Making the Decision to Pursue Therapy

There are myriad reasons why people decide to seek therapy. Some individuals want to explore recurring patterns in their lives. They may find themselves making the same mistakes or ending up in situations where they feel chronically dissatisfied and unfulfilled. Others may be searching for clarity or closure on an issue, desiring increased insight and self-awareness, or simply seeking a safe place to process their thoughts and emotions. Some folks may notice that they are not coping well with life’s stressors, such that they are consuming more alcohol than usual, using substances, or avoiding situations or people. Impairment in sleeping and eating habits, frequent conflicts with loved ones, decreased motivation to perform work and household tasks, and a sense of isolation may also be signs that professional support can be helpful. Seeking counseling may be about obtaining feedback about how one is doing and preemptively gaining support before reaching “rock bottom” (one’s subjectively lowest point).

The decision to begin the challenging, yet often rewarding process of psychotherapy can be a difficult one. It is normal to feel uncertain and to experience mixed emotions. This is known as ambivalence, which Merriam-Webster defines as: “simultaneous and contradictory attitudes or feelings (as attraction and repulsion) toward an object, person, or action.” As per Dr. Derek Lee, ambivalence is often characterized by uncertainty, indecision, and fear; he states, “it is a tension between opposing beliefs, feelings or behaviors.” He indicates that our motivation to pursue action may change depending on our complex and sometimes conflicting needs and priorities at a given moment. Rollnick, Miller, and Butler agree that competing motivations—“to simultaneously want and not want [change] are normal and common” (2008). Ambivalence may manifest as simultaneously wanting to lose weight, but hating exercise/diets or wanting to quit smoking/drinking alcohol for the personal health benefits, but needing the stress relief it provides.

The prospect of change can be exhilarating, while terrifying and overwhelming all at once. There may be a comfort in the familiar and a tendency to stay in the exact same situation, even when it is clearly dysfunctional or unhealthy. One need not hit “rock bottom” in order to decide that it may be helpful to seek the services of a mental health professional. If you recognize that something needs to change, but do not know what or how to make the change, you may benefit from professional counseling services. Perhaps you know that you are miserable in a relationship, job, or otherwise, but you cannot figure out how to resolve this dilemma or there is a discrepancy between your current self-perception and how you wish to see yourself. You might have a hard time identifying goals or overcoming the obstacles (i.e., low motivation/energy, poor organization) to achieving them.

Why is change in your life necessary and important? Achieving self-growth and actualizing one’s goals can be empowering and improve our sense of self-confidence and agency that we CAN achieve and are in control of our lives. The capacity to change demonstrates mental flexibility, which is believed to be a sign of emotional health and well-being (Ebberwein, 2010). Sometimes it can be helpful to stir things up in a positive direction. If you decide to pursue therapy, remember that you are not necessarily making a lifelong commitment. Try framing therapy as an opportunity to try something new. Imagine what you can learn about yourself! Of course, along with all the potential benefits of therapy, there are some intrinsic risks as well. Learning about yourself may be helpful in the long run, but it may also illuminate aspects of your personality or ingrained behavioral patterns that are not congruent with how you would like to see yourself, thus, potentially causing some temporary distress as you figure out how to reconcile this discrepancy.

These are some questions/issues to consider when deciding whether or not to begin therapy:

1)    What are your expectations of therapy? Clarify any misconceptions and get more information as needed.

2)    Consider your goals and what you hope to get out of counseling. This may be a collaborative process between you and your therapist, who may facilitate the development of realistic, achievable goals.

3)    What are you willing/able to afford on a weekly basis? Will you be using insurance or paying for services out-of-pocket?

4)    Does your health insurance cover mental health (also called “behavioral health”) services? What is your co-payment and deductible? The therapist’s office should be able to assist you in obtaining this information if you have difficulty.

5)    Consider the pros and cons of starting therapy. Pros may include: having an outlet to share concerns with an objective third party, working with a professional toward personal goals, learning new coping skills, becoming aware of patterns that may not have previously been clear. Meanwhile, cons may include: actively confronting the thoughts and feelings you may have been avoiding or repressing, in addition to investing time, financial resources, and energy “doing the work” required to effect desired changes.

6)    What are the motivating factors pushing you to seek help (i.e., what do you want to be different)? What values are perhaps incongruent with your current behaviors (i.e., you value health and quality of life, yet cannot seem to quit smoking)?

