Many therapists, myself included, feel that the most potent work in psychodynamic treatment is in what’s called “working with the here-and-now.” Addressing what’s going on in the therapy room—and by that I mean what’s coming up between the person in therapy and the therapist—means we’re really cookin’! It puts the “dynamic” in psychodynamic therapy.

If you are at a place with your therapist where you feel okay about talking about your therapeutic relationship, it likely indicates a healthy level of trust between the two of you. You’ve moved from talking “about” issues (such as describing the latest negative interaction with your boss, the last argument with your wife, or the most recent bout of passive aggressiveness with that annoying neighbor) toward experiencing an issue together.

It can be scary. It takes guts. And it’s where so much amazing work happens.

[fat_widget_right]

So if the here-and-now is so important, why do therapists ask so many questions about the past? Why are there so many stereotypes about therapists asking about, say, your mother or father? Heck, why does your therapist want to know about your parents at all? After all, it’s you in therapy, not them, right?

Looking for Patterns

Early on in treatment, many therapists try to get a sense of your early history—questions about where and how you grew up, the family members who were (or weren’t) around, and much, much more. Was Dad down all the time? Did Mom never let you see her cry? Were you the oldest and thus “in charge” of your siblings? Were you always compared to another family member?

Therapists are often looking to suss out patterns, many of which tend to be dutifully followed in a less-than-conscious way. Emotional patterns could be strong feelings that come up for you seemingly out of nowhere. A therapist may ask you if a feeling is familiar. It may lead you to a memory of something small or large, but trusting it and seeing where it takes you can lead to uncovering and healing a long-held wound you didn’t know was still there.

Therapists are also attuned to relationship patterns and how they may be affecting you now. These may be recurring types of relationships (“Why am I always dating the same type of person who treats me this way?”) as well as patterns in your family’s history. For example, a man who feels he needs to hold the family together without showing emotion may have been modeled that by his father, who may have been modeled that by his father, perhaps instilling an unconscious limitation regarding what a father can be.

Using Patterns to Promote Change

In this way we are moving back and forth, examining how your past was the forerunner to who you are now. It dictates nothing. Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.

Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.

The past can provide some insight. It’s a reminder that your mental health is not all about “you” because there’s a larger picture of you in an environment, a greater context. The past can help put all of this together to better understand who you are. When you look at a pattern that has led to “you” and realize you’ve been using what you were given the best you could, you invite room for self-compassion. Positive change is very difficult without allowing yourself some of that.

It’s not about the insight, though. Insight-only therapy would make treatment an interesting intellectual exercise, but one that led to little actual transformation. Once we connect with past issues, uncover patterns, and unpack how strong emotions elicited by passing thoughts are actually learned responses to old hurts, we can finally heal those hurts.

That’s what we do when we work with the here-and-now.

We can finally let out anger that previously found its voice as depression.

We can finally cry about something that had been manifesting as resentment in every power dynamic we were on the less empowered side of.

We can truly, deeply laugh at something we once held as morbidly sacred.

Using the present to connect with the past, and then the past to connect back to the present, is how we move forward.

While recently updating our business practices, my colleague and I had a lengthy conversation regarding cancellation and no-show policies and related fees. I became curious how others, both clinicians and those seeking therapy, feel about this sometimes seemingly taboo topic.

Let me first state my practice’s policy: We request 24 hours’ notice for cancellations. Cancellations made prior to this window are rescheduled with no penalty. Cancellations made without 24 hours’ notice but prior to the start of the session incur a $50 late-cancellation fee. No-shows or cancellations made after the start of the session incur the full fee.

I’m curious what people’s reactions to this policy are. My guess is some may find it too harsh, while others may find it too lenient or too complicated. Many mental health care practitioners’ policies include charging the full fee for any cancellation within a 24- to 48-hour requested window of notice.

[fat_widget_right]

For a long time, I had a hard time justifying collecting money, especially the full fee, for what ultimately amounted to me ending up with “free” time. But as I gained experience, missed appointments added up to a significant loss of income, and I came to recognize that the potential for frustration and resentment was not healthy for the therapeutic relationship.

Knowing I needed to find an effective and fair solution, I decided upon the above policy. My rationale included several factors, the first involving the recognition that the people who choose to work with me are ultimately paying for my time. In general, individuals in therapy tend to come to weekly or, sometimes, every-other-week sessions. Their session time is carved out in my calendar and set aside just for them. If somebody cancels with some notice, I know I have an open hour. I can schedule another appointment, run out and do an errand, or peacefully return calls without watching for a potential latecomer. I have had a hard time charging people a full fee in this situation. The $50 fee for less than 24 hours’ notice, however, feels like a fair compromise. It’s like collecting a deposit to have held the session time.

On the other hand, if someone doesn’t show up at all or communicates a cancellation after the start of the session time, I’m stuck waiting to see if they are running late. At about a quarter after, I spend time trying to get in touch to follow up and reschedule. It doesn’t leave me the freedom to be truly productive with the time and minutes left until my next appointment. Thus, I’m better able to justify collecting a full fee in these instances.

I understand stuff happens—projects at work pop up, kids get sick, tires go flat. Most people respect the policy after a gentle reminder and tend not to have frequent last-minute conflicts or cancellations arise. However, I found that routinely not charging for late cancellations sets a precedent some people end up taking advantage of, and I’ve noticed a trend where the people who cancel late or no-show tend to be chronic offenders.

I understand stuff happens—projects at work pop up, kids get sick, tires go flat. Most people respect the policy after a gentle reminder and tend not to have frequent last-minute conflicts or cancellations arise. However, I found that routinely not charging for late cancellations sets a precedent some people end up taking advantage of, and I’ve noticed a trend where the people who cancel late or no-show tend to be chronic offenders.

The more I contemplated whether it is fair to charge a late-cancellation fee, the more I came to understand that implementing some penalty for late cancellations and no-shows is an important part of the broader scope of the therapeutic work. People seek therapy to improve their overall quality of life, and those who frequently cancel or fail to show up for appointments often demonstrate issues with commitment, accountability, and responsibility in other areas of their lives. I ultimately realized I am doing the people I work with a disservice if I enable them to avoid facing responsibility, and that I am failing to help them develop an understanding that the real world has consequences to various choices and actions.

Instead, I want to model healthy and clear boundaries and empower people to be responsible in their lives and assertive in their ability to communicate regarding their circumstances. Therapy is about helping people to develop a sense of awareness about themselves and how their actions impact those around them.

Therapy tends to be most helpful to people who view their appointments as an important and valuable component of their lives. And for most people, money equals value. When people are willing to make therapy a priority and accept the financial commitment involved, they tend to experience greater and quicker growth and positive change.

