent to an independent person. It sees the person’s need to separates and be his/her own person. It sees the need to be a separate individual. It creates experiences that force and focus the individual on being, growing, and having experiences that allow the patient to cope and feel confident in their own abilities.

It looks to push the individual into taking risks. It blocks the individual from avoiding problems or issues. The focus is instead on avoiding anything that will keep the patient in a dependent relationship. This model allows the therapist to be aware that the patient needs to struggle between the normal issues of dependence versus independence.

At times the patient will need to find fault with the parent/therapist in order to fully separate and find their own independent identity. This struggle can be minimized if the therapist works to establish experiences that allows the patient to move out on their own. Additionally, the struggle is minimized if the therapist, and others, do not react to the normal developmental struggles, adolescent fault finding, and normal psychological splitting between good and bad parents/therapists.

It acknowledges the fact that as the patient matures they will find therapy to be less and less helpful, or necessary, in their lives for a particular developmental phase. They may even tend to minimize the helpfulness of the process of therapy to their development. It acknowledges that as the patient nears termination there is a tendency for symptoms to worsen, for the patient to become more dependent, and for parents, and therapists, to question whether the patient is really ready to leave home. It accepts the termination regression period as not being a sign of a lack of being ready to leave home. It understands that separation brings out our fears of surviving on our own.

Solution-Focused Brief Therapy

Solution-Focused Brief Therapy (SFBT) is another subtype of Cognitive-Behavioral Therapy. SFBT focuses on what patients would like to achieve through therapy rather than on their troubles or mental health issues. By envisioning a desirable future, the goal of SFBT is to help you map out the specific changes necessary in order to achieve your desired outcome. With this technique, it is very important to focus on successful experiences in order to promote encouragement rather than dwell on problems or limitations. SFBT is important in that it focuses on goals and outcomes rather than in endlessly dwelling on the past.

Winnicott Good-Enough Model of Therapy

A good-enough therapist is much like what Winnicott defines for a good-enough mother. The good-enough mother seeks to provide for the child’s needs. She works hard initially to gratify needs that the child cannot meet for themselves. As the child slowly becomes able to do more on their own, the mother does less and less for the child. The mother slowly frustrates the need for full gratification, allowing the child to learn from their own experiences through logical and natural consequences.

The parent/therapist is still good-enough as she does less and less for the child (patient), though she stays in close supportive proximity to the child. The parent/therapist constantly is aware of what will help the child (patient) grow, and promotes more independent functioning. The parent/therapist sees the importance of the child (patient) needing to be an active doer rather than solely a passive receiver.

The therapist’s job is to promote growth, independence and action, avoiding any promotion of dependence after the initial brief beginning of the first few sessions. The promotion of independence by parents, and therapists, requires an active approach where the therapist works, and comments, on tasks that encourage growth and change designed to fit specific psychological developmental levels.

What is Gottman Method Couples Therapy?

Some patients prefer to use a specific type of Relationship Counseling called the Gottman Method of Couples Therapy. Based on Dr. John Gottman’s research from the 1970’s, this type of therapy is designed to help teach specific tools to deepen friendship and intimacy in one’s relationship.

Officially, the Gottman Method of Couples Therapy relies on a specific structure and approach. Which is interesting in that Dr. John Gottman is also a vocal advocate for making modifications and adaptations to his techniques as each therapist sees as appropriate.  The structure involves a series of assessment phases, followed by treatment and then specific termination sessions phased out over a period of time. During different phases of therapy, the therapist works with the couples together to help them appreciate the relationship’s strengths and to gently navigate through its vulnerabilities.

Two of the main reservations that I have about this technique are that it is built upon correlational-based evidence (as opposed to cause-and-effect) and that in its popularity, it has become somewhat larger than life (emphasis is often placed on the brand name itself rather than the specific techniques involved). However, it is a solid and well-founded theoretical framework that I have found to produce reliable and consistent results.

In the assessment phase of couple’s therapy, couples are given some homework and/or written materials to complete that will help the therapist better understand the couple’s relationship. Once the issues and goals for therapy have been identified, the real work of treatment can begin. Most of the work will involve sessions where both partners are seen together as a couple. However, there may be times where individual sessions are recommended. The therapist may also give exercises to practice between sessions.

