WEBVTT
00:01:20.859 --> 00:01:29.020
Hey everyone and welcome to the Psych2 Practice Podcast, your one-stop for practical and useful clinical information, masterful insights from experts in the field and a guide to daily living.
00:01:29.260 --> 00:01:31.340
I'm your host, Paul Wagner, and joining me.
00:01:31.740 --> 00:01:32.780
Ray Krishner.
00:01:33.020 --> 00:01:33.180
Yeah.
00:01:33.420 --> 00:01:52.700
And you know, kind of an interesting topic, I think we're getting into for today, Ray, like talking about how how easy it is for, I think, normalized behaviors or just normal experiences to end up being pathologized in the therapy room for a variety of reasons and trying to expand on that because I think it's a trend that we might be seeing a little bit more of an uptick in.
00:01:53.099 --> 00:02:03.900
I don't think it's a new experience, but it's just how do we be discerning as clinicians and trying to provide support without also maybe kind of making things a bit more difficult or maybe even making things worse here.
00:02:04.300 --> 00:02:07.900
Yeah, yeah, I think this is a uh kind of an interesting topic.
00:02:07.979 --> 00:02:31.659
And you know, as as we were kind of thinking about this, you know, one of the things for me was I also almost feel it's a little controversial, which maybe it shouldn't be, but I this balance of not minimizing somebody's experience, but also making sure that we're not overrepresenting it in a way that might also do more harm.
00:02:31.819 --> 00:02:35.900
And it, you know, I think you know, it happens all the time with what we talk about, right?
00:02:35.979 --> 00:02:39.340
There's there's this balance that we have to kind of create.
00:02:39.500 --> 00:02:49.900
And I I think what I see more and more is that we're leaning into normal experiences somehow being looked at as as pathological.
00:02:50.460 --> 00:03:03.340
Um, and so I it was, you know, I I I I go back all the time to my training, and I I was thinking about time that I did some training with Al Ellis, and you know, who has a million different quotes.
00:03:03.419 --> 00:03:08.140
But like one of the quotes that I liked, he's like, Sometimes things are a hassle, not a horror, right?
00:03:08.219 --> 00:03:21.019
This idea that we we may have things that are uncomfortable, but they are just experiences that that we have, and that by focusing a certain way, we may actually make them worse.
00:03:21.180 --> 00:03:28.620
And so I I think that's easy in general, but I think as clinicians, we have to really kind of pay attention to that.
00:03:29.259 --> 00:03:29.900
Uh yeah.
00:03:29.979 --> 00:03:45.019
So I mean, I think this is a I think an interesting topic, and and with what we see kind of going on in the media about mental health and self-diagnosis and over-diagnosis and underdiagnosis and all these things, I think I think a timely topic.
00:03:45.340 --> 00:03:45.659
Yeah.
00:03:45.900 --> 00:04:00.460
And you know, I think one thing that you had said as we were getting ready, and it just I think it really uh captures that in like the to the breadth of what uh Al Ellis's quote was is like, you know, we don't want to let discomfort equate to a diagnosis.
00:04:00.620 --> 00:04:00.859
Yeah.
00:04:01.099 --> 00:04:09.739
And in in that, like, I think there's a variety of reasons why, but it's well actually maybe like we can talk a little bit about those variety of reasons.
00:04:09.819 --> 00:04:20.540
So like one of the things I I certainly think can be just that that clinicians oftentimes might have something that they're looking out for.
00:04:20.699 --> 00:04:36.780
So I I think I know actually from for me, as I'm sitting down with someone, there can be this tendency to kind of say, like, okay, based off their paperwork, based off the initial interview, what's the diagnosis that we're gonna move forward with so that way we can continue treatment and build like going through the insurance process there?
00:04:36.860 --> 00:04:44.300
And like I think that has played a role of for treatment connecting and individuals interested in kind of going gaining access.
00:04:44.460 --> 00:04:46.379
Insurance has been a part of that.
00:04:46.540 --> 00:04:59.579
And then also by the nature of kind of like how I try to put myself out there in the community, the population that I tend to get oftentimes already comes in, and they're like, oh, I read your bio, I saw you at ADHD, I saw you have like the experience working here.
00:04:59.740 --> 00:05:22.540
And so we're coming in also with this like kind of prior prior identified, and so I'm looking at things through this lens, already maybe seeing distractability as like, okay, well, are we looking at that as poor executive functioning as a result of like trying to kind of really get into that when it might just be, hey, this this specific time period is really boring, and I'm I'm struggling with paying attention, and that can be an orbitive response.
00:05:22.620 --> 00:05:31.420
And so I know that's one of those pitfalls I can find myself falling into of like overviewing ADHD when it I know that that's not not the case.
00:05:31.660 --> 00:05:40.300
Yeah, I mean, it it's almost like, you know, I mean, thinking back all the times we talk about things like cognitive biases and things, you know, it's almost like a referral bias, right?
00:05:40.379 --> 00:05:46.300
Like, I mean, somebody comes in and we we see that that's what they they think they have, and and how does that impact us?
00:05:46.460 --> 00:05:49.180
You know, I I I just made a comment the other day.
00:05:49.260 --> 00:06:00.939
I was doing a training and I said, you know, I I asked the question, you know, how many times do we have referrals that come in that says, please determine that nothing's wrong?
00:06:01.180 --> 00:06:02.620
You know, that that there's nothing.
00:06:03.420 --> 00:06:06.060
No, most people are like, I want to know if I'm depressed.
00:06:06.220 --> 00:06:08.700
I want to know if I'm, you know, whatever it may be.
00:06:08.860 --> 00:06:13.660
So in that mindset, right, it's so easy for us to kind of go down that.
00:06:13.820 --> 00:06:18.140
And, you know, again, like some some people may put, like, I'm depressed.
00:06:18.220 --> 00:06:25.100
And, you know, I've given the story a bunch of times where, you know, my doctor, after my grandmother died, wanted to give me an antidepressant medicine.
00:06:25.260 --> 00:06:26.939
Like it's so we may hear that.
00:06:27.020 --> 00:06:36.300
And and I think that we have to, I think as clinicians, we have to move past this kind of idea that distress symptom equals diagnosis and treatment.
00:06:36.540 --> 00:06:38.460
Like, I think that's a bad sequence.
00:06:38.620 --> 00:06:54.939
And I think that uh instead we need we should look at the experience first, uh the context, yeah, the meaning, the function behind what somebody's coming in with, the course, the the impairment, which we can talk about later, and then make a diagnosis.
00:06:55.100 --> 00:07:02.620
Like the like the diagnosis part goes should come way after we understand uh you know that these kind of issues.
00:07:02.780 --> 00:07:05.180
So yeah, I think that referral bias is a big piece.
00:07:05.260 --> 00:07:20.140
You know, I I I I oftentimes, yeah, I guess kind of two for me is uh that uh I see that sometimes those of us psychologists who do evaluations uh they get into kind of rating scale thinking, right?
00:07:20.300 --> 00:07:25.900
Like because a PHQ9 is high, that must mean depression.
00:07:27.180 --> 00:07:32.060
Maybe that just means that subjectively they they feel a certain way.
00:07:32.220 --> 00:07:41.100
So when we see those elevations, we we're trying to diagnose instead of understanding why those those may be happening at the at the moment.
00:07:41.260 --> 00:07:55.340
Uh I just went to my doctor just a couple days ago and and I had to fill one out, and and mine wasn't high, but I was thinking like as I was filling it out, like you know, another day that could have looked very different for me.
00:07:55.500 --> 00:08:03.820
And you know, again, I think my doctor does a great job, but uh that that's one of those kind of you know things where yeah, we could misinterpret it.
00:08:04.379 --> 00:08:04.939
Absolutely.
00:08:05.260 --> 00:08:08.460
Yeah, I think the other the other piece, I guess this goes back to what you said.
00:08:08.540 --> 00:08:14.780
I I was thinking of symptom matching, you know, this this idea like we know criteria.
00:08:15.100 --> 00:08:28.620
So when we know the criteria for things, it's easy for us to to try to find where the symptoms are, or you know, that it's easy to see individuals with symptoms kind of everywhere.
00:08:28.780 --> 00:08:36.939
And it's yeah, I I go back to the metaphor that you know when you're depressed, it's like wearing blue glasses, everything is blue.
00:08:37.100 --> 00:08:40.539
You can find all the bad stuff in life, even if really good things happen.
00:08:41.100 --> 00:08:44.700
I think we can do that with clinician as clinicians as well.
00:08:44.860 --> 00:08:54.139
We can line our questions to lead us down a path to find all the time somebody is depressed, uh, versus being more curious.
00:08:54.220 --> 00:08:57.820
And I I'll go, man, I'm gonna give you a real back a throwback.
00:08:58.460 --> 00:09:08.299
John Murphy, when we had him on with solution-based counseling, you know, he asked the question tell me when you don't have this as a problem, right?
00:09:08.379 --> 00:09:10.700
I want to know when things are going well for you.
00:09:10.860 --> 00:09:14.299
Tell me when these issues don't affect you.
00:09:15.259 --> 00:09:21.659
Still very diagnostic, but it also helps us understand that things are more flexible than pervasive.
00:09:21.820 --> 00:09:23.659
And I think that's that's important.
00:09:24.299 --> 00:09:25.100
Absolutely.
00:09:25.659 --> 00:09:44.460
And you know, it it's funny just because uh the nature of this conversation coming up, I there were conversations that I had later actually after we decided on this topic, that I very much had seen this coming through, but even one beforehand, and I don't it didn't necessarily I think spark this, but now that I'm looking back, I think it did.
00:09:44.540 --> 00:09:53.420
Like I was uh talking with a guy, I've been working with him for a while, and significant depression, significant anxiety, where it becomes debilitating, he's missing work.
00:09:53.500 --> 00:09:59.580
He's you know, he's been kind of teetering on the edge of like some marital uh strife as a result of it.
00:09:59.659 --> 00:10:01.340
So it is having this impact.
00:10:01.500 --> 00:10:17.580
And we were talking about how as the summer's winding down and he's getting ready to return back into his work, he had this moment of he's like, you know, Paul, I felt it coming on, I felt it, and then I stop and I ask myself, wait, is this actually depression or am I just sad for the right now?
00:10:17.899 --> 00:10:22.940
And like that became such, I mean, that was like that was such a celebrated moment because that's what we've been talking about.
00:10:23.019 --> 00:10:32.620
It's like because just because he has depression doesn't mean every instance of the experience of a strong sadness is a a depressive episode that he's falling into.
00:10:32.779 --> 00:10:39.659
But one of the things that I think was so important that I think if he would have let himself believe it was depression, I think he could have lingered.
00:10:39.740 --> 00:10:49.340
I think he would have fixated, and I think he would have then started putting like the the those blue glasses would have come back on and he would have started to see all the events that have been going on.
00:10:49.500 --> 00:10:59.500
And he tried like there's a lot of resilience he's shown right now because there was a lot of things that were happening, but just the way he's being he's like, no, this this moment right now just kind of sucks.
00:10:59.820 --> 00:11:15.500
You know, I man, I'm so glad you gave that example because you know, I as we were kind of thinking through this topic, I I was thinking in sense of somebody without a diagnosis coming in and not pathologizing it in that way.
00:11:15.980 --> 00:11:28.060
And and then man, I think that's a whole what you just said is such a bigger picture is how do we help people differentiate their own experiences as not being part of a condition?