7)    What is your availability and willingness to commit to therapy, even for a trial period?

8)    Conduct research online to find a therapist who is both qualified and seems to be a good fit for your needs. Consider someone’s credentials and training relative to the problems you are hoping to address (i.e., a life coach may be suitable for certain concerns, whereas someone with a master’s or doctoral-level education may be better equipped to help you through more complex mental health or relationship issues). Do you want someone who specializes in a particular area (i.e., weight loss, medical illness, couple’s work, grief counseling, relationship concerns, LGBTQ issues)? Do you feel more comfortable speaking with a counselor of a particular gender, someone who is younger or more senior in the field, someone who shares a similar cultural background or speaks your native language? You may contact your insurance company for referrals and/or find referrals for local providers through comprehensive websites such as Psychology Today.

There is no right or wrong decision about whether to pursue therapy. Consider the above to determine if it is the “right” choice for you at this time. 

Dr. Jacquie Talesnick is a licensed clinical psychologist at the Rowan Center for Behavioral Medicine who has trained in both cognitive-behavioral and psychodynamic therapeutic approaches. She considers herself to be an integrative therapist, pulling from different methodologies and theories to tailor treatment to each individual with whom she works. She offers psychotherapy services to the adult population in individual and couples modalities. She specializes in working with individuals in the LGBTQ community. Her other specialties include treatment of relationship difficulties, trauma, depression, and anxiety. She has a special interest in the benefits of animal companions, as well as supplementing traditional “talk therapy” with creative approaches (i.e., writing, art). 

 REFERENCES

Ebberwein, C. (2010, May). Practicing Flexibility for Good Mental Health. Retrieved September 08, 2016, from http://www.yourmindyourbody.org/practicing-flexibility-for-good-mental- health/ 

Lee, D. (n.d.). Ambivalence in Therapy: Exploration & Resolution. Retrieved September 8,  2016, from http://www.psychodelights.com/pdfs/ambivalence1.pdf

Rollnick, S., Miller, W.R., & Butler, C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press.

Life-threatening Pediatric Medical Diagnoses and Treatment: Overcoming the Adversity

Pediatric patients diagnosed with a life-threatening medical condition and their families are catapulted into crisis mode as they embark upon a challenging journey with numerous potentially traumatizing situations.  These children and adolescents may experience frightening diagnoses, emergency room visits and multiple hospitalizations with unknown duration, painful or distressing procedures, adverse side effects, and repeated losses related to one’s underlying illness or disability. Even with such experiences, both research and clinical experience have shown that many of these youngsters and families and are resilient, meaning that they are able to cope and adjust effectively to the challenging circumstances; however a subset of patients and families continue to experience emotional and adjustment difficulties that can lead to significant disruption to their lives. 

Life-threatening pediatric medical conditions and treatment can hinder the achievement of normal developmental tasks of pediatric patients, especially for adolescents. A medical illness may impede their ability to establish an identity, make decisions about education and career paths, and form relationships (Dahl, 2004).  Particularly challenging can be the clash between their need for independence (and sense of invincibility) and the dependent status as a patient.  In addition, their usual concerns with body image and emerging sexuality may be worsened by the changes in physical appearance related to the medical condition and treatment, such as weight gain, hair loss, and scares from procedures/surgeries.  Mintzner and colleagues found that 16.3% of adolescents who underwent solid organ transplant met all criteria for post-traumatic stress disorder (PTSD), and an additional 14.4% endorsed post-traumatic stress symptoms (PTSS).  In study of 63 cancer patients (ages 7-20 years), 25.4% met the DSM-IV criteria for Major Depressive Disorder (MDD), 14.3% for anxiety disorder, and 12.7% for comorbid MDD and anxiety disorder (Gothelf et al., 2005).  These symptoms are alarming as it can not only impact one’s quality of life, but also lead to avoidant behaviors that negatively impact treatment and recovery (e.g. missing clinic appointments and being non-adherent to their treatment regimen). 

