Finding the Psychologist that is Right for you (or your child)

Finding a Good Psychologist: The Essentials

So finding a good psychologist or therapist can be very confusing. Like what is even the difference between those that call themselves a therapist vs. psychologist!?!  I was going to start this post very analytically and list all the different types of therapists, what all the letters (e.g. LPC vs LMFT vs LCSW vs Ph.D.) meant at the end of everyone's name - but after mulling that over I decided that I would start off with the essentials of finding a good psychologist. Because in the end - if these are not "on point" - then the letters at the end don't really matter. So people, here are the absolute essentials - the thing all psychologists (or therapists) have to get right. 

1.) Therapist- Client "Fit". You aren't going to like everyone, and everyone is not going to like you. It's just a fact of life. That being said having an immediate "spark" or "super warm fuzzy" feelings are not required to gain progress in therapy, but feeling comfortable and safe with your therapist is!!!  There literally is no other relationship quite like it! Research has shown that the quality of the relationship with your therapist is more important than even the therapy modality. This is pretty amazing and shows the incredible power of authentic human connection. So if you are more than a few sessions in and you are feeling awkward, uncomfortable, or are doubting that you are in the right hands -  voice your opinions! A good therapist will openly welcome these thoughts - sometimes these thoughts may relate to the very issues that are bringing you to therapy in the first place.  When you are transparent about your concerns, this may lead to a better level of understanding or perhaps spur discussion about the "goodness of fit" between you and your therapist.

2.) Does the therapist have a speciality? Just like you wouldn't go to an ENT doctor for your GI troubles, many psychologists have specialty practices or niches that they focus on. I would shy away from seeing a clinician that "specializes in everything- or sees everyone" because generally it is really hard to be super good at all things. Specialties can range from age group, to presenting symptoms (e.g. depression, anxiety, OCD, health issues), or they can specialize in a certain treatment modality (psychodynamic vs ACT vs. CBT. vs DBT).

3.) The focus should be on you. Some therapist self-disclosure (therapy jargon for when therapists reveal personal things) may be carefully used in specific and planned ways to help clients. But generally speaking, you are paying for the therapist to listen to YOU and discuss YOU. When therapists start to discuss their own issues or personal experiences it takes the focus off the client and really blurs the boundaries of the client-therapist relationship. So if you notice yourself "taking care of" or being the therapist to your therapist, then this issue should be addressed in therapy and discussed.

4.) You have to respect them and feel that in some way they are your intellectual match.  Make sure your therapist has the brain power to keep up with your mind. Therapists are not experts in everything and their job is to ask the right questions. To be sure, explaining is a part of the process, but when you find yourself explaining (and reexplaining) basic aspects of the things you are trying to convey then perhaps goodness of fit needs to be discussed.

5.) Online reviews can be helpful to a point. According to our ethical code of conduct, psychologists are barred from breaching client-patient confidentiality.  So keep in mind that psychologists are placed in a particularly difficult position when compared to other service providers when responding to online reviews. 

6.) When looking for a therapist for your child - simply finding a psychologist or therapist that is "good with kids" is not enough. I explain to parents that Clinical Child Psychology is a subspecialty of our field and psychologists usually have to complete specific training in Child Psychology to refer to themselves as a "Child Psychologist." So not only look for a therapist with specific training to work with children, but determine whether your psychologist/therapist has a particular age range that is their specialty. Developmentally, kids can be so different at every stage. Going to a psychologist that knows what to expect given your child's development (and is able to take this into account when providing therapy) is essential. Providing therapy to a 5 year old is completely different than providing therapy to a ten year old.

7.)  The rules and expectations related to communication outside of therapy should be set up on the front end. The degree to which communication is encouraged outside of the therapy sessions is dependent on the individual therapist. There is not necessarily a "right" or "wrong " in this - but you should be clear about the expectations in terms of communication outside of sessions.

8.) They should hold you accountable. And when they (and you) feel ready they should be willing to call you out on "your stuff" - but ALWAYS in an appropriate and therapeutic way. You are not paying someone to be your friend or to just tell you what you want to hear. You are investing in a relationship that is unlike any other and part of the therapist's responsibility is to point out when maladaptive patterns emerge in session that may (or may not) be present in others areas of your life. Sometimes hearing this feedback can be uncomfortable and even painful - but the therapist is there to be your ally, not your friend. So if you feel a therapist is just "telling you what you want to hear" - point that out to them and use that a springboard for further discussion.

Want more information on how to find a great psychologist and the best therapy for you? My friend and colleague Nicholas Wignall, Ph.D. wrote a book on this very topic. Here is the link.

-Andrea

Hi! I’m Andrea Pihlaskari, Ph.D., and I’m a licensed psychologist who specializes in helping people with anxiety and health issues.  If you or someone you love has questions about finding the psychologist that is right for you, email me or give me a call to schedule a free phone consultation. 

