Counseling

Summary

Consider:

• Professional quality
• Organizational quality

Finding a good fit to help with a mental health or substance use issue can be hard. You have to consider accreditation, quality, cost, program philosophy, insurance, and more. Here are a few ideas to help you get started:

• Ask your doctor, a friend, or others you trust if they know of a program. Where would they take a loved one who needs the same care?
• Call expert organizations and your state and local health care groups. Ask for a list of member clinics and credentialed experts who can help.
• Check with your mental health insurance group on approved clinics. Your employee assistance program (EAP) can also help.

Professional quality

There are many types of people who can help:

• Psychiatrists are medical doctors who can give meds and talk therapy.
• Addiction medicine professionals are medical doctors who have training in the diagnosis and treatment of addictive disorders.
• Psychologists have a doctoral degree and can give one-on-one, group, and/or family therapy. They can also test and do other assessments as part of the review or treatment process.
• Other therapists often have a master’s degree in a related field. They can give assessments, one-on-one or group counseling, and discharge planning. This includes:
• Licensed clinical social workers (LCSW)
• Advance registered nurse practitioners (ARNP)
• Licensed mental health counselors (LMHC)

Check your state’s licensing board website or the National Practitioner Data Bank for more info. Find out:

• What is the program philosophy and treatment goals?
• What are the expertise and credentials of the staff? What is the level of experience of the medical or clinical director?
• Is there support for the family?

Organizational quality

Two of the most influential organizations that accredit and certify standards of quality for hospitals and mental health clinics are:

• The Joint Commission (also known as JCAHO)
• CARF International (formerly Commission on Accreditation of Rehabilitation Facilities)

Both are independent, not-for-profit groups that set the nation’s standards in health care. They each research and create professionally-based best practices. They also test the quality and compliance of health care centers.

With these groups in mind, ask:

• Is the center or program accredited? By what group(s)?
• Does it offer a full range of care needed for the diagnosis and treatment of a specific condition?
• How long has it been under its current management?
• Does it take your health plan?
• Are there extra costs for doctors, testing, etc.?
• What are the visitation rules?

It may sound like a lot of work, but more info will help you find the right path to recovery for you or your loved one.

Resources

American Addiction Centers
https://americanaddictioncenters.org

CARF International
www.carf.org/home

National Practitioner Data Bank
www.npdb.hrsa.gov/

The Joint Commission
www.jointcommission.org

By Drew Edwards, M.S., Ed.D., and Andrea Rizzo, M.F.A.

©2005-2019 Carelon Behavioral Health

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

• Therapists are covered under the same federal privacy rules that apply to other health care providers.
• In general, a therapist cannot disclose information about a client without that person’s consent.

In the field of talk therapy, strict privacy rules exist for a reason. Diagnosis of an emotional disorder is a private matter. Therapists routinely learn little-known facts about people’s lives. If you go into treatment, you can feel sure that your information will stay between you and your therapist. Knowing more about the guidelines which keep your condition or your thoughts private may help you make better choices about your care.

Laws and codes of ethics protect your privacy, but only to a point. Knowing the rules which guide confidentiality and their limits is important. To begin with, therapy must start with trust. This is a clear understanding of who has a right to your private information. You also have a right to know your therapist’s own policy.

The federal firewall: HIPAA

Health plans and most doctors fall under the privacy rule of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA protects “individually identifiable” information such as your health and claims records. Normally, your employer cannot see it. But it can be shared with others to coordinate care and protect public health. The police can see it if there are signs of a crime, such as a gunshot wound.

HIPAA has tighter rules for your therapist and the notes taken when talking with you. With rare exceptions, your therapist cannot show these without your consent, even to a health care provider.

HIPAA does not cover all doctors. It governs those who send electronic bills for payment to private plans, Medicare, or Medicaid. That should include any hospitals or doctors you are likely to use. Even if your doctor uses paper billing, they most likely file electronically.

NOTE! HIPAA may not cover a provider who doesn’t take payment from health plans. If you go to a provider outside your plan, ask if HIPAA applies. If it doesn’t, make sure you know what privacy policy exists.

Ethics add protection

Psychiatrists, psychologists, counselors, social workers, and nurses all have their codes of conduct. These are clearer than HIPAA about the needs of people in therapy.

Privacy protection applies to individuals. This is a good thing to know in couples or family therapy. When two or more people are in treatment, what one says in private should not be passed on.

None of the privacy rules in the law or ethics codes are ironclad. A therapist has to obey a court order to share information. And codes give therapists some room to tell details when consulting with other doctors on a person’s case. Even then, the therapist is told to share only as much as is needed to give proper care. The main rule is, “When in doubt, don’t disclose.” If you are in therapy, know this rule applies to you.

Resources

For details on HIPAA and how it may apply to you, go to this HHS consumer brochure at www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf.

HHS also has a review of the HIPAA privacy rule at www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html.

To see the confidentiality codes for therapists of all types, you can start with the Zur Institute’s list at www.zurinstitute.com/ethicsofconfidentiality.html. The Institute is an online educational site for psychologists, counselors, and other professionals.

Here are some codes for specific professional groups: Psychology (American Psychological Association), www.apa.org/ethics/code/index.aspx (see Standard 4, “Privacy and Confidentiality”).

By Tom Gray

©2012-2019 Carelon Behavioral Health

Source: U.S. Department of Health and Human Services, Office for Civil Rights; American Association for Marriage and Family Therapy; American Psychological Association; American Psychiatric Association; American Counseling Association

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

The most common types of therapy to treat depression are cognitive-behavioral therapy, interpersonal therapy, and psychodynamic therapy.

There are many helpful treatments for depression. One of the key things that add to care that works is getting professional help right away. An added benefit of quickly seeking help is that it can also avoid it happening again and again. There is no need to feel badly. There are proven methods to help it.

Types of therapy

The most widely used methods to treat depression are medications and counseling.

Counseling does not rely on medications. Just as there are many types of medications, there are several kinds of counseling. The three most widely used to treat depression are cognitive-behavioral therapy (CBT), interpersonal therapy (IPT) and psychodynamic therapy.

A licensed clinical psychologist, licensed clinical social worker, or licensed clinical counselor has specialized training in one of these methods. Many psychiatrists also still practice counseling. A primary care doctor can guide a person to the proper counselor who specializes in one of these therapies.

Cognitive-behavioral therapy (CBT)

The idea behind CBT is that depression stems from harmful thoughts. These bad thoughts then lead to feelings of sadness. CBT helps people with depression change or cut back on their harmful thoughts. The theory in CBT is that feelings or thoughts are what lead to your actions and moods. If thoughts are changed, then a person’s mood and actions will change.

