Thursday, December 24, 2015

Counselors & Doctors & Stuff

Original image by mondspeer
Guys, do you like my Microsoft Paint skills or what?




You don't have to answer that.

Anyways, I'd like to start off this post by addressing a popular misconception: you don't have to have a mental illness to go to a counselor. For myself, and a lot of people I know, one of the biggest barriers to deciding to see a counselor was feeling like your problems weren't big enough to see a counselor about, or like you probably didn't really have depression, anxiety, OCD, etc., so wouldn't you feel really dumb if you went to a therapist and they were all like, why are you even here? Just suck it up and deal with it like a normal person!

The thing is, there is no sign saying "Your mental or emotional problems must be at least this crazy to see a psychologist." There's not, I checked. Trust me. In fact, people go to psychologists for a number of reasons. You may be really stressed, or have difficulty coping with something that happened in your life, or you might be experiencing problems with your attention span or motivation. Counselors are trained to teach people practical, practice-able skills to deal with almost any problem. Mental disorders are what happens when some of these problems go way beyond what most people experience, but even people who are experiencing these same issues to a lesser extent can benefit from the same kind of therapy. 

So if you're worried about your problem "not being real enough," or getting diagnosed with some sort of scary problem, don't be. Honestly, going to a counselor before your problems become big issues makes them easier to treat, and ideally, you can practice what you learn and stop them from getting any bigger. It's kind of like going to the doctor and getting antibiotics within the first few days of strep throat, instead of waiting a few months and risking getting scarlet fever or getting so sick that you have to miss a month of classes.


Making the Appointment

College is a great time to go to counseling, because your university usually has a free counseling center. For BYU, it's the Counseling Center in the Wilk. If you're not at college, I would probably start by seeing your primary care doctor and asking for any referrals to psychologists in the area.

Guys, it took me SO LONG to see a counselor at BYU, because it's behind these doors and shuttered windows and opening those doors just felt like stepping into the unknown and it felt way more scary than they probably intended it to be. They keep it like that to protect the privacy of anyone hanging out in the waiting room, but it was still intimidating. I tried to find a picture of the waiting room for everyone, but I couldn't. It looks kind of like this, except with a detached reception desk instead of one built into the wall and a BYU blue color scheme:

(Image source)

It literally just looks like every waiting room ever on the inside, trust me. At the front, there are usually two students manning the reception, and behind them is an older lady. You can talk to any of them.

Before you make an appointment, you have to do some paperwork. It's easier if you do it before you come; just follow the instructions here. The first few questions are pretty open-ended, kind of along the lines of "why do you want to see a counselor," and it can be hard to think of what to write. It's not really a big deal though, because the rest of the form is checking a bunch of very detailed boxes with a multitude of symptoms. They just want a brief overview in your own words — it can be as simple as "I feel disproportionately stressed a lot of the time," "I'm having trouble concentrating on anything," or "I feel down/blue/unmotivated frequently." Seriously, feel free to put that exact phrase in there if you can't think of anything. It's fine.

After that, you can either call them at 801-422-3035 to schedule an appointment, or you can walk in and talk to anyone at the desk. If both of those feel intimidating, recruit a friend, family member, or roommate to come with you or help you call. In either case, all you have to say is "I'd like to schedule an intake appointment." They'll ask you if you completed the paperwork, to which the answer is yes, and you'll set up a time!

Again, the procedure will obviously be slightly different at other universities, but the general idea may be the same. You might have to talk to someone at the desk to get the paperwork, depending on how they have things set up.

Your First Appointment

At your first appointment, just go up to the desk and say, "Hey I have an intake appointment scheduled for [time]." They'll probably ask for your student ID number or your initials, and then you sit there and wait until your therapist calls your name. You'll go back into a little office and usually there's a couch and a few chairs. You can sit anywhere you want. Modern therapy doesn't actually look like the whole "lying down on a couch" trope; you just sit face-to-face and talk.

They'll probably ask you a couple of open-ended questions about why you're here and what you'd like to get out of therapy, so come prepared to describe what's bothering you. I had trouble answering "Why I'm here" because it was kind of like, " make all of these feelings not be the way that they are? Duh?" If you're struggling with that question, a good thing to say might be something along the lines of, "[Symptoms] are impacting [school, relationships, etc.] really negatively, and I'd like to reduce them to the point where they're not interfering with [the things] as much."

At this point, you'll probably talk about future treatment options. The two big options, at least at BYU, are individual vs. group therapy. Your experience will vary depending on who your counselor is and/or who is in your group therapy, but this is my experience with the two:

It's totally okay to choose one, the other, or both. When I first started going to therapy, the idea of talking to a group of people about everything was really intimidating, so I went to individual therapy only for a while and then eventually added group therapy. They're both great in their own way.