Discussion regarding money can be an uncomfortable topic, especially in a therapeutic relationship where connection, support, and compassion are paramount. The collection of money for services—rendered or not—sometimes feels contradictory to the nature of the work, and it is often difficult to navigate the line between the professional and truly caring ends of the relationship. But the handling of and attitude toward these finer details of business are important to the process and worth consideration for all involved. Being confident in and mindful of boundaries and policies, paired with the ability to broach uncomfortable topics, is often where true trust, authenticity, and connection develops—and these are the components that make therapy genuinely helpful.

The information age has rapidly changed how we conduct ourselves in business, education, and in general human interaction.

Advances such as email, instant messaging, and social media were all created to make communication easier and more convenient. Families and friends across great distances can now more easily communicate face-to-face anytime they want. Dating sites successfully match thousands of soon-to-be spouses each year, and parents can more easily keep in touch with their children throughout the day.

However, as society adapts to these fresh avenues of contact, there are also ways new technology threatens to strip away important aspects of how people relate and connect on a personal level. This can be especially true in our most intimate relationships.

Here are three areas in which technology may negatively impact relationships:

1. Intimacy

Intimate relationships often have their own challenges, and changing technologies can contribute even more to the stress of modern relationships. Sometimes, the ways people use technology can create problems between romantic partners, potentially stirring conflict and dissatisfaction in the relationship.

A 2014 Pew Research Center poll indicated that one in four cell phone owners in a relationship or marriage found their partner too distracted by their cell phone. Nearly 1 in 10 had argued with a partner about excessive time spent on the devices. The poll noted that many arguments between couples may have something to do with tech use, such as deciding when to use devices and when to abstain. They also found that younger users were more likely to report both increased tension and enhanced closeness in their relationships as a result of technology.

[fat_widget_right]Technology is also changing some of the most intimate ways in which couples connect. Sexting—sending someone text messages containing explicit sexual content—has increased among adults since 2012, with one in five cell users having received a sext from someone they know—a one-third increase in four years.

2. Distraction

Technology can be an effective distraction in the current moment, over a long period of time, and even in its absence. According to a 2015 poll of 453 adults across the United States, nearly half of all respondents reported being distracted by their phones in the presence of a romantic partner.

Those moments spent focused on technology can quickly add up to a sizable portion of a person’s waking hours. The same allotment of time that just a few years ago might have been considered an online addiction is now commonplace in smartphone use, especially among younger users. It represents a shift in how people spend their time and where they focus their energy.

Technology can also be a distraction when it is not in use. When briefly disconnected from their smartphones in a 2014 study, self-described heavy users indicated having higher anxiety levels than moderate users after just 10 minutes.

3. Depression

Heavy use of social media has also been shown to negatively affect mental health. A recent study from the University of Pittsburgh School of Medicine examined depression rates in younger adults, finding significantly increased odds of depression among those spending the most time engaged in social media.

Looking specifically at only personal social media activity, they concluded that heavy use was significantly associated with increased depression and highlighted the importance of identifying interventions for heavy social media users before they experience any mental health issues.

The report also notes that multiple studies have linked social media use with declines in mood, sense of well-being, and life satisfaction. These declines could be related to FOMO, or the fear of missing out, which studies have shown is often exacerbated by social media use.

Syncing Up by Powering Down

According to Ohio counselor Jessica Wade, MAMFT, LPCC, the emotional connections forged by couples through body language, nonverbal communication, tone of voice, and facial expression are essential to the relationship and impossible to replicate with technology.

“Overreliance on technology might cause misunderstandings, and partners lose the opportunity to make those immediate relationship repair attempts that happen in the moment during in-person communication,” Wade said.

The benefits of technology reside in an ability to elevate the human experience, but experts advise use of new devices and platforms should be grounded in perspective of how the new technology has the power to change communication and the way people relate to one another.Experts recommend finding alternatives for curtailing technology’s potential downsides. To break the cycle, the first step may be to temper, or significantly reduce, how much time is spent focused on devices, apps, and messaging services.

Finding time to consistently detach may require penciling it in on a daily schedule. Allotting non-use times (such as during dinner or date night) can help reground partners in their relationship or individuals to their surroundings.

Many individuals, couples, and families have sought therapy when technology overtakes other priorities. Experts also advise improving communication skills whenever possible—something technology can actively disrupt. In a time when emails and text messages have replaced other methods of communicating, the manner and skill with which people express themselves can become less robust and more mechanical.

Studies have also found significant value in spending as much time in nature as possible. One study by Dutch researchers found lower levels of anxiety and depression among people living within 0.6 miles of a park or wooded space.

The benefits of technology reside in an ability to elevate the human experience, but experts advise use of new devices and platforms should be grounded in perspective of how the new technology has the power to change communication and the way people relate to one another. Identifying ways to use these new inventions successfully—without cheating yourself out of genuine human connection in the process—may ultimately require more low-tech solutions.

References:

1. Cheever, N. A., Rosen, L. D., Carrier, L. M., & Chavez, A. (2014). Out of sight is not out of mind: The impact of restricting wireless mobile device use on anxiety levels among low, moderate and high users. Computers in Human Behavior, 37, 290-297. doi:10.1016/j.chb.2014.05.002
2. Gardner, A. (2009, October 15). Being near nature improves physical, mental health. Retrieved from http://usatoday30.usatoday.com/news/health/2009-10-15-nature-anxiety-exercise_N.htm
3. Lenhart, A., & Duggan, M. (2014). Couples, the internet, and social media. Retrieved from http://www.pewinternet.org/2014/02/11/couples-the-internet-and-social-media/
4. Lin, L. Y., Sidani, J. E., Shensa, A., Radovic, A., Miller, E., Colditz, J. B., . . . Primack, B. A. (2016, January 19). Association between social media use and depression in U.S. young adults. Depression and Anxiety, 33(4), 323-331. doi:10.1002/da.22466
5. Penn, C. (2015, October 5). Stop “pphubbing”: New research shows what happens when you focus more on your phone than your lover. Retrieved from http://www.essence.com/2015/10/05/stop-pphubbing-new-research-cell-phones-relationship

“I have nothing to talk about.”

Maybe two or three months after beginning therapy—maybe later, sometimes sooner—a person might say this to me and perhaps look a little surprised or confused.

“There’s nothing coming up for me.”

Often the person is weirded out. Concerned, even. The person will tell me how they usually have one, two, seven, eight things they really want to talk about and just don’t know what to make of not having something ready to go.

Coming to Therapy After a ‘Good Week’

Sometimes a person may need some prompting, but often within the first couple of weeks of therapy, with gentle encouragement, people tell what they think is their story. They talk about whatever has been causing them distress: communication problems, feelings of isolation, anger-control issues, deep sadness, etc.