Often people with depression view what is occurring in their life from a harmful or unrealistic way. A cognitive-behavioral therapist helps restructure such views and social relationships with others in a more positive and realistic way. CBT may seem like taking a course in that one learns new, more helpful ways to handle problems in life. The therapist offers specific things to do to change the thoughts that lead to the unhappy feelings. CBT can help people with depression point out things that may be contributing to their bad mood and then aid in changing the resulting actions that may be making the depression worse.

Signs of depression start to lessen in 10 to 20 weeks if visits are done once a week. This can vary from person to person.

Interpersonal therapy

IPT is a type of talk therapy that focuses on helping a person look at and better learn from past and present relationships that may have caused the depression or may be making it worse. The therapist is less directive during the sessions. He may ask more questions to help the person with depression come to her own understanding of what has happened to cause the feelings. This understanding can help to curb the unhappy feelings.

An interpersonal therapist does not offer specific tools or make recommendations as to things to do differently in one’s life. As a rule, IPT is longer term. It can be nine months to a year or longer. Some therapists like to have visits more than once a week.

The National Institute of Mental Health suggests that for mild to moderate depression, counseling may be the best choice for treatment. But, for major depression or for some people, counseling may not be enough. Some research has shown that combining antidepressant drugs with counseling is the most useful way to remedy serious depression.

Psychodynamic therapy

This is a more in-depth exploration of a person’s emotional life, attempting to find meaningful connections between painful events in the past. These events can be losses, trauma, or the development of negative self-talk leading to depression. It’s originally based on the pioneering work of Freud, and has been further developed and refined by generations of practitioners.

By Chris E. Stout, Psy.D., Clinical Professor, Department of Psychiatry, College of Medicine, University of Illinois at Chicago

©2012-2019 Carelon Behavioral Health

Source: March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J. Treatment for Adolescents with Depression Study (TADS) team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. Journal of the American Medical Association, 2004; 292(7):807ﾖ820; Reynolds CF III, Dew MA, Pollock BG, Mulsant BH, Frank E, Miller MD, Houck PR, Mazumdar S, Butters MA, Stack JA, Schlernitzauer MA, Whyte EM, Gildengers A, Karp J, Lenze E, Szanto K, Bensasi S, Kupfer DJ. Maintenance treatment of major depression in old age. New England Journal of Medicine, 2006 Mar 16; 354(11):1130ﾖ1138; National Institute of Mental Health.

Reviewed by Philip Merideth, M.D., J.D., Physician Advisor, Beacon Health Options

Summary

Goals for therapy may include enabling more effective discussions, learning how to argue constructively, decreasing tension at home, and increasing satisfaction with the relationship. The therapist should help participants identify conflicts and decide what changes to make.

Choosing to go to couples counseling is a big decision, and one not often easily made. Although you shouldn’t expect counseling to work miracles, it may change your relationship and help you avoid—or choose—divorce or separation. If you and your partner have decided on couples therapy, you should know what to expect and how to set appropriate goals before you start.

Set goals

Both of you should be committed to counseling and set goals for therapy. Goals will depend on your situation, but may include:

• Having useful discussions
• Learning to argue constructively
• Easing tension at home
• Having a more satisfying relationship

Know what to expect

Depending on your counselor’s treatment approach, you and your partner may spend the first session going over your situation, the history of your relationship and your hopes for therapy. From there, your counselor may schedule separate sessions for each of you to learn one-on-one about your goals and expectations of the relationship and of therapy. Subsequent sessions would include the two of you together. Regardless of your counselor’s approach, they should:

• Provide an unbiased, safe and private setting for you and your partner to explore your relationship
• Help you identify conflicts and decide what changes to make—both one at a time and within the relationship
• Work on finding common ground rather than assigning blame

You and your partner should:

• Be willing to view your relationship from a new perspective
• Take responsibility for your actions
• Share self-discoveries, even after the counseling ends

It may take 10 to 15 sessions before you both see progress in your relationship.

Choosing the right therapist

Look for a therapist who will tailor therapy to you and your partner’s strengths and challenges. Your therapist should be sensitive to your needs. When you come away from counseling, you both should feel your therapist is an understanding ally.

Both you and your partner should feel comfortable with your therapist, so take time to evaluate how your therapist affects each of you.

By Kristen Knight

©2002-2021 Carelon Behavioral Health

Summary

• Mental health problems are common.
• It’s normal to feel fear, sadness, anger, and other negative emotions.
• If everyone in your life says you need help, maybe you do.

All of us have a physical illness from time to time. And hardly anyone gets through life without going to a doctor at least once to take care of a problem. When it comes to our bodies, we know when things don’t feel right, and we’re usually not reluctant to get help.

We may feel differently about mental health. Those problems are not always clear-cut. It’s common to have a down day or two, but at some point longer than that a spell of the blues might point to depression. Fears are common, but phobias can reveal a problem. How do we know if we’ve crossed that line? That is the same issue with stress after a traumatic event. How do we know if we’re not able to handle it on our own?

These questions boil down to one: Do I need therapy? There’s strong evidence that more Americans could be helped by speaking to a therapist. The National Institute of Mental Health estimates that about one in five U.S. adults have some type of mental health problem in any given year. But less than one half of these problems get treated. Some people may think they just have to feel that way, while others may want help but fear being labeled “crazy” for seeking it.

Asking for help with an emotional problem is a healthy decision. Many find that consulting a therapist lessens the problem, or makes it easier to solve than they feared.

Here is some advice to help you decide if you, like tens of millions of other Americans, could benefit from talking to a mental health provider:

Look for the three “D”s: Distress, Duration and Disability. Simon Rego, a psychologist at Montefiore Medical Center in The Bronx, NY, says everyone now and then has symptoms that are associated with mental illness. The trouble is when these symptoms don’t go away and take over your life. Rego says you should ask for help if you’re distressed by the symptoms and if their duration seems unusually long. The third sign is if they are disabling. That is, if they “have reached a point where they’re preventing you from functioning in your work, personal, and social life.”

Take a hint from friends and family. Others may be able to see changes in your mood and behavior that you fail (or refuse) to recognize. Stress reactions, substance overuse, depression, and uncontrolled anger can destroy relationships. Those close to you may be the first to see the damage being done. Says Rego, “If everyone in your life says you need help, maybe you do.”

Practice self-help, but know its limits. You can (and should) be doing all that is possible to keep yourself mentally healthy. The American Academy of Family Physicians suggests these four rules for managing your emotions:

1. Learn to express your feelings in appropriate ways. Let people close to you know when something is bothering you.
2. Think before you act. Before you get carried away by your emotions and say or do something you might regret, give yourself time to think.
3. Strive for balance in your life. Make time for things you enjoy. Focus on positive things in your life.
4. Take care of your physical health. Exercise regularly, eat healthy meals, and get enough sleep. Don’t overuse drugs or alcohol.