Of note, pediatric illnesses have a significant impact on parents and siblings, representing a psychological health risk for the whole family.  Caregivers must often absorb complicated medical information and make critical decisions about treatment, witness the child in pain and undergoing intensive treatment, as well as face uncertainty about their child’s future.  Thus, it is not surprising that PTSS have been well documented in caregivers.  In particular, Kazak et al. (2001) found that 11% of mothers (who had a child diagnosed with cancer) met criteria for PTSD diagnosis, while 95% of them met criteria for the re-experiencing symptom cluster and 53% for the hyperarousal cluster; for families who had two participating parents, 80% had at least one parent with moderate-to-severe PTSS (Kazak, Boeving, Alderfer, Hwang, & Reilly, 2005). Similarly, Farley and colleagues (2007) reported 19% PTSD prevalence among parents of children who underwent heart transplantation.  Similarly, healthy siblings may be suddenly separated from family members for long periods of time, witness the physical and emotional pain of the ill brother/sister and parent distress, and deal with the uncertainty of the future.  Research has shown that siblings experience mood disturbances, conduct problems, poor academic achievement, and difficulties in social relationships (Alderfer, Labay, Kazak, 2005; Barbarin et al., 1995).  

Overcoming the Adversity:

While mild symptoms of most children and family members will be resolved without formal psychological or psychiatric intervention, evidenced-based treatment is indicated for those who continue to have elevated and/or escalated psychological distress. While there is no one specific template or road map for maneuvering the pediatric illness journey, trauma-focused cognitive-behavioral strategies have demonstrated efficacy for traumatized children and their families, and should be considered the first line treatment.  Psychopharmacological treatment, involving Selective Serotonin Reuptake Inhibitor (SSRI), is recommended for the treatment of PTSD in combination with psychotherapy; it is considered as a first line medication for children who are not responding effectively to psychotherapy or when symptomatology is severe (Forgey & Bursch, 2013).

It is important to note that the effects of traumatic experiences may not be universally negative.  In fact, childhood cancer survivors have shown to report increased maturity, greater compassion and empathy, new values and priorities, new strengths, and recognition of one’s vulnerability and appreciation for life (Parry and Chesler 2005).  In addition to being resilient, research and clinical experience have also revealed the phenomenon, posttraumatic growth (PTG), which is the positive psychological change that results from a struggle through a life-altering experience (Seligman & Csikszentmihalyi 2000; Levine et al., 2008).  Picararo and colleagues (2014) conducted a literature review and posited that PTG may involve numerous components, including greater appreciation of life, improved interpersonal relationships, greater personal strength, recognition of new possibilities in one’s life course, spiritual or religious growth, and reconstruction of a positive body image.  They authors revealed that parents and children may experience PTG following medical trauma through a combination of cognitive and affective processing of their subjective experience.  These findings are encouraging as psychotherapy provides a safe place for such cognitive and affective processing to take place, guided by a skilled and empathic clinician.   

A family-based approach to assessment and treatment is central to the overall adjustment and well-being of the pediatric patient.  Given that a secure attachment to a caregiver, healthy parental psychological functioning, effective parenting skills, and cohesive family functioning have demonstrated to be protective factors in the face of adversity (Laor et al., 1996; Lavingne & Faier-Routman, 1992), families can benefit from treatment that aim to foster these relationships and skills.  When receiving support that is grounded in trauma-informed care, many can experience posttraumatic growth and develop resilient characteristics that allow them to overcome ongoing or future adverse experiences. 

Dr. Kanchi Wijesekera, is a licensed clinical psychologist currently completing a postdoctoral fellowship at University of California, Los Angeles (UCLA).  Here, she provides trauma-focused assessment, consultation, and treatment to children, adolescents, and families who have been exposed to a wide range of challenging life circumstances and traumatic experiences.  In addition to providing services in the general family trauma clinic at UCLA, she’s also part of two multidisciplinary teams that serves the needs of patients and families in the pediatric heart transplant and hematology-oncology outpatient clinics.  She co-facilitates support groups for caregivers of solid-organ transplant pediatric patients who are admitted to Mattel Children’s Hospital as well.  Dr. Kanchi has many years of experience working with youth and families; using evidence-based treatment, she builds upon the current strengths of her patients and offers tailored treatment to bolster coping skills and optimize their emotional health. She also provides outpatient treatment to children, adolescents, and families in her private practice office in Westwood, CA, located within just 1-mile of UCLA. She can be reached for questions or consultation at (310) 800-7112.

