Resources for Therapy

Part 1 (Populations)

Greetings, some time ago I spoke about doing therapy and by coincidence, it occurred shortly afterward. We have therapists but there was such a need that I volunteered to start it… and shortly regretted it, but now I’m okay. Not because I didn’t want to do it, but I guess I underestimated the need and can only f/u with people usually 1-2x/month as opposed to weekly or biweekly, which isn’t good if people need something more intensive or specialized. Even making the choice not to see kids, court stuff, or families, I’m getting bombarded with intakes. However, the purpose of this post is to offer some guidance, resources, tips, and information about documentation/plan of care (part II).

I would like to share some tips that helped me. You can find formal resources in other areas, but my personal rule of thumb is to stick to what’s practical and safe. I spoke about some of these things in the substance abuse population, which is going back to the basics or a clean slate to retrain the brain. This requires dedication and I don’t sugarcoat it, I tell my patients this is not easy stuff to let them know, they also have personal responsibilities.  Therefore, the following tips are patient-focused whereas the provider should guide them in this process. Simply put, the provider cannot work harder than the patient because it’ll create a co-dependency. This is where you’ll find the BAD advice and other problems in therapy… I normally promote independence with patients so this is what my personal tips are primarily focused on:

Teaching and Tips for Major Disorders/Symptoms  

Anxiety/Fears: this applies to all humans. I explain to patients, that no one can take away all the anxiety because it’s our primitive reflex (fight/flight response) to avoid or reduce dangers. Sometimes letting someone know that it’s normal to have anxiety can be some kind of relief (like your body is being NORMAL), but also educate when it’s unhealthy; not leaving the house, crying, heart racing, excessive weight gain/loses, rage/anger, higher BP… with therapy, focus on improving the quality of life.

  • Provider: improve coping skills, stress management, promote a healthy lifestyle
  • Patient-Focused: limit social media/news/harmful content (television, crime shows, internet, music), limit or stop ETOH/cigarettes/drug use, physical/labs/vitals r/o medical conditions

Depressive Symptoms: this is a lack of motivation, drive, ambition, etc. in addition to being sad, crying, apathetic, hopeless, or helplessness. Depression is tricky because it could be related to a medical condition such as cancer, thyroid, or something else serious like grief. If there’s no other etiology or it’s primary, then usually I’ll target the thought process. This is different than anxiety because technically speaking, it’s not natural to be depressed or have thoughts to self-harm. So with all psych disorders, r/o trauma/abuse, etc. I usually ask them to get a physical, labs -r/o anemia, etc. This is also where medication may be necessary but as far as therapy, target the thought process.

  • Provider:  most people who fall in this category have a very rigid (black/white or all or nothing) way of thinking. With therapy, I try to have them see what’s rational vs. irrational and work out why their process is negative, and not healthy… Focus on their skills/talents, and encourage them to find their goals and meaning in life.
  • Patient-focused: limit or avoid social media, harmful content, or things that could make them despair more… consider a different career or volunteering or improve leisure activities.

OCD/Intrusive Thoughts: anything that makes you do or think something that you can’t control is put in this category. It may require medications (DOC escitalopram) depending on the severity but I usually give advice that has helped me, which is writing or neutralizing the thoughts. This is hard work because these thoughts/actions could’ve been going on for years. CBT is the most helpful because the patient has to do the work to neutralize/change the thoughts, which should mainly occur outside of therapy sessions, i.e. their homework. Therefore, I encouraged the pt. to get a journal or use their cell phone to write out these thoughts and reduce/neutralize the triggers.

  • Provider: we are not targeting the thought process like with depression, because in general, they don’t want the thoughts at all and they need to be replaced or neutralized. Let the patient determine the pace and guide them in the process. Helped them stay objective r/o paranoia and improve stress management.
  • Patient-focused: discuss triggers -which are usually stress-induced and have them consider journaling/tracking the repetitive thoughts or behaviors. Replace the distressing thoughts with something positive or distracting. I had one patient who replaced the bad thoughts with more bad thoughts!…again the patient has to put in more effort for results, so sometimes they have to repeat the process until they improve.

PTSD: I have patients who want to go back 20-30 years and I let them know it’s usually not helpful and it’s like feeding the beast, and most of the time, they have vague, unclear memories. I know intrusive thoughts are one of the symptoms of PTSD but the main difference is timing, PTSD is about the past, and OCD/intrusive thoughts are about the present/future, but it could be based on past events. With psych disorders, try to stay objective and present/future-oriented, which are things that are in our control.  Another difference is that PTSD is also more serious and you really want to target the triggers.

  • Provider: depending on the severity of the PTSD they may have to do EMDR or trauma-focused cognitive behavioral therapy (which is specialized) but for general therapy purposes, improve stress management and coping skills. Anticipate or help the patient prepare for stressful situations, especially for veterans like around holidays… Assess sleep and treat nightmares.
  • Patient: they need to focus on their lifestyle, reducing triggers, limiting harmful content, avoid/limit ETOH, and substances, and tracking irrational thought processes or triggers.

Some Teachings for Certain Groups 

Tips for Couples: I call this double trouble because that’s how I feel about doing couples counseling. It’s rough because men are rough. Sometimes it’s like expecting an emotional connection and some respect from a lizard. They’re looking for a miracle when in actuality it boils down to 2 major problems; improving communication and conflict resolution. The next post will be about documentation/the sessions, but for general purposes, those are the 2 areas I focus on…

Tips for Senior Citizens: I love old people! They’re just adorable like babies and here I mainly focus on the ADLS and safety. I don’t see kids in therapy (or not yet) but with med reviews, I still focus on safety and quality of life for all populations.

Tips for Kids: I don’t see kids for therapy but like senior citizens, I focus on safety, ADLS, quality of life… This isn’t an ongoing process but look at it as starting off with a strong foundation and then going to the next direction from there…. (Sidebar) I watched a YouTube video about kids not doing therapy and I completely disagree, a therapist/provider may be the only reasonable or rational person in a child’s life. However, I do believe that the therapy is only beneficial if it’s not biased, having a personal agenda, or other red flags… Here are some main reasons why it may be helpful or super beneficial for a kid to have therapy;

  • ANY trauma: abuse, bullying, family/close deaths, divorce, major accidents/disabilities i.e. burns
  • Help with understanding chronic conditions or medication management i.e. diabetes
  • Other major events: moving to a different country, delays with development, natural disasters, new school/languages   

Part 2 (Documentation and Resources)

(PDF) Downloads Related to Therapy

Cognitive Behavioral Therapy (CBT)

Dialectical Behavior Therapy (DBT) 

 

Trauma Responses

Self Care and Coping Skills

Social Relationships 

Additional: 

Riding the Wave: how to deal with unwanted urges. Free (PDF Handout) by Therapist Aid  

Main References and Resources

  • Get Self-Help: honestly, this website doesn’t get enough credit, they have a ton of free good downloads!
  • Psych Point: provide mental health professionals with the tools they need to facilitate a healthy, meaningful journey to recovery for their clients.
  • Therapist Aid: dedicated to helping mental health professionals improve their craft by providing free evidence-based education and therapy tools.

Last Updated 11/2023

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