If you do all this and your problem persists, then it’s a good idea to look into therapy. As with physical health, self-help is not always enough to make you well.

Know the signs of serious illness. Major mental illness, such as bipolar disorder or schizophrenia, usually gives off early warning signs before it develops fully. The American Psychiatric Association says you should be concerned if several (not just one or two) of the following symptoms occur:

• Recent social withdrawal and loss of interest in others
• An unusual drop in functioning, such as quitting sports, failing in school, or difficulty performing familiar tasks
• Problems with concentration, memory, or logical thought and speech that are hard to explain
• Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations
• Loss of initiative or desire to participate in any activity; apathy
• A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality
• Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult
• Fear or suspicions of others, or a strong nervous feeling
• Uncharacteristic, peculiar behavior
• Dramatic sleep and appetite changes or deterioration in personal hygiene
• Rapid or dramatic shifts in feelings or “mood swings”

Do you need therapy, or just some fine-tuning?

On the less serious side of the spectrum, you may have mild symptoms that keep you from feeling your best but aren’t disabling you. That is, they may not amount to an illness as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM). This can mean your treatment is not covered by insurance. On the other hand, it may pay to consult a mental health professional anyway. You may get helpful advice, along with reassurance that you’re OK.

By Tom Gray

©2022 Carelon Behavioral Health

Jenna recalls her family’s initial reluctance to seek family counseling. “My husband was worried about the cost. My children feared their friends and our neighbors would find out. And I felt ashamed. I thought, ‘Are we really so bad off that we cannot work things out on our own?’”

Your family, too, may be reluctant to obtain professional help for problems at home. Yet doing so can help your family identify and change dysfunctional communication and behavior patterns as well as improve the health of your family dynamic.

When to seek help

Sometimes, a family has trouble working through an unexpected crisis or stressful event. Or, perhaps constant family squabbling is making home life unpleasant. Often, when a family “troublemaker” acts out, it indicates larger family issues. Other possible reasons for seeking counseling include:

• When a child or teen is troubled, has behavioral problems, or performs poorly in school
• When a family member is overusing a substance
• When words or actions are physically or emotionally hurtful or abusive
• When a physical struggle is used to settle disagreements
• During times of family transition (for example, birth of child, child leaving home, separation, divorce, etc.)
• When problems are recurring and never adequately solved
• When one family member has a mental illness

Finding the right therapist

You should shop around for a good therapist who specializes in working with families. Your physician, school, friends, clergy, and local mental health association are good referral sources. If you are uninsured or concerned about cost, your local family service agency and mental health association can help you obtain affordable counseling. Make sure your chosen therapist is licensed by the state or accredited by a professional organization.

Your first meeting

During your first meeting, the therapist will:

• Get to know each family member
• Try to obtain a basic understanding of your family dynamic
• Identify the underlying problem that brought you to therapy 
• Try to identify alliances among family members, as well as communication and behavior patterns
• Ask about family values and beliefs as well as unspoken “rules”
• Review the therapeutic process, treatment termination, confidentiality, and cost

Once your family has become acquainted with the therapist, make sure everyone feels comfortable with her.

How therapy works

Your family can expect to see the family counselor one or two times a week. The duration of therapy varies. Sometimes, the session will include all family members. But the therapist also may request to see just one or a few family members together. The therapist will use many techniques to learn more about your family’s problem. She may listen, ask questions, reflect back, and interpret what is said during the session, give advice, and make recommendations. She may ask you to role-play or assign “homework,” such as keeping a journal or changing a behavior.

What to expect

As therapy progresses, the counselor will help your family uncover feelings and conflicts that underlie the problems appearing on the surface. Doing so may be painful or troubling, often resulting in a short-term worsening of how the family functions. Ultimately, however, working through tough family issues will result in better communication and improved family functioning.

By Christine P. Martin

©2000-2021 Carelon Behavioral Health

Summary

• Get help from trusted sources in your search for a therapist.
• Be sure to check for licensing and training.
• Before you start, know what the therapy will cost and if it is covered by your insurance.

Going to a mental health provider is something like going to a doctor to deal with physical sickness. In both cases, care most often starts with a talk. You are asked what’s wrong and you try to explain. Honesty and trust are fundamental aspects of a healthy relationship with any health care provider.

But talk therapy and a physical exam are different in an important way. For talk therapy, talking is almost the whole treatment. For a physical problem, your doctor will usually discover the problem with an exam and tests. For a mental health issue, your therapist often knows only what you choose to talk about. And the subject is typically something you would not talk about with a stranger or even a loved one.

In short, talk therapy is personal. So it’s important to find a therapist who is trained to treat your problem, makes you feel comfortable, and is someone you can trust.

How do you find a skilled therapist who is right for you? Here are some steps to take:

Look to trusted sources for referrals. These can be friends, family, your doctor, or your company employee assistance program (EAP). Asking friends or family members for referrals can be helpful as a search tool, but remember that your personality and needs are not like others.

Insurance plans are one more source of referrals. They also tell you whose services are covered. You can search further by going online. You need to know about the therapist’s credentials, training, and licensing.

Choose only the qualified. Anyone can use the label “psychotherapist.” It is just a general term covering a wide range of licensed professions, from social work to psychiatry. In choosing a therapist, you need to know specifically what that person is licensed and trained to do. Most often, a professional will be one of these:

• Psychiatrist. This is a medical doctor (M.D. or D.O.) who specializes in care of mental illness. In most states, psychiatrists are the only therapists fully authorized to give drugs. Like all doctors, they must have a state health care license. Also, they can be certified by the American Board of Psychiatry and Neurology.
• Psychologist. This profession requires a doctorate (Ph.D., Psy.D., or Ed.D.) along with clinical training and state licensing. A national group, the American Board of Professional Psychology, certifies psychologists in 14 specialties.
• Licensed social workers and counselors. These therapists have titles such as licensed clinical social worker (L.C.S.W.), licensed marriage and family therapist (L.M.F.T.) and licensed mental health counselor (L.M.H.C.). These labels can vary from state to state. You may find licensed psychoanalysts and art therapists in your state as well. Most have master’s degrees along with clinical training.
• Psychiatric nurses. These are registered nurses with extra schooling and training in mental health. They have master’s degrees or doctorates, and have extra certification (such as advanced practice registered nurse [A.P.R.N.]) along with their R.N. (registered nursing degree). One type, the nurse practitioner, works with doctors and can give drugs.

Don’t neglect practical matters. Talk therapy can be costly. In choosing a therapist, find out what your health plan covers, and whether the therapist you want is part of the plan’s network. You may find that your plan favors certain types of care, such as cognitive-behavioral therapy (CBT), depending on the diagnosis. It’s important that your therapist’s methods are a good fit with your plan. Finally, be ready to talk about fees and payment options. This is very important if you will have to pay all or some of the costs out of your own pocket.