00:11:28.300 --> 00:11:41.659
Like so if you know, so if somebody has ADHD and they get distracted during a mundane task, yes, it could be related to their ADHD, but it could also just be a really boring task.
00:11:41.820 --> 00:11:49.740
Like, I mean, in reality, like it could be an experience that uh other people also would have in that that situation.
00:11:49.899 --> 00:11:57.580
And wow, I think that I mean that that may even be a whole other episode, Paul, because I'm thinking, like, yeah, how do we build that resilience?
00:11:57.740 --> 00:12:12.060
I I I think that's that's a wonderful mindset because every sadness isn't depression, even for somebody who's depressed, uh, every moment of anxiety isn't an anxiety disorder, even with somebody who has an anxiety disorder.
00:12:12.220 --> 00:12:14.460
Like that's a that is fantastic.
00:12:14.620 --> 00:12:47.100
I think that that's something we yeah, I don't know that we do well in mental health in that arena, that we we end up treating it rather than normalizing it and just kind of going like, yeah, you know, it was you know, it made me think of a I had somebody I saw a few several years ago, an uh an older adolescent college student, and she came, she had moved to Philadelphia, went to Temple University, and you know, she believes the Hanover PA, which is pretty small, and now all of a sudden she's living in Philadelphia.
00:12:47.580 --> 00:12:52.139
And she came in one time and she said, Oh my gosh, like my anxiety was so bad.
00:12:52.300 --> 00:12:54.379
And I said, Oh, like, yeah, what what's happening?
00:12:54.540 --> 00:13:01.580
She goes, I was out one night and I saw a group of people, and you know, she's like, I'm pretty sure it was kind of a drug deal.
00:13:01.740 --> 00:13:08.700
And I got so nerve nervous, I walked to the other side of the street and I went, Yeah, like of course you did.
00:13:08.860 --> 00:13:11.500
Like, isn't that like that's protective?
00:13:11.659 --> 00:13:14.700
Like, that's that's not you being anxious, that's you being aware.
00:13:15.259 --> 00:13:22.060
Now, if you never leave your dorm ever again and walk down the street, we'll call that anxiety.
00:13:22.300 --> 00:13:26.620
But if you're vigilant, that doesn't mean that you're anxious.
00:13:26.779 --> 00:13:30.300
Like, I may do the same thing as a person who's not anxious.
00:13:30.460 --> 00:13:31.740
So, yeah, great.
00:13:31.899 --> 00:13:36.540
This that's a that's I'm so glad you brought that case up as a good example.
00:13:36.860 --> 00:14:03.019
And and I think even going back to like talking about the rating scales and talking about like looking at the symptom, like because and I'm happy he like he was the one who called this out because given the circumstance, I think he probably could have made a really valid case that, like, hey, I'm in just in the circumstances we've been talking about, and I was look already looking and hearing his story as he was sharing the events that have been going on and like the way it was impacting him.
00:14:03.100 --> 00:14:04.779
It's like, all right, here we go.
00:14:04.940 --> 00:14:07.420
Like, and it caught me completely off guard.
00:14:07.580 --> 00:14:19.580
Like, and in such a way I was I'm so grateful for because I think that is I was looking at okay, I'm working with my uh you know, my client who has a history of depression and experiencing these events, that must be depression.
00:14:19.659 --> 00:14:21.259
So there wasn't that stop and check.
00:14:21.340 --> 00:14:26.860
So I think again, like that bias not a lane that earlier on, but I just saw the symptoms like when he was sharing it.
00:14:26.940 --> 00:14:30.460
And thank goodness that he's been doing the work that he called it out there.
00:14:30.700 --> 00:14:31.019
Right.
00:14:31.259 --> 00:14:34.060
He recognized the hassle, not the horror.
00:14:34.300 --> 00:14:39.500
Yeah, like he he did, which is brilliant, like fantastic.
00:14:39.659 --> 00:14:44.379
Like, I mean, I I I think that's a great measurement of progress.
00:14:44.460 --> 00:14:46.700
Like, I think it's really fantastic, you know.
00:14:46.940 --> 00:15:08.220
So I guess like as we've kind of talked about some of these things, you know, so as as you think through these moments where people come in and they bring up kind of these behaviors that we're trying to decide, you know, are they just typical reactions or are they something that we need to be concerned about?
00:15:08.700 --> 00:15:30.940
I I'm curious, like what's some of the things that you think about or that you use to help kind of tell the difference and start gauging is this a normal kind of reaction and do we deal with it in that way versus it increasing our our clinical antennae to to something deeper.
00:15:31.340 --> 00:15:36.460
And actually, there's something I've been doing probably for the past maybe four, six months or so.
00:15:36.540 --> 00:15:48.779
Um, and it's the session after my intake session, because I oftentimes, and if you've listened back to our like one of our first episodes, Words Matter, I think I mentioned and shared that up, I usually have the same starting line and the same ending line.
00:15:48.860 --> 00:15:52.540
And it's tweaked slightly, but if you listen to that episode, it's pretty much the same.
00:15:52.700 --> 00:16:03.899
But what I found myself doing is when I'm asking, hey, how things have been going for you since we last talked, I get a lot of information there, and not all of it is clinically the most valuable.
00:16:03.980 --> 00:16:09.659
And so what I kind of do in my first session afterwards, I'm like, hey, I'm gonna over-explain this here for to you for a moment.
00:16:09.980 --> 00:16:13.019
Every time you see me, I'm gonna ask some version of this.
00:16:13.259 --> 00:16:21.420
I want you to be open to share, but also I want you to recognize I'm probably not gonna grab everything because if I don't acknowledge this now, we run into the problem of the week.
00:16:21.580 --> 00:16:29.180
And the problem of the week is something that feels really significant, really heavy in this moment, but two, three days, not an issue.
00:16:29.259 --> 00:16:33.500
And it's not a part of the larger pattern or the overall experience that we're trying to treat.
00:16:33.659 --> 00:16:43.899
And so I try to distinguish that in like working, and the individuals that have uh have had intakes with where I've been starting to do that, I've been finding less of those pieces and we're able to reframe it back.
00:16:43.980 --> 00:16:48.060
But I still do try to invite them like that doesn't mean I don't want to hear about significant life events.
00:16:48.139 --> 00:16:52.060
That doesn't mean I don't want to hear about this, but I don't know that we're always going to run with it in treatment.
00:16:52.139 --> 00:17:00.940
And I can then refer back to that comment that I've made, like, hey, is this something like, is it valuable for us to really attend to this, or is this something that you think we'll resolve and like we can work through?
00:17:01.019 --> 00:17:08.299
So, like kind of putting it out there in more of like, I think, an objective way of like, hey, we have a limited amount of time, is this worth our investment?
00:17:08.379 --> 00:17:15.980
And in kind of letting them kind of gauge, and I'll I'll like I'll bring up here are the things we've been working on, here's this new topic, which one?
00:17:16.139 --> 00:17:25.180
And so at times I try to put that in their hands to try to like, oh, I'm here for this bigger issue, and that doesn't really relate or connect, so let me then lean further in.
00:17:25.339 --> 00:17:30.379
So that's kind of with more of my established individuals that I've been like or the as time has been going on.
00:17:30.619 --> 00:17:39.099
I think early on, especially during some of the intake or earlier experiences, I try to listen to to see pattern or persistence.
00:17:39.259 --> 00:17:39.420
Yeah.
00:17:39.659 --> 00:17:48.700
So when we're talking about something, is this again a problem of the week that they just happen to be sharing in this moment, type of thing, or is this a current time period?
00:18:19.389 --> 00:18:22.909
And like maybe it's consideration for an adjustment disorder and those pieces there.
00:18:23.069 --> 00:18:39.869
But also some of these pieces that, you know, if they're mentioned, it's like, okay, like today, one of the individuals I'm working with, their parent came in, they're like, hey, I'm concerned that my child was messaging some of their friends about sexual orientation and gender identity pieces.
00:18:39.949 --> 00:18:42.429
And I'm concerned that they didn't come and talk to me first.
00:18:43.229 --> 00:18:47.869
And I was talking about like, I was, hey, like, by it's fairly normative.
00:18:48.189 --> 00:18:52.189
And the their child was sitting in the room, and they're like, you're just gonna bring it up constantly.
00:18:52.269 --> 00:18:56.429
I was like, there's that piece of they can tell to a friend and then they can distance themselves from a friend.
00:18:56.749 --> 00:19:00.429
They tell it to you, it might be athletic, and even try your try your best you might.
00:19:00.589 --> 00:19:04.269
And so we talked about like how like there's this concern as a parent that's sitting there, yeah.
00:19:04.429 --> 00:19:08.909
Yet typical behavior of being able to be explorative and like just being able to talk for themselves.
00:19:08.989 --> 00:19:20.109
So like I think like it's kind of calling out little moments like that and being able to share, hey, like I hear the can we can hear the concern, I can understand the concern, but I also don't need to then sound like alarm.
00:19:20.429 --> 00:19:21.629
Yeah, no, I think that's great.
00:19:21.709 --> 00:19:28.909
You know, I I think for me, I think the first thing, and I kind of maybe alluded to this earlier, I think with all of these moments, yeah.
00:19:28.989 --> 00:19:35.469
I I think the first question is does the response that they're having make sense?
00:19:36.269 --> 00:19:38.269
Like, does it make sense with their situation?
00:19:38.429 --> 00:19:40.509
Like with grief, I think that's easy.
00:19:40.749 --> 00:19:44.829
The girl who was at temple crossing the street, like it makes sense.
00:19:44.909 --> 00:19:46.189
Like you're in a new environment.
00:19:46.429 --> 00:19:48.029
Yes, you're gonna be hyper-vigilant.
00:19:48.109 --> 00:19:50.589
Like, so I think context matters.
00:19:50.749 --> 00:20:00.909
And I think digging into context and understanding that in you know, you know, what's happened that uh that might uh make this response understandable.
00:20:01.069 --> 00:20:04.669
I think that's that's a great question for us to kind of keep in mind.
00:20:04.829 --> 00:20:21.149
And the other one for me is um I I agree with the pervasiveness, but I think also the the the proportionality aspect, you know, if if somebody's coming in and they have anxiety uh before an important presentation, that's expected.
00:20:21.229 --> 00:20:22.429
Like we would expect that.
00:20:22.589 --> 00:20:25.149
That's proportional to the the situation.
00:20:25.789 --> 00:20:34.109
But repeated panic attacks for weeks because you have to introduce yourself at a meeting next month, that's a different question.
00:20:34.269 --> 00:20:42.669
Like it's you know, so you know, I I think it it's finding out like is the proportion of the response consistent?
00:20:42.829 --> 00:20:54.029
And and sometimes they may even be uh proportionally higher than we would like, but it still may not lean clear over that we we should overreact to to those things.
00:20:54.189 --> 00:20:56.109
So I I I think that's an important one.
00:20:56.509 --> 00:20:58.269
And then I I I'm just gonna throw one other way.
00:20:58.509 --> 00:20:59.389
I think culture.
00:20:59.549 --> 00:21:19.469
I think yeah, I think this is one of those situations where as clinicians, we we may yeah, we may be biased in in some way of how somebody is reacting and us tend to pathologize versus kind of going like, oh wait, let me understand this within kind of your system.
00:21:19.629 --> 00:21:20.909
And and and I've had that.
00:21:20.989 --> 00:21:29.549
Like I've had families I've worked with from other cultures where when they then explain their reaction, I go, Oh, oh yeah, that perfectly makes sense.
00:21:29.709 --> 00:21:31.629
It may not be consistent with me.