REFERENCES

Alderfer, M., Labay, L., Kazak, A. (2003).  Brief report: Does posttraumatic stress apply to siblings of childhood cancer survivors? Journal of Pediatric Psychology, 28(4), 281-286. doi: 10.1093/jpepsy/jsg016

Barbarin, O., Sargent, J., Sahler, O., Carpenter, P., Copeland, D., Dolgin, M., et al. (1995). Sibling adaptation to childhood cancer collaborative study: Parental views of pre- and postdiagnosis adjustment of siblings of children with cancer. Journal of Psychosocial Oncology, 13, 1–20.

Dahl, R.E. (2004).  Adolescent brain development: a period of vulnerabilities and opportunities. Keynote address.  Annals of the new York Academy of Sciences, 1021, 1-22.

Farley, L., DeMaso, D., D’Angelo, E., Kinnamon, C., Bastardi, H., Hill, C., Blume, E., Logan, D. (2007). 

Parenting stress and parental post-traumatic stress disorder in families after pediatric heart transplantation. Journal of Heart Lung Transplant; 26(2):120–126.  

Forgey, M. & Bursch, B. (2013).  Assessment and management of pediatric iatrogenic medical trauma. Current Psychiatry Reports, 15(2):340.

Gothelf, D., Rubinstein, M., Shemesh, E., Miller, O, Farbstein, I, Klein, A., …, Yaniv, I. (2005).  Pilot study: fluvoxamine treatment for depression and anxiety disorders in children and adolescents with cancer.  Journal of American Academy of Child and Adolescent Psychiatry, 44(12), 1258-1262.  

Kazak, A., Barakat, L., Alderfer, M., Rourke., M.,Meeske, K., Gallagher, P., et al. (2001). Posttraumatic stress in survivors of childhood cancer and mothers: Development and validation of the Impact of Traumatic Stressors Interview Schedule (ITSIS). Journal of Clinical Psychology in Medical Settings, 8, 307–323

Kazak, A., Boeving, C., Alderfer, M., Hwang, W., Reilly, A. (2005) Posttraumatic stress symptoms during treatment in parents of children with cancer.  Journal of Clinical Oncology, 23, 7405–7410.

Laor N, Wolmer L, Mayes LC, et al. (1996). Israeli preschoolers under scud missile attacks: a developmental perspective on risk-modifying factors. Archives of General Psychiatry, 53(5), 416– 23.

Lavigne, J. V., & Faier-Routman, J. (1992). Psychological adjustment to pediatric physical disorders: A meta-analytic review. Journal of Pediatric Psychology, 17, 133-157.

Levine, S. Z., Laufer, A., Stein, E., Hamama-Raz, Y., & Solomon, Z. (2008). Posttraumatic growth in adolescence: Examining its components and relationship with PTSD. Journal of Traumatic Stress, 21(5), 492-496.   

Mintzer, L., Stuber, M., Seacord, D., et al. (2005). Traumatic stress symptoms in adolescent organ transplant recipients. Pediatrics, 115, 1640-4.

Parry, C. & Chesler, M. (2005).  Thematic evidence of psychosocial thriving in childhood cancer survivors.  Qualitative Health Research, 15, 1055-1073.

Picoraro, J., Womer, J., Kaza, A., and Feudtner, C. (2014).  Posttraumatic growth in parents and pediatric patients.  Journal of Palliative Medicine, 17(2): 209–218.

Seligman MEP., Csikszentmihalyi, M. (2000). Positive psychology: An introduction. The American Psychologist, 55, 5–14.

Savvy Internet Searching and Your Health

There have been many changes to the our healthcare system – managed care organizations are enrolling more individuals, providers are spending less time with patients and costs are being more carefully monitored. The United States healthcare system has maintained a fairly stable position as the most expensive healthcare system in the world (The World Health Report, 2013).  Though healthcare expenditure has increased in the past few decades, the quality of care has gone down. The United States ranks lower on health outcomes, quality and efficiency as compared to other countries. 

Physicians in the U.S. are constantly forced to deal with administrative hassles, care coordination and the difficulties in receiving timely information (Davis, 2014). A study from the University of California, San Francisco (UCSF) reported that the average U.S. patient-physician face-to-face time is about 1/2 the average of that in New Zealand and 1/3 of that in Australia. This has impacted the management of chronic conditions and helps to explain why Americans have poorer overall health outcomes compared to citizens of other countries (Bindman, Forrest, Britt, Crampton, & Majeed, 2007). The low relative ranking of our healthcare system shows there is an inverse relationship between quantity and quality. 