Resources

If you’re looking for a therapist or have found one and want to learn more about his licensing, training and credentials, online sites can be helpful. A good place to start is the National Register of Health Service Providers in Psychology (www.nationalregister.org), the largest credentialing organization for psychologists in the United States. To see profiles in a particular area, with their training and specialties, go to the organization’s “Find a psychologist” site: www.findapsychologist.org.

The National Institute of Mental Health has advice on finding a therapist, as well as useful links, www.nimh.nih.gov/health/topics/getting-help-locate-services/index.shtml.

Therapists can also be certified by medical or psychological boards. You can look up certification data from the American Board of Psychiatry and Neurology at https://application.abpn.com/verifycert/verifycert.asp. For psychologists, go to the American Board of Professional Psychology certification at www.abpp.org/i4a/member_directory/feSearchForm.cfm?directory_id=3&pageid=3288&showTitle=1.

To find a therapist certified in cognitive-behavioral therapy, go to the Academy of Cognitive Therapy at http://members.academyofct.org/i4a/member_directory/feSearchForm.cfm?directory_id=5&pageid=3348&showTitle=0.

By Tom Gray

©2012-2019 Carelon Behavioral Health

Source: New York State Education Department Office of the Professions, www.op.nysed.gov, American Board of Medical Specialties, www.abms.org; American Board of Professional Psychology, www.abpp.org

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

• When a problem has an impact on functioning, it is important to seek help from a doctor or professional therapist.
• Consider how the problem is affecting health, relationships, work, and parenting.

Have you ever been listening intently to a friend talk about a problem, when suddenly, you become worried? Perhaps it’s the content of what has been said, or the way in which it is said, but an alarm has gone off inside your head, signaling a problem. When we hear something that seems too hard for a friend to manage, it can feel overwhelming.

When do we suggest to a friend, or realize ourselves that we need, the help of a professional?

Impact on functioning?

One way to think about the issue is to ask the question, “How is this problem affecting the ability to function?” Is the problem interfering with relationships, health, parenting, or work? What is the actual impact of the problem? When the impact of a problem is noticeably changing how someone is functioning, it may be time to encourage professional help.

Signs that may suggest professional help is a good idea include:

• Feeling unable to work, parent, or keep up a home
• Feeling unable to handle stress with normal coping strategies
• Decreased appetite with significant weight loss
• Increased use of drugs or alcohol
• Increase in risk-taking behaviors, including gambling and sex
• Feeling unable to focus or get anything done
• Having a sense of inappropriate guilt and unworthiness
• Inability to fall asleep or to stay asleep, or awakening too early
• Feeling like sleeping all the time, despite potential consequences
• Feeling very angry and engaging in violent fantasies
• Experiencing panic attacks
• Feeling fearful of being around others, even children or family
• Feeling suspicious of people who are normally trusted, especially when normally trusted friends are providing feedback that seems overly suspicious
• Taking no enjoyment or satisfaction in activities that are normally enjoyed
• Feeling agitated or restless
• Thoughts of suicide or homicide (Always take these thoughts or statements seriously. Call a professional for help if someone is expressing thoughts to harm herself or others.)

If a friend is having any of the above signs, it may be a good time to tell your friend you are worried and want to help.

Ways you can help

In addition to suggesting professional help, such as a licensed therapist, you can also take action yourself. You might suggest ways you could help your friend so he may seek help.

You can leave the advice to the professionals, and still actively support a friend facing difficulties. Here are some ideas of what to offer a friend experiencing a tough time:

• Offer child care if it is needed, so that a friend can attend counseling appointments.
• Offer to call clergy if a friend might benefit from spiritual support.
• Offer to make a meal or pick up groceries.
• Offer to call a friend’s workplace. Perhaps help with paperwork if a friend needs a leave from work.
• Call and check in daily while distress continues.
• Offer to go for a walk.
• Connect a friend with a support network that may help; for instance, a depression support group or a grief support group.

Being a friend to someone needing support is a unique chance to grow as a person, and to foster trust and closeness. Trust your worried feelings and take action if you notice signs that indicate professional help is in order.

Resource

Depression and Bipolar Support Alliance
www.dbsalliance.org

By Rebecca Steil-Lambert, M.S.W., L.I.C.S.W., M.P.H.

©2012-2019 Carelon Behavioral Health

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

• Medical and nonmedical treatment options are available.
• Federal laws ensure the child will get help at school.
   

A child may go through a mild depressed mood for some weeks or even a few months. Without help, it may last for many months or longer. But, there is good news that treatment is as successful for children as it is for adults.

Individual talk therapy

Childhood depression can be treated with many forms of individual talk therapy, including play therapy, art therapy, and more. In talk therapy, the therapist and child work to develop a warm, accepting, and supportive relationship. The child is then encouraged to express thoughts and feelings about what is going on in his life. The therapist works to lower the child’s upset feelings.

Play therapy can be helpful with some children, especially younger ones. The play could be acting out an emotion that is hard to name. Or it may be by using the expressive arts of music or drawing.

Family therapy

Family therapy can be helpful for a child with depression. This is also true for other members of the family. Siblings may have a hard time understanding that a brother or sister is depressed. Family therapy can help teach parents or guardians and siblings to be more understanding and supportive of the child. They can also learn how to be on the lookout for suicidal ideas or actions.

Medication

Parents or guardians should talk with the child’s doctor or a psychiatrist regarding concerns whether medication is needed to help. There are drugs available for treatment of depression in children. Using them depends on a child’s age, weight, and the type of drug, among other factors that you can talk about with the doctor.

Getting your child to comply with treatment

Getting treatment is needed for a child with depression. But sometimes the child may not wish to see a therapist and/or take the prescribed drugs. This is common. The parent or guardian should be supportive and encourage the child. They can also get ideas from the therapist and doctor that can help. But if the depression is very bad and the child does not want help, hospitalization may be needed.

Hospitalization

In very severe cases that involve a high chance of the child hurting herself, inpatient psychiatric hospitalization might be needed. It is an option for a child if an evaluation by a professional shows a high level of risk of harm.

How to deal with your child’s school

Depending on how intense the child’s depression is, he may have trouble at school as well. Children may need tutoring or other special services if it gets in the way with the ability to learn. Although most school staffs today may be more aware and sensitive to childhood depression, not all are. They may need to be told of the nature of the child’s symptoms and diagnosis, and perhaps be involved in her care. A school nurse may need to hold onto and give meds during the school day as well.

Several U.S. laws require that services be provided to a child who has a disability that gets in the way of his ability to learn or be educated. It may also apply to the family. An evaluation can be given for free by the child’s school district. From there, an individualized education plan (IEP) that describes the services will be created for the child.