[fat_widget_right]

Therapists are trained to help people talk about and process these things. And often, once people start, they keep right on going! We all hold a lot of stuff in, and sometimes we don’t even realize what’s in that backlog until we finally open up.

So the door opens, the person speaks and … here’s something interesting: things may seem a little worse at first. When you’ve been very intentionally not looking at distressing stuff for a long time, it’s bound to bring up some difficult feelings once you start exploring.

But eventually, with some work, compassion, and patience, there’s generally some relief.

Things don’t seem as pressing.

And after a while, the person isn’t itching to get to their therapy session so they can unpack, say, that incident at work or the uncomfortable time with the in-laws.

They had an okay week. Maybe even a good one. Maybe not great, but … they have “nothing to talk about.”

Peeling Back the Layers of Therapy

It used to be that therapy was viewed as an archaeological dig into the psyche and the therapist held the shovel. The therapist’s job was to dig until they uncovered what was buried underneath. But rarely is it so simple, and rarely does healing come from insight alone. Often we can discover a possible explanation to an issue, but that doesn’t mean the issue is resolved.

Therapy is done in layers, but unlike an onion, we don’t simply peel off and discard layers once we look at them.

Therapy is done in layers, but unlike an onion, we don’t simply peel off and discard layers once we look at them. We take a layer, examine it, put it back, take another layer, leave it for later, skip a layer to see something else, then go back to the second layer and reexamine it with what we know now. Maybe along the way you fall back into an old habit (remember, the layers don’t disappear) and we spend some time just holding all the layers without processing or questioning them.

Entering therapy with much to talk about—that’s the top layer, or maybe even the second or third. Sometimes that top layer—what we sometimes refer to in therapy circles as the “presenting problem”—has been getting all the attention for so long because it’s the loudest or most painful. When that’s peeled back for a moment, when it has received some attention, we need to take some time to see what else may be exposed. These may be quieter parts of you but are no less important or meaningful.

Letting the Little Thoughts Be Heard

Have you ever met a couple where one partner is a chatterbox and the other seems mute? Until, that is, you get some time alone with the quiet one who, it turns out, actually has some stuff to say, but it gets overshadowed by their partner.

We all have stuff like this inside us. If the “fires” we seek therapy for are turned down a bit, even if just for the moment, then what seems insubstantial can be given more attention. It might not be so insubstantial after all. We just need to allow for the space, maybe even the silence, to give it permission to be heard.

Once you get over your surprise at not having anything “pressing” to say in therapy, don’t be afraid to say whatever you’re thinking or feeling, no matter how inconsequential it may seem. What might seem like little thoughts or feelings can lead to big breakthroughs, too.

When I educate medical health professionals about the complex links between emotional functioning and physical health, many express a fear that their patients will respond to a referral to therapy by saying, “So, are you saying this is all in my head?” I will try to provide a useful, realistic answer to this potentially thorny question.

Body, Mind, or Bodymind?

Modern neuroscience has helped us begin to see that the separation of body and mind is more a matter of grammatical convenience than scientific truth. Our nervous system, the network of cells that helps our brains connect with the rest of our organs, links our emotional processing center to every structure of our physical being. This has led some to use the term “bodymind” in recognition of the idea we gain nothing by continuing to arbitrarily separate mental life and physical life when they are so clearly interwoven (e.g., Keleman, 1989). When we think about ourselves as bodyminds, it begins to make sense that many physical symptoms are exacerbated or caused by emotional processes.

[fat_widget_right]

How Emotions Become Physical Symptoms

Much developmental theory and research has helped demonstrate that experiences in our development, especially with our caregivers, shape our relationship to our emotions (e.g., Felitti, et al., 1998). We tend to treat our emotions similarly to how they were treated by others (Frederickson, 2013). As a result, those of us who had parents who responded to our emotions with anxiety, misattunement, or even punishment may develop anxiety about our own emotions. Many people experience anxiety when emotions are triggered by relationships and events in their day-to-day lives.

Maybe someday, rather than feeling afraid of the notion some aspect of their physical problems is “in their head,” people will feel hopeful about the possibility their symptoms might finally be explained and treated with psychotherapy.

Anxiety can manifest physically in the body in many ways. It can cause our skeletal muscles to tense, leading to pain and cramps. It can cause tension in the smooth muscles of the bowels, vascular system, urogenital system, and bronchi, leading to a variety of symptoms such as irritable bowel, hypertension, sudden urge to urinate or defecate, and difficulty breathing. Anxiety at very high levels can even cause changes in the flow of blood and oxygen to the brain, leading to difficulties thinking and perceiving the world, such as dizziness or blurry vision (Frederickson, 2013).

I point all this out to illustrate that anxiety triggered by the emotionally evocative events of our daily lives can produce a huge variety of physical symptoms. These symptoms can easily be, and often are, diagnosed and treated as if they are purely somatic, without considering the possibility emotional factors might be a major contributor. This can result in failed treatments and frustrated patients. See my other articles for more detailed information on the links between emotions and physical symptoms.

So, Is It All in Your Head?

The fact that emotional factors are contributing to your symptoms does not mean your symptoms are fake, as the notion of “all in your head” seems to suggest. Emotional factors create very real physical symptoms that are often mistaken for symptoms that have a purely medical origin. A recent study even showed that the brain of a person in emotional pain, when observed under fMRI, has a similar appearance to the brain of a person in physical pain (Kross, et al., 2011).

When we treat emotion-driven symptoms as if they are purely physical, and deny the component that is “in the head,” health care costs go up, symptoms persist or worsen, and frustration grows. Alternatively, evidence is beginning to show we can save time and health care costs by treating medically unexplained physical symptoms with psychotherapy (Abbass, et al., 2010).

Despite this evidence, it seems many medical practitioners fear their patients will be hurt by a referral to psychotherapy. There is some truth to this: many health care consumers are upset by the possibility their physical symptoms may have an emotional engine, and sometimes they exhaust all other diagnostic and treatment options before pursuing counseling. I hope the information presented here and in my other posts on somatization will help patients and practitioners to reap the benefits of a clearer understanding of the bodymind and the links between emotions and physical symptoms. Maybe someday, rather than feeling afraid of the notion some aspect of their physical problems is “in their head,” people will feel hopeful about the possibility their symptoms might finally be explained and treated with psychotherapy.

References:

1. Abbass, A., Campbell, S., Hann, G., Lenzer, I., Tarzwell, R., & Maxwell, D. (2010). Cost savings of treatment of medically unexplained symptoms using intensive short-term dynamic psychotherapy by a hospital emergency department. Journal of the Academy of Medical Psychology, 1, 34-43.
2. Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., & Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
3. Frederickson, J. (2013). Co-creating change: Effective dynamic therapy techniques. Kansas City, MO: Seven Leaves.
4. Keleman, S. (1989). Your body speaks its mind. Berkeley, CA: Center Press.
5. Kross, E., Berman, M.G., Mischel, W., Smith, E.E., & Wager, T.D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of the Sciences of the United States of America, 108, 6270-6275.