00:21:31.709 --> 00:21:43.709
And I but I think and I I think we know that, but I think we should we always have to consider that because how we react then may affect our relationship with that person or get them to doubt in a different way.
00:21:43.869 --> 00:21:48.269
So I I think the culture piece is something else we need to look at at that level.
00:21:49.069 --> 00:22:01.309
And I I think at its core, when something is like pathological, I think there has to be a recognized like that pervasive functional impairment.
00:22:01.389 --> 00:22:05.469
And like that's I think that's a comment you've made in many other episodes beforehand.
00:22:05.549 --> 00:22:16.669
Um and I think like when we're talking about these elements, like these are the ways in which it's it either reduces the pervasiveness or it reduces the impact of the functional impairment.
00:22:16.749 --> 00:22:22.989
And so, yes, it might have an impact, but is it an impact within the culture that's more normative or more expected?
00:22:23.149 --> 00:22:27.229
Or again, I'm can't sleep the night before a big presentation.
00:22:27.709 --> 00:22:29.629
Okay, like that I mean that sucks.
00:22:29.789 --> 00:22:36.189
Like that that we can validate that, but also does that then signify an anxiety disorder?
00:22:36.349 --> 00:22:38.029
Or is it the pervasiveness?
00:22:38.109 --> 00:22:41.309
And again, were you still able to give the speed like the presentation?
00:22:41.469 --> 00:22:43.629
Like, did it impair your ability to go and do that?
00:22:43.869 --> 00:22:45.469
Did it impair things leading up to it?
00:22:45.549 --> 00:22:49.469
Like it impaired your sleep, but again, that's that scope piece that you're talking about.
00:22:49.549 --> 00:22:56.349
So I think in the context of what we're kind of those elements like, is trying to find and identify where is that threshold.
00:22:56.429 --> 00:23:03.869
And I think a part of that is using our our clinical experience to really identify normative versus non-normative there.
00:23:04.109 --> 00:23:04.269
Yeah.
00:23:04.429 --> 00:23:07.069
It's but you brought up the the sleep one.
00:23:07.309 --> 00:23:14.989
I had a uh a parent one time who was like, Yeah, I'm taking this my child to the sleep clinic, like I'm really worried about sleep.
00:23:15.069 --> 00:23:22.509
And and when we kind of dug down, they were like, you know, every night every night time before a test, he doesn't sleep well the night before.
00:23:23.229 --> 00:23:31.469
And and I I had reframed it and I said, And and they're a family who celebrates Christmas, and I said, How does he sleep the night before Christmas?
00:23:31.869 --> 00:23:34.269
Christmas, like like Christmas Eve to the next morning.
00:23:34.349 --> 00:23:35.229
And she went, terrible.
00:23:35.309 --> 00:23:36.749
He's up at like one o'clock in the morning.
00:23:36.909 --> 00:23:39.069
I'm like, why is that not a problem?
00:23:39.309 --> 00:23:48.269
Like, why, like, why is that like that's it's the same behavior that there's something happening in his life that's changing his sleep patterns.
00:23:48.349 --> 00:23:50.669
Um and she's like, Oh, well, he does that all the time.
00:23:50.989 --> 00:23:51.229
Right.
00:23:51.469 --> 00:23:56.909
So let's not make the moments uh now let's address the the anxiety about testing.
00:23:56.989 --> 00:24:00.989
That's the thing, we should probably at least kind of give some strategies around that.
00:24:02.189 --> 00:24:04.349
But I don't know that we need a sleep study.
00:24:04.429 --> 00:24:12.109
Like, I think that it's easy to kind of just go, okay, wait, sometimes our sleep's disrupted for multiple emotional reasons.
00:24:12.269 --> 00:24:18.509
Uh may not be disordered, it just may be the situation happened.
00:24:18.669 --> 00:24:26.749
So I I guess piggybacking off of that, let let's maybe throw out a few, like, what are some cases where we might get into trouble?
00:24:26.829 --> 00:24:33.789
Like, where are some so so the idea of maybe you know, a situation and sleep, but what are some other differentials?
00:24:33.869 --> 00:24:39.149
So I I've mentioned grief and depression before, but what what's one that comes to mind for you?
00:24:39.629 --> 00:24:54.509
And I want to be kind of uh very cautious about this, because I do think this is one when we hear it, it's one to really lean in and pay attention to, but it's also I don't want to jump the gun and pathologizing it, and it's the idea of um passive suicide ideation.
00:24:54.989 --> 00:25:04.109
I I I think that that is a can be a quite common experience, especially in the aftermath of a really stressful or challenging circumstance.
00:25:04.269 --> 00:25:17.229
And again, I don't I don't mean to make light of that, but at the same point in time, if we had the number of of follow-through with that compared to the number of like reports and experiences that passive suicidal ID, those are hugely disproportionate.
00:25:17.389 --> 00:25:21.629
And so it's important for us to note, but not necessarily to pathologize.
00:25:21.709 --> 00:25:28.429
And I think again, um, there can be individuals who experience a like, what is wrong with me that I had this thought?
00:25:28.669 --> 00:25:33.629
And like that, again, if we then treat that like, oh, well, like that's your exact that's your depression.
00:25:34.109 --> 00:25:50.829
If we lean in and we try to start explaining it with a diagnosis before really kind of understanding those core pieces, I think that again we might we have the potential of doing more harm than good when you know, if it's hey, I went to this breakup and this person was in my life for so long and now they aren't.
00:25:51.069 --> 00:25:58.269
And now I feel lost and I don't quite know what to do, and it's so challenging that I just wish I didn't have to feel this way any longer.
00:25:58.989 --> 00:26:00.189
I get that.
00:26:00.589 --> 00:26:03.229
Yeah, I I I think that's a an important one.
00:26:03.389 --> 00:26:18.989
I mean, I think even, you know, I I can't even name the number or or count the number of cases I've had where a child gets mad at their parents and they go, I'm just gonna kill myself, and they run to their room and slam the door.
00:26:19.469 --> 00:26:25.389
And that's the you know, that that becomes the reason that that they're referred.
00:26:25.549 --> 00:26:32.669
And and again, sometimes, yeah, absolutely, that there's there's a deeper issue, but sometimes it's a reaction.
00:26:33.149 --> 00:26:42.509
And I I again I think kind of thinking that through, and it's again, it's this balance, you gotta take it serious, but also not not dig in too deep.
00:26:42.749 --> 00:27:01.789
Um I I I think one that's kind of been interesting to me, and and I I I think this is kind of goes to you know, some of the the self-diagnosis culture, I think, a little bit is you know, the the idea of like normal food, let's call that selectivity that people have.
00:27:02.589 --> 00:27:12.349
And later as in life, they they kind of go back and go, oh yes, this is a symptom of me uh having autism or neurodivergence.
00:27:12.509 --> 00:27:23.629
And you know, I I had an ex an example that I I saw recently where you know someone used the the idea of they liked one food and they liked another food.
00:27:23.789 --> 00:27:27.229
So let's say they liked macaroni and they liked cheese.
00:27:27.549 --> 00:27:31.389
But if it was macaroni and cheese, they wouldn't eat it if it was combined.
00:27:31.469 --> 00:27:42.189
And they were like, see, that that means that I I have these food sensitivities and it's it's a justification that I probably had I've had autism my whole life.
00:27:42.429 --> 00:27:49.629
And you know, I I kind of I I've shared with you, you know, I won't eat tomate raw tomatoes.
00:27:49.869 --> 00:27:55.629
I won't eat unless they're chopped up and put in pigo de gallo, then I can eat them.
00:27:55.949 --> 00:28:02.189
Now it it makes no sense, but my selectivity is for some reason I just can't do it.
00:28:03.069 --> 00:28:10.349
It's a it's it's a ordinary preference more than it is something that we look at diagnostically.
00:28:10.509 --> 00:28:18.189
So this idea of kind of going back and finding these little oddities that we may have done at some point, you know.
00:28:18.349 --> 00:28:21.629
I've had people say, as a kid I had to have tags cut out of my shirt.
00:28:22.749 --> 00:28:23.709
A lot of people do.
00:28:23.869 --> 00:28:25.549
Like that's a that's pretty common.
00:28:25.789 --> 00:28:41.469
So I I think you know, some of these ideas of you know, either food sensitivities or things, they're they're also ones that we can lean into without getting the broader picture that that's that's problematic.
00:28:42.669 --> 00:28:51.549
And I think that can even extend, like, you know, as you were saying that and specifically like that connection with like food sensitivity and autism.
00:28:51.789 --> 00:29:00.269
I'm thinking about the over prevalence of like, and this is I think just overuse of the term, and then it lessens the clinical rigidity of it.
00:29:00.349 --> 00:29:13.469
But like I remember when I was a teenager, it would bother me when the vacuum cord was on like wasn't put up correctly, like actually like on like little like spindles and like my parents neither one did that.
00:29:13.709 --> 00:29:26.909
I didn't really love vacuuming, and I didn't see it and go out and search for it, but like and I saw it, I'd stop and I'd go and do it, like I'd wrap the cord around it, and at one point I don't know if it was me or if it was my my parents was like, oh, like you know, that's your OCD.
00:29:27.229 --> 00:29:27.629
Yeah.
00:29:27.869 --> 00:29:32.189
And it's like or like it's just annoying to detangle it.
00:29:32.669 --> 00:29:33.869
And like that was my reason.
00:29:33.949 --> 00:29:40.669
Like, whenever I had to go use it, it was always just a a tangled mess, and so we take the time, and then I'm not gonna be annoyed and frustrated in the future.
00:29:40.829 --> 00:29:55.789
One of the few moments I would do something from future Paul, but but in that case, like it's we're normalizing certain language, and I think even I have a bit of a I have a bit of concern using even the terms anxiety and depression as a symptom.
00:29:56.429 --> 00:30:03.549
And I try to really differentiate that in in sessions of like anxiety, when we're talking about this, like when someone's saying, Oh, I'm feeling depressed.
00:30:04.269 --> 00:30:09.389
Okay, like let's really expand on that because also does that then mean you have depression?
00:30:09.549 --> 00:30:12.349
Or if I'm feeling anxious, does that mean I have anxiety?
00:30:12.509 --> 00:30:17.789
And really trying to delineate like what is the difference here when we're using it as a symptom or using it as a diagnosis?
00:30:17.949 --> 00:30:18.109
Yeah.
00:30:18.269 --> 00:30:24.749
And I think if we don't do that or if we don't bring that clarity, uh, you know, an anxious moment can lead to an anxiety disorder.
00:30:24.989 --> 00:30:25.229
Sure.
00:30:25.389 --> 00:30:27.069
Yeah, oh yeah, I I agree.
00:30:27.229 --> 00:30:31.229
I uh Yeah, I I think that you know, you mentioned like the OCD term.
00:30:31.469 --> 00:30:33.869
Man, does that get thrown around uh a lot?
00:30:34.029 --> 00:30:49.309
Uh you know, it's but I I even looked at it as, you know, I I've had evaluations where people have come in because a spouse or a parent says, oh, yeah, I think this person has OCD because they like predictability.
00:30:49.469 --> 00:30:52.909
And you know, I kind of go like a lot of people like predictability.
00:30:53.069 --> 00:30:54.509
Like I love predictability.
00:30:54.669 --> 00:30:56.909
I like to know kind of what my schedule is.
00:30:57.069 --> 00:31:01.309
I like to have things in a certain way that makes that makes my world go smoother.
00:31:01.469 --> 00:31:08.989
I mean, I think, and so again, it's it's a behavior that it misses the other core components, right?