By Chris E. Stout, Psy.D., Clinical Professor, Department of Psychiatry, College of Medicine, University of Illinois at Chicago

©2012-2019 Carelon Behavioral Health

Source: Beardslee WR, Gladstone TR. Prevention of childhood depression: recent findings and future prospects. Biol Psychiatry. 2001;49:1101-1110; Bonin L. Depression in adolescents: epidemiology, clinical manifestations, and diagnosis, www.uptodate.com/contents/depression-in-adolescents-epidemiology-clinical-manifestations-and-diagnosis; Carlson GA. The challenge of diagnosing depression in childhood and adolescence. J Affect Disord. December 2000;61(suppl 1):3-8; Castiglia PT. Depression in children. J Pediatr Health Care. March-April 2000;14:73-75; Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR). American Psychiatric Association, 1999; National Institute of Mental Health, www.nimh.nih.gov/statistics/1MDD_CHILD.shtml; Synopsis of Psychiatry by Benjamin J. Sadock, Virginia A. Sadock and Pedro Ruiz, M.D., L.W.W., 11th edition, 2014.

Reviewed by Mario Testani, M.D., Physician Advisor, Beacon Health Options

If a loved one needs help for a harmful behavior but refuses it, or denies a problem even exists, you can take action by planning an intervention.

At an intervention, family members, friends and concerned others join forces to engage a person about a problem behavior in a loving and non-confrontational way and invite the person to get help. It can reach people who refuse or are resistant to help for issues such as:

• Substance and alcohol use disorders
• Addictive or compulsive behaviors such as with gambling, sex, internet use, gaming or shopping
• Eating disorders

Planning is vital

A well-carried out intervention involves thoughtful planning and is best done before a crisis happens. These steps can help guide you:

• Mobilize a planning team. Ask a few close friends or family members to help you. Talk about the problem and set a goal. An example goal would be for your loved one to agree to enter a treatment program.
• Research help choices and make all needed arrangements before the intervention. Otherwise your loved one might change their mind before the arrangements are set. Think of every detail, from making reservations to deciding who will drive your loved one from the intervention to a care center.
• Set a time and place. Timing is especially important if your loved one has a drug problem. Pick a time when the person is most likely to be sober and clearheaded, such as after work or first thing in the morning. Choose a comfortable and private location where they would readily go, such as a friend or family member’s home. You also need to decide the approach you will take to get the person to the meeting. Some research suggests that asking a loved one to an intervention works as well if not better than a surprise intervention.
• Decide whom to invite. Participants should be important to or influential to your loved one and might include close friends and family members, a pastor or rabbi, coach, teacher, roommate or employer.
• Plan what to say. Many people find that writing a letter can help them organize their thoughts and make sure the message is delivered in a loving, caring and respectful way. The letter should express your love and concern and cite specific cases of how the behavior has caused problems for you and for your loved one. The letter should end with a request that your loved one get help and an expressed willingness to be involved. Try to anticipate how the person will react and be ready to respond to excuses, objections or attempts to bargain.
• Set consequences. Each participant should be ready to name a consequence should your loved one say no to the group’s terms.  Withholding financial help, restricting contact with children and ending a romantic relationship are some potential consequences.
• Organize the meeting and rehearse. Choose someone to act as a spokesperson for the group and facilitate the meeting. Make sure participants know the goal, how to plan and how much time they will have to speak. Decide seating and the order of speakers. Rehearsing the intervention is a good idea. This gives all participants a chance to hear all the letters and to make sure that the collective message is caring and consistent.

After the intervention

If the intervention is successful, you and others close to your loved one should play an active role in healing. This could involve making changes at home or work or finding a new set of friends to lower the chances of relapse. Family or one-on-one counseling can help you and others work through tough emotions and dysfunctional patterns that get in the way of family healing.

If the goals of the intervention are not met, the consequences must go into effect right away. In time, your loved one might make the choice to get help. But that is unlikely if you or others weaken and fail to stick to your plans for the long term. Look for ways to support and hold each other accountable, which can help keep up the group’s unity over time.

Involving a professional

Consult an interventionist, addiction specialist or other skilled counselor who can help plan and facilitate the intervention. Moreover, a professional can help family members learn better ways to communicate and look at the problem in the context of the family system. Friends and family may contribute to the problem and need to make changes themselves.

Final thoughts

Intervention involves risk. You risk ending a relationship with somebody you care deeply about in the hope that they will accept your offer of help. But doing nothing is also a risk. A successful intervention offers the chance for personal triumph over a harmful behavior and the chance to restore meaningful relationships.

By Christine Martin

©2013-2022 Carelon Behavioral Health

Summary

People with mental illnesses do recover and resume normal activities when they receive proper support and treatment.

What does it take to get you to the doctor for a physical health issue? Maybe not much. A bad cough and fever might be enough, or a new pain that has you worried, or maybe a broken bone.

But what if you’ve noticed a troubling change in your mood, sleep patterns, work habits, gambling, drinking, or relationships? What if you start thinking about killing yourself? These are times when you should ask for help.

But for many people going to a company employee assistance program (EAP) or making an appointment with a therapist is hard to do.

Maybe it’s a feeling that you need to handle your problems alone. Maybe you’re embarrassed about talking about your feelings. Maybe you’re worried that the therapist will judge you or tell your boss or family that you’ve been to their office.

Myth of mental illness as a sign of weakness

Advances in education and research have helped our understanding of mental illnesses, and the success of treatments. Experts now believe that mental illnesses are likely the result of chemical imbalances in the brain. A person with such an imbalance may inherit the condition, or it could be brought on by stress, drug misuse, or changes in your chemical makeup due to pregnancy, medicines, menopause or aging.

Mental illnesses can cause many types of behaviors such as great sadness and irritability, and in dire cases, hallucinations and withdrawal. These behaviors cannot be changed at will and many times are out of your control.

The good news is that people with mental illnesses do get better and get back to normal life when they get the right support and care.

Fear that seeking help may harm one’s job

Employees are protected by laws, both as to privacy and nondiscrimination. If you don’t know these laws, ask your employer. If your company offers an EAP, you can talk privately with an expert who can help you sort through your concerns and direct you to the right support.

Seeking help is best done early, before problems have snowballed into a crisis.

Misconceptions about the therapy process

Some may be held back by false notions about the therapy process. Some people may be afraid of their own feelings, and of what might happen if they admit them.

Others might have fears about the sessions themselves. Therapy often isn’t a deep probe into childhood traumas and inner thoughts. It’s more like a short series of problem-solving sessions, focused on certain behaviors or thought patterns and learning techniques to change them. This type of therapy works well on issues that haven’t yet become job- or life-threatening crises.

The danger of waiting

It’s time to get help when your daily life is disrupted for two or more weeks.

And with thoughts of killing oneself, the risk of not getting help in time is far worse than a lost job or relationship. Planning for suicide is a red alert. Any time a person starts hoarding medicine or thinking about a suicidal act in other concrete terms, they better have an immediate plan to get help.

