Psychotherapy: How can it Help you

Psychotherapy: How it Works and How it Can Help

Psychotherapy (also known as talk therapy) can be an important part of treatment for depression or bipolar disorder (manic depression). A good therapist can help you cope with feelings and symptoms, and change behavior patterns that may contribute to your illness.
Talk therapy is not just “talking about your problems”; it is also working toward solutions. Some therapy may involve homework, such as tracking your moods, writing about your thoughts, or participating in social activities that have caused anxiety in the past. You might be encouraged to look at things in a different way or learn new ways to react to events or people.
Most of today’s psychotherapy is brief and focused on your current thoughts, feelings and life issues. Focusing on the past can help explain things in your life, but focusing on the present can help you cope with the present and prepare for the future. You might see your therapist more often at the beginning of treatment, and later, as you learn to manage problems and avoid triggers, you might go to psychotherapy appointments less often.

Psychotherapy can help you:

• Understand your illness
• Define and reach wellness goals
• Overcome fears or insecurities
• Cope with stress
• Make sense of past traumatic experiences
• Separate your true personality from the mood swings caused by your illness
• Identify triggers that may worsen your symptoms
• Improve relationships with family and friends
• Establish a stable, dependable routine
• Develop a plan for coping with crises
• Understand why things bother you and what you can do about them
• End destructive habits such as drinking, using drugs, overspending or unhealthy sex. 

Who provides talk therapy?

Your therapist may be a psychiatrist (MD), psychologist (PhD, PsyD, EdD, MS), social worker (DSW, MSW, LCSW, LICSW, CCSW), counselor (MA, MS, LMFT, LCPC), or psychiatric nurse (APRN, PMHN). Your ability to talk honestly and openly with your therapist, set clear goals and make real progress is important. Think of your relationship with your therapist as a partnership. The two of you will work together to help you feel better. You do not need to feel ashamed or embarrassed about talking openly and honestly about your feelings and concerns.

How do I get started?

Make a list of the things that are bothering you and the issues you would like help with. Bring it with you to your first appointment. You might include:

• Issues in your family or other relationships
• Symptoms like changes in eating or sleeping habits
• Anger, anxiety, irritability or troubling feelings
• Thoughts of hurting yourself

In your first few sessions, you will probably do most of the talking. You should tell the therapist why you are there and what you would like to get from therapy. Make a list of short- and long-term goals with your therapist at the beginning of treatment. After a few sessions, your therapist may be able to give you an idea of how long therapy will take and when you can expect to see changes in your moods.

How will I know if I’m making progress?

After some time has passed, check the list and see if you’re closer to reaching your goals. It may be helpful to track how you feel each day and how you cope with difficult situations. Review your progress with your therapist. Improvement won’t happen overnight, but you should see some change, even if it’s just a better understanding of your own thoughts and feelings. It is also helpful to learn everything you can about depression and bipolar disorder and their treatments. Check your local library for other books and reference materials.

What if I’m not making progress?

If, after some time, you don’t begin to feel some relief, you have a right to seek a second opinion (as you would with any illness) from another therapist or mental health professional. You have a right to have the best treatment possible, and you can feel better.

What type of therapy is best for me?

There are many types of talk therapy and most therapists use a combination of approaches. Behavioral therapy concentrates on your actions; cognitive therapy focuses on your thoughts; and interpersonal therapy looks at your relationships with others. Your loved ones may join you in sessions of family or couples therapy. Group therapy involves several, usually unrelated people working with the same therapist and each other. One approach is not necessarily better than another the best choice is the one that works best for you.

What are some therapies commonly used for depression or bipolar disorder?

Interpersonal therapy (IPT) was originally developed to treat depression. It has since been adapted for bipolar and other disorders. It is time-limited and goal-oriented, and addresses a person’s symptoms, social relationships and roles. IPT focuses on what is happening “here and now” and attempts to help a person change, rather than just understand his or her actions and reactions. The patient and therapist examine current and past relationships. IPT does not focus on unconscious or subconscious motivations, wishes or dreams. It looks at conscious, outward action and social adjustment. It does not try to change the personality, but rather to teach new skills that can lessen symptoms.

