MyThoughts

This is the final installment of my series on "Expectations of Therapy".  While I decided to write about this subject last, it is perhaps one of the most important.  I am referring to the fears and and reservations that prevent people in need from seeking help from a professional counselor or psychotherapist.  Let me guide you through a few of the more common hindrances:

• Fear of being labeled: There are some people who forego seeking help from a psychotherapist for fear of being labeled as crazy, psychotic, neurotic or some derivation thereof.  Others may fear a diagnosis of Depression, Bipolar Disorder or some other disorder.  For the most part, I try to avoid labeling or diagnsoses in my practice.  However, there are certain times when they are appropriate.  In order to conquer something, it is sometimes necessary to know what it is you are fighting.  If I do find it necessary to disclose a diagnosis to someone, it is done when I feel the time is right with the utmost delicacy and respect for the person.  This is something that only a trained and seasoned psychotherapist can know how to do properly. 
• Fear of disclosing personal information: It can be intimidating for some people to disclose highly personal information to someone that they just met.  This is exactly why I do an evaluation with every new client.  This enables both of us to get to know each other before any major decisions are made regarding the counseling process.  Contrarily, disclosing personal information to a therapist you do not know has its benefits.  The fact that a counselor is not a friend or family member can actually make it easier for the counselor to help you.  The advice of friends and family members can often be colored with biases, judgments, or preconceptions.  Not only do counselors work to be objective and non-judgmental with their clients, that is what they are trained to do. 
• Cost of treatment: People often cite the cost of treatment as a major reason for foregoing therapy.  One thing I have learned throughout my career is that money itself is rarely the issue, the issue is what money represents in the person's mind (security, safety, power, etc.).  Many times my clients end up being more financially well-off and secure because I help them to overcome the issues that were preventing them from being successful (depression, anxiety, self-esteem, etc.).  I also understand that there are some people that are going through financial hardship and to those I offer several different options for quality treatment at a price that they can afford.

     That wraps up my thoughts on some of the expectations of therapy.  I hope this was helpful in spurring those of you who have been hesitant to seek help to do so at this time.  I also hope that this was helpful for those of you who might be trying to sway someone else to seek help.  I will be writing a blog in the first week of January in order to address New Year's resolutions and starting off 2010 on the right foot.  Until then, enjoy the rest of the holiday season and Happy New Year!

 
Sincerely,

Nathan M. Comerford, MA, LLPC, NCC

Nathan M. Comerford is a psychotherapist in Farmington Hills, MI who has been helping people with their relationship issues, emotional difficulties and mental health problems for the past 9 years. 

Thought Perspectives Counseling, PLLC
31275 Northwestern Hwy., Suite 120
Farmington Hills, MI 48334
Phone: (248) 225-5259
www.thoughtperspectives.com

• If you or someone you know needs to speak to someone regarding relationship issues, emotional difficulties or mental health problems, help is a phone call away.  Schedule an appointment today!
  Just call (248) 225-5259 to set up an appointment with
  Nathan Comerford, MA LLPC NCC.
      
  Visit www.thoughtperspectives.com for more information on counseling and psychotherapy!
  