00:31:09.149 --> 00:31:14.429
There's there's not necessarily a distress and we're not getting rid of a distress.
00:31:14.589 --> 00:31:21.789
We're we're trying to organize ourselves in a way that's that's gonna have just in have a a more smooth day.
00:31:21.949 --> 00:31:23.469
And it's but it's interesting.
00:31:23.549 --> 00:31:33.789
I think that that that's another one where the symptoms can really or the the behavior can be looked at pathologically when it may or may not.
00:31:33.949 --> 00:31:38.189
There's a lot of other variables that that can come into the the the picture.
00:31:38.589 --> 00:31:53.149
You know, I I I think as we're wrapping up, I guess, you know, as one of the things I thought maybe to end with, like you know, I I guess what are your thoughts on why is this important to talk about to begin with?
00:31:53.309 --> 00:32:00.429
You know, in the sense of like, you know, so we're we're kind of um you know, talking about all these little examples.
00:32:00.669 --> 00:32:06.669
And when it does go wrong, what what do you see as some of the concerns with it?
00:32:07.709 --> 00:32:18.589
I think if we treat it like it's a pathology, it can at times turn into pathology or or uh maybe not even what we are treating, but a a different variation of that.
00:32:18.749 --> 00:32:39.549
And it's uh I guess the call of being more discerning because if we if we just use a checkbox to identify something and then we begin the treatment, you made the comment earlier of like we have all these uh we have the list of concerns that come along with medication and if you know all the side effects and all the potential harms that can come along with this.
00:32:39.789 --> 00:32:45.069
I mean, I think about like exposure thing, exposure therapy, it's hard, like it is not a fun experience.
00:32:45.149 --> 00:32:52.429
And so it's like if someone isn't in necessarily need of exposure, like is that something that we necessarily want them to have to go through?
00:32:52.589 --> 00:32:57.789
And so, or like so does the treatment create this cut like unnecessary harm?
00:32:57.949 --> 00:33:05.309
And also, are we then like if if that individual that I was talking about with his depression and he said, no, I think that's just a just sad.
00:33:05.869 --> 00:33:11.069
If I treated that like this, we probably would have gone back into like, okay, so how do we engage your support systems?
00:33:11.149 --> 00:33:20.349
How do we make sure, you know, hey, like you've been inconsistent with medication to do, you know, let's get you back hooked up with your psychiatry again and like make sure just in like how do we make sure you're not missing work?
00:33:20.509 --> 00:33:35.309
And like we would have kind of gone into this response that probably that isn't warranted that and probably would have led to some of those things and a fixation on maybe he would have missed work because he would have been so frustrated of here I go again, and like, you know, when is this gonna end?
00:33:35.389 --> 00:33:39.469
It's never gonna like those things I think would have become far more impactful.
00:33:39.629 --> 00:33:51.469
And so I think we're reducing kind of the potential harm in the treatment as well as creating more distress or concern by overvalidating this kind of temporary discomfort.
00:33:51.949 --> 00:33:54.989
I I I'm I'm I my thoughts are in line with that as well.
00:33:55.149 --> 00:34:06.509
I mean, I I I think we've in other episodes may have used the term iatrogenesis, and iatrogenesis is you know, this idea that sometimes the treatment can do more harm.
00:34:06.669 --> 00:34:18.190
And you know, you kind of alluded to the idea that sometimes our reaction to a symptom can actually reinforce it accidentally as being pathological.
00:34:18.349 --> 00:34:23.150
And you know, and it's interesting because as therapists, we don't want to hear about this sometimes.
00:34:23.309 --> 00:34:26.029
But you know, I I made this comment when I was doing a training one day.
00:34:26.110 --> 00:34:32.989
I said, you know, sometimes therapy itself can communicate that you shouldn't feel a certain way.
00:34:34.110 --> 00:34:50.030
That's a really hard thing to hear as a therapist because our goal is absolutely to feel to make people feel better, get better, all of these things, and to say like what we are doing and how we are communicating may be heard the wrong way.
00:34:50.110 --> 00:34:58.990
And I think that it's so important for us to at least have the uh the the awareness of understanding that that could happen.
00:34:59.230 --> 00:35:10.750
And that, you know, uh you know, it's this every time we do an intervention to reduce stress, that's again, it's giving that message that the stress should be reduced.
00:35:11.150 --> 00:35:18.590
Maybe the stress is okay sometimes, and you know, anger might just signify injustice.
00:35:18.829 --> 00:35:21.550
That that might be an okay thing to be angry about.
00:35:21.789 --> 00:35:27.870
Anxiety might just be a signal of uncertainty, you know, grief it reflects our loss.
00:35:28.030 --> 00:35:47.309
Like, I mean, all of these connectors and so I I think it's important that we we really kind of instead of trying to uh talk to people about how to get rid of it, you know, I I think this is where the mindfulness movement has been just absolutely brilliant.
00:35:47.470 --> 00:35:55.550
And all of the therapies that have have risen out of of that, where sometimes it's okay to just be present with those feelings.
00:35:55.710 --> 00:35:59.630
It's okay to just be there for a second, you know.
00:36:00.269 --> 00:36:05.869
Our our goal of treatment is not emotional anesthesia, like that's not what we're trying to do.
00:36:06.030 --> 00:36:07.949
Like we're not trying to just take it away.
00:36:08.110 --> 00:36:20.510
It's you know, this idea of how do we be with it and be okay with it and understand what that tells us about ourselves and how we can in a healthy way.
00:36:22.429 --> 00:36:23.070
Yeah.
00:36:24.269 --> 00:36:28.349
And and to just piggyback off that, like one of the Dr.
00:36:28.429 --> 00:36:35.070
Ron Levant, when we were talking to him in uh his book of the problem with men, it it sparked kind of this interest for me.
00:36:35.150 --> 00:36:46.590
And I don't know that it was intentional for him, but just like talking about just the value and importance of emotional literacy, and I talk about this more so with men, and like you know, just because uh because of that interaction there.
00:36:46.829 --> 00:37:08.670
However, just in that those conversations, it's really kind of driven me to spending more time of like uh he uses the example of like the the two groups and the emotional literacy that we see in the women's group and being able to just I diversify, identify what is my emotion, why am I feeling this way, and what am I going to do with it kind of experience.
00:37:08.909 --> 00:37:11.230
And for the men, it was I'm pissed off.
00:37:11.309 --> 00:37:14.030
And that was about the the scope of that.
00:37:14.269 --> 00:37:21.949
And being able to kind of encourage, like, hey, like let's try to engage in this in this literacy way where like when I'm feeling this, what is it telling me?
00:37:22.190 --> 00:37:44.030
And so when we can better understand that and when we can better read that, I think we we can then become more effective and kind of feeling a greater sense of fulfillment, but the uncomfortable emotions tell us something, and so when we're experiencing that, it isn't to shut them down because the injustice I when you said ang, you know, is anger a representation of injustice?
00:37:44.429 --> 00:37:46.190
That I think is such an important piece.
00:37:46.349 --> 00:37:56.510
And if we are just saying, like, hey, no, like you're, you know, it's inappropriate that you're angry and that you're like, you know, expressive and that you're, you know, that you're the way that you're responding to this.
00:37:56.670 --> 00:38:07.230
And if we view it in the context of like, hey, I'm calling out an injustice, like, man, there would have been many significant historical movements that would not have happened had that got path, you know, pathology.
00:38:07.389 --> 00:38:11.150
It's like, oh, you know, you know, you just you know you need therapy versus you need to create change.
00:38:11.230 --> 00:38:32.349
And so I think there's an important con like aspect of like for us as clinicians, also kind of better equipping those that we work with of like, how can they understand just because I'm experiencing this emotion, it's it's not a pathology, but also what is it telling me and how do I how do I experience it in a way that doesn't just feel like it lingers or it feels stuck?
00:38:32.429 --> 00:38:34.670
But they give me giving them some tools.
00:38:34.750 --> 00:38:47.949
And so we can provide treatment, but it's not a it's not a therapeutic treatment to try to challenge it or discontinue it, but it's more of it encouraging this how do we lean in the mindfulness side of that to to engage with it and better understand it.
00:38:48.269 --> 00:39:00.909
Yeah, I mean I I I think it the kind of bottom line is like you know, psychological health or mental health, you know, it we have to get beyond that it's that's not the absent of negative emotion.
00:39:01.470 --> 00:39:03.949
Like that's that's not what we're aiming, you know.
00:39:04.670 --> 00:39:12.990
Mental health is the capacity to experience a full range of emotions without becoming imprisoned by them, right?
00:39:13.150 --> 00:39:16.590
Like so it's about that and that pervasiveness piece, right?
00:39:16.670 --> 00:39:20.670
Like if if yeah, if we're just living in that, that that's unhealthy.
00:39:20.829 --> 00:39:28.269
But we want, like, I want to be sad, I want to at times to be anxious, I want to be angry.
00:39:28.349 --> 00:39:33.230
Like, I think those are things like that's a part of who we are.
00:39:33.470 --> 00:39:37.389
And but what's our capacity to deal with those?
00:39:37.470 --> 00:39:44.269
And I think that if we change that view of not eliminating negative emotion, but instead building capacity, it's different.
00:39:44.909 --> 00:39:51.949
I I know we're not talking about happiness, but it reminded me of like I read a study and I I wish I had the reference for it.
00:39:52.030 --> 00:39:56.510
If if I do, I'll I'll I'll send it to you so we can put it in the the show notes.
00:39:56.670 --> 00:40:01.630
But they were talking about that eliminating depression doesn't create happiness.
00:40:01.789 --> 00:40:08.829
That you know, no matter how much we treat depression, all that does is eliminate the negative symptoms.
00:40:08.990 --> 00:40:15.309
It doesn't build the positives because that's because we're missing the full range of our emotional experiences.
00:40:15.949 --> 00:40:23.309
When we're dealing with depression, we also have to build pleasure, we have to find other there's another end of that that spectrum.
00:40:23.470 --> 00:40:30.110
And I think the more we see new research in psychology, I think we're getting better at that.
00:40:30.269 --> 00:40:31.710
I think I think over time.
00:40:32.030 --> 00:40:44.429
But for so long, we have looked at treatment as trying to to numb emotions or to take away negative emotions, and it's it's a much bigger picture than that.
00:40:44.670 --> 00:40:50.349
So, you know, it's yeah, I mean, our job is not to make every uncomfortable experience disappear.
00:40:50.510 --> 00:40:52.349
That's not what we're doing in therapy.
00:40:52.670 --> 00:41:08.510
You know, we might be diagnosing sometimes, we're sometimes gonna treat, but I think sometimes it's okay to that our job is just to help people understand that what they're experiencing is profoundly difficult, but it's also profoundly human.
00:41:08.909 --> 00:41:09.150
Yeah.
00:41:09.630 --> 00:41:12.750
It's just what we we go through.
00:41:13.070 --> 00:41:14.670
And that's okay.
00:41:14.829 --> 00:41:16.750
Like that's that's okay to kind of be there.
00:41:16.909 --> 00:41:27.630
So yeah, I mean, I think this was a kind of a fun conversation in that way to think about it as, you know, if we think in this way, we really do broaden mental health, which I think is important.
00:41:27.869 --> 00:41:30.670
And, you know, with that, we hope you enjoyed this conversation.
00:41:30.829 --> 00:41:34.110
Uh Ray and I will be back in two weeks, but until then, be well.
00:41:34.349 --> 00:41:35.470
Stay psyched.