Olympic athletes train for years to reach their common goal: a medal at the Olympics. They push their bodies to the edge of human capability to stand on a podium and collect a gold, silver, or bronze medal. While competing in the Olympic Games requires immense physical ability, the pressure often adds up to a heavy psychological load for athletes, both at the games and beyond.

Sport psychology is not new in the mental health field, but it has gained greater attention, interest, and acceptance in recent decades. The discipline of sport psychology has an inexact placement at the intersection of athletic training and personal counseling, varying widely depending on the sport and the practitioner.

The focus is often directed at how different aspects of competition affect the player or team’s overall mental health. While the well-being of the athlete is the ultimate aim, sport psychologists also promote mental toughness to optimize athletic achievement. At the international games, and with a massive global audience watching, another crucial hurdle faces the sport psychologist: Olympic-sized performance anxiety.

What Is Sport Psychology?

It started with a simple observation by a psychologist named Norman Triplett in 1898. A pioneer in the field of social psychology, he noticed that cyclists typically performed better when in the presence of a competitor. Recognizing cues like that has helped psychologists find not just the best ways to enhance athletic performance, but also to understand the distinct pressures faced by elite athletes. Concerns such as not wanting to disappoint a coach or teammates and striving to meet the expectations of fans can be paired against personal issues, stress, and self-doubt.

[fat_widget_right]Today, sport psychologists work with athletes at all levels to improve their performance, manage performance-related stress and anxiety, help them handle any mental challenges associated with injuries, and encourage athletes to enjoy what they do. Research has shown there is value in tapping into a player’s love for the game. Such efforts can help keep an athlete motivated against grueling training regimens and physical exertion.

Sport psychologists work with their athletes by encouraging them to set high but realistic goals, developing skills to maintain concentration and focus, and by helping them manage stress through controlled breathing and positive self-talk. A common technique used by sport and fitness psychologists to enhance athletic performance is visualization. For example, basketball players often spend practice time not just physically shooting hoops, but also visualizing the basketball dropping into the hoop successfully. Similarly, archers may paint a mental picture of the arrow finding its target, while divers might imagine themselves going into the pool in perfect form with minimal splash.

Sport psychologists also teach athletes to deal effectively with people, both within the sport and in general. They commonly help coaches and family members of athletes as well, watching out for the general well-being of the “team,” even in individual competitions. Particular techniques, including stress-reducing methods, can help those surrounding the athlete to more effectively offer support.

A sport psychologist may be one of the only people in a professional athlete’s life who doesn’t look at the scoreboard. While family members, coaches, and spectators might instinctively or involuntarily judge an athlete based on performance, the sport psychologist is likely looking beyond the outcome with a focus on giving support in the face of defeat and offering perspective in the thrill of victory.

Athletes worldwide appear to be embracing sport psychologists as a crucial member of the team. Olympian Elana Meyers won a silver medal at the 2014 Winter Olympics in Sochi and took bronze at the 2010 Winter Olympics in Vancouver as part of the U.S. Olympic Bobsled Team. Throughout her career, she says her coaches and sports psychologist have worked side by side.

“Recently, we have all been working together to improve my driving, even though we’re not on ice,” Meyers said. “My coach interacts to ensure that the work we’re doing on driving is accurate and appropriate. My sport psychologist interacts with my coach to ensure that my mental environment is appropriate around times of training and competition.”

Occasionally those roles can become blurred, she said. “Sometimes my coach is like my sport psychologist and my sport psychologist acts as a coach.”

On a more global scale, Meyers sees the field of sport psychology expanding, in part thanks to the international games.

“Now it’s openly discussed on Olympics coverage,” she said. “I think sport psychology is becoming mainstream and really elevating athletes’ performances across the world.”

The Modern Sport Psychologist

While individual competitions may not have changed too drastically in the last century, the arenas in which today’s athletes perform have. The 2012 Summer Olympics in London set new records as the most-watched TV event in U.S. history, drawing nearly 220 million American viewers across the two-week games in just one country.

Today’s Olympic athletes must compete in this glaring international spotlight, surrounded by increased technical distractions and sometimes weighed down by the expectations of fans and fellow athletes. The size and scale of modern Olympic Games make the services of a sport psychologist even more valuable, no matter the event.

Today, sport psychologists work with athletes at all levels to improve their performance, manage performance-related stress and anxiety, help them handle any mental challenges associated with injuries, and encourage athletes to enjoy what they do.How sport psychologists operate professionally can vary. Some consult or maintain private practices, while others are on staff with professional teams, leagues, or individual athletes. Their services are now commonly accepted and employed in major sports organizations worldwide, ranging from the National Football League and Major League Baseball in the U.S to Brazil’s World Cup Team.

During the 2016 Summer Olympics in Rio, even more so than in past competitions, sport psychology received individual attention at the games. As media outlets tell the back stories of Olympic stars like gymnast Simone Biles and swimmer Michael Phelps, they seek new angles that include the athletes’ mental toughness and resilience required to win their medals.

Occasionally, sport psychologists may find their own merit judged against an athlete’s performance, as was the case with Brazil’s 2014 World Cup defeat. The coach’s pre-game support for the team psychologist quickly became scrutinized following their loss to Germany.

Yet, those in the field of sport psychology might actually be better equipped to face such challenges through their own personal experiences. Those practicing sports psychology today—who often have backgrounds as former athletes or active sports enthusiasts—have first-hand awareness of the sharp edges of doubt and defeat and the internal drive for athletic greatness.

References:

1. AASP. (n.d.). Applied Sport & Exercise Psychology. Retrieved from http://www.appliedsportpsych.org/about/about-applied-sport-and-exercise-psychology/
2. Joyce, N. (2008, July). The early days of sport psychology. Retrieved from http://www.apa.org/monitor/2008/07-08/sport-psych.aspx
3. O’Connell, M. (2016, August 6). TV Ratings: Rio Olympics Opening Ceremony Falls 28 Percent From London. Retrieved from http://www.hollywoodreporter.com/live-feed/tv-ratings-rio-olympics-opening-ceremony-how-many-watched-917393
4. OCSP Services. (n.d.). Retrieved from https://www.sportpsych.org/services
5. Patmore, A. (2014, July 9). Why sports psychologists couldn’t save Brazil’s World Cup hopes. Retrieved from https://www.theguardian.com/football/2014/jul/09/why-sports-psychologists-couldnt-save-brazil-world-cup
6. Rathi, A. (2016, August 9). What sports psychologists do for Olympic athletes that coaches can’t. Retrieved from http://qz.com/753857/for-olympians-to-reach-the-highest-level-they-need-a-sports-psychologist/

We evaluate. That’s what we do. We ask question after question after question, and when we’re not asking questions, we’re noting answers to questions we haven’t asked. We’re so curious, professionally curious. It’s a trained curiosity, and if we’re not careful, a habitual curiosity, a distractive curiosity, a harmful curiosity.