  Visit the "Ask the Counselor" Blog at:www.thoughtperspectives.com/blog
  

     Now that the summer months are coming to an end and Fall is setting in, many people decide to initiate therapy for the first time while others may return after a sabbatical.  Busier work schedules, children returning to school and changes in weather can cause increased stress in personal, marital and family relationships sparking people to seek the assistance of a counselor or therapist.  Problems with depression and anxiety are also exacerbated during this time of year which is another reason why I am choosing to highlight what people can expect when they come to me for help.  
     First Contact- the therapeutic relationship starts when someone first contacts me by phone or sometimes by email.  If I am unavailable when someone contacts me I will get back to them within the same day, usually within a few hours.  My goal is to talk to the person on the phone so I can get them to summarize what the presenting problems are and why they decided to seek help at the current time.  If their presenting problems are something that I can assist them with then I will schedule an appointment for them to come in.  If their presenting problem is something that falls outside of the scope of my practice, I will try to refer them to another professional that may be able to help.  
     At some point in the phone conversation I will explain to them my process of conducting an evaluation with all new clients that I see whether they are individuals, couples or families.  The evaluation is approximately 3-5 sessions depending on the nature of the problems and how many people are present.  During the evaluation, I would be gathering info about the nature and history of the problem.  I would also be asking questions about family history and previous therapy experiences.  At the end of the evaluation, I then give my thoughts as to what I believe is going on and what direction I believe would be most helpful.  The evaluation also gives the client(s) a chance to get some idea of who I am and, if we decide to continue, whether they would be comfortable working with me. 
     The evaluation that I conduct is no different than an evaluation a medical doctor would perform.  If someone consulted a doctor for pain in their lower back, the doctor would want to first run a series of tests in order to find out exactly what the problem was before treating it.  The evaluation gives me a chance to learn about the nature and causes of the underlying problems rather than using conjecture and running the risk of misdiagnosis.
     Next month I will discuss and outline what to expect during the initial office visit.  I will also talk about some of the fears and reservations that delay or prevent people from seeking professional help from a counselor or therapist.
 
Sincerely,

Nathan M. Comerford, MA, LLPC, NCC

Nathan M. Comerford is a psychotherapist in Farmington Hills, MI who has been helping people with their relationship issues, emotional difficulties and mental health problems for the past 8 years. 

Thought Perspectives Counseling
31275 Northwestern Hwy., Suite 120
Farmington Hills, MI 48334
Phone: (248) 932-7799
www.thoughtperspectives.com

• If you or someone you know needs to speak to someone regarding relationship issues, emotional difficulties or mental health problems, help is a phone call away.  Schedule an appointment today!
  Just call (248) 932-7799 to set up an appointment with
  Nathan Comerford, MA LLPC NCC.
      
  Visit www.thoughtperspectives.com for more information on counseling and psychotherapy!
  
  Visit the "Ask the Counselor" Blog at:www.thoughtperspectives.com/blog
  
• This is a question and answer blog where Nathan answers questions concerning mental health topics.
•  If you have a question, you can send it to: questions@thoughtperspectives.com to have it answered by: Nathan Comerford, MA, LLPC, NCC.

     In this month's blog I would like to wrap up this series on depression by discussing some of the causes of depression.  Contrary to popular belief, there is no concrete evidence that depression is genetically inherited or that it is caused by a chemical imbalance in the brain.  There are some research studies that show some slight evidence for those two things as being contributing factors to depression but the research in general is inconclusive.  Depression for the most part is caused by psychological factors which means that psychotropic drugs such as antidepressants will do little to cure depression.  Antidepressants are a palliative approach to treating depression which means that they only work on relieving the symptoms of depression such as irritable mood, insomnia, hypersomnia, or fatigue.  They do not work on treating the psychological root of the problem which is why psychotherapy is recommended to help alleviate depression from the underlying cause.

What are the true causes of depression?

• Depression is centered on a sense of loss.  In essence, the depressed person feels that he has lost someting that is essential to his happiness or survival.  This could include the loss of a loved one, the loss of a job, feeling that youth or physical attractiveness is lost, or many other things.  Whatever the sense of loss is centered around, the feelings engendered by it are equivalent to feeling that life will never be complete or fulfilling.
• The gap of where one thinks they should be in life and where they actually are in life is too great.  An example of this would be a woman who feels that she should have accomplished much more in her life by age 40.  She feels depressed because she thought she would have been married, graduated from college and started a family by 40.  Depression occurs in these situations when people feel that defects in their personality or character are at fault for the underachievements.  
• Existential concerns.  Depression often occurs when people do not understand what their purpose is in life or why they have been put on Earth.  Severe religious or spiritual conflicts and moral and ethical dilemmas may also be of relevance in this category.    

     The causes listed above are only abreviated and highly generalized categories.  There are many more psychological causes of depression but, many of the causes will fit into one of those categories.  Those who may be afflicted with depression can take comfort in the facts that depression is highly treatable in many cases and that there are many experienced and qualified counselors and psychotherapists that can provide answers and treatment. Those who may be unsure if they are depressed or not could benefit from talking to a professional in the mental health field before things deteriorate further. Preventative measures can be taken to thwart depression before it becomes unmanageable which is perhaps the most preferred method of treatment.