00:01:20.859 --> 00:01:29.020
Hey everyone and welcome to the Psych2 Practice Podcast, your one-stop for practical and useful clinical information, masterful insights from experts in the field and a guide to daily living.
00:01:29.260 --> 00:01:31.340
I'm your host, Paul Wagner, and joining me.
00:01:31.740 --> 00:01:32.780
Ray Krishner.
00:01:33.020 --> 00:01:33.180
Yeah.
00:01:33.420 --> 00:01:52.700
And you know, kind of an interesting topic, I think we're getting into for today, Ray, like talking about how how easy it is for, I think, normalized behaviors or just normal experiences to end up being pathologized in the therapy room for a variety of reasons and trying to expand on that because I think it's a trend that we might be seeing a little bit more of an uptick in.
00:01:53.099 --> 00:02:03.900
I don't think it's a new experience, but it's just how do we be discerning as clinicians and trying to provide support without also maybe kind of making things a bit more difficult or maybe even making things worse here.
00:02:04.300 --> 00:02:07.900
Yeah, yeah, I think this is a uh kind of an interesting topic.
00:02:07.979 --> 00:02:31.659
And you know, as as we were kind of thinking about this, you know, one of the things for me was I also almost feel it's a little controversial, which maybe it shouldn't be, but I this balance of not minimizing somebody's experience, but also making sure that we're not overrepresenting it in a way that might also do more harm.
00:02:31.819 --> 00:02:35.900
And it, you know, I think you know, it happens all the time with what we talk about, right?
00:02:35.979 --> 00:02:39.340
There's there's this balance that we have to kind of create.
00:02:39.500 --> 00:02:49.900
And I I think what I see more and more is that we're leaning into normal experiences somehow being looked at as as pathological.
00:02:50.460 --> 00:03:03.340
Um, and so I it was, you know, I I I I go back all the time to my training, and I I was thinking about time that I did some training with Al Ellis, and you know, who has a million different quotes.
00:03:03.419 --> 00:03:08.140
But like one of the quotes that I liked, he's like, Sometimes things are a hassle, not a horror, right?
00:03:08.219 --> 00:03:21.019
This idea that we we may have things that are uncomfortable, but they are just experiences that that we have, and that by focusing a certain way, we may actually make them worse.
00:03:21.180 --> 00:03:28.620
And so I I think that's easy in general, but I think as clinicians, we have to really kind of pay attention to that.
00:03:29.259 --> 00:03:29.900
Uh yeah.
00:03:29.979 --> 00:03:45.019
So I mean, I think this is a I think an interesting topic, and and with what we see kind of going on in the media about mental health and self-diagnosis and over-diagnosis and underdiagnosis and all these things, I think I think a timely topic.
00:03:45.340 --> 00:03:45.659
Yeah.
00:03:45.900 --> 00:04:00.460
And you know, I think one thing that you had said as we were getting ready, and it just I think it really uh captures that in like the to the breadth of what uh Al Ellis's quote was is like, you know, we don't want to let discomfort equate to a diagnosis.
00:04:00.620 --> 00:04:00.859
Yeah.
00:04:01.099 --> 00:04:09.739
And in in that, like, I think there's a variety of reasons why, but it's well actually maybe like we can talk a little bit about those variety of reasons.
00:04:09.819 --> 00:04:20.540
So like one of the things I I certainly think can be just that that clinicians oftentimes might have something that they're looking out for.
00:04:20.699 --> 00:04:36.780
So I I think I know actually from for me, as I'm sitting down with someone, there can be this tendency to kind of say, like, okay, based off their paperwork, based off the initial interview, what's the diagnosis that we're gonna move forward with so that way we can continue treatment and build like going through the insurance process there?
00:04:36.860 --> 00:04:44.300
And like I think that has played a role of for treatment connecting and individuals interested in kind of going gaining access.
00:04:44.460 --> 00:04:46.379
Insurance has been a part of that.
00:04:46.540 --> 00:04:59.579
And then also by the nature of kind of like how I try to put myself out there in the community, the population that I tend to get oftentimes already comes in, and they're like, oh, I read your bio, I saw you at ADHD, I saw you have like the experience working here.
00:04:59.740 --> 00:05:22.540
And so we're coming in also with this like kind of prior prior identified, and so I'm looking at things through this lens, already maybe seeing distractability as like, okay, well, are we looking at that as poor executive functioning as a result of like trying to kind of really get into that when it might just be, hey, this this specific time period is really boring, and I'm I'm struggling with paying attention, and that can be an orbitive response.
00:05:22.620 --> 00:05:31.420
And so I know that's one of those pitfalls I can find myself falling into of like overviewing ADHD when it I know that that's not not the case.
00:05:31.660 --> 00:05:40.300
Yeah, I mean, it it's almost like, you know, I mean, thinking back all the times we talk about things like cognitive biases and things, you know, it's almost like a referral bias, right?
00:05:40.379 --> 00:05:46.300
Like, I mean, somebody comes in and we we see that that's what they they think they have, and and how does that impact us?
00:05:46.460 --> 00:05:49.180
You know, I I I just made a comment the other day.
00:05:49.260 --> 00:06:00.939
I was doing a training and I said, you know, I I asked the question, you know, how many times do we have referrals that come in that says, please determine that nothing's wrong?
00:06:01.180 --> 00:06:02.620
You know, that that there's nothing.
00:06:03.420 --> 00:06:06.060
No, most people are like, I want to know if I'm depressed.
00:06:06.220 --> 00:06:08.700
I want to know if I'm, you know, whatever it may be.
00:06:08.860 --> 00:06:13.660
So in that mindset, right, it's so easy for us to kind of go down that.
00:06:13.820 --> 00:06:18.140
And, you know, again, like some some people may put, like, I'm depressed.
00:06:18.220 --> 00:06:25.100
And, you know, I've given the story a bunch of times where, you know, my doctor, after my grandmother died, wanted to give me an antidepressant medicine.
00:06:25.260 --> 00:06:26.939
Like it's so we may hear that.
00:06:27.020 --> 00:06:36.300
And and I think that we have to, I think as clinicians, we have to move past this kind of idea that distress symptom equals diagnosis and treatment.
00:06:36.540 --> 00:06:38.460
Like, I think that's a bad sequence.
00:06:38.620 --> 00:06:54.939
And I think that uh instead we need we should look at the experience first, uh the context, yeah, the meaning, the function behind what somebody's coming in with, the course, the the impairment, which we can talk about later, and then make a diagnosis.
00:06:55.100 --> 00:07:02.620
Like the like the diagnosis part goes should come way after we understand uh you know that these kind of issues.
00:07:02.780 --> 00:07:05.180
So yeah, I think that referral bias is a big piece.
00:07:05.260 --> 00:07:20.140
You know, I I I I oftentimes, yeah, I guess kind of two for me is uh that uh I see that sometimes those of us psychologists who do evaluations uh they get into kind of rating scale thinking, right?
00:07:20.300 --> 00:07:25.900
Like because a PHQ9 is high, that must mean depression.
00:07:27.180 --> 00:07:32.060
Maybe that just means that subjectively they they feel a certain way.
00:07:32.220 --> 00:07:41.100
So when we see those elevations, we we're trying to diagnose instead of understanding why those those may be happening at the at the moment.
00:07:41.260 --> 00:07:55.340
Uh I just went to my doctor just a couple days ago and and I had to fill one out, and and mine wasn't high, but I was thinking like as I was filling it out, like you know, another day that could have looked very different for me.
00:07:55.500 --> 00:08:03.820
And you know, again, I think my doctor does a great job, but uh that that's one of those kind of you know things where yeah, we could misinterpret it.
00:08:04.379 --> 00:08:04.939
Absolutely.
00:08:05.260 --> 00:08:08.460
Yeah, I think the other the other piece, I guess this goes back to what you said.
00:08:08.540 --> 00:08:14.780
I I was thinking of symptom matching, you know, this this idea like we know criteria.
00:08:15.100 --> 00:08:28.620
So when we know the criteria for things, it's easy for us to to try to find where the symptoms are, or you know, that it's easy to see individuals with symptoms kind of everywhere.
00:08:28.780 --> 00:08:36.939
And it's yeah, I I go back to the metaphor that you know when you're depressed, it's like wearing blue glasses, everything is blue.
00:08:37.100 --> 00:08:40.539
You can find all the bad stuff in life, even if really good things happen.
00:08:41.100 --> 00:08:44.700
I think we can do that with clinician as clinicians as well.
00:08:44.860 --> 00:08:54.139
We can line our questions to lead us down a path to find all the time somebody is depressed, uh, versus being more curious.
00:08:54.220 --> 00:08:57.820
And I I'll go, man, I'm gonna give you a real back a throwback.
00:08:58.460 --> 00:09:08.299
John Murphy, when we had him on with solution-based counseling, you know, he asked the question tell me when you don't have this as a problem, right?
00:09:08.379 --> 00:09:10.700
I want to know when things are going well for you.
00:09:10.860 --> 00:09:14.299
Tell me when these issues don't affect you.
00:09:15.259 --> 00:09:21.659
Still very diagnostic, but it also helps us understand that things are more flexible than pervasive.
00:09:21.820 --> 00:09:23.659
And I think that's that's important.
00:09:24.299 --> 00:09:25.100
Absolutely.
00:09:25.659 --> 00:09:44.460
And you know, it it's funny just because uh the nature of this conversation coming up, I there were conversations that I had later actually after we decided on this topic, that I very much had seen this coming through, but even one beforehand, and I don't it didn't necessarily I think spark this, but now that I'm looking back, I think it did.
00:09:44.540 --> 00:09:53.420
Like I was uh talking with a guy, I've been working with him for a while, and significant depression, significant anxiety, where it becomes debilitating, he's missing work.
00:09:53.500 --> 00:09:59.580
He's you know, he's been kind of teetering on the edge of like some marital uh strife as a result of it.
00:09:59.659 --> 00:10:01.340
So it is having this impact.
00:10:01.500 --> 00:10:17.580
And we were talking about how as the summer's winding down and he's getting ready to return back into his work, he had this moment of he's like, you know, Paul, I felt it coming on, I felt it, and then I stop and I ask myself, wait, is this actually depression or am I just sad for the right now?
00:10:17.899 --> 00:10:22.940
And like that became such, I mean, that was like that was such a celebrated moment because that's what we've been talking about.
00:10:23.019 --> 00:10:32.620
It's like because just because he has depression doesn't mean every instance of the experience of a strong sadness is a a depressive episode that he's falling into.
00:10:32.779 --> 00:10:39.659
But one of the things that I think was so important that I think if he would have let himself believe it was depression, I think he could have lingered.
00:10:39.740 --> 00:10:49.340
I think he would have fixated, and I think he would have then started putting like the the those blue glasses would have come back on and he would have started to see all the events that have been going on.
00:10:49.500 --> 00:10:59.500
And he tried like there's a lot of resilience he's shown right now because there was a lot of things that were happening, but just the way he's being he's like, no, this this moment right now just kind of sucks.
00:10:59.820 --> 00:11:15.500
You know, I man, I'm so glad you gave that example because you know, I as we were kind of thinking through this topic, I I was thinking in sense of somebody without a diagnosis coming in and not pathologizing it in that way.
00:11:15.980 --> 00:11:28.060
And and then man, I think that's a whole what you just said is such a bigger picture is how do we help people differentiate their own experiences as not being part of a condition?
00:11:28.300 --> 00:11:41.659
Like so if you know, so if somebody has ADHD and they get distracted during a mundane task, yes, it could be related to their ADHD, but it could also just be a really boring task.
