In April 2020, I wrote an article for The UpTake about telemental health and telepsychology. At that time, I had been working remotely for about one month and had just gotten certified in telemental health. I also thought that working from home was a short-term solution. Weeks have become months, and although schools are looking to resume in-person classes this fall, my practice continues to be entirely online. Although I already had some experience and training in telemental health, there has been a bit of a learning curve, especially with young children.
With these challenges, though, there is a silver lining. Clients of all ages who struggle with leaving their homes (due to agoraphobia, sensory issues, or severe depression) who normally would have cancelled or missed appointments because they could not get to my office can meet with me without having to get out of bed. Those with unreliable transportation don’t have to find a way to get to me because I can come to them. Sioux Falls Psychological Services says, “We meet you were you are, offering hope,” and that is true in a literal sense now more than ever!
If you’re dealing with mental illness, whether symptoms are new or have affected you for years, telemental health offers access that was not possible years ago. Although clients who are used to in-person sessions have had to adjust to online therapy, most are able to do so, and research has shown that treatment outcomes for telemental health are comparable to in-person sessions.
Bernice Lewis says, “Normal’s just a setting on the washing machine,” and she’s right. There is no one way to feel or be.
But I think it’s important to talk about our “new normal,” or living in the era of COVID-19. The Washington Post says that 34 out of every 100 Americans has met criteria for a major depressive episode, an anxiety disorder, or both so far in 2020. Typically, about one in 10 Americans meets criteria for a mental illness, and 6.7% have a depressive episode in a given year.
This is something to think about. A lot of people who come to see me at my clinical practice express concern about being strange or abnormal for needing therapy. Many of them have a history of trauma, stress, or challenging life events. When they explore it, they often realize that their mental health symptoms make sense in the larger context of their lives. I can’t count how many times I’ve told someone, “With what you’re describing to me, I’d be concerned if that didn’t make you anxious/depressed/etc.”
We are going through massive shifts in our world. People are stressed out, anxious, and depressed because we live in a stressful, anxiety-provoking, and depressing time. Behaviors that would have been concerning a year ago are necessary for our safety in parts of the world. It’s understandable to feel this way, and it is okay to ask for help!
According to Twitter, today would have been Robin Williams’s 69th birthday. In honor of that, I dug up something I wrote just after he died, which is still relevant today.
Here are some myths and facts about suicide and mental illness:
If he/she/they had had more/better friends, he/she/they would not have died. I addressed this somewhat in my last post, but I will keep saying it until people understand: That is not how depression works. Mental illness does not follow this kind of logic. Would you say that a cancer patient might have pulled through if only they had better social support? Yes, a solid network of friends is important when it comes to overcoming mental illness, but it certainly does not prevent suicide. When someone is in a suicidal mindset, they are not thinking about their loved ones. They are just thinking about the pain that they are in. I am NOT saying that their choice is selfish, but that the level of suffering that comes with clinical depression is so great that you are not capable of thinking of anything else. Have you ever had a kidney stone? Were you thinking about the people who would be inconvenienced by a commitment you were missing? Maybe it crossed your mind, but I would be willing to bet that your primary concern was how much pain you were in and how to make it stop.
He/she/they was/were not brave enough to keep fighting. Suicide has nothing to do with bravery. Again, mental illness does not follow this kind of logic. Suggesting that people with suicidal thoughts are cowardly is counter-productive. That kind of negativity only serves to further beat down individuals who are already struggling. This same argument applies to calling those who have died by suicide selfish.
People with depression just need to be stronger and get over it. When I am feeling upset, I really try to avoid saying that I feel “depressed” because depression isn’t equal to sadness. Depression is a pervasive state of being that transcends more fleeting moods. There is a reason why a diagnosis of clinical depression requires that symptoms be persistent for a minimum of two weeks: Because depression is more than just feeling low or sad for a short while. Think about it. If it were so easy to “snap out of it,” why would anyone kill themselves?
But he/she/they didn’t seem depressed. This plays into the myth that depression has to look a certain way. Most of us have a picture in our minds of what we think depression looks like, and while there most likely exist cases that fit this image, no two cases are identical. Everyone copes differently, and there is no way to know for certain what someone else is thinking and feeling. Some people prefer not to show their emotions and may seem stoic or even sad when they feel fine. Others project a similar demeanor in response to the pain they are in. Some use humor to cover how they are feeling. Others joke constantly because they feel happy and want to share it. It is impossible to paint a picture of depression because no one picture could accurately encompass every experience.