An IPT therapist is an active supporter of the patient on the wellness journey. The therapist does not assign homework, but may encourage a patient to engage in social activities. The therapist helps the patient review his or her symptoms and relate these symptoms to one of four things: grief over a loss, conflicts with others, changes in life status such as moving or changing jobs or isolation/ lack of social skills. The therapist and patient then work through specific situations, one by one, to relieve symptoms and stress.

Cognitive-behavioral therapy (CBT) combines cognitive therapy, which involves examining how thoughts affect emotions, and behavioral therapy, which involves changing a person’s reactions to challenging situations. CBT is goal-oriented and works best when the patient takes an active role. One aspect of CBT helps a person recognize the automatic thoughts or core beliefs that contribute to negative emotions. The therapist helps the person see that some of these thoughts and beliefs are false or don’t make sense and helps the person change them. Types of automatic thoughts may include focusing on one negative idea (an unkind person) and applying the negative quality to everything (the human race in general); viewing things as “all good” or “all bad”; or applying labels such as “loser,” “no good,” or “worthless.” Types of core beliefs may include, “I have to succeed at everything”; “Everyone has to love me”; “It’s a disaster if things don’t go the way I plan or expect”; or “I can’t change the miserable way I am.”

The behavioral aspect of CBT takes place after a person has a more calm state of mind. The person can then take actions that help him or her move closer to planned goals. For example, if depression has caused someone to withdraw from life, that person may be encouraged to participate in hobbies or spend time with friends. Or a person may be gently coached, under supervision, to confront situations, things or people that cause fear or panic. Through practice, a person learns new, healthier behaviors.

With CBT, the therapist assigns homework. It may include journaling, reviewing notes or tapes of the therapy session, or trying a new approach to an old problem. There may also be exercises to make a person more aware of his or her own thoughts and actions without judging them.

The most important parts of any type of therapy are partnership, communication, goals, collaboration, trust, understanding and action. Successful therapy can help a person change thoughts, beliefs, perceptions, actions and moods for the better. 

PTSD and the Emergency Services

Post Traumatic Stress

The Facts:
Police, fire brigade, army or ambulance workers are more likely to be exposed to traumatic experiences and suffer with PTSD.

Most people, in time, get over experiences like this without needing help. In some people though, traumatic experiences set off a reaction that can last for many months or years which is now known as PTSD.

Physical Signs:
Adrenaline is a hormone our bodies produce when we are under stress. It "pumps up" the body to prepare it for action. When the stress disappears, the level of adrenaline should go back to normal.

In PTSD, it may be that the vivid memories of the trauma keep the levels of adrenaline high. This will make a person tense, irritable, and unable to relax or sleep well.

Why is PTSD often not recognised? -
None of us like to talk about upsetting events and feelings. - We may not want to admit to having symptoms, because we don't want to be thought of as weak or mentally unstable. - Doctors and other professionals are human. They may feel uncomfortable if we try to talk about gruesome or horrifying events. -

People with PTSD often find it easier to talk about the other problems that go along with it - headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems.

Which treatments first?
The National Institute for Clinical Excellence (NICE) guidelines suggest that trauma-focussed psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.

What is Vicarious Trauma?

What is Vicarious Trauma?

Most simply put, vicarious trauma can be thought of as the negative changes that happen to humanitarian workers over time as they witness other people’s suffering and need. While many humanitarian workers are changed positively by their experiences, here we focus on the negatives.

These negative changes are the cost of caring for and caring about others who have been hurt. We could therefore define vicarious trauma this way: Vicarious trauma is the process of change that happens because you care about other people who have been hurt, and feel committed or responsible to help them. Over time this process can lead to changes in your psychological, physical, and spiritual well-being.

Think about Looking at the definition, what questions do you have about vicarious trauma? Now, let’s take that definition apart and look at each element for a deeper understanding of how vicarious trauma relates to humanitarian work. Vicarious trauma is a process of change Vicarious trauma is a process that unfolds over time. It is not just your responses to one person, one story, or one situation. It is the cumulative effect of contact with survivors of violence or disaster or people who are struggling. It is what happens to you over time as you witness cruelty and loss and hear distressing stories, day after day, and year after year.