Telling another person about your issue is the first step to solving it, and maybe saving your life.

By Tom Gray

©2004-2021 Carelon Behavioral Health

Source: Tina Tessina, Ph.D.; Patricia A. Farrell, Ph.D.; National Institute of Mental Health, National Mental Health Association

It’s normal to need mental health support at times. Even people with good mental health can suffer setbacks and need emotional support at times. It’s human nature to have emotional ups and downs, and it’s healthy to respond to the downs by talking them through with someone who can listen, sympathize, and offer helpful support.

It’s unfortunate that some people consider admitting to and seeking help for mental health issues as signs of weakness. They’re not. They’re signs of strength and resilience. It’s perfectly normal to deal with mental health issues, and the best way to work through and get past them is with support.

It’s estimated that in any given year, one in every five adults will experience a diagnosable mental health issue. Those range from unhealthy levels of stress and anxiety to depression, grief, and problems with substance abuse or other addictions. Over the course of a lifetime, most people will experience one or more of those mental health challenges. Why suffer alone and risk getting worse when help is available?

Fortunately, attitudes toward mental health are changing. Prominent figures in sports, entertainment, politics and other public arenas are helping to normalize mental health challenges by being open about their own emotional issues and showing how appropriate help can make a difference.

If you’re concerned about a mental health issue, be strong and seek help. You’ll be glad you did.
 

What kinds of mental health support are available?

Social support

Social support—through your network of friends and family—is an important element in maintaining good mental health. When you’re feeling frustrated or down, talking through your emotions and the situations behind them can be tremendously helpful.

While your social support network can provide an emotional boost and a safety net for the normal twists and turns of life, it may not be all you need when you’re dealing with a more serious or complex mental health issue. Depression, anxiety disorders and addiction typically require professional support.

Counseling

Counseling is the process of talking with a trained mental health professional to collaboratively work through a problem. In this interactive process, called talk therapy, the counselor helps you identify goals and possible solutions, strengthen communication and coping skills, and work toward improved well-being in your mental health and relationships.

Professional counselors typically have at least a master’s degree in counseling, psychology, social work or a related field. To be licensed or registered to provide counseling services, they are typically required to meet certain standards and participate in ongoing education. Psychiatrists are medical doctors who provide mental health counseling and can also prescribe medications (which master’s-level counselors are not authorized to do).

There are many approaches to counseling, including three main models:

• Cognitive-behavioral therapy (CBT) focuses on changing negative or counterproductive thought patterns as a way to improve emotional well-being. In CBT, you learn skills to cope with problems and form new habits in the present, rather than delving into the sources of those problems and habits in the past.
• Psychodynamic therapy involves the examination and resolution of inner conflicts by exploring how behaviors have developed unconsciously from experiences early in life. Psychodynamic therapy is typically a longer-term approach to counseling.
• Humanistic or existential therapy emphasizes positive capabilities, creativity and personal growth rather than focusing on negative behaviors or the past. In humanistic therapy, the counselor helps you reconsider how you perceive yourself and works to build on your strengths and potential.

Depending on your needs and the counselor’s approach, different models may be combined to help you resolve your problem. The key is to find a counselor or therapist you trust and whose approach works for you.

Medication

For some mental health problems, including depression, anxiety and psychosis, medications can be a helpful supplement to counseling. A psychiatrist or another medical doctor can prescribe medication.

How to get mental health support

Your workplace may have a program that provides short-term counseling to help you resolve a mental health problem and can refer you to a qualified therapist for longer-term support. Your doctor can also refer you to a qualified therapist for counseling support and can discuss medication options with you.

©2021 Workplace Options

Summary

These approaches include:

• Animal-assisted therapy
• Creative art therapies
• Mind-body medicine

Medicine and therapy work well at treating many mental health problems. Yet some people want to try other ways to feel better. Here, you can read about some of those ways. Many people try these methods along with their standard plan of care. They may help support your efforts to get well.

• Animal-assisted therapy (AAT). This method is based on research suggesting that animals are good for people’s health. It is more than visiting with a pet. A therapist trained in AAT makes a treatment plan that involves animal interaction. Many studies suggest that animals are useful therapy tools. One study found that AAT reduced anxiety in people with mood disorders and psychotic disorders.
• Creative art (expressive) therapies. Art, music, writing, and dance are useful tools. They can help people work through feelings and events that are hard to talk about, or those that cannot be expressed using words alone. They are holistic. This means they work with the body, mind, and spirit. Studies suggest that these therapies can lower anxiety and depression. They may also boost self-esteem and self-awareness.
• Self-help groups. Social support can help you cope with or recover from a mental health problem. Self-help groups bring together people with problems like yours. Groups can give you helpful advice. Groups also allow you take steps to help yourself stay well.
• Pastoral counseling. Many people with mental health problems turn to a trusted pastor, priest, or rabbi for prayer and support. Some people seek help from a pastoral counselor. This is a person educated and trained in religion and providing mental health care.
• Food and supplements. Many special diets claim to help mental health. Studies looking at how diet affects mood and mental health are limited or have mixed results. We do know that a healthy and well-balanced diet gives your body all the nutrients needed for good health. We also know that taking large doses of vitamins is not needed and may even be harmful. Some people try herbal supplements to boost mood, reduce worry, or sleep better. For instance, good evidence suggests that St. John’s wort can ease mild depressive symptoms. But it is not a proven cure for depression. Many herbal supplements may not mix well with drugs you use. Some can even be harmful.
• Mind-body medicine. Meditation, yoga and similar techniques teach people how to use the mind to feel better. Evidence suggests that mind-body medicine might help with stress, worry, depression, and mood. It may also boost self-awareness and self-care.
• Massage therapy. This involves touching and rubbing the body to ease tension and stress. It may lower symptoms of anxiety too.

Do these work?

Many mental health providers think that these methods can play a role in treatment when used along with conventional methods. Yet, we don’t always have scientific proof that they work or are safe if used alone. In some cases, a therapy may seem to lessen symptoms in the short-term. But we don’t know if the benefits will last. Some have little to offer and may even be harmful. More research is needed to learn about the usefulness and limitations of many less-established ways. 

Before you try a new approach

Talk to your doctor to get all the facts. Your doctor can tell you if it may be useful and safe for you to try. Never stop or change your current plan without talking to your doctor first.

By Christine P. Martin

©2012-2021 Carelon Behavioral Health

Summary

• Talk therapy includes a wide range of ways to treat mental health problems.
• It involves talking with a therapist, either alone or with others.
• Which type of talk therapy is best for you?