Psychologist James Hillman (1967) warned: “Curiosity awakens curiosity in the other. He then begins to look at himself as an object, to judge himself good or bad, to find faults and place blame for these faults, to develop more superego and ego at the expense of simple awareness, to see himself as a case with a label from the textbook, to consider himself as a problem rather than to feel himself as a soul.”

There is often a contradiction between my image of a person in therapy through their self-assessment of their issue and my actual experience of the person. There is also a vast gulf between the diagnosable issues as seen through the lens of psychological expertise and the essence, identity, strengths, and hopes of the person before me.

[fat_widget_right]

Therefore, I must cultivate space to come to know the whole person. This begs the question of what “knowing the whole person” entails. But let’s be clear: trained curiosity and assessment are not the soul of psychological change. Therapists mean well, but I know at times even I have strayed outside the bounds of helpfulness. Here are seven ways therapists sometimes irritate people in therapy and get in the way of therapy:

1. Interrogating

When people come into session in the midst of an emotional storm, the last thing they need is to be inundated with endless questions on the basis of an agenda that is likely intended more to fulfill organizational protocols than to promote a foundation of therapeutic empathy and rapport.

Questioning always runs the risk of interrogation. The details learned about people’s lives ever tempt helping professionals toward distraction. There is a distinct difference between a personality and a person, a diagnosis and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.

2. Pathologizing

The concept of “mental disorder” is rigid and misleading. In short, diagnosis is description, and by and large, mental health diagnosis provides description of “software” issues rather than “hardware,” so to speak. It’s a language of understanding what type of struggle a person is experiencing. When therapists refer to people by these diagnostic labels, we overgeneralize a person’s experience and distance ourselves from a critical resource: the powerful, complex, and fluid process of therapeutic understanding, the power center of effective therapy.

It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.

One of my professors, Bill Collins, taught me “pathology” is a dangerous categorization of a person’s experience. He contrasted “providing treatment to people” with “puzzling through a process with someone.” He told of one friend whose father, growing up, would never let him finish anything without taking over. His friend would, as his father asked, begin to screw in a nail with a screwdriver, and before he could finish, his father would grab it from him and say, “Oh, just give me that.” Those kinds of experiences, he noted, leave long-lasting impressions on a person in regard to self-worth and competencies. Bill said we are to “help others to unpack their conclusions about who they are.”

3. Shaming

We ever risk a false sense of expertise about people’s lives against the backdrop of anxiety about our own. If we’re not careful, we may find ourselves reinforcing the tyranny of the perceived should. Should is shame’s accomplice, and therapists must take care not to aid and abet them.

4. Sympathizing

Researcher Brené Brown (2010) rightfully proclaimed, “Empathy fuels connection, while sympathy drives disconnection.” Saying you understand is unhelpful and probably not true. And let’s be honest—it’s usually a ploy to rush people out of their emotionalism, which sends the message, “I really don’t care enough to walk with you through your suffering.”

5. Lecturing

Psychologist and psychotherapy researcher Les Greenberg (2002) wrote, “Darwin, on jumping back from the strike of a glassed-in snake, having approached it with determination not to start back, noted that his will and reason were powerless against even the imagination of a danger that he had never even experienced. Reason is seldom sufficient to change automatic emergency-based emotional responses.”

With a surge in cognitive therapies, there has been a surge in their wrongful implementation, with many therapists engaging in power struggles to convince people of faulty beliefs in order for new, more positive truths to simply work some magic ripple effect into their lives.

As an emotion-focused therapist, I have been prone to, for instance, encourage couples to engage in safer, softer, and more emotionally responsive interactions, yet when I have stood on my own soapbox, encouraging them to do so out of pace with their own readiness, I have violated my own guidance. Miller (1986) observed that people will “persist in an action when they perceive that they have personally chosen to do so.”

6. Babbling

Silence can provoke anxiety, even for therapists, who think they should surely be redirecting, conjecturing, advising. I find myself observing people in therapy watch me watch them watching me watch them. And I have found a power in it. Like a Rorschach ink blot, presence has power in and of itself to nudge a person’s anxiety so it presents and speaks up for itself.

Another of my mentors, Blanche Douglas (2015), wrote: “There was a method in Freud’s madness when he prescribed the analyst be as undefined as possible, not disclosing details about his life and sitting behind the patient out of sight, saying little. This forced the patient to make meaning out of an ambiguous situation, and the only way he could do this was by recourse to his own experiences.”

7. Methodologizing

If a psychotherapist is lifeless or their technique too technical, their efforts to help may be worthless. Therapy, in this case, is not a relationship but a poor excuse for scientific experimentation. The mechanisms of some psychotherapies undermine their therapeutic value. When we fixate on therapeutic modality, we run great risk of missing prime opportunities to interject the most valuable therapeutic tool we have to offer—ourselves.

Additional reading: The Elements of Good Therapy.

References:

1. Brown, B. (Speaker). (2010). Brené Brown: The power of vulnerability [Video file]. Retrieved from https://www.ted.com/talks/brene_brown_on_vulnerability?language=en
2. Douglas, B.D. (2015). Therapeutic space and the creation of meaning. Context. Warrington, England, United Kingdom: Association for Family Therapy and Systemic Practice. [Edited by Edwards, B.G.]
3. Greenberg, L.S. (2002). Emotion-focused therapy: Coaching clients to work through their feelings. Washington, DC: American Psychological Association.
4. Hillman, J. (1967). Insearch: Psychology and religion. New York, NY: Charles Scribner’s Sons.
5. Miller, W.R. (1986). Increasing motivation for change. In W.R. Miller & N.H. Heather (Eds.), Addictive behaviors: Processes of change. New York, NY: Plenum.

Change is hard. We resist it, maintaining our longstanding behaviors and belief systems, because familiar is comfortable. We typically seek psychotherapy when our old ways lead to problems that make change necessary.

In conventional therapy, you may spend one or two hours per week developing new skills and exploring alternative perspectives. Once you leave the office, your therapist hopes you will incorporate the work you did into your daily life. Sometimes your therapist will assign you “homework” that reinforces the concepts addressed in your session. You might choose to journal or simply think about what you learned to make better sense of it and to uncover new insights for your next appointment.