As the couples progress in their relationship, the couples will begin to phase out of therapy and meet less frequently. This allows the couple to test out their new relationship skills, to make sure that it is not too soon to stop, and if successful, to prepare for the termination of marital/relationship therapy. Although couples may terminate therapy whenever they wish, most find it to be helpful to have at least one session together to summarize progress, define the work that remains, and say good-bye.

This termination session gives the couple a sense of closure and helps to remind them of their new skills and need for continuing to practice these skills. Finally, in order to prevent falling back into old habits, the couples arrange to meet with the therapist again after six months.

How NOT to Talk to Your Doctor

In order to understand how to best talk with your doctor (or psychiatrist, psychiatric mental health nurse practitioner, or other medical provider), you need to know one very important concept: Your doctor wants to help you!

However, as healthcare costs continue to rise, there is a push for doctors to see as many patients as they can. This can frustrate even the best doctors, and happens more often than not. Also, doctors are human beings and despite our expectations, they tend to dislike displays of unpleasant emotions, disorganized patients or those that make them feel as if they must “fix” everything, “or else”.

As a result, it is not uncommon for doctors to be limited in the time that they can spend with you. Because of this, we often leave our appointments feeling unheard or, occasionally, unwelcome. We end up putting off additional appointments, minimizing our symptoms or simply not presenting well when talking to our doctor.

Well-meaning patients can end up making things worse, despite our best intentions. Our expectations and frustrations with the healthcare system can end up making us anxious and, as a result, a “poor storyteller” of our problems and symptoms. Sometimes our fears of being judged or being thought of as a “terrible person” or being seen as “weak” or even “difficult” can keep us from sharing important details.

Or, as is often the case, we are simply exhausted by our suffering. We hold things together until our appointment, and then we end up “falling apart” in front of the doctor. Without presenting things in a straightforward and direct manner, we often run into problems getting adequate help for our symptoms.

So WHAT can we do to fix this? As with all things, you can only control the things you can control. We can try to “fix” the system, but this is difficult even in the best of times and would take longer than we want. When we need help from our doctor, the last thing we need is another problem. Since we can’t control the system, we can at least control how we talk about things with our doctor.

What follows, then, is a list of things that you should NOT to do when working with your doctor. Your mileage may vary, however these “rules” have been found to be true over and over again, both by patients and medical professionals.

Whimpering or Whining

When we’re sick and in pain, sometimes our voices take on a whimpering, whining quality. No one likes to listen to whining. If you have children, you know that you’re more apt to ignore the pleas of a whining child than one who makes his requests in a normal conversational tone. Even though we may not realize it, we tend to give less credibility to someone who whines – be it a child or an adult. You may not even be aware that you sound whiney at times. If you have any doubts, ask a family member who will be honest with you. When you talk with your doctor, you want your voice to sound calm and rational.

Stay Away from Exhibiting Behaviors

These are the behaviors that we do to show we are suffering, hurting or in pain. If we’re extremely depressed, we end up being very quiet and withdrawn. If we’re full of panic and anxiety, we tighten our muscles and start breathing rapidly. Those suffering from chronic pain end up rubbing their back, groaning, moaning or walking with a limp. While it is normal and natural to want to do these things while you are suffering, it gives less credibility to your illness.

However, this does not mean that you should hide your symptoms. The goal is to avoid making your doctor sorry that he or she stepped in the room. Overly excessive displays of emotion and pain take the focus away from the conversation and end up hurting you in the long run.

Don’t Over-Do It

Since your symptoms are invisible, it is important to remember that the physician is looking for ways to make the problems real. One of these ways is to ask you how you are feeling on a scale from one to ten: Typically, one being low and ten being the worst thing you have ever experienced. This can be done for depression, anxiety and even chronic pain.

Now, before you think this is a simple question… it is actually a test to bring credibility to your symptoms. Proceed with caution when answering this one. Ten should only be reserved for “can’t breathe, barely alive” types of symptoms. Many people will rate their symptoms above a ten… say, a fifteen. This is a red flag for your doctor because research shows that those who rate their symptoms at ten or above may be exaggerating how they feel.