00:11:41.820 --> 00:11:49.740
Like, I mean, in reality, like it could be an experience that uh other people also would have in that that situation.
00:11:49.899 --> 00:11:57.580
And wow, I think that I mean that that may even be a whole other episode, Paul, because I'm thinking, like, yeah, how do we build that resilience?
00:11:57.740 --> 00:12:12.060
I I I think that's that's a wonderful mindset because every sadness isn't depression, even for somebody who's depressed, uh, every moment of anxiety isn't an anxiety disorder, even with somebody who has an anxiety disorder.
00:12:12.220 --> 00:12:14.460
Like that's a that is fantastic.
00:12:14.620 --> 00:12:47.100
I think that that's something we yeah, I don't know that we do well in mental health in that arena, that we we end up treating it rather than normalizing it and just kind of going like, yeah, you know, it was you know, it made me think of a I had somebody I saw a few several years ago, an uh an older adolescent college student, and she came, she had moved to Philadelphia, went to Temple University, and you know, she believes the Hanover PA, which is pretty small, and now all of a sudden she's living in Philadelphia.
00:12:47.580 --> 00:12:52.139
And she came in one time and she said, Oh my gosh, like my anxiety was so bad.
00:12:52.300 --> 00:12:54.379
And I said, Oh, like, yeah, what what's happening?
00:12:54.540 --> 00:13:01.580
She goes, I was out one night and I saw a group of people, and you know, she's like, I'm pretty sure it was kind of a drug deal.
00:13:01.740 --> 00:13:08.700
And I got so nerve nervous, I walked to the other side of the street and I went, Yeah, like of course you did.
00:13:08.860 --> 00:13:11.500
Like, isn't that like that's protective?
00:13:11.659 --> 00:13:14.700
Like, that's that's not you being anxious, that's you being aware.
00:13:15.259 --> 00:13:22.060
Now, if you never leave your dorm ever again and walk down the street, we'll call that anxiety.
00:13:22.300 --> 00:13:26.620
But if you're vigilant, that doesn't mean that you're anxious.
00:13:26.779 --> 00:13:30.300
Like, I may do the same thing as a person who's not anxious.
00:13:30.460 --> 00:13:31.740
So, yeah, great.
00:13:31.899 --> 00:13:36.540
This that's a that's I'm so glad you brought that case up as a good example.
00:13:36.860 --> 00:14:03.019
And and I think even going back to like talking about the rating scales and talking about like looking at the symptom, like because and I'm happy he like he was the one who called this out because given the circumstance, I think he probably could have made a really valid case that, like, hey, I'm in just in the circumstances we've been talking about, and I was look already looking and hearing his story as he was sharing the events that have been going on and like the way it was impacting him.
00:14:03.100 --> 00:14:04.779
It's like, all right, here we go.
00:14:04.940 --> 00:14:07.420
Like, and it caught me completely off guard.
00:14:07.580 --> 00:14:19.580
Like, and in such a way I was I'm so grateful for because I think that is I was looking at okay, I'm working with my uh you know, my client who has a history of depression and experiencing these events, that must be depression.
00:14:19.659 --> 00:14:21.259
So there wasn't that stop and check.
00:14:21.340 --> 00:14:26.860
So I think again, like that bias not a lane that earlier on, but I just saw the symptoms like when he was sharing it.
00:14:26.940 --> 00:14:30.460
And thank goodness that he's been doing the work that he called it out there.
00:14:30.700 --> 00:14:31.019
Right.
00:14:31.259 --> 00:14:34.060
He recognized the hassle, not the horror.
00:14:34.300 --> 00:14:39.500
Yeah, like he he did, which is brilliant, like fantastic.
00:14:39.659 --> 00:14:44.379
Like, I mean, I I I think that's a great measurement of progress.
00:14:44.460 --> 00:14:46.700
Like, I think it's really fantastic, you know.
00:14:46.940 --> 00:15:08.220
So I guess like as we've kind of talked about some of these things, you know, so as as you think through these moments where people come in and they bring up kind of these behaviors that we're trying to decide, you know, are they just typical reactions or are they something that we need to be concerned about?
00:15:08.700 --> 00:15:30.940
I I'm curious, like what's some of the things that you think about or that you use to help kind of tell the difference and start gauging is this a normal kind of reaction and do we deal with it in that way versus it increasing our our clinical antennae to to something deeper.
00:15:31.340 --> 00:15:36.460
And actually, there's something I've been doing probably for the past maybe four, six months or so.
00:15:36.540 --> 00:15:48.779
Um, and it's the session after my intake session, because I oftentimes, and if you've listened back to our like one of our first episodes, Words Matter, I think I mentioned and shared that up, I usually have the same starting line and the same ending line.
00:15:48.860 --> 00:15:52.540
And it's tweaked slightly, but if you listen to that episode, it's pretty much the same.
00:15:52.700 --> 00:16:03.899
But what I found myself doing is when I'm asking, hey, how things have been going for you since we last talked, I get a lot of information there, and not all of it is clinically the most valuable.
00:16:03.980 --> 00:16:09.659
And so what I kind of do in my first session afterwards, I'm like, hey, I'm gonna over-explain this here for to you for a moment.
00:16:09.980 --> 00:16:13.019
Every time you see me, I'm gonna ask some version of this.
00:16:13.259 --> 00:16:21.420
I want you to be open to share, but also I want you to recognize I'm probably not gonna grab everything because if I don't acknowledge this now, we run into the problem of the week.
00:16:21.580 --> 00:16:29.180
And the problem of the week is something that feels really significant, really heavy in this moment, but two, three days, not an issue.
00:16:29.259 --> 00:16:33.500
And it's not a part of the larger pattern or the overall experience that we're trying to treat.
00:16:33.659 --> 00:16:43.899
And so I try to distinguish that in like working, and the individuals that have uh have had intakes with where I've been starting to do that, I've been finding less of those pieces and we're able to reframe it back.
00:16:43.980 --> 00:16:48.060
But I still do try to invite them like that doesn't mean I don't want to hear about significant life events.
00:16:48.139 --> 00:16:52.060
That doesn't mean I don't want to hear about this, but I don't know that we're always going to run with it in treatment.
00:16:52.139 --> 00:17:00.940
And I can then refer back to that comment that I've made, like, hey, is this something like, is it valuable for us to really attend to this, or is this something that you think we'll resolve and like we can work through?
00:17:01.019 --> 00:17:08.299
So, like kind of putting it out there in more of like, I think, an objective way of like, hey, we have a limited amount of time, is this worth our investment?
00:17:08.379 --> 00:17:15.980
And in kind of letting them kind of gauge, and I'll I'll like I'll bring up here are the things we've been working on, here's this new topic, which one?
00:17:16.139 --> 00:17:25.180
And so at times I try to put that in their hands to try to like, oh, I'm here for this bigger issue, and that doesn't really relate or connect, so let me then lean further in.
00:17:25.339 --> 00:17:30.379
So that's kind of with more of my established individuals that I've been like or the as time has been going on.
00:17:30.619 --> 00:17:39.099
I think early on, especially during some of the intake or earlier experiences, I try to listen to to see pattern or persistence.
00:17:39.259 --> 00:17:39.420
Yeah.
00:17:39.659 --> 00:17:48.700
So when we're talking about something, is this again a problem of the week that they just happen to be sharing in this moment, type of thing, or is this a current time period?
00:18:19.389 --> 00:18:22.909
And like maybe it's consideration for an adjustment disorder and those pieces there.
00:18:23.069 --> 00:18:39.869
But also some of these pieces that, you know, if they're mentioned, it's like, okay, like today, one of the individuals I'm working with, their parent came in, they're like, hey, I'm concerned that my child was messaging some of their friends about sexual orientation and gender identity pieces.
00:18:39.949 --> 00:18:42.429
And I'm concerned that they didn't come and talk to me first.
00:18:43.229 --> 00:18:47.869
And I was talking about like, I was, hey, like, by it's fairly normative.
00:18:48.189 --> 00:18:52.189
And the their child was sitting in the room, and they're like, you're just gonna bring it up constantly.
00:18:52.269 --> 00:18:56.429
I was like, there's that piece of they can tell to a friend and then they can distance themselves from a friend.
00:18:56.749 --> 00:19:00.429
They tell it to you, it might be athletic, and even try your try your best you might.
00:19:00.589 --> 00:19:04.269
And so we talked about like how like there's this concern as a parent that's sitting there, yeah.
00:19:04.429 --> 00:19:08.909
Yet typical behavior of being able to be explorative and like just being able to talk for themselves.
00:19:08.989 --> 00:19:20.109
So like I think like it's kind of calling out little moments like that and being able to share, hey, like I hear the can we can hear the concern, I can understand the concern, but I also don't need to then sound like alarm.
00:19:20.429 --> 00:19:21.629
Yeah, no, I think that's great.
00:19:21.709 --> 00:19:28.909
You know, I I think for me, I think the first thing, and I kind of maybe alluded to this earlier, I think with all of these moments, yeah.
00:19:28.989 --> 00:19:35.469
I I think the first question is does the response that they're having make sense?
00:19:36.269 --> 00:19:38.269
Like, does it make sense with their situation?
00:19:38.429 --> 00:19:40.509
Like with grief, I think that's easy.
00:19:40.749 --> 00:19:44.829
The girl who was at temple crossing the street, like it makes sense.
00:19:44.909 --> 00:19:46.189
Like you're in a new environment.
00:19:46.429 --> 00:19:48.029
Yes, you're gonna be hyper-vigilant.
00:19:48.109 --> 00:19:50.589
Like, so I think context matters.
00:19:50.749 --> 00:20:00.909
And I think digging into context and understanding that in you know, you know, what's happened that uh that might uh make this response understandable.
00:20:01.069 --> 00:20:04.669
I think that's that's a great question for us to kind of keep in mind.
00:20:04.829 --> 00:20:21.149
And the other one for me is um I I agree with the pervasiveness, but I think also the the the proportionality aspect, you know, if if somebody's coming in and they have anxiety uh before an important presentation, that's expected.
00:20:21.229 --> 00:20:22.429
Like we would expect that.
00:20:22.589 --> 00:20:25.149
That's proportional to the the situation.
00:20:25.789 --> 00:20:34.109
But repeated panic attacks for weeks because you have to introduce yourself at a meeting next month, that's a different question.
00:20:34.269 --> 00:20:42.669
Like it's you know, so you know, I I think it it's finding out like is the proportion of the response consistent?
00:20:42.829 --> 00:20:54.029
And and sometimes they may even be uh proportionally higher than we would like, but it still may not lean clear over that we we should overreact to to those things.
00:20:54.189 --> 00:20:56.109
So I I I think that's an important one.
00:20:56.509 --> 00:20:58.269
And then I I I'm just gonna throw one other way.
00:20:58.509 --> 00:20:59.389
I think culture.
00:20:59.549 --> 00:21:19.469
I think yeah, I think this is one of those situations where as clinicians, we we may yeah, we may be biased in in some way of how somebody is reacting and us tend to pathologize versus kind of going like, oh wait, let me understand this within kind of your system.
00:21:19.629 --> 00:21:20.909
And and and I've had that.
00:21:20.989 --> 00:21:29.549
Like I've had families I've worked with from other cultures where when they then explain their reaction, I go, Oh, oh yeah, that perfectly makes sense.
00:21:29.709 --> 00:21:31.629
It may not be consistent with me.