This consistent attention to your therapy leads to continuity, the unbroken thread that ties together your revelations from week to week. This is the key to lasting change. You and your therapist plant the seeds for change in your session, and then your independent efforts allow them to take root and grow into the foundation for an improved life.

[fat_widget_right]

Ideally, that is how therapy functions. In less ideal situations, you leave your therapy at the office door and pick it up only when you return the following week. If your needs are minimal, or you just need someone to listen, this pattern could work for you. However, if your goals revolve around healing deep-seated hurts, improving relationships, or breaking lifelong habits, this pattern rarely works. Without consistent effort between sessions, your therapy may feel disconnected from or even irrelevant to your daily life. If you don’t complete the tasks assigned to you each week, you miss the opportunity to practice new skills that contribute to the goals you set for yourself.

When you find yourself forgetting or even avoiding therapeutic work, you might ask yourself what is getting in the way of taking full advantage of your therapy. The most common answer is you don’t have enough time. After work, family, and other commitments, finding additional time and energy to be introspective or to practice new tools seems overwhelming. You feel stretched too thin, and just making it to a weekly appointment feels like the most you can do. If this reflects your situation, you and your therapist can plan how to optimize the limited time you have in a way that feels realistic to you.

If you’re wondering if there’s more to the story, ask yourself the following questions:

1. Do you prioritize others’ needs over your own?

Consider how much time and energy you devote to other people. Once you’ve given to your partner, your children, your friends, your parents, and your colleagues, you may struggle to find any remaining resources for yourself.

If your generosity leaves you feeling depleted, you may need to create stronger boundaries, which includes prioritizing self-care and carving out time for self-reflection outside of therapy.

Changing your life requires work. Weekly therapy sessions are just the beginning.

2. Are your expectations reasonable?

When your therapist asks you to practice a new behavior, it is expected that you will feel uncomfortable and may stumble on your new path. Your therapist wants you to challenge your status quo and take small, calculated risks that result in incremental change. Sometimes, though, perfectionism and all-or-nothing thinking may lead you to believe you must implement new strategies right the first time—or else they’re not worth trying at all. When you operate under this assumption, you miss out on the small victories that add up to greater achievement and increased self-confidence.

Perfectionism and the shame that comes with it may also convince you that what you’re learning in therapy should come easily to you. If these new concepts were obvious to you, you might not need a therapist in the first place! Ask your therapist for help when you’re confused, concerned, or unsure about something you’re processing. They can offer you additional guidance, but only when you’re willing to let them know you need it.

3. Are you afraid of something?

Despite your desire to change your life, actually changing it can be scary. Uncertainty tends to accompany change; perhaps you can’t imagine life any other way than what is familiar to you. Not being able to predict what happens next can feel paralyzing and prevent you from moving forward. Perhaps you also worry that you’ll become someone you don’t recognize.

Modifying your outlook on the world, behaving differently in relationships, and forgiving others and yourself has the power to transform you. You and your therapist should proceed at a pace that is appropriate for you, so you can integrate these new ways of being into your identity. Rather than feeling like you have to become someone else, you can explore how to evolve into a more adaptive, flexible, and limitless version of who you already are.

4. Do you really want to change?

Ultimately, you are in charge of how your life unfolds. You have the right to accept yourself as you are and live your life as you see fit. You have the right to determine which relationships to maintain, what behavior to tolerate, and who deserves your forgiveness. If the change you seek clashes with your core values or is the result of outside pressure, you may struggle to motivate yourself to work on your therapy.

Sometimes, therapy will help you realize you don’t want to or are not ready to change. You get to make that choice. You must remember, however, that you don’t get to choose the consequences of your choice. Your decision may create more peace in your life and/or lead to the end of important relationships. Your decision may leave you stuck in an untenable situation and/or open your eyes to the positive aspects of your life that you previously ignored. Whatever you do, make sure your choice not to change is the one that feels right for you.

Changing your life requires work. Weekly therapy sessions are just the beginning. The real work happens between sessions, when you actively engage in the creation of change and commit to making it last.

What is good therapy? I recently wrote about tips for identifying the best counselor for you. I’d like to shift the focus a bit and talk about the role of relationships and what I call the four pillars of counseling: trust, respect, positive regard, and open-mindedness.

While these concepts may seem straightforward, fostering them within a healing therapeutic relationship can be challenging depending on the quality of previous relationships you’ve experienced, whether you’ve been able to form trusting relationships in other areas of your life, how open you are ready or able to be, and how truthful you can be with yourself. I believe these things form the foundation of the relationship needed to help you meet your goals.

I’ve been a counselor for a long time, and I’ve had counseling with many different therapists. Some of it was very good and helpful and some wasn’t. None of it was bad or meant the therapist wasn’t qualified. I believe the connection between the counselor and the person seeking support is the most important part of a therapeutic relationship. Creating a strong relationship with a counselor is affected by personality, age, gender, race, life experiences, and other factors. There must be a good fit in order for therapy to be effective.

[fat_widget_right]

While the relationship between the counselor and the counselee is important, the relationship you have with yourself is equally important. From the moment we are born, our relationships begin to form everything about us—from our beliefs to our behaviors, traditions, and rituals. The strength of our earliest relationships directly impacts the strength of our relationships in the here and now, which directly impact the relationship with the counselor you choose to work with.

When relationships in early life aren’t nurturing and supportive—which can happen for many reasons, including abuse, neglect, or the inability of parents to emotionally bond with a child—the impact can be long-lasting and prevent people from developing healthy connections. It can take a long time to experience trust in a relationship if you have experienced broken relationships or abandonment, especially in childhood.

Whatever the challenge in a relationship, the first step of therapy must be to identify and name that pain. That takes courage, regardless of how scary it may feel.

Whatever the challenge in a relationship, the first step of therapy must be to identify and name that pain. That takes courage, regardless of how scary it may feel.

Good therapy addresses the pain that brought you into therapy and helps you develop solutions to the issues you are experiencing. It focuses on the goals you have set and the challenges and limiting beliefs that may prevent you from reaching those goals. Recognizing these beliefs can occur when there is trust and respect between you and the counselor. If you sense the counselor is open to your challenges, you may be more open to addressing them using tools the counselor provides.

When early life relationships are inadequate, a person’s ability to trust can be severely impacted. Without trust between a counselor and a person in counseling, therapy can be ineffective. It is the counselor’s responsibility to work with you to develop trust though open-mindedness, communication, consistency, and compassion. Your responsibility is to try to meet the counselor in this process as best you can.

Because you are so deeply impacted by your relationships, both past and present, you must examine them as a part of the therapy you seek even if you believe they are unrelated. We are interconnected to everyone we have ever interacted with in a good or not-good manner. Like it or not, our relationships help determine who we are and how we are in the world. This truth must be acknowledged and honored in order to begin the journey of healing in counseling.