This process of change is ongoing. Your experiences of vicarious trauma are continuously being influenced by your life experiences (both those you choose and those that simply happen to you in the course of your professional and personal lives).  This is an important point because it provides hope: as the process of VT unfolds, there are many opportunities along the way to recognize the impact your work is having on you and to think about how to protect and care for yourself while doing that work.

Vicarious trauma is an ongoing process of change over time that results from witnessing or hearing about other people’s suffering and need. Think about What are some ways that you have changed over time because of your work?  

Vicarious trauma happens because you care about people who have been hurt. Vicarious trauma happens because you care – because you empathize with people who are hurting. Empathy is the ability to identify with another person, to understand and feel another person’s pain and joy. Empathy doesn’t mean feeling exactly what someone else is feeling.

Everyone is unique. Everyone has his or her own personal history, personality, and life circumstances. You cannot ever feel exactly what someone else is feeling. But to a certain extent (and more effectively in some cases than others), when you care, you can relate to other people’s experiences, reactions, and feelings. And when you care about and identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience and feel it along with them in some way.

When you identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience.   Think about What sort of problems or people do you find it especially easy to empathize with? What are some ways that caring about people who have been hurt affects you?  

Vicarious trauma happens not only because you care about people who have been hurt, but because you feel committed or responsible to help. At its core, the point of humanitarian work is to serve and collaborate with people who need help.

Humanitarian workers do that in many different ways. Some work as advocates; some help provide food, shelter, sanitation, or medical services; some work in community or economic development, or peace-building. Whatever your particular role, as a humanitarian worker you are in the business of helping people who may have experienced terrifying violence and profound losses. Many of these people are desperate and some have lost hope. Humanitarian workers assume a heavy responsibility by showing up and conveying the message, “I’m here to help. There is hope.”

Many humanitarian workers are very committed to their work and take this responsibility very deeply. This is not necessarily a bad thing! However, feeling deeply committed and responsible can contribute to the process of vicarious trauma. It can lead to very high (and sometimes unrealistic) expectations of yourself and others, and for the results you want to see from your work. For example, you may take it personally when your work or the work of your organization doesn’t have the impact you want.

Ironically, your sense of commitment and responsibility can eventually contribute to you feeling burdened, overwhelmed, and hopeless in the face of great need and suffering. It can also lead you to extend yourself beyond what is reasonable for your own well-being or the best long-term interests of beneficiaries.

Your commitment and sense of responsibility can lead to high expectations and eventually contribute to your feeling burdened, overwhelmed, and perhaps hopeless. Think about How does your sense of commitment and responsibility to your work help you? Are there ways in which your sense of commitment and responsibility to your work might hurt you? How?   Over time, vicarious trauma leads to changes in your own psychological and spiritual well-being.

Vicarious trauma is the result of opening up your heart and mind to the worst in human experience - natural and human-made disasters, and human cruelty. When you witness the suffering of people you care about and feel responsible to help, over time this can change the way that you see yourself, the world, and what matters to you. These challenges can change your spirituality (your deepest sense of meaning and purpose, hope and faith).

A key component of vicarious trauma is changes in spirituality. Not all of the spiritual changes that come from humanitarian work are negative! Many humanitarian workers feel they have grown and matured as the result of things they have seen and experienced. You may feel you gain a broader and more balanced perspective on life and end up better able to understand and empathize with others.

However, witnessing disasters, violence, and suffering can challenge your spirituality in less positive ways. You can come to question your deepest beliefs about the way life and the universe work, and the existence and nature of meaning and hope.

Humanitarian workers often use the phrase “existential angst” to refer to their sense that they are constantly being pushed out of their comfort zone and forced to question the meaning of events, and their own and others’ actions and reactions. A key component of vicarious trauma is changes in spirituality. Vicarious trauma, like experiencing trauma directly, can deeply impact the way you see the world and your deepest sense of meaning and hope.

Think about What are two ways you feel your work has had a positive influence on the way you see the world, yourself, or what matters to you (your sense of meaning and purpose, hope and faith)? What are two ways you feel your work has had a negative influence on the way you see the world, yourself, or what matters to you (your sense of meaning and purpose, hope and faith)?  