Sincerely,

Nathan M. Comerford, MA, LLPC, NCC

Nathan M. Comerford is a psychotherapist in Farmington Hills, MI who has been helping people with their relationship issues, emotional difficulties and mental health problems for the past 8 years. 

Thought Perspectives Counseling
31275 Northwestern Hwy., Suite 120
Farmington Hills, MI 48334
Phone: (248) 932-7799
www.thoughtperspectives.com

• If you or someone you know needs to speak to someone regarding relationship issues, emotional difficulties or mental health problems, help is a phone call away.  Schedule an appointment today!
  Just call (248) 932-7799 to set up an appointment with
  Nathan Comerford, MA LLPC NCC.
      
  Visit www.thoughtperspectives.com for more information on counseling and psychotherapy!
  
  Visit the "Ask the Counselor" Blog at:www.thoughtperspectives.com/blog
  
• This is a question and answer blog where Nathan answers questions concerning mental health topics.
•  If you have a question, you can send it to: questions@thoughtperspectives.com to have it answered by: Nathan Comerford, MA, LLPC, NCC.

 In my last blog I shared some staggering statistics concerning depression and answered the question of why people who may be depressed choose not to seek help.  In this blog I would like to answer some questions related to the definitions of depression.

• What is Clinical Depression?

     Clinical Depression (also known as major depression, major depressive disorder, and unipolar depression) is classified as a mood disorder by the DSM-IV-TR (a clinical reference manual for mental disorders).  This is an abbreviated definition of a Major Depressive Episode from the DSM-IV-TR: At least 5 of symptoms from the list below must have been met for at least a two week period and one of the symptoms must have been either 1) depressed mood or 2) loss of interest in pleasure. 
1) Depressed mood the majority of the time.
2) Loss of interest in pleasure.
3) Significant weight loss or weight gain.
4) Significant increase or decrease in sleep.
5) Psychomotor agitation or retardation.
6) Fatigue.
7) Feelings of worthlessness or excessive guilt.
8) Diminished ability to think or concentrate.
9) Recurrent thoughts of death or suicide.
     The symptoms must cause significant impairment in social, occupational, or other important areas of functioning.  The presence of two or more Major Depressive Episodes would constitute Major Depressive Disorder, Recurrent (long term depression). 

• What is the difference between Clinical Depression and Situational Depression?

     Situational depression is more commonly known as sadness related to an unfortunate  event or situation that may occur in everyday life.  Situational depression is normally temporary or short term and has little to no interference with one's normal life and daily functioning.  However, situational depression can lead to a more severe case of clinical depression if it is not treated or dealt with in a healthy and timely manner. 
     Clinical depression is characterized by overwhelming feelings of loss, hopelessness, helplessness and despair that is more long term (at least 2 weeks or more) and interferes with one's normal life and everyday functioning.  Pyschological treatment is strongly recommended for clinical depression.  Pyschiatric treatment in the form of psychotropic drugs may be needed in some cases.
     In my next blog I will be answering questions related to the causes of depression.  Until then, enjoy the summer months while they still last!
Sincerely,

Nathan M. Comerford, MA, LLPC, NCC

• If you or someone you know needs to speak to someone regarding relationship issues, emotional difficulties or mental health problems, help is a phone call away.  Schedule an appointment today!
  Just call (248) 932-7799 to set up an appointment with
  Nathan Comerford, MA LLPC NCC.
      
  Visit www.thoughtperspectives.com for more information on counseling and psychotherapy!
  
  Visit the "Ask the Counselor" Blog at:www.thoughtperspectives.com/blog
  
• This is a question and answer blog where Nathan answers questions concerning mental health topics.
•  If you have a question, you can send it to: questions@thoughtperspectives.com to have it answered by: Nathan Comerford, MA, LLPC, NCC.

Nathan M. Comerford is a psychotherapist in Farmington Hills, MI who has been helping people with their relationship issues, emotional difficulties and mental health problems for the past 8 years. 