While all these changes have been taking place and continue to take place with the Affordable Care act, the internet continues to be the main source of health information delivery system for many individuals with chronic health conditions. The internet provides a diversity of health care information, including: online global network communities for individuals with common interests and support, e-mail, e-commerce, forming sites for consumers to share stories and experiences and also delivering the information and resources at a very low-cost (Mittman & Cain, 1999). This channel of information delivery has given the consumer more control of their own health (Pennbridge, Moya, & Rodrigues, 1999). 

Individuals are using the internet to research information about their medical conditions, treatment side effects, and for second opinions. Though there are many reliable health-focused internet sites, there are many sites that have misleading information. Even though many may be getting information from these unreliable sites, studies suggest that the majority of health information seekers are confident that they are accessing reliable information, and most do not share this information with their doctors. 

Despite the existence of many reliable medical and health-related web sites, several reviews have demonstrated that patients may encounter potentially misleading or inaccurate information when navigating the internet (Biermann, 1999; Sacchetti, Zvara, & Plante, 1999; Pandolfini, Impicciatore, & Bonati, 2001). The problem is that much of the health related information on the internet does not pass through an editorial review process and many websites do not even provide the author’s name (Ayonrinde, 1998; Lindberg & Humphreys, 1998).

Many difficulties exist when integrating the internet into health and health care. These difficulties include (Mittman & Cain, 1999).: 

  • Poor-quality of information on numerous websites

  • Not knowing the source of origin or authorship

  • More often than not there is no editorial review process on these sites

  • The uncertainty and uneven quality of publicly available information

  • The lack of universal standards for communications and transactions

What should you do and where should you look for accurate information? I have included the National Institute of Medicine/National Institute of Health link that discusses this in detail so please review this site and the video tutorial. In brief:

  • Always consider the source

  • When you go to a site look for an “about us” page and always check to see who is running the website. Is it …

    • A branch of the government

    • A university

    • A health organization

    • A hospital

    • A business

  • Focus on quality of information

  • Check for source citations. Are the authors referencing high quality studies? For example are they quoting journal articles from peer-reviewed publications? If unsure always check with a health-care professional.

  • Check to see if the site has an editorial board.

  • Is the information reviewed before it is posted?

Resources to help you evaluate the health information you are finding online:

http://www.nlm.nih.gov/medlineplus/evaluatinghealthinformation.html

16 Minute Video Tutorial from National Institute of Health

http://www.nlm.nih.gov/medlineplus/webeval/webeval.html (you can watch it directly on their website)

OR

http://www.nlm.nih.gov/medlineplus/webeval/webevaldownload.html  (you can download the video and watch it later)

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES

  1. Ayonrinde O. (1998) Patients in cyberspace: information or confusion? Postgrad Med J. 74:449–50.

  2. Biermann JS, Golladay GJ, Greenfield ML, Baker LH. (1999) Evaluation of cancer information on the Internet. Cancer. 86:381–90.

  3. Bindman, A. B., Forrest, C. B., Britt, H., Crampton, P., & Majeed, A. (2007). Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from three national surveys. British Medical Journal, 334(7606), 1261. doi: bmj.39203.658970.55 10.1136/bmj.39203.658970.55

  4. Davis, K. Stremikis, K. Squires, D. and Schoen, C (2014). Mirror, Mirror on the Wall: How the Performance of the U.S., Health Care System Compares Internationally. The Commonwealth Fund

  5. Lindberg DA, Humphreys BL. Medicine and health on the Internet: the good, the bad, and the ugly (1998). JAMA. 280:1303–4.

  6. Mittman, R., & Cain, M. (1999). The Future of the Internet in Health Care: Five-Year Forcast. Oakland: Institute for the Future, Written for California Healthcare Foundation.

  7. Pandolfini C, Impicciatore P, Bonati M. (2000) Parents on the web: risks for quality management of cough in children. Pediatrics. 105(1):e1

  8. Pennbridge, J., Moya, R., & Rodrigues, L. (1999). Questionnaire survey of California consumers’ use and rating of sources of health care information including the Internet. The Western Journal of Medicine, 171(5-6), 302-305.

  9. Sacchetti P, Zvara P, Plante MK. (1999). The Internet and patient education resources and their reliability: focus on a select urologic topic. Urology. 53:1117–20.

Call Now Button