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.

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