Continuing Therapy

BYU has you complete a 40-question survey before each appointment. (If you have trouble accessing it or forget, the people at the front desk have iPads you can take it on before your appointment). Some therapists make more use of it than others. Both therapists I had primarily looked at your overall "score" to get a rough idea of how you were doing from week-to-week. This also helps them evaluate how treatment is going; once your scores fall below a certain range, they'll typically bring up tapering off the therapy. BYU's therapy model is short-term, which means they have the goal to help you learn skills that will allow you to manage your mental health independently in the long term.

Sometimes, the first therapist you get may not be right for you. A friend of mine explained it this way: expecting your first therapist to be the right one for you is kind of like expecting to marry the first person you go on a blind date with. If your therapist doesn't seem to get you, it's perfectly fine to transfer to another one. I did, although mine was going on maternity leave anyways. You don't have to worry about offending them — it happens all the time. Just say something like, "I've really appreciated having therapy with you, but I don't feel like we're clicking. I was wondering if I could transfer to a different therapist?" They'll probably ask you a few questions about why you feel that way, but don't worry; they're just trying to get a better sense of who would be a good fit for you. Alternatively, they might realize that the things you're describing are easy for them to do differently, and they'll change their approach slightly. Either way, it's a good idea to bring things up so that you can get the best experience possible.

Doctors & Medication

Most counselors, therapists, and psychologists can't prescribe medication. For that, you need someone who's been to med school. You don't need a referral from a counselor or anything to see a doctor about medication. You can just book an appointment with your primary care provider. On the BYU Health website, you can even schedule the appointment online and select the "mental health" category.

You'll go in, check in like any other appointment, and the nurse will call you back. He or she will probably weigh you and take your blood pressure, and ask you what you're here for. You can describe your symptoms, or if you've already seen a counselor and been diagnosed with something, you can say, "I have [disorder] and wanted to see about trying medication for it." They'll probably give you a form to fill out to rate the severity of your symptoms while you wait for the doctor to come in. He or she will come in, look at the form, and prescribe you something.

I only have experience with antidepressants, but typically, medications aren't a life-long thing. With antidepressants, for example, they'll typically start you on Prozac or another common one, and wait a few months to see if it works. If it works, they'll keep you on it for 6 to 9 months, at which point, you can choose to go off it or continue. If you go off it and relapse, they'll put you back on for twice as long, at which point you can again choose to discontinue. If you relapse again, that's when they'd recommend you take them permanently. Sometimes, the first medication they try for you won't work, or will even make things worse in rare cases (Prozac definitely exacerbated both my depression and anxiety), and they'll try a different medication. Once they find one that works, they'll follow the same procedure.

Typically, the doctor will make a followup appointment about a month from your first appointment to see how the drug is working. Depending on how well you're doing, they'll give you a refill for a longer or shorter amount of time, or switch you. If your condition proves resistant to most common medications for your condition, they'll give you the option to consult with a doctor who specializes in psychiatric medication to help you find something, if you want to keep trying.

The generics of both Prozac and Zoloft cost less than $0.80/month on the BYU Health Plan, so you don't have to worry about breaking the bank.

So, Which One Do I Choose?

Before I get to the actual pros and cons of both kinds of treatments, let me note that a lot of the things that will help you deal with mental illness in college require documentation. Getting accommodations is almost impossible without a letter from a counselor or doctor to verify your condition. In my experience, counselors write better letters, plus you see them on a regular basis, which makes them easier to request as part of a normal visit. For that reason alone, it can be useful to meet with a counselor at least occasionally. However, if you really don't want to try therapy, a doctor can also provide medical documentation. Additionally, neither counselors nor doctors are allowed to ever tell anyone else about your treatment without your consent; your privacy is equally safe with either.

As far as effectiveness goes, the thing about mental health is that it's very individual, with a lot of different causes. Some people may do better with therapy, some with medication, and some with both. For mild to moderate depression, for example, medication isn't more effective than therapy; however, severe depression often can't be fully treated with therapy alone. ADHD, anxiety, OCD, bipolar disorder, schizophrenia, and other disorders all have their own unique needs, as does every individual person.

Neither therapy nor medication needs to be long term. To a certain extent, it depends on what you feel the most comfortable with. In my personal opinion, therapy is always a good idea to at least try. If your disorder is being heavily influenced by certain ingrained patterns of thinking or reacting to situations, medication may not provide a long-term solution. However, if your disorder is more biological in nature, therapy may not provide a permanent solution.

The thing about therapy is a lot of the things you learn are little "rope ladders" of their own. Therapy requires effort, and if your mental state is really severe, you may not be capable of climbing those ladders right away. For instance, a lot of things that help with depression are getting enough sleep, maintaining a regular schedule, eating enough nutritious food, staying as on top of your responsibilities as you can, keeping your apartment clean, and exercising. A lot of the effects of depression are insomnia, an inability to get out of bed in the mornings, loss of appetite or eating too much, and not having the motivation to shower, let alone complete responsibilities or exercise.