00:21:31.709 --> 00:21:43.709
And I but I think and I I think we know that, but I think we should we always have to consider that because how we react then may affect our relationship with that person or get them to doubt in a different way.
00:21:43.869 --> 00:21:48.269
So I I think the culture piece is something else we need to look at at that level.
00:21:49.069 --> 00:22:01.309
And I I think at its core, when something is like pathological, I think there has to be a recognized like that pervasive functional impairment.
00:22:01.389 --> 00:22:05.469
And like that's I think that's a comment you've made in many other episodes beforehand.
00:22:05.549 --> 00:22:16.669
Um and I think like when we're talking about these elements, like these are the ways in which it's it either reduces the pervasiveness or it reduces the impact of the functional impairment.
00:22:16.749 --> 00:22:22.989
And so, yes, it might have an impact, but is it an impact within the culture that's more normative or more expected?
00:22:23.149 --> 00:22:27.229
Or again, I'm can't sleep the night before a big presentation.
00:22:27.709 --> 00:22:29.629
Okay, like that I mean that sucks.
00:22:29.789 --> 00:22:36.189
Like that that we can validate that, but also does that then signify an anxiety disorder?
00:22:36.349 --> 00:22:38.029
Or is it the pervasiveness?
00:22:38.109 --> 00:22:41.309
And again, were you still able to give the speed like the presentation?
00:22:41.469 --> 00:22:43.629
Like, did it impair your ability to go and do that?
00:22:43.869 --> 00:22:45.469
Did it impair things leading up to it?
00:22:45.549 --> 00:22:49.469
Like it impaired your sleep, but again, that's that scope piece that you're talking about.
00:22:49.549 --> 00:22:56.349
So I think in the context of what we're kind of those elements like, is trying to find and identify where is that threshold.
00:22:56.429 --> 00:23:03.869
And I think a part of that is using our our clinical experience to really identify normative versus non-normative there.
00:23:04.109 --> 00:23:04.269
Yeah.
00:23:04.429 --> 00:23:07.069
It's but you brought up the the sleep one.
00:23:07.309 --> 00:23:14.989
I had a uh a parent one time who was like, Yeah, I'm taking this my child to the sleep clinic, like I'm really worried about sleep.
00:23:15.069 --> 00:23:22.509
And and when we kind of dug down, they were like, you know, every night every night time before a test, he doesn't sleep well the night before.
00:23:23.229 --> 00:23:31.469
And and I I had reframed it and I said, And and they're a family who celebrates Christmas, and I said, How does he sleep the night before Christmas?
00:23:31.869 --> 00:23:34.269
Christmas, like like Christmas Eve to the next morning.
00:23:34.349 --> 00:23:35.229
And she went, terrible.
00:23:35.309 --> 00:23:36.749
He's up at like one o'clock in the morning.
00:23:36.909 --> 00:23:39.069
I'm like, why is that not a problem?
00:23:39.309 --> 00:23:48.269
Like, why, like, why is that like that's it's the same behavior that there's something happening in his life that's changing his sleep patterns.
00:23:48.349 --> 00:23:50.669
Um and she's like, Oh, well, he does that all the time.
00:23:50.989 --> 00:23:51.229
Right.
00:23:51.469 --> 00:23:56.909
So let's not make the moments uh now let's address the the anxiety about testing.
00:23:56.989 --> 00:24:00.989
That's the thing, we should probably at least kind of give some strategies around that.
00:24:02.189 --> 00:24:04.349
But I don't know that we need a sleep study.
00:24:04.429 --> 00:24:12.109
Like, I think that it's easy to kind of just go, okay, wait, sometimes our sleep's disrupted for multiple emotional reasons.
00:24:12.269 --> 00:24:18.509
Uh may not be disordered, it just may be the situation happened.
00:24:18.669 --> 00:24:26.749
So I I guess piggybacking off of that, let let's maybe throw out a few, like, what are some cases where we might get into trouble?
00:24:26.829 --> 00:24:33.789
Like, where are some so so the idea of maybe you know, a situation and sleep, but what are some other differentials?
00:24:33.869 --> 00:24:39.149
So I I've mentioned grief and depression before, but what what's one that comes to mind for you?
00:24:39.629 --> 00:24:54.509
And I want to be kind of uh very cautious about this, because I do think this is one when we hear it, it's one to really lean in and pay attention to, but it's also I don't want to jump the gun and pathologizing it, and it's the idea of um passive suicide ideation.
00:24:54.989 --> 00:25:04.109
I I I think that that is a can be a quite common experience, especially in the aftermath of a really stressful or challenging circumstance.
00:25:04.269 --> 00:25:17.229
And again, I don't I don't mean to make light of that, but at the same point in time, if we had the number of of follow-through with that compared to the number of like reports and experiences that passive suicidal ID, those are hugely disproportionate.
00:25:17.389 --> 00:25:21.629
And so it's important for us to note, but not necessarily to pathologize.
00:25:21.709 --> 00:25:28.429
And I think again, um, there can be individuals who experience a like, what is wrong with me that I had this thought?
00:25:28.669 --> 00:25:33.629
And like that, again, if we then treat that like, oh, well, like that's your exact that's your depression.
00:25:34.109 --> 00:25:50.829
If we lean in and we try to start explaining it with a diagnosis before really kind of understanding those core pieces, I think that again we might we have the potential of doing more harm than good when you know, if it's hey, I went to this breakup and this person was in my life for so long and now they aren't.
00:25:51.069 --> 00:25:58.269
And now I feel lost and I don't quite know what to do, and it's so challenging that I just wish I didn't have to feel this way any longer.
00:25:58.989 --> 00:26:00.189
I get that.
00:26:00.589 --> 00:26:03.229
Yeah, I I I think that's a an important one.
00:26:03.389 --> 00:26:18.989
I mean, I think even, you know, I I can't even name the number or or count the number of cases I've had where a child gets mad at their parents and they go, I'm just gonna kill myself, and they run to their room and slam the door.
00:26:19.469 --> 00:26:25.389
And that's the you know, that that becomes the reason that that they're referred.
00:26:25.549 --> 00:26:32.669
And and again, sometimes, yeah, absolutely, that there's there's a deeper issue, but sometimes it's a reaction.
00:26:33.149 --> 00:26:42.509
And I I again I think kind of thinking that through, and it's again, it's this balance, you gotta take it serious, but also not not dig in too deep.
00:26:42.749 --> 00:27:01.789
Um I I I think one that's kind of been interesting to me, and and I I I think this is kind of goes to you know, some of the the self-diagnosis culture, I think, a little bit is you know, the the idea of like normal food, let's call that selectivity that people have.
00:27:02.589 --> 00:27:12.349
And later as in life, they they kind of go back and go, oh yes, this is a symptom of me uh having autism or neurodivergence.
00:27:12.509 --> 00:27:23.629
And you know, I I had an ex an example that I I saw recently where you know someone used the the idea of they liked one food and they liked another food.
00:27:23.789 --> 00:27:27.229
So let's say they liked macaroni and they liked cheese.
00:27:27.549 --> 00:27:31.389
But if it was macaroni and cheese, they wouldn't eat it if it was combined.
00:27:31.469 --> 00:27:42.189
And they were like, see, that that means that I I have these food sensitivities and it's it's a justification that I probably had I've had autism my whole life.
00:27:42.429 --> 00:27:49.629
And you know, I I kind of I I've shared with you, you know, I won't eat tomate raw tomatoes.
00:27:49.869 --> 00:27:55.629
I won't eat unless they're chopped up and put in pigo de gallo, then I can eat them.
00:27:55.949 --> 00:28:02.189
Now it it makes no sense, but my selectivity is for some reason I just can't do it.
00:28:03.069 --> 00:28:10.349
It's a it's it's a ordinary preference more than it is something that we look at diagnostically.
00:28:10.509 --> 00:28:18.189
So this idea of kind of going back and finding these little oddities that we may have done at some point, you know.
00:28:18.349 --> 00:28:21.629
I've had people say, as a kid I had to have tags cut out of my shirt.
00:28:22.749 --> 00:28:23.709
A lot of people do.
00:28:23.869 --> 00:28:25.549
Like that's a that's pretty common.
00:28:25.789 --> 00:28:41.469
So I I think you know, some of these ideas of you know, either food sensitivities or things, they're they're also ones that we can lean into without getting the broader picture that that's that's problematic.
00:28:42.669 --> 00:28:51.549
And I think that can even extend, like, you know, as you were saying that and specifically like that connection with like food sensitivity and autism.
00:28:51.789 --> 00:29:00.269
I'm thinking about the over prevalence of like, and this is I think just overuse of the term, and then it lessens the clinical rigidity of it.
00:29:00.349 --> 00:29:13.469
But like I remember when I was a teenager, it would bother me when the vacuum cord was on like wasn't put up correctly, like actually like on like little like spindles and like my parents neither one did that.
00:29:13.709 --> 00:29:26.909
I didn't really love vacuuming, and I didn't see it and go out and search for it, but like and I saw it, I'd stop and I'd go and do it, like I'd wrap the cord around it, and at one point I don't know if it was me or if it was my my parents was like, oh, like you know, that's your OCD.
00:29:27.229 --> 00:29:27.629
Yeah.
00:29:27.869 --> 00:29:32.189
And it's like or like it's just annoying to detangle it.
00:29:32.669 --> 00:29:33.869
And like that was my reason.
00:29:33.949 --> 00:29:40.669
Like, whenever I had to go use it, it was always just a a tangled mess, and so we take the time, and then I'm not gonna be annoyed and frustrated in the future.
00:29:40.829 --> 00:29:55.789
One of the few moments I would do something from future Paul, but but in that case, like it's we're normalizing certain language, and I think even I have a bit of a I have a bit of concern using even the terms anxiety and depression as a symptom.
00:29:56.429 --> 00:30:03.549
And I try to really differentiate that in in sessions of like anxiety, when we're talking about this, like when someone's saying, Oh, I'm feeling depressed.
00:30:04.269 --> 00:30:09.389
Okay, like let's really expand on that because also does that then mean you have depression?
00:30:09.549 --> 00:30:12.349
Or if I'm feeling anxious, does that mean I have anxiety?
00:30:12.509 --> 00:30:17.789
And really trying to delineate like what is the difference here when we're using it as a symptom or using it as a diagnosis?
00:30:17.949 --> 00:30:18.109
Yeah.
00:30:18.269 --> 00:30:24.749
And I think if we don't do that or if we don't bring that clarity, uh, you know, an anxious moment can lead to an anxiety disorder.
00:30:24.989 --> 00:30:25.229
Sure.
00:30:25.389 --> 00:30:27.069
Yeah, oh yeah, I I agree.
00:30:27.229 --> 00:30:31.229
I uh Yeah, I I think that you know, you mentioned like the OCD term.
00:30:31.469 --> 00:30:33.869
Man, does that get thrown around uh a lot?
00:30:34.029 --> 00:30:49.309
Uh you know, it's but I I even looked at it as, you know, I I've had evaluations where people have come in because a spouse or a parent says, oh, yeah, I think this person has OCD because they like predictability.
00:30:49.469 --> 00:30:52.909
And you know, I kind of go like a lot of people like predictability.
00:30:53.069 --> 00:30:54.509
Like I love predictability.
00:30:54.669 --> 00:30:56.909
I like to know kind of what my schedule is.
00:30:57.069 --> 00:31:01.309
I like to have things in a certain way that makes that makes my world go smoother.
00:31:01.469 --> 00:31:08.989
I mean, I think, and so again, it's it's a behavior that it misses the other core components, right?