On the reverse side of things, don’t over-think things. If you choose an answer of, “6.5” or “between a six and a seven,” your doctor may think that you are over-analyzing and may wonder if some of your symptoms are “in your head”.

What we often forget is that using numbers to describe how we are feeling is very useful when talking to a medical professional. Saying that you have been feeling “very sad for a while” is not as effective as saying, “on a scale of one to ten, I’ve been feeling about a 6 for the past two weeks.” Some patients even use an old- fashioned paper calendar to write down their numbers (whether for depression, anxiety, chronic pain, etc.) each day and then bring this in with them to their appointment for “show and tell”. Surprisingly, this is very effective and gives you both credibility and prevents you from not adequately describing how you’ve been feeling.

Crying

We all know that when we are suffering, we tend to become more moody, irritable and emotional. As true as this may be, the more emotional you are when talking with your doctor, the more he or she may label you as “histrionic” and discount your story. You deserve fair treatment, and to ensure this, practice deep breathing so you don’t cry during the office visit.

This can be especially difficult for those suffering from severe depression. If it can’t be helped, then it can’t be helped. However, it does take valuable time away from being able to tell your doctor about your symptoms so that he or she can give you the best type of care. Ask yourself, would you rather walk away with a hand full of Kleenex or a revised prescription that might be of help.

Your Doctor is not Your Best Friend

Even though you are getting to know your doctor quite a lot lately due to how often you see him or her, remember, they are still not your therapist or friend. This also holds true for psychiatrists and psychiatric mental health nurse practitioners. You are paying them to be your “medical professional”.

Worse, you end up putting them in an unrealistic position. They have a job to do, and if you start treating them as your “best friend,” chances are that they will disappoint you and you will end up with a “bad feeling” about the relationship as a result. Your doctor does care about your well being, but they are not in a position to be your “best friend”.

Explaining and Talking Too Much

As it was told to me by one doctor, “When I ask a patient about his or her symptoms, I am not looking for a long story… I want a short, to-the-point answer.” Just like the old show Dragnet, it should be, “just the facts Ma’am, just the facts”. This is where coming in prepared will help.

This also is important in providing documentation. If you walk in to your appointment with a five-page, single-spaced and typewritten description of your symptoms, how they have made you feel and how unfair all of this is, your doctor’s eyes will start to glaze over. Keep it simple and straightforward.

Keep your list just like a resume: It should be no longer than one page. Perhaps filled with single-sentence bullet points listing the important parts. You should assume that whoever reads it will spend on average only about 10-15 seconds on it. Your writing style should reflect, and not challenge, this reality. This can mean the different between walking out of your appointment with nothing changing and the doctor saying, “Hmm… I had no idea your symptoms were still bothering you. Let’s increase your medication.”

Another aspect of this is the “handwritten on the back of a napkin” approach towards documentation. NO ONE wants to be handed a napkin with potentially illegible writing on it. It looks rushed, as if you just made up your list of symptoms on a whim. Your doctor may consider this evidence of disorganization and approach you differently.

Finally, a new trend is for people to keep their list on their smartphones. While convenient, handing your doctor your phone doesn’t help him or her as well as a printed out piece of paper. Chances are they will glance at it and the majority of what you’ve written down won’t end up getting across.

What to Do Instead

After reading this, you might be asking yourself if there is a list of things that you should do with your doctor. Indeed, there is. It’s a short list, given that many of these items have previously been covered here. Some of the essential highlights to keep in mind are:

  • Patients with the most success in working with their doctor tend to be the ones who are more “scientific” about their situation. They keep track of their symptoms, are organized, and are able to provide concrete and specific information without a lot of extra “jibber jabber”.
  • Bonus points to those who bring this documentation with them to their appointments to show their doctor, whether this be in the form of a diary or simple markings on a calendar. Be organized, be inquisitive, and above all be honest with how you are feeling.
  • Doctors tend to be encouraged when a patient is curious and inquisitive about their condition. This shows that you are taking ownership of your situation and are willing to do whatever it takes to make things better.
  • Finally, if you have difficulty remembering what your doctor tells you, take notes. Again, bonus points if you bring your own pad of paper and pencil with you rather than having to ask the doctor to find one for you. This shows, you guessed it, ownership.