Where do you feel safe? For me, it is not in my husband’s arms, it is in his heart. It is in a deep knowing that he will hold me there and that he feels me there even when I am not immediately in his presence. That with him I can take deep breaths and breathe in the love and affection he provides. The safety. What must it be like to have never had this feeling?

I didn’t have this feeling consistently before him. I trusted me, and I took care of me because that is what I learned to do as a child. Children who don’t feel “seen” by their parents often have an emptiness that grows with them as they move into adulthood.

What if you have carried this feeling with you for years, and now here you are, sitting in a therapist’s office, trying to “open up” and share your trauma history and heal from past abuse? How do you learn to trust the person who is supposed to be helping you, the one who is sitting across from you saying they will be with you in your journey, who holds you gently in their heart, looks at you with knowing eyes, and talks to you about your worth? The one who says they won’t judge you even before you share your most painful secrets?

[fat_widget_right]

As a therapist, when I sit with someone who has never felt seen, I ask myself, “Why do I know you? Why can I feel you? What is it about your pain that is also mine?”

We all have parts of ourselves we wish we didn’t know, parts we say to ourselves, “That’s not me” or, “Who is that person?” We reject these needy, angry, or acting-out parts of ourselves in the same way they were rejected by the very people who were supposed to hold us fiercely in their hearts and minds: our parents.

We tell ourselves, “If they couldn’t love me, those people who bore me in their bodies, how could anyone else?”

And then we give up trying to explain these ugly secrets to ourselves, to others. We hide them, lock them away in the attics of our minds, put them in files, into containers, send them away. When an experience is too much for the minds of children to bear, this can happen in a fraction of a second.

And then we give up trying to explain these ugly secrets to ourselves, to others. We hide them, lock them away in the attics of our minds, put them in files, into containers, send them away. When an experience is too much for the minds of children to bear, this can happen in a fraction of a second.

Later, as adults, we may berate ourselves for this. But children cannot handle the types of trauma or even harsh words from a loved one the way most adults can. They crack more easily.

Other times, forgetting doesn’t come so easily or quickly. We have to focus our attention on trying to forget. Eventually, the more parts of ourselves that are hidden, the more we reject and disavow ourselves of them, the larger and more intense they grow. Sometimes they develop a life of their own.

When parts of the self develop their own life, memories, experience, belief systems, and values, when they have their own sets of thoughts and feelings about experiences, they are so separate we call them “alters” or “self states”—parts, in other words. These parts are out of our awareness or just on the other side of it. Dissociation should be thought of not as mental illness but rather mental injury, born out of the anguishing kind of pain that comes from feeling empty or from being filled with rage, feeling unloved, unwanted, used. You feel unrelatable and unknown, even to yourself. Getting to know these discarded parts of the self can be scary.

I know you likely will not trust me, that you may not be able to bear looking into my eyes. That it will become more painful as you get to know me and start to expect me to be there. That just when you think you are starting to feel hope, you will become the most terrified you have ever been. Because you will have finally been seen. And while you have waited your whole life for this, it may very well be more petrifying than you imagined.

That is why I will forever be in debt to you, the person in therapy—for allowing me to see into your eyes, your past, your most feared parts of the self. I will wonder to myself why and how I know you, why you are in my life, and how it is I can “feel” your presence. I will remain separate from you and yet walk beside you for a time. I will try to be a vessel worthy of your sorrow.

“Ending a therapy session is a hostile act.”

This was said to me by my therapist once after we discussed how, regardless of whether I had a “good” session or a frustrating one, I usually felt annoyed at the end. Either I was upset it was over and afraid of losing momentum, or I was upset we didn’t get to the heart of what I wanted to talk about. I’d question whether anything really changed because of the therapy session, and I didn’t recognize the importance of the feelings that arose at the end of a session or what that ending was doing to me.

Unfortunately, that annoyance inevitably dissolved by the start of the next session. A whole other week had passed, and other things had come up. Feelings (as they are wont to do) had come and gone. It was difficult to find a way to process that fleeting end-of-session feeling.

[fat_widget_right]

Holding on to Feelings Between Therapy Sessions

I tried several ways to hold on to the feeling I’d have at the end of a session because I believed it was important. With one previous therapist, I got permission to record our sessions and then listen to the recording on the way to my next session. (I stole this idea from Irvin Yalom.) The idea was to connect each session to the previous one. This technique didn’t last. It was too much of a commitment: spending a whole other chunk of time rehashing the previous week. Also, it didn’t take into consideration what I was feeling at the time of the new session, which was just as valid.

Another tactic I tried was to jot down notes as I left therapy. I’d write down any insights I thought I’d want to return to or ideas I thought about as the session ended. I’d try to record associations I made later that day or that week. This helped a little (sometimes I still do this).

Doing that had reminded me of how I used to go to a coffee shop near my therapist’s office and journal for a while before meeting with her. That journaling became agenda writing: I’d compile a list of all the stuff I wanted to make sure we spoke about.

Gosh, I was working hard. And sometimes we’d get to a lot of that agenda. We’d really get somewhere and I’d settle in to how I was feeling and …

“Time’s up.”

“More to say next week.”

She could end at 45 minutes, but I had to keep living my life. I had to go back out into the world and manage and deal and, well, I wanted to be finished. Complete. My therapist hadn’t done her job because I needed to come back next week, right?

“That’s all the time we have.”

Or my favorite:

“To be continued.”

Those phrases would annoy me so much. They made me feel that, to my therapist, I was only 45 minutes’ worth of purging. She could end at 45 minutes, but I had to keep living my life. I had to go back out into the world and manage and deal and, well, I wanted to be finished. Complete. My therapist hadn’t done her job because I needed to come back next week, right?

It took a long time for me to realize this was anger.

It took a while to express it as anger.

It took quite some time (and another therapist—a man this time) to relate that anger at being “cut off” to all the other shames and endings and cut-offs in my life.

Talk to Your Therapist About These Feelings

The end of a therapy session can provide a lot of important fuel because it brings the feeling toward the therapist. This happens when the person in therapy feels safe enough to let the therapist “have it.” It happens when the person trusts that the therapist isn’t going to become defensive or punitive for expressing feelings they have spent weeks talking about.

This is the relational part of many types of therapy. It’s bringing real-world emotion into the therapy room where it’s most potent, where it can be held and fully expressed.

Written into the process of therapy is that the caring, patient, empathic person you’re paying to listen to you and witness your life will tell you time is up. That should suck. That should make you upset. And you should say all that to your therapist. And if you’re aware of those feelings at the end of a session, let your therapist know you need help expressing them at the next session.