00:31:09.149 --> 00:31:14.429
There's there's not necessarily a distress and we're not getting rid of a distress.
00:31:14.589 --> 00:31:21.789
We're we're trying to organize ourselves in a way that's that's gonna have just in have a a more smooth day.
00:31:21.949 --> 00:31:23.469
And it's but it's interesting.
00:31:23.549 --> 00:31:33.789
I think that that that's another one where the symptoms can really or the the behavior can be looked at pathologically when it may or may not.
00:31:33.949 --> 00:31:38.189
There's a lot of other variables that that can come into the the the picture.
00:31:38.589 --> 00:31:53.149
You know, I I I think as we're wrapping up, I guess, you know, as one of the things I thought maybe to end with, like you know, I I guess what are your thoughts on why is this important to talk about to begin with?
00:31:53.309 --> 00:32:00.429
You know, in the sense of like, you know, so we're we're kind of um you know, talking about all these little examples.
00:32:00.669 --> 00:32:06.669
And when it does go wrong, what what do you see as some of the concerns with it?
00:32:07.709 --> 00:32:18.589
I think if we treat it like it's a pathology, it can at times turn into pathology or or uh maybe not even what we are treating, but a a different variation of that.
00:32:18.749 --> 00:32:39.549
And it's uh I guess the call of being more discerning because if we if we just use a checkbox to identify something and then we begin the treatment, you made the comment earlier of like we have all these uh we have the list of concerns that come along with medication and if you know all the side effects and all the potential harms that can come along with this.
00:32:39.789 --> 00:32:45.069
I mean, I think about like exposure thing, exposure therapy, it's hard, like it is not a fun experience.
00:32:45.149 --> 00:32:52.429
And so it's like if someone isn't in necessarily need of exposure, like is that something that we necessarily want them to have to go through?
00:32:52.589 --> 00:32:57.789
And so, or like so does the treatment create this cut like unnecessary harm?
00:32:57.949 --> 00:33:05.309
And also, are we then like if if that individual that I was talking about with his depression and he said, no, I think that's just a just sad.
00:33:05.869 --> 00:33:11.069
If I treated that like this, we probably would have gone back into like, okay, so how do we engage your support systems?
00:33:11.149 --> 00:33:20.349
How do we make sure, you know, hey, like you've been inconsistent with medication to do, you know, let's get you back hooked up with your psychiatry again and like make sure just in like how do we make sure you're not missing work?
00:33:20.509 --> 00:33:35.309
And like we would have kind of gone into this response that probably that isn't warranted that and probably would have led to some of those things and a fixation on maybe he would have missed work because he would have been so frustrated of here I go again, and like, you know, when is this gonna end?
00:33:35.389 --> 00:33:39.469
It's never gonna like those things I think would have become far more impactful.
00:33:39.629 --> 00:33:51.469
And so I think we're reducing kind of the potential harm in the treatment as well as creating more distress or concern by overvalidating this kind of temporary discomfort.
00:33:51.949 --> 00:33:54.989
I I I'm I'm I my thoughts are in line with that as well.
00:33:55.149 --> 00:34:06.509
I mean, I I I think we've in other episodes may have used the term iatrogenesis, and iatrogenesis is you know, this idea that sometimes the treatment can do more harm.
00:34:06.669 --> 00:34:18.190
And you know, you kind of alluded to the idea that sometimes our reaction to a symptom can actually reinforce it accidentally as being pathological.
00:34:18.349 --> 00:34:23.150
And you know, and it's interesting because as therapists, we don't want to hear about this sometimes.
00:34:23.309 --> 00:34:26.029
But you know, I I made this comment when I was doing a training one day.
00:34:26.110 --> 00:34:32.989
I said, you know, sometimes therapy itself can communicate that you shouldn't feel a certain way.
00:34:34.110 --> 00:34:50.030
That's a really hard thing to hear as a therapist because our goal is absolutely to feel to make people feel better, get better, all of these things, and to say like what we are doing and how we are communicating may be heard the wrong way.
00:34:50.110 --> 00:34:58.990
And I think that it's so important for us to at least have the uh the the awareness of understanding that that could happen.
00:34:59.230 --> 00:35:10.750
And that, you know, uh you know, it's this every time we do an intervention to reduce stress, that's again, it's giving that message that the stress should be reduced.
00:35:11.150 --> 00:35:18.590
Maybe the stress is okay sometimes, and you know, anger might just signify injustice.
00:35:18.829 --> 00:35:21.550
That that might be an okay thing to be angry about.
00:35:21.789 --> 00:35:27.870
Anxiety might just be a signal of uncertainty, you know, grief it reflects our loss.
00:35:28.030 --> 00:35:47.309
Like, I mean, all of these connectors and so I I think it's important that we we really kind of instead of trying to uh talk to people about how to get rid of it, you know, I I think this is where the mindfulness movement has been just absolutely brilliant.
00:35:47.470 --> 00:35:55.550
And all of the therapies that have have risen out of of that, where sometimes it's okay to just be present with those feelings.
00:35:55.710 --> 00:35:59.630
It's okay to just be there for a second, you know.
00:36:00.269 --> 00:36:05.869
Our our goal of treatment is not emotional anesthesia, like that's not what we're trying to do.
00:36:06.030 --> 00:36:07.949
Like we're not trying to just take it away.
00:36:08.110 --> 00:36:20.510
It's you know, this idea of how do we be with it and be okay with it and understand what that tells us about ourselves and how we can in a healthy way.
00:36:22.429 --> 00:36:23.070
Yeah.
00:36:24.269 --> 00:36:28.349
And and to just piggyback off that, like one of the Dr.
00:36:28.429 --> 00:36:35.070
Ron Levant, when we were talking to him in uh his book of the problem with men, it it sparked kind of this interest for me.
00:36:35.150 --> 00:36:46.590
And I don't know that it was intentional for him, but just like talking about just the value and importance of emotional literacy, and I talk about this more so with men, and like you know, just because uh because of that interaction there.
00:36:46.829 --> 00:37:08.670
However, just in that those conversations, it's really kind of driven me to spending more time of like uh he uses the example of like the the two groups and the emotional literacy that we see in the women's group and being able to just I diversify, identify what is my emotion, why am I feeling this way, and what am I going to do with it kind of experience.
00:37:08.909 --> 00:37:11.230
And for the men, it was I'm pissed off.
00:37:11.309 --> 00:37:14.030
And that was about the the scope of that.
00:37:14.269 --> 00:37:21.949
And being able to kind of encourage, like, hey, like let's try to engage in this in this literacy way where like when I'm feeling this, what is it telling me?
00:37:22.190 --> 00:37:44.030
And so when we can better understand that and when we can better read that, I think we we can then become more effective and kind of feeling a greater sense of fulfillment, but the uncomfortable emotions tell us something, and so when we're experiencing that, it isn't to shut them down because the injustice I when you said ang, you know, is anger a representation of injustice?
00:37:44.429 --> 00:37:46.190
That I think is such an important piece.
00:37:46.349 --> 00:37:56.510
And if we are just saying, like, hey, no, like you're, you know, it's inappropriate that you're angry and that you're like, you know, expressive and that you're, you know, that you're the way that you're responding to this.
00:37:56.670 --> 00:38:07.230
And if we view it in the context of like, hey, I'm calling out an injustice, like, man, there would have been many significant historical movements that would not have happened had that got path, you know, pathology.
00:38:07.389 --> 00:38:11.150
It's like, oh, you know, you know, you just you know you need therapy versus you need to create change.
00:38:11.230 --> 00:38:32.349
And so I think there's an important con like aspect of like for us as clinicians, also kind of better equipping those that we work with of like, how can they understand just because I'm experiencing this emotion, it's it's not a pathology, but also what is it telling me and how do I how do I experience it in a way that doesn't just feel like it lingers or it feels stuck?
00:38:32.429 --> 00:38:34.670
But they give me giving them some tools.
00:38:34.750 --> 00:38:47.949
And so we can provide treatment, but it's not a it's not a therapeutic treatment to try to challenge it or discontinue it, but it's more of it encouraging this how do we lean in the mindfulness side of that to to engage with it and better understand it.
00:38:48.269 --> 00:39:00.909
Yeah, I mean I I I think it the kind of bottom line is like you know, psychological health or mental health, you know, it we have to get beyond that it's that's not the absent of negative emotion.
00:39:01.470 --> 00:39:03.949
Like that's that's not what we're aiming, you know.
00:39:04.670 --> 00:39:12.990
Mental health is the capacity to experience a full range of emotions without becoming imprisoned by them, right?
00:39:13.150 --> 00:39:16.590
Like so it's about that and that pervasiveness piece, right?
00:39:16.670 --> 00:39:20.670
Like if if yeah, if we're just living in that, that that's unhealthy.
00:39:20.829 --> 00:39:28.269
But we want, like, I want to be sad, I want to at times to be anxious, I want to be angry.
00:39:28.349 --> 00:39:33.230
Like, I think those are things like that's a part of who we are.
00:39:33.470 --> 00:39:37.389
And but what's our capacity to deal with those?
00:39:37.470 --> 00:39:44.269
And I think that if we change that view of not eliminating negative emotion, but instead building capacity, it's different.
00:39:44.909 --> 00:39:51.949
I I know we're not talking about happiness, but it reminded me of like I read a study and I I wish I had the reference for it.
00:39:52.030 --> 00:39:56.510
If if I do, I'll I'll I'll send it to you so we can put it in the the show notes.
00:39:56.670 --> 00:40:01.630
But they were talking about that eliminating depression doesn't create happiness.
00:40:01.789 --> 00:40:08.829
That you know, no matter how much we treat depression, all that does is eliminate the negative symptoms.
00:40:08.990 --> 00:40:15.309
It doesn't build the positives because that's because we're missing the full range of our emotional experiences.
00:40:15.949 --> 00:40:23.309
When we're dealing with depression, we also have to build pleasure, we have to find other there's another end of that that spectrum.
00:40:23.470 --> 00:40:30.110
And I think the more we see new research in psychology, I think we're getting better at that.
00:40:30.269 --> 00:40:31.710
I think I think over time.
00:40:32.030 --> 00:40:44.429
But for so long, we have looked at treatment as trying to to numb emotions or to take away negative emotions, and it's it's a much bigger picture than that.
00:40:44.670 --> 00:40:50.349
So, you know, it's yeah, I mean, our job is not to make every uncomfortable experience disappear.
00:40:50.510 --> 00:40:52.349
That's not what we're doing in therapy.
00:40:52.670 --> 00:41:08.510
You know, we might be diagnosing sometimes, we're sometimes gonna treat, but I think sometimes it's okay to that our job is just to help people understand that what they're experiencing is profoundly difficult, but it's also profoundly human.
00:41:08.909 --> 00:41:09.150
Yeah.
00:41:09.630 --> 00:41:12.750
It's just what we we go through.
00:41:13.070 --> 00:41:14.670
And that's okay.
00:41:14.829 --> 00:41:16.750
Like that's that's okay to kind of be there.
00:41:16.909 --> 00:41:27.630
So yeah, I mean, I think this was a kind of a fun conversation in that way to think about it as, you know, if we think in this way, we really do broaden mental health, which I think is important.
00:41:27.869 --> 00:41:30.670
And, you know, with that, we hope you enjoyed this conversation.
00:41:30.829 --> 00:41:34.110
Uh Ray and I will be back in two weeks, but until then, be well.
00:41:34.349 --> 00:41:35.470
Stay psyched.