Sometimes called counseling, talk therapy is a basic part of mental health care. It works through talks between a therapist and a person seeking help, and it aims to teach both self-knowledge and coping skills. As the National Institute of Mental Health describes, it is “a way to treat people with a mental disorder by helping them understand their illness.” It does not rely on drugs, though it often is used as part of a plan that includes them.

Hundreds of talk therapy techniques are in use today. It is hard to do research on how well all the types work. Some of the most studied and often helpful include cognitive-behavioral therapy, behavior therapy, and psychodynamic therapy.

For most issues therapists use methods such as these alone or at the same time:

Cognitive-behavioral therapy (CBT). The most widely found. CBT trains you to avoid unhealthy ways of thinking while teaching you better mental habits. It plays a key role in treating bipolar disorders, stress reactions, panic disorders, depression, and anxiety. A course of CBT is most often short. About 16 sessions is typical. It sets a specific goal, such as conquering a phobia or stopping a compulsive behavior. CBT often calls for homework like breath work for stress or to keep a record of your thoughts.

Behavior therapy works by setting up very structured ways of reinforcing actions that are desired. It also finds a mixture of nondisciplinary ways of getting rid of bad behaviors. It is more often used with younger children and people who may have limited verbal skills. It can be helpful to treat attention-deficit/hyperactivity disorder (ADHD) in some children.

Psychodynamic therapy. While CBT works with the conscious mind, this method digs deeper. It goes into the unconscious forces that drive thoughts and behavior. It focuses on our past and how we may be reacting to it in harmful ways. It is the basis for many methods. It can help with issues such as eating disorders, post-traumatic stress disorder (PTSD), and depression.

As well as one-to-one meetings, these may also be helpful:

Group therapy. In this method, a therapist meets with a small number of people who share the same problem. The group setting can be helpful in many ways. It can lead to shared insights, it can give a sense of belonging, and it can help people let go of their emotions by expressing them to others. One use of it is for treating PTSD. 

Family therapy. Like group, family therapy involves many people. Its goal is to help people learn from each other better ways to get over conflicts. It also can help families deal with the stress of one member’s illness, such as autism.

Other therapies help with specific issues or use unique methods. Exposure therapy helps people face their fears by carefully showing them things that upset or frighten them.

Specific healing methods may help treat specific problem areas. Biofeedback techniques, including neurofeedback, track brain activity to treat stress and anxiety disorders such as PTSD. Some therapists also use relaxation methods, including hypnosis, to treat anxiety and mood disorders.

What type of talk therapy will work for you?

The answer depends on at least two things. One is the type of problem. As the American Psychological Association points out, it is important to “choose the type that best addresses the person’s problem and best fits the patient’s characteristics and preferences.” The treatment plan being followed by your therapist and health worker are also very important. Mental health doctors and insurers prefer methods that can meet clear goals quickly. It often calls for drugs along with therapy for illnesses like bipolar disorder, major depression, and ADHD.

Finally, keep in mind that the goal of therapy is to fix a certain problem. In the language of health plans and doctors, it is acute treatment. You can’t expect it to change your life or nature in basic ways. But it should get you back to your normal state before too long.

Resources

The American Psychological Association’s helpful article “What Do Practicing Psychologists Do?” can be found at www.apa.org/helpcenter/about-psychologists.aspx.

The National Institute of Mental Health has a description of therapy and some of its methods at www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.

By Tom Gray

©2012-2019 Carelon Behavioral Health

Source: American Psychological Association; International Society for Neurofeedback & Research, www.isnr.org; National Institute of Mental Health, www.nimh.nih.gov; Simon Rego, Psy.D.

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

• You need to understand the goals that were set at the start.
• You cannot expect instant results.
• You may continue a therapeutic relationship or use your new skills to carry on with self-help.

There is no one “right” length for therapy. It can take weeks or years, depending on the diagnosis and the methods used. But on any given course of therapy, there does come a time when you can consider it over. This can be when the goals are met or the person is able, in the words of psychologist Judith S. Beck, Ph.D., to “continue to work toward his goals himself.” Therapy can also end when it is clearly not making progress.

What should you be looking for? The answer depends on the goals of your treatment plan. If they are clear and specific, it’s not difficult to tell when they have been met.

Hitting SMART targets

Aim for targets described by the acronym SMART, says Simon Rego, a psychologist who specializes in cognitive-behavioral therapy (CBT). These should be specific, measurable, attainable, rewarding, and time-limited. A specific goal might be, “I want to start getting in shape by going to the gym three times a week,” as opposed to a more general one like, “I want to feel better.”  Rego says a SMART goal may also be as simple as hitting a certain score on a self-assessment test.

The “R” for “rewarding” is important no matter what the target is: It needs to be something you want to do, and something that will make you feel better.

Goals of this type are a natural fit with CBT, which is meant to work on well-defined issues in a limited time. But clear targets are good for any types of therapy, even when the aim is to make changes that go deeper than specific behaviors. Author and therapist Tamara L. Kaiser, Ph.D., says such goals might be to “learn better how to set limits” or “manage my anxiety in a different way,” or “decide to break up with this person or marry this person.” Whatever time it takes to resolve such issues, Kaiser says, at the end should be “a sense that you came to do some work, and that work is done.”

Is it time for a split?

Therapy can end in failure as well as success. At some point when there is no sign of the progress you and your therapist were expecting, it makes sense to end the relationship. Deciding when that point is reached can be difficult. Therapy doesn’t deliver instant results, but it may be time for a change. That change may be a new therapist or just another opinion. It may be no one is at fault, or you and the therapist are not a good fit. “If you consistently feel misunderstood or if the therapist asks you to do things you can’t possibly do, the relationship may need to end,” says Kaiser.

But friction with your therapist can be a positive signal. You may be reacting to a difficult task which, if you succeed at it, could lead to a breakthrough. “The impulse to leave could mean you’re getting somewhere,” Kaiser says. You also need to look at your own side of the ledger: If things aren’t going well, is it really all the therapist’s fault? Therapy requires work on both sides, and change may not be painless. In any event, it is important to talk things over with your therapist if you’re thinking of leaving. You may decide to go, or realize you’re making more progress than you thought.

On to the self-help stage

For many, therapy does not end when goals of a treatment plan have been met. If treatment includes drugs and talk therapy, you may continue with the medications indefinitely. If you have successfully tackled a short-term acute problem, you may want to work on other issues, or continue therapy so you don’t revert to old ways of thinking and acting. These decisions may be financial, shortened by costs and limits on insurance or part of the therapeutic goal. Successful treatment should leave you with self-help tools you did not have before. In a sense, even successful therapy never really ends. It has just met a goal that Beck sees as central: “To teach patients to become their own therapists.”