I do the same thing now. I tell people it’s time to end a session and they have all kinds of feelings. Sometimes there’s relief. Often there’s annoyance. Sometimes there’s intense anger. But I’m always glad when they have enough courage to tell me how they feel about it.

Sometimes I’m brave enough to tell my therapist as well.

According to a recent health story from National Public Radio, depression is the catalyst for more than 8 million doctors’ appointments each year. More than half of those appointments are with primary care physicians, which highlights the important role primary care physicians have in the screening, diagnosis, and treatment of depression and other common mental health conditions.

Despite the high number of individuals trying to access some level of mental health treatment through their primary care physicians’ offices, a 2013 brief by the Centers for Medicare and Medicaid Services (CMS) estimates 80% of adults experiencing mental health issues never see or are referred to a mental health specialist for treatment. In fact, CMS suggests that only 25% of people with depression or other common mental health issues ever receive effective care.

[fat_widget_right]To address the significant gap that exists between mental and physical health treatments in primary care settings, CMS has pushed for states to adopt a collaborative care model that integrates primary care with case managers and mental health specialists. This approach mirrors the treatment guidelines from the American Psychiatric Association, which advocates for treating major depression, from mild to severe cases with psychotic features, with a combination of pharmacotherapy and psychotherapy.

As a leading online directory of psychotherapists, psychiatrists, and mental health specialists that has helped connect millions of people with a mental health professionals since 2007, GoodTherapy.org recognizes the importance of collaborative care. Below, we outline three powerful reasons for physicians to refer to or collaborate with mental health specialists:

Mental Health Referrals and Collaborative Care Help Provide Better Treatment for Your Patients

The Centers for Medicare and Medicaid Services estimate that as few as 20% of people who started an antidepressant medication in primary care will show “substantial clinical improvement.” Additionally, CMS states that we know when mental and behavioral health concerns are left untreated, the following occurs:

• A person’s ability to maintain self-care becomes impaired
• Adherence to treatment plans are negatively affected
• Mortality rates increase
• The person’s work productivity can decrease
• Health care costs increase

Despite the high level at which patients enter primary care for depression and other common mental health issues, a recent study published in the journal Health Affairs suggests that primary care practices may not be well equipped to manage depression as a chronic illness. Simply put, reaching out to a mental health professional for collaborative care may allow you to provide better mental and physical health outcomes overall for your patients.

Available Evidence Supports the Efficacy of Collaborative Care for Mental Health Issues

The collaborative care approach has been studied extensively across various primary care settings and populations. In its brief on collaborative care, CMS points to more than 70 randomized controlled trials as its body of evidence for The gaps in mental health treatment exacerbate poor physical health for many and causes some to live with treatable mental health issues, often as a result of stigma. Pursuing better approaches to treating mental health and wellness creates a world of stronger, healthier communities, which benefits us all.the treatment model. The agency found that collaborative health care teams consisting of a primary care provider, support care management staff (such as a psychologist or clinical social worker), and a psychiatric consultant were both more effective at delivering better health care outcomes and more cost-effective overall, regardless of practice size or population being treated. Additionally, several studies highlighted by CMS indicate a collaborative approach to health care may be especially effective at reducing health disparities in ethnic minority groups and low-income populations.

The IMPACT Trial, a program of the University of Washington Department of Psychiatry and Behavioral Sciences, is one of the largest research projects to have studied depression care. The study followed the outcomes of more than 1,800 adults experiencing depression from more than 18 different primary care facilities over a 2-year period.

According to the findings of the IMPACT Trial, published in 2002 in the Journal of the American Medical Association, people experiencing depression who received collaborative care reported a 50% reduction in symptoms, compared to about 19% who received care from a physician only. Additionally, follow-up research after the conclusion of the IMPACT Trial revealed that patients who received collaborative care experienced more than 100 additional days free of depression symptoms over a 2-year period when compared to those treated solely by a primary care physician.

Reaching Out to Mental Health Partners Makes Physical and Mental Health Care More Cost-Effective

Referring a patient to a mental health specialist or integrating mental health care as part of a collaborative care approach makes financial sense too. The Centers for Medicaid and Medicare Services estimate that health care costs can increase by 50-100% if a patient is experiencing depression. Additionally, patients experiencing major depression and a chronic medical condition, on average, have more than twice the health care costs when compared to people who aren’t experiencing depression.

Another important part of the University of Washington’s IMPACT Trial was examining long-term health care costs over a 4-year period. At the end of the study, researchers discovered an initial investment in collaborative care resulted in significant savings over time. The published results indicate that every dollar spent on collaborative care saves $6.50 in health care costs. Primary care practices that used a collaborative care approach for depression treatment during the study saved an average of nearly $850 per year for each patient. The average net cost savings over a 4-year period for people with depression were about $3,400 per patient.

How We Can Help

Part of our mission at GoodTherapy.org is to challenge mental health stigma and educate the public about mental health conditions and treatment. The gaps in mental health treatment exacerbate poor physical health for many and causes some to live with treatable mental health issues, often as a result of stigma. Pursuing better approaches to treating mental health and wellness creates a world of stronger, healthier communities, which benefits us all.

Our organization is ranked as one of the top directories of mental health professionals, therapists, and psychiatrists on the internet, with thousands of members in more than 30 countries worldwide. Visitors to GoodTherapy.org can search for a mental health specialist or therapist by location, specialty, treatment modality, or several other factors. We ensure the highest membership standards of any online mental health directory and verify that each member meets strict educational, licensure, and philosophical guidelines.

Whether you’re searching for a mental health referral or a partner to assist your practice in a collaborative care approach, GoodTherapy.org can help you provide better, more cost-effective treatment for people experiencing mental health challenges.

References:

1. Bishop, T. F., Ramsay, P. P., Casalino, L. P., Bao, B., Pincus, H. A., & Shortell, S. M. (2016 March). Care management processes used less often for depression than for other chronic conditions in US primary care practices. Health Affairs, 35(3). 394-400. doi: 1377/hlthaff.2015.1068
2. Luthra, S. (2016, March 7). Doctors often fail to treat depression like a chronic illness. NPR. Retrieved from http://www.npr.org/sections/health-shots/2016/03/07/469504900/doctors-often-fail-to-treat-depression-like-a-chronic-illness
3. Overview of the IMPACT trial. (n.d.) University of Washington, Department of Psychiatry and Behavioral Sciences. Retrieved from http://impact-uw.org/about/
4. Treating major depressive disorder: a quick reference guide. (n.d.) American Psychiatric Association. Retrieved from http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd-guide.pdf
5. Unützer, J., Harbin, H., Shoenbaum, M., & Druss, B. (2013 May). The collaborative care model: an approach for integrating physical and mental health care in medicaid health homes. Health Home. Retrieved from https://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/HH-IRC-Collaborative-5-13.pdf