You can see where this can run into problems. If you have mild or moderate depression, your therapist can help you find strategies to start doing at least some of these things, which can improve your mood and help you build up to doing all the things. However, if you can't even start doing any of the things, medication can provide a jump start to help you work on the things you learn in therapy. Think of it as a prosthetic arm that helps you climb the ladder. Except in this case, the more ladders you climb, the more likely your arms are to grow back and help you eventually climb out of the hole entirely, and you may not need that prosthetic arm anymore. Or, I guess, maybe your arms don't grow back but the prosthetic arm helps you climb out of the hole. Everyone's arms are different.

Analogies are hard, you guys.

Now if you'll excuse me, my prosthetic arm is giving me a weird compiler error and I need to do some troubleshooting.

Stay tuned for more posts about mental health in college, or read the series introduction to start from the beginning.

Wednesday, December 23, 2015

Mental Health & University Series: Introduction

Some of you may be aware that I've been having a really fun time with depression and anxiety over the past year or so. Some of you may not have been aware of that. It's been fun, though, trust me.

The good news is, college is full of useful resources and accommodations for people with physical or mental health conditions. The bad news is, nobody seems to know about them, or if they do, they're not entirely capable of accessing them.

Here's an analogy:


You have no arms. (This may seem weird, just go with it. It's relevant later.)


So you have no arms, and somehow you fall into a hole. Or are pushed into a hole. Or you're just walking along and the hole opens up underneath you. Or maybe you run and jump into the hole on purpose. The thing is — and this is crucial — it doesn't really matter why you ended up in a hole. A lot of people seem to miss this point, including the people (professors, petitions committee members, etc.) who are supposed to help you. Yeah, there's a time and place for examining how you got into the hole, and maybe you could have prevented it, and it might help the university to figure out how to put up fences around the holes or prevent them from spontaneously appearing in the first place. However, the time and place for that isn't while you're still in the hole. If you're still in the hole, the first priority should be to get you out.

The point is, you're in this hole, and somehow you've managed to convince the people standing outside the hole to stop interrogating you about how you got into it and they're willing to try to get you out. You need to get out, because you can't really do your homework in the hole, or go to the testing center, or shower, or really do anything. The hole is pretty boring, not to mention unproductive. It doesn't even have WiFi.

Your rescuer lowers a rope ladder, says "Here you go! Don't forget to hand in your paper on European portraiture on Tuesday!", and walks away.

"Wait! I can't climb this ladder! I have no arms!" you yell as they leave. They keep walking.

Several days later, they come back. You have a couple of bruises from trying to climb a rope ladder without arms, and you're pretty hungry and greasy. "Why didn't you finish your paper?" they demand. "You can't stay in this hole forever. I even gave you a way to get out!"

"Being stuck in a hole isn't an excuse to blow off your assignments."

"But," you protest, "I couldn't get out of the hole. I can't climb a rope ladder with no arms."

"Look. You shouldn't have fallen into this hole in the first place, but we've given you all the resources you needed to get out. Just because you have no arms doesn't mean you get to be self-pitying and take no responsibility for yourself. Rope ladders have helped plenty of people climb out of holes before. You have everything you need — you're just not using it."

They walk away and leave you in the hole.

Somehow, being stuck in a dirt hole for days on end is less upsetting to you than the fact that you're failing Art History.


That's the thing about mental health. Just because various resources are made available doesn't mean you're capable of taking advantage of them on your own, or that they're designed in a way that's actually helpful. And that's assuming you even know about the resources! If you don't, it's more like being told, "If you dig around in the bottom of this hole for a while, you'll find a set of directions to find some rope. If you follow those directions, you'll find another note, which tells you that the rope is back in the first place you dug. Dig around a little longer, and you might stumble upon a length of rope and a couple of stakes. Tie the rope into a ladder, attach it to the top of the hole with the stakes, and you can climb out!"

Then, if you don't manage to follow all those steps and get out of the hole, you have to convince someone to lower a ramp into a hole, and whether or not you get the ramp is dependent upon your ability to justify why you couldn't just use the resources they already provided, or why you need a ramp instead of another ladder. Somehow, I don't have any freaking arms isn't an acceptable answer.

Fortunately for me, between the stars aligning and the support of my husband, I actually managed to climb the ladder somehow. However, between my experience and talking to friends of mine who have had similar experiences, it's come to my attention that most students don't know what resources are available to them, or if they do, they face significant challenges in using them. As an attempt to help with this, I'll be writing a multi-part series that addresses as many relevant topics as I can think of, namely:

These posts will lay out the basic process for completing these tasks, explain how to know when you need to make use of these resources, and provide examples of emails, petitions statements, and hypothetical conversations for anyone you need to talk with. While these posts focus on BYU, most of the ideas within them should hopefully be applicable across a range of institutions. As the posts are written, links will be added to this page.

If you're experiencing a mental illness in college, or if you know someone who is, please share this information so that people can get the help they need.