On the Importance of Seeking Face-to-Face Treatment

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Reader’s Question

Reader 1: I’m a 19-year-old male, and recently I’ve felt like I’m going crazy. I have an extremely overactive mind, constantly thinking of things deeply. I seem to go into my own little mental world and I can go into a hazy state and feel lost in my own mind. I feel like it lasts for 2 minutes, but sometimes I’m in these trance-like states for an hour or more. I feel like I’m starting to find it hard to cope with everything, and it’s quite scary that I feel I’m losing control over my consciousness or reality. I also find I have extreme changes in my views on life day to day. What’s going on?

Reader 2: I am a 22-year-old female, recently diagnosed with ADHD. I have a multitude of other issues that I am too embarrassed to speak of with somebody face-to-face. I suffer from anxiety, depression and, very possibly, psychosis. When it comes to discussing personal issues, I become deeply introverted and afraid. When I tried consulting a therapist, I failed to mention my biggest mental and emotional distress, and started babbling about the very minor problems I have. As a result, I was diagnosed with ADHD and was prescribed Ritalin. I am so ashamed of my mental illness that I can’t get any help. The idea of revealing my thoughts and feelings to someone is horrifying. How do I proceed?

Psychologist’s Reply

These two letters seem rather different from each other, yet I chose to address them together because I think there is an important underlying issue that needs to be addressed: the necessity of finding a competent mental health professional with whom to meet in person. I base this conclusion on the fact that psychological disorders are so subjective. That is, there is no laboratory test to indicate the existence of a mental disorder. Diagnosis is based on gathering information, almost all of which is communicated verbally from client to therapist. Successful intervention is based on a good working relationship, in which the client and the professional work together to figure out what is going on and what to do about it.

Because of this subjective nature of mental disorders and their treatment, it’s imperative that clients be as open, honest, and articulate as possible. It’s not necessary to be perfect in this regard, but the helpfulness of the diagnosis and intervention rests on how much accurate information the client shares regarding his or her experience. The positive news is that good therapists are skilled at helping clients feel comfortable sharing their innermost thoughts and feelings, and helping clients sort through their mental experiences to make better sense out of them. Good therapists pride themselves on being nonjudgmental and not easily shocked. Unfortunately, clients frequently worry about the reverse: that the therapist will be appalled and repulsed as the client shares the workings of his or her mind.

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The subjective nature of psychological problems and their treatment extends to the fact that each person is different. Diagnostic labels are sometimes useful, as in research and medical records and billing. For treatment, though, it’s usually more important to focus on symptoms and the unique experience of the individual client. It’s not disorders that are the focus of treatment, but rather symptoms, and those are only fully understood in the context of the client’s life and day-to-day experience. For example, experiences that may prompt one person to seek treatment may not even bother another person who has similar experiences.

I encourage both of the letter writers to seek consultation with a mental health professional, and not to stop searching until finding one with whom it feels possible to be entirely open and honest. To overcome initial anxiety, it may be necessary to focus on the fact that there is nothing a client can say to send an experienced mental health professional fleeing the room in horror. When we are able to share our most private experiences and concerns with another individual, and receive nonjudgmental caring in response, that experience alone is often therapeutic. From there we can then begin the collaborative work that is effective mental health treatment.

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