So, what should you do about vicarious trauma? Being impacted by vicarious trauma is a predicable outcome of being in a job that is focused on helping others during or after traumatic experiences. So what can you do about this? Looking at the definition we’ve just discussed, you might be thinking about several options. Should you try to stop caring so much – stop empathizing with people who are hurting? Should you stop feeling committed and responsible? Should you quit your job?

Those are options, but there are better options! Simply understanding more about vicarious trauma is a great first step. This will help you decide what you need in order to best prevent and address your vicarious trauma. Learning to be aware of and address vicarious trauma in an ongoing manner goes a long way toward making sure you don’t burn out or feel crushed by vicarious trauma, or unintentionally harm others because of its effects.

With appropriate tools, humanitarian workers and organizations can better understand, prevent, and address VT. Being beaten down by VT isn’t inevitable, but having to address it constantly is.

Considering suicide?

Considering Suicide How to stay safe and find treatment

Despair and hopelessness may lead you to think about suicide. Learn how to stay safe, get through a crisis and find treatment.By Mayo Clinic staff

When life doesn't seem worth living anymore or your problems seem insurmountable, you may think that the only way to find relief is through suicide. You might not believe it, but you do have other options — options to stay alive and feel better about your life.

Maybe you think you've already tried them all and now you've had enough. Or maybe you think your family and friends would be better off without you. It's OK to feel bad, but try to separate your emotions from your actions for the moment. Realize that depression, other mental disorders, despair and hopelessness can distort your perceptions and impair your ability to make sound decisions. Suicidal feelings are the result of treatable problems. So try to act as if there are other options instead of suicide, even if you may not see them right now.
No, it may not be easy. You might not feel better overnight. Eventually, though, the sense of hopelessness and thoughts of suicide can lift. You can find support, appropriate treatment and reasons for living.

Immediate help for thoughts of suicide

If you're considering suicide right now and have the means available, talk to someone first. The best choice is to call 911 or your local emergency services number.
If you simply don't want to do that, for whatever reason, you have other choices for reaching out to someone when you feel suicidal:
Contact a family member or friend.
Contact a doctor, mental health provider or other health care provider.
Contact a minister, spiritual leader or someone in your faith community.
Go to your local hospital emergency room.
Call a crisis center or hot line.

Crisis centers and suicide hot lines are often listed in the front of your phone book or on the Internet. They generally offer trained volunteer counselors who can help you through an immediate crisis. While some crisis centers with an Internet presence offer e-mail contact, remember that responses may not be as prompt as they are with telephone support.
Talking to someone about your suicidal feelings can help relieve the burden of despair and isolation, even if just temporarily. It may help you shift perspective and more clearly see that you have options instead of suicide.

Daily coping strategies

You may struggle with suicidal feelings frequently, perhaps many times a day if you're in the depths of depression. Develop a strategy to cope with those feelings in a healthy way. Consider asking a doctor, family member or friend to help create a strategy tailored to your specific situation that will help you cope with thoughts of suicide.

That strategy may mean doing things you don't feel like doing, such as making the effort to talk to friends when you'd rather stay in your bedroom all day. Or it may mean going to the hospital for a mental health evaluation. But stick to your strategy, especially when you're in the grips of despair and hopelessness. And if you're already in treatment, be certain to go to all of your psychotherapy appointments and take medications as directed.

As part of your strategy, consider these measures:

Keep a list of contact names and numbers readily available, including doctors, therapists and crisis centers that can help you cope with suicidal thoughts.

If your suicide plans include taking an overdose, give your medications to someone who can safeguard them for you and help you take them appropriately.
Rid your home of knives, guns, razors or other weapons you may consider using for self-destructive purposes.

Schedule daily activities for yourself that have brought you even small pleasure in the past, such as taking a walk, listening to music, watching a funny movie, knitting or visiting a museum. If they no longer bring you at least a modicum of joy, however, try something different.
Get together with others, even if you don't feel like it, to prevent isolation.

Avoid drug and alcohol use. Rather than numb painful feelings, alcohol and drugs can increase suicidal thoughts and the likelihood of harming yourself by making you more impulsive and more likely to act on your self-destructive feelings.