Burnout: Diabetes Edition

Diabetes Burnout (Part 1 of 2)

Burnout. If you are human you have probably experienced some form of burnout. Burnout is when the very act of caring for a chronic illness, another person, or a job feels completely overwhelming. This feeling of overwhelm trickles into all aspects of “the job” and every small part of the task feels like climbing Mount Everest.  I think people intuitively know what burnout is, but let's start off with operationalizing it a bit.

burn out:  Exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration. (thank you, Merriam Webster)

One distinction I would like to make is the difference between burnout and depression. Burnout can definitely lead to depression and they are deeply interconnected, but in the literature they are two distinct concepts. Burnout is like a specific depression that is usually centered around a specific area of life – whether that is caregiving, managing a chronic illness, or a job. Depression affects all areas of life and makes you feel like every aspect of what you do is like walking through thick mud. Burnout starts off as pretty specific – but can often lead to a more general depression. The difference between these two is very nuanced and usually requires a professional, like a psychologist, to help tease the two apart. There is a lot of overlap between depression and burnout, and you can definitely experience both at the same time.

Personally, from my clinical experiences, I strongly feel there is an aspect of learned helplessness in burnout. Upon further research, lo and behold, there are other researchers that have examined the proposed link between these two constructs! We’ll get into the learned helplessness part a bit later in the post in the context of preventing burnout. For starters, there are various ways that the ugly face of burnout can turn up. Today in the context of this post I will be focusing on diabetes burnout (which can also relate to other medical illnesses) and I will expand on the series of burnout with future blogposts. But for today, we will be focusing on diabetes burnout.

11 SIGNS OF DIABETES BURNOUT

1.)  Feeling like every aspect of your life is in some way related to (and not in a good way) your diabetes.

2.)  You begin “opting out” of certain aspects related to your diabetes care. This can look like rescheduling (and rescheduling, and rescheduling) your endo/doctor’s appointments. Sometimes this is in the hope that if you could use just another few weeks you can buckle down and get some more in range numbers. Sometimes it’s simply just because you don’t feel like going.

3.)  You start to “not notice” or try to ignore when your numbers are not in range and you begin to skip out on the usual steps you take to care for the more daily aspects of diabetes (skipping bolusing or injections, “guesstimating” blood sugars more than you’d like.

4.)  Just thinking of the word A1c makes you cringe. You generally feel less competent in taking care of your diabetes.

5.)  You have become increasingly disengaged with your social world - you avoid social functions or fun activities because of diabetes.

6.)  You just look at all of those stupid, smiley, unaware “idiots” around you who have no friggin’ clue how easy they have it because they don’t even have to think about how many carbs a banana has. Or how they will be “paying” for that Chinese food well into the next day…and they don’t have to worry about kinked tubing, sites, nighttime lows, insulin to carb ratios….I could go on…

7.)  Being your own pancreas is hard – and you feel very alone in doing this “taking care of diabetes thing” day in and day out.

8.)  Diabetes doesn’t rest – so you feel that neither can you, like ever. It’s hard to remember the last time you slept peacefully.

9.)   The thought of even talking to someone about how you feel makes you feel exhausted because you don’t want to go through all of that educating of others thing and talking about the mechanics of diabetes in hopes that this will lead them to “get it”, because you think usually people can’t or won’t. After all, just talking about your diabetes makes you feel drained.

10.) You feel that major life choices (and countless minor ones) have become impacted by your diabetes in a negative way. You often fantasize about life without diabetes and how much better your life could be without it. You start feeling fatalistic about your future and how diabetes has prevented you from reaching your goals and being who you want to (or were meant to) be.

11.) You feel like you can add about 20 more to this list….

Ok, so these are some of the major signs of diabetes burnout, and it’s important to be aware that these signs can be very personal. Some people can have burnout and really only experience a handful of these, while others feel that this list is only the tip of the iceberg. So, how do you go about preventing diabetes burnout? Of course, talking to a therapist would be a great first step. And speaking to a therapist that specializes in helping others with health issues, or even one like myself that specializes in helping individuals with diabetes would be ideal. You can find a therapist near you that specializes in diabetes via the ADA mental health directory. These are therapists and psychologists that have undergone special training to help others with diabetes. Finding a therapist that specializes in helping people who have been affected by diabetes is helpful because you won’t feel like you have to provide basic diabetes education so that they can understand the context of your emotions. Now I’m not saying you won’t have to do any education. Personally, I like to say that I know a heck of a lot of more than your average psychologist about diabetes, but that guarantees me very little knowledge about your specific experience with diabetes. Everybody's experience is different and I don’t take that for granted. Additionally, there are specific aspects of diabetes that affect behavior and emotion in very unique ways. Without specific training, your average mental health professional won't know to look out for this. So in addition to finding a professional that “gets it” -  read on to "Part 2" of this blog post to learn more about ways to address diabetes burnout.