By Tom Gray

©2012-2019 Carelon Behavioral Health

Source: Judith S. Beck, President, Beck Institute for Cognitive Behavior Therapy, Bala Cynwyd, PA; Tamara L. Kaiser, Ph.D., M.S.W., L.I.C.S.W.; Simon Rego, Psy.D., Director of Psychology Training, Montefiore Medical Center, Bronx, NY

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

• Talk therapy treats emotional problems by increasing self-knowledge and teaching healthy mental habits.
• Whether short- or long-term, the focus should be on meeting a goal that you and the therapist have agreed upon.

What happens when you go into therapy? First, there’s the fact that it’s all about talk. As therapist and author Tamara L. Kaiser describes, it is “a conversation between therapists and their clients.” Along with this conversation, you may have some homework between sessions.

But how will this make you better? That’s your real concern. After all, people go into treatment because they have an emotional issue causing them real pain. In many cases, prescribed drugs such as antidepressants may ease the pain with little talk-therapy. How can therapy work as well, or even better, than these?

The answer is in your head, literally. Modern neuroscience found the circuitry of the human brain to be highly “plastic.” That is, the brain changes nerve connections and signal pathways as it takes in new experiences. All your life it is constantly learning and adapting. This means patterns of thought and emotion are not set in stone. They can be altered. Therapy targets the patterns that are harmful and essentially trains your brain to choose different ones.

In this way, therapy is simply another form of learning aimed to teach you about yourself as you replace bad mental habits with healthy ones.

A participant, not just a person seeking help

Therapy comes in many forms, and therapists have long-running debates about which methods work best. What’s clear, though, is the success of any method calls for effort and motivation by the person undergoing therapy. In cognitive-behavioral therapy (CBT), you can expect to get homework assignments. In all types of therapy, the goal is for the person to gain self-knowledge and to act on it. First you learn, with the therapist’s help, why you think and act the way you do. Then you do the work of changing. “The goal is to teach patients to become their own therapists,” says Judith S. Beck, Ph.D., President of the Beck Institute of Cognitive Behavior Therapy.

Research shows therapy works best with “extra-therapeutic” supports. These include motivation from family and friends, and from life events (such as changing jobs) which happen during therapy. Then there is the quality of the relationship between person and therapist, the choice of method, and the person’s own level of hopefulness. Therapy can involve just the therapist and you. Successful therapy often includes the support of family, friends, and community.

From intake to outcomes

Therapy often starts with an assessment followed by a diagnosis and treatment plan. Clients may fill out a health history questionnaire including questions about home, work, life, relationships, parents, partners, and other factors that affect their emotional life.

The therapist and client may decide on focused goals like: “Improve depressed mood by engaging in at least one pleasurable activity each day and sleeping no more than eight hours per day.” (Goals of this kind are typical of CBT.) Or they may be more wide-ranging, like learning how to have healthy relationships. In any case, both the therapist and person in therapy need to keep the goal visible and be able to reach it.

This “intake” process, as it’s sometimes called, is followed by scheduled sessions of 45 to 50 minutes.

What happens in and between those sessions will depend on the therapy method. The therapist may ask frequent questions to reveal issues and habits of thought the client had not noticed. This “Socratic questioning,” is important in CBT. In other forms of therapy, the therapist may mostly listen and let the person talk. This can include free association for which the therapist steps aside and lets the client say whatever comes into his mind.

Between sessions, especially in CBT, people can be given tasks which support the work they are doing with their therapist. An unhappy and anxious person who is out of work, for instance, might submit a job application as homework.

Time and progress

How long your therapy takes will depend greatly on the diagnosis. In CBT, says the Beck Institute, uncomplicated cases of anxiety or depression might need only six to 12 sessions. More deep-seated or long-term problems, such as bipolar disorders, can take many more. Some other methods take longer than CBT. Treatment for some complex problems, for instance, can go for many years. The major thing is to have realistic expectations from the start. And that comes when you and your therapist set the right goals in the right amount of time.

Resource

For a more in-depth look at a typical CBT course of therapy, see the U.S. Department of Veterans Affairs’ Cognitive Behavioral Therapy for Depression in Veterans and Military Service members: Therapist Manual by Amy Wenzel, Ph.D., Gregory K. Brown, Ph.D., and Bradley E. Karlin, Ph.D., at www.mirecc.va.gov/docs/CBT-D_Manual_Depression.pdf.

By Tom Gray

©2012-2019 Carelon Behavioral Health

Source: Beck Institute for Cognitive Behavior Therapy, Bala Cynwyd, PA, www.beckinstitute.org; U.S. Department of Veterans Affairs; Tamara L Kaiser, M.S.W., Ph.D., L.I.C.S.W.

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

• Coordination of care is crucial in treating emotional disorders, which often respond best to drugs and therapy combined.
• Multiple providers may or may not share notes.

Going through the health care system can take patience. This is very true when mental health and drug use issues are part of the treatment plan. But it can be done if you realize it is your plan.

Coordinating care is important when mind and body are involved. The drugs used in treating emotional disorders have physical results and can interact with other drugs. They may also raise the chance of getting certain diseases. One 2011 study of male twins showed that use of antidepressants may thicken artery walls. Taking drugs for depression may still be a wise course. But it’s best to have all the needed experts in the loop when that issue is decided.

Medicine is most often given for bipolar disorder and schizophrenia. This is even if some results are positive using holistic methods like meditation, diet, and exercise. Drugs can be helpful for other issues, such as attention-deficit/hyperactivity disorder (ADHD), major depression, and anxiety disorders.

Sometimes a mixture of drugs and therapy is better than either one alone. The National Institute of Mental Health has been funding research to find how best to mix drugs and therapy for bipolar disorder and obsessive-compulsive disorder (OCD). The combo is also helpful with moderate to severe depression. Again, holistic methods are gaining in appeal as more becomes known about their results.

The team approach

Psychologist Simon Rego, Ph.D., says he often takes a team approach with psychiatrists. Rego says drugs “sometimes work quite well” with cognitive-behavioral therapy (CBT). It can calm symptoms quicker than therapy. But without learning new skills “you’re more likely to have a relapse.” Many with behavioral health issues move away from drugs and therapy as they become more familiar with themselves and their symptoms. 

You are in charge of making sure each of your health care doctors know what the others are doing. At the very least make sure you have a written treatment plan that those who care about you can follow. Your psychiatrist and psychologist may already be communicating about your care, but don’t assume this. Doctors in different practices don’t automatically share notes.

Talk therapy is a team effort, one based on a therapist and the person seeking help working side by side. The larger the team gets, the more it needs a leader. And the one best suited to fill that role may be the person in the middle of it all … you. Therapy is about learning to take charge of your thoughts and feelings, and steering them in a healthy way. It is also a time to take charge of your care.

By Tom Gray

©2012-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov; American College of Cardiology, www.cardiosource.org/acc; Simon Rego, Psy.D., Director of Psychology Training, Montefiore Medical Center, Bronx, NY

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options