Thought Perspectives Counseling
31275 Northwestern Hwy., Suite 120
Farmington Hills, MI 48334
Phone: (248) 932-7799
www.thoughtperspectives.com>

 Depression Statistics:

• 14.8 million (6.7%) adult Americans are affected by Major Depressive Disorder in a given year.  (Archives of General Psychiatry, 2005 Jun; 62(6) : 617-27)
• Women experience depression at twice the rate of men.  (Journal of the American Medical Association, 1996)
• Depression is the cause of over two-thirds of the 30,000 suicides reported every year in the U.S.  (White House Conference on Mental Health, 1999)
• Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment.  (Depression And Bipolar Support Alliance, 1996) 

     Over the next several months I will be writing about depression and answering questions related to depression.  As you can see from the statistics presented above, the pervasiveness of depression is highly significant among our population and it only gets worse as time moves forward.  I would like to start this series out by looking at why people with depression do not seek treatment or why they wait until the level of severity becomes so intense that it becomes much more difficult to treat. 

Question: If depression has a high treatment success rate, then why do people forego treatment?

• When people are depressed, the motivation to seek help can evaporate.

     The paradoxical nature of depression is perhaps one of its most debilitating characteristics.  A person who is truly depressed can experience an almost complete reversal in behavior and personality traits.  When depression hits, instincts for self-preservation disappear, the panacea of sleep diminishes and biological drives such as sex and hunger become irrelevant.  Any enjoyment in life is replaced with the drive to intensify emotional pain and suffering.  For example, the depressed person will intentionally avoid engaging in behaviors or activities that will improve their situation.  Exercising, eating healthy and seeking out counseling or therapy are just a few things that will be avoided even though they are known to be helpful.  Escape, avoidance and withdrawal consume the depressed person.

     The motivation to seek help is absent because those experiencing depression become enraptured by pessimism and negative thought patterns. This in turn engenders beliefs that they deserve to be miserable and that they are undeserving of a happy and fulfilling life.  In other words, they do not seek help because they do not believe they are worthy of being helped.       

• Stigma in seeking help is still present.

     Even though counseling and psychotherapy have become much more accepted and mainstream since their inception, the stigma to seek out mental health services still presides.  Most people do not have a problem seeking out medical services when they are physically ill or having a medical crisis.  The same cannot be said for people experiencing mental illness or emotional crises.  Perhaps it is because people see that medical problems are outside their locus of control whereas emotional problems are not.  When it comes to emotional difficulties, many people feel that they should be able to handle them on their own without any outside assistance.  On a similar note, some even feel that they have some how failed in their personal lives if they have to ask for emotional assistance.  Not too many people feel guilty or ashamed to ask for help when they are afflicted with medical conditions like diabetes or cancer.  The fact remains that those who can humble themselves to seek help for their emotional and psychological problems are more likely to make improvements in their lives.

     In my next blog I will be discussing several definitions of depression as well as what depression really looks like.

Sincerely,

Nathan M. Comerford, MA, LLPC, NCC

• If you or someone you know needs to speak to someone regarding relationship issues, emotional difficulties or mental health problems, help is a phone call away.  Schedule an appointment today!
  Just call (248) 932-7799 to set up an appointment with
  Nathan Comerford, MA LLPC NCC.
      
  Visit www.thoughtperspectives.com for more information on counseling and psychotherapy!
  
  Visit the "Ask the Counselor" Blog at:www.thoughtperspectives.com/blog
  
• This is a question and answer blog where Nathan answers questions concerning mental health topics.
•  If you have a question, you can send it to: questions@thoughtperspectives.com to have it answered by: Nathan Comerford, MA, LLPC, NCC.

Nathan M. Comerford is a psychotherapist in Farmington Hills, MI who has been helping people with their relationship issues, emotional difficulties and mental health problems for the past 8 years. 

Thought Perspectives Counseling
31275 Northwestern Hwy., Suite 120
Farmington Hills, MI 48334
Phone: (248) 932-7799
www.thoughtperspectives.com>