He/she/they just wanted attention. Suicide is not something to trivialize, and that is what this statement does. I hear this a lot in response to people who use means with lower lethality for a suicide attempt. This phenomena stems from the stigma I have been talking about. When we teach people that they are weak or lesser than if they seek help for mental illness, it becomes difficult to say “I need help” or “I am depressed/thinking about hurting myself.” When you feel you can’t express your pain in a healthy or productive way, it comes out by other means. Are the individuals in these cases seeking attention? Technically yes, in that they desperately want and need help that they do not know how to seek. There are much easier ways to get attention. That is not what suicide is about, and it is insensitive and stigmatizing to claim otherwise.
“Genie, you’re free.” This quote circulated Twitter for days after Robin Williams died, and it really bothered me, as both a mental health professional and as a person. I need to explain why this quote in this context made me so angry. Sure, it sounds poetic. But let’s take a minute to really think about what this statement implies. Essentially this quote is stating that, because he is dead, Robin Williams is now “cured” of his mental illness. After a celebrity dies by suicide, the suicide rate goes up for a short while, and the implication that death is freeing is a dangerous one. Imagine you have been struggling with suicidal thoughts. You hear that Robin Williams, a world-famous actor, has killed himself. You then see a huge outpouring of emotion from his fans saying that he is now “free.” Suddenly that tweet sounds like an argument in favor of ending your life. Although it is true that asking someone if they are having suicidal thoughts will not cause them to become suicidal, saying to a friend, “I’m worried about you. Have you had thoughts of wanting to hurt yourself?” is hugely different from asserting that suicide is somehow a cure for mental illness, and when it comes down to it, that is what this quote is saying. Please do not romanticize tragedy. It’s dangerous.
If you are thinking of hurting yourself, please reach out. In the United States, the National Suicide Prevention Lifeline is available 24 hours a day, 365 days a year (or 366 days this year). They provide support and help for those in need and information about long-term services.
I wrote this post for kids who have had something bad or scary happen to them.
This is Vera. She has lived with me for about three years now.
As all my clients know, I love animals and absolutely adore my cats. Those who are currently receiving services as I work from home have gotten to meet them on camera.
A little back story on Vera: we aren’t sure exactly how old she is because she was brought into the rescue as a stray. We don’t know where she was born or whether she lived with other humans before us, but we do know some things about her based on her behavior.
We know that Vera gets easily startled by loud noises, and she runs away and hides from strange people. We know she hates the stepladder (I like to say it’s because she never met her biological ladder). We know she had short hair when they found her, but after getting enough to eat for several months, her coat grew long and soft.
We might not know exactly what Vera’s life was like before we met her, but we know that she probably felt scared a lot of the time, and she had to always be on the lookout for danger. We know that she still looks out for danger a lot of the time, no matter how safe she is at our house.
Vera has a hard time letting go of the fear and worry that helped her survive when she lived outside. This happens to a lot of people, too: when something bad or scary happens, it’s hard not to be on the lookout for something bad or scary in the future.
Vera might never completely stop feeling scared when the microwave beeps or when I get the ladder out to reach something up high. But she will always know that we love her, and we will always keep her safe.
When we work with children, it is vital that we remember that their brains are different than our adult brains. The frontal lobe, or the part of the brain in charge of talking, logic, and impulse control, continues developing well into our 20s and possibly our 30s, depending on which study you read. Have you ever wondered why college students Act Like That? It’s because the part of their brain in charge of making good choices isn’t fully online yet.
Children have not learned the skill of communicating their feelings with words, both because they haven’t been alive long enough to practice, and because that part of their brain isn’t there yet. It’s up to us to give them the tools to tell us what they need.
Since it can be hard even for adults to find words for our feelings, I’ve found it helpful to give kids visual aids. One of the first things I give a lot of the families at my clinical practice is a feelings thermometer that teaches kids how to notice how strong their feelings are on a scale from 1-10. A lot of templates for this activity exist online, but here is one that I put together:
This worksheet helps kids with two skills: noticing feelings inside their bodies and sharing that information in a way that the adults taking care of them can understand. Often, a child will not identify that they feel angry until they are FURIOUS, and it’s hard to come down without an outburst. The feelings thermometer helps them start to notice when their anger is at a 3 instead of an 8.
They also practice communicating and asking for help from adults so the adults can understand and then provide that help. When the parent hears, “I’m feeling scared at a 5/10,” they can use that information when deciding the best way to help the child cope.
If you’re not sure where to start in giving kids the tools to express their feelings appropriately, the feelings thermometer is a good first step.
There is conflicting information about the origins of this expression, but it is generally agreed to be a curse. We are watching history be made as each day goes by, and frankly, I wish I lived during a more boring chapter of future history books. At the same time, though, it is through the difficult times that we grow.
As a psychologist, I’m used to walking with people through the difficult times. I usually can’t offer a quick or simple fix, but I can be there with tools, hope, and connection.
My goal in creating this site is to offer resources to a wide audience during these trying times. I want to reach those who share my drive to help children and provide them with the tools to do this effectively: teachers, social workers, counselors, and fellow psychologists. If there