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Archive for June, 2009

(This post was written at the suggestion of two people who commented on . Leaving therapy – so what’s the problem?)

Sometimes therapy ends, and it’s not your (the client’s) idea at all. I have no statistics on how often this happens, and I don’t know how this happens, when it does.  I do know that sometimes therapists move to another  location, or financial support for the therapy ends, or maybe a spouse moves, taking you to another location for reasons not deriving from anything you planned.

While I cannot address all situations, perhaps I can address some of them.

THERAPIST TERMINATES YOU

This can happen if they come to believe that they are not the one to be providing services, or if they don’t think you are getting enough out of it, or are in therapy for reasons other than that you are wanting, and able, to do meaningful work. In any case, it not at all a common event. I’ve never done it. I don’t think I have much to say that might be useful, in this case, except that the best thing to do, if you want to continue, is find another therapist – and to learn as much as you can about the reasons for the termination, so you can make use of the information, if possible.

FUNDING ENDS

The involvement of “managed care” brings in 3rd party service utilization reviewers, whose job it is to minimize spending of money for treatment. This makes sense if one seeks to maximize profits, or maximize service coverage to a population under conditions of limited funding. In terms of meeting the clients need, it is less likely to make sense.

Regrettably, sometimes utilization reviewers do not really understand the situation they are reviewing, or do not accept the therapists assessment of it, or have an evaluation process they must follow which drives their decision for them. The result, in all cases, is that you’re leaving before you want to.

This is a difficult situation – certainly for you and likely for your therapist too.  There are a number of ways in which you can try make the best of it. If it were me, I’d seek out books that seems to address my problems, and I’d journal a lot – talking to yourself on paper is a proven method for self-therapy, as is “bibleotherapy”. Several studies have shown these methods, if well done and conscientiously applied, to be just as effective as traditional therapy. That’s right – just as effective.

The problem is that you have to manage yourself. There’s no one to lead you through the process. A major key to susccess here is motivation. People can do incredible things when motivated. So, seize the opportunity, and simply declare to yourself that you will NOT be defeated by circumstances. Then start reading, and writing, and WORK at it. Act like your life depends on it. It does, yes?

THE PROBLEM OF SITUATIONAL INJUSTICE

Being, in effect, kicked out of therapy against your will is probably hardest for those who have a real sense of not having been treated fairly by life, and many people have good reasons for thinking that this is their lot.

OK. Life isn’t fair. Almost everyone I can think of, including me, has reason for complaint. But, the problem is that if y9u get stuck in the complaint, nothing really happens. You have to get to the next stage: converting your protest into self-supportive action. What that might be is well beyond anything I can address here, but the general idea is the real point I want to stress: You stop being a victim of circumstances the day you decide to. You do this by changing your response to circumstances over which you have no control.

If the world isn’t giving you what you need, find a way to get it for yourself, or at least to get something for yourself. Consider Beethoven, the great German Classical/Romantic composer. He wrote 9 symphonies, and by his third, he was obviously going deaf. It’s essentially a worst-case scenario. What did he do? He did what he could to get treatment, and it didn’t work. He also continued writing music, for years and years, hearing it only in his head. He got something for himself, and in so doing gave us all much more. He did the best he could with what he had. What else was there to do? You must do the same, if you hope to achieve a sense of happiness.

SELF-SUPPORT

You got into therapy to get something for yourself – an act of self-support. If therapy is no longer available to you, you simply continue this action, with what IS available to you, and there’s always something.

I recall a wonderful story I heard once about a meditation student. He was becoming discouraged. He worked hard but didn’t think he getting where he wanted to go with his meditation practice. He consulted his teacher, and was simply told that what he needed to do was go out into the area where he lived, find discouraged people,  and encourage them!

This sounds a bit absurd, initially, but it’s actually very clever. It’s often easier to do something for others than for yourself, but in this case, encouraging others is likely to give the student ideas about how he might encourage himself. But there’s more: by being helpful to others, he’s giving sustenance to his own sense of self worth.

DO WHAT YOU CAN DO, NOT WHAT YOU CANNOT

You cannot change the national health system, or how your insurance company operates, or the fact of your having to live with a limited budget. So, don’t throw yourself against a rock – an immovable object. If you want to advocate for systems change, do it! But be realistic. And while you’re working to change the world, work also promote your own health in every way you can think of. THAT you CAN do.

In doing this, you give yourself PRIMARY SELF RESPECT, something I’m much in favor of. You must be the first person who offers you support and encouragement. If it’s hard, do it anyway. Persist, and it’ll become easier, like anything else you practice.

One way you can work to improve your situation is to join a self-help group. Some can be found  on the Internet, and other will be advertising localling in your region – or you might start one. The challenge with these groups is to be wary of advice from people who really don’t understand your problem. So, even if you work with a group, you should be reading and writing (journaling) on your own, to help you “keep your own counsel”.

DO NOT DEFEAT YOURSELF

Life itself is struggle. Your struggle to advance your own mental health is just a part of that. In challenging circumstances, the first rule is not to defeat yourself, which is what you do if you give up. It takes maturity, and courage, to continue working when the world is not supporting your effort very much. If your mental health is at stake, the matter is serious, and it likely that your continued effort is justified. People who struggle usually make progress, though it may not at all be linear progress.

So, remember: there’s always something you can be doing to help yourself. Identify it, and go to work. Be resolved to be defeated only by that which you cannot control, not by your failure to engage with that which you do control.

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A new brief screening test for early detection of Alzheimer’s disease has been developed. Good information on this research, and the test, is available on the Internet as of this week. The test has excellent sensitivity (ability to detect the disease when actually present) and selectivity (ability to exclude from detection those who do NOT have the disease.

LIMITATIONS

This is a screening test, not a diagnostic assessment tool. At this point in its development, it also lacks sufficient validity research to be used in a clinical setting. At best, it should be considered as possibly indicative of the status of any individual who takes it. That status, if of real interest, should be confirmed by other means.

KEY LINKS

Quick Alzheimer’s Test Highly Accurate – A brief but thorough summary report on the new research, written for health care professionals. Read this first.

Self administered cognitive screening test (TYM) for detection of Alzheimer’s disease: cross sectional study – The full test of the research report published in the British Medical Journal on 2009.06.09. This is technically demanding text, but rich in detail, with plenty of content useful to the non-technical reader as well.

Diagnosis of dementia – Editorial in the British Medical Journal, 2009.06.09, related to “Self-administered…” article in the same edition. Valuable additional information on the topic.

TYM (Test Your Memory) test – A PDF version of the test card used in the research. PLEASE NOTE that this test is designed for patients of British origin. I believe one can make some obvious cultural adjustments to the test text  without compromising validity.

TYM Scoring instructions – From the authors of BMJ research report.

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