-Andrea

Hi! I’m Andrea Pihlaskari, Ph.D., and I’m a licensed psychologist who specializes in treating young people with anxiety and health issues. Because I have worked with people with diabetes for over ten years, I know more than your average psychologist about diabetes. That being said, I recognize that everyone's diabetes is unique and one person's experience doesn't necessarily generalize to everyone.  If you or someone you love is ready to start living life as a person who happens to have diabetes as opposed to diabetes being front and center, email me or give me a call to schedule a free phone consultation. Together we can find a way to get you moving beyond your burnout!

Burnout: Diabetes Edition

Diabetes Burnout (Part 2 of 2)

ADDRESSING DIABETES BURNOUT:

A FEW STARTING POINTS

So you’ve read the first part of this post and you realize you have diabetes burnout. Now what?  Like I mentioned before, a key part in overcoming burnout is targeting an underlying aspect of burnout – and this is where undoing some of that learned helplessness becomes essential. Sometimes no matter how hard you try, how hard you work, you can’t seem to “get ahead” of diabetes. Working hard with very little reward or control over outcomes is the definition of learned helplessness. So here are some small ways to gain a bit of efficacy.

1.)  Focus on the small things that diabetes has not taken away from you. This can be your ability to love your family, your ability to enjoy nature, for some people we have to get back to the basics and have gratitude for really basic things like: the ability to walk, to breathe, to feel.

2.)  Bring your focus to the present. Sometimes getting caught up in worries about the future or regrets about the past can compound negative feelings and cause us to start catastrophizing. Be grateful for this moment. Even just by reading the text on this page, you are taking a positive step.

3.)  Communicate how you are feeling with your endo/MD/diabetes educators. If you don’t feel comfortable enough talking about how you're feeling with your physician, perhaps it’s time to re-evaluate that relationship. Finding the right- fit physician is key to your long-term health. You should feel like they have time to truly listen to you and are providing you with compassionate and understanding care.

4.)  Reach out for social support. Sometimes this can be found with family, friends. Sometimes reaching out for support anonymously online can be helpful. The diabetes community, particularly the type 1 diabetes online community is full of supportive forums like this one and this one.

5.)  Start caring for yourself in ways that are not necessarily diabetes specific. Get that massage, go on that walk, take the afternoon off to watch that new release movie you’ve been wanting to see. If you love baseball, go see our 'Stros. 

6.)  No one is perfect, nor do you need to take care of diabetes “perfectly” to have good health. Persistence and consistency is more important in the long term than perfection. Keep on keeping on!! #nevergiveup

7.)  Remember that there are no “good” or “bad” numbers – they are just data. Yes, easier said than done, but this is really a saner way to view your sugars. And this way of thinking takes a lot of practice. And practice. And practice.

8.)  Examine whether you are beating yourself up for past mistakes in terms of your diabetes care. Some people carry feelings of guilt and are burdened by their previous mistakes and tend to hold on to these a little more tightly than needed. If you feel regret or guilt about how you have taken care of (or not taken care of) your diabetes in the past, write a letter to yourself as if you were a friend forgiving another friend for a mistake. (e.g. “Dear Past Me, I forgive you for not being there for your diabetes like you could have been, you were young, you had a lot going on, and didn’t know what you know now.)

9.)  If you haven’t told seemingly important people about your diabetes, examine the reasons behind not telling others. It’s definitely your prerogative about who to tell about your diabetes and when, but some people might find keeping their diabetes hidden from others as very tiresome and burdensome. This can be a major energy suck, and it takes away useful energy you could be using in other areas of your life.

10.)  And remember don’t beat yourself up for having burnout!! Like I mentioned everyone experiences burnout at some point or another, especially if you have diabetes. Burnout out guilt won’t help the situation.

So, what are you waiting for? Reach out to someone like a psychologist that can help walk you through these burnout interventions. You can get through burnout more efficiently if you don’t go it alone. Remember, there is a better way, not necessarily an easier way, but another way of being that doesn’t have diabetes running the show 100% of the time.

-Andrea

Hi! I’m Andrea Pihlaskari, Ph.D., and I’m a licensed psychologist who specializes in treating young people with anxiety and health issues. Because I have worked with people with diabetes for over ten years, I know more than your average psychologist about diabetes. That being said, I recognize that everyone's diabetes is unique and one person's experience doesn't necessarily generalize to everyone. If you or someone you know is ready to start living life as a person who happens to have diabetes as opposed to diabetes being front and center, email or give me a call to schedule a free phone consultation. Together we can find a way to get you moving beyond your burnout!