Write about your thoughts and feelings. Remember to also write about the things in your life that you value and appreciate, no matter how small they may seem at the time.

Keeping yourself safe

Some mental health providers and support organizations recommend creating a "plan for life," "safety contract" or similar plan of action that you can refer to when you're considering suicide or are in a crisis. Such plans offer a checklist of activities or actions you promise yourself to take in order to keep yourself safe when you have thoughts of suicide.

For instance, your plan may require that you contact certain people when you begin considering suicide. It may also include commitments to take medication as prescribed, to attend treatment sessions or appointments, and to remind yourself that your life is valuable even if you don't feel it is.

Also, consider creating a list of specific activities to try when negative thoughts start to intrude. The key is to engage in activities you find soothing for your negative feelings. Don't wait to do these activities until you've reached the point of suicidal thoughts. Engage in healthy activities when the first negative thoughts start to creep in. Also, make certain they're activities that would normally offer enjoyment and that can help comfort you, not cause additional stress.
Then, do each item on your list until you feel like you can go on living.

Your list can include such things as:

Practicing deep-breathing exercises
Playing a musical instrument
Taking a hot bath
Eating your favorite food
Writing in a journal
Going for a walk
Seeing a funny movie
Contacting family, friends or other trusted confidantes

Even if the immediate crisis passes with your self-care strategies, consult a doctor or mental health provider, or seek help through a hospital emergency room if your community doesn't offer good access to mental health providers. They can help make certain you're getting appropriate treatment for suicidal thoughts and feelings so that you don't have to continually operate in a crisis mode.

Beyond thoughts of suicide

The despair and hopelessness you feel as you consider suicide may be the side effects of illnesses that can be treated. These emotions can be so overpowering that they cloud your judgment and lead you to believe that taking your own life is the best, or only, option.
But even people who've had suicidal thoughts for months or years can learn to manage them and to develop a more satisfying life through effective coping strategies. Take an active role in saving your own life, just as you would help someone else. Enlisting others for support can help you see that you have other options and give you hope about the future. Remember that suicide isn't a solution — it's an ending.

Know the Signs of Trauma

People often wonder, “If most trauma reactions are normal and will pass by themselves in time, how do I know when I should seek professional help?”

That’s a good question. On one hand, the reactions you are experiencing may subside by themselves during the days and weeks after an event if you:

Recognize that the trauma reactions seem to be normal responses to abnormal events.
Take some time to care for yourself.
Have supportive people around you.
On the other hand, just like it’s sensible to check in with a doctor when you’ve got a severe case of the flu, talking to a trained counselor after a traumatic event can be very helpful. There are also some trauma reactions that require you to seek help from a mental health professional. To continue with the medical analogy, these severe trauma symptoms suggest that your case of the flu may have been complicated by pneumonia. If you catch pneumonia, you need to see a doctor. And if you experience any of the following severe trauma reactions, you should contact a mental health professional. Likewise, if you observe these signs in someone else who has experienced a traumatic event, you should strongly encourage them to contact a mental health professional.

The following may be signs of a severe trauma reaction:

Suicidal thoughts
Feeling as if you might be a danger to yourself or others
Heart palpitations, chest pain, trouble breathing or other potentially serious physical symptoms (contact a physician immediately)
Severe psychological symptoms, including:
Flashbacks
Amnesia
Enduring feelings of unreality and “disconnection from the world”
Feeling completely overwhelmed or paralyzed
Feeling that you cannot handle the intense thoughts, feelings, and bodily sensations alone
A history of mental illness and psychiatric treatment
Substance abuse (e.g., consistently using alcohol or sleeping medication to help you sleep)
Feeling that your emotions are not “falling into place” over time and experiencing chronic tension, confusion, emptiness, and exhaustion
Noticing that your relationships are suffering and/or sexual problems are developing
Driving yourself to stay active all the time to avoid your feelings
How do I find professional help?

Many humanitarian workers live and work in places where contacting a mental health professional is difficult. Begin by contacting the Human Resources department of your employer. They may be able to refer you to an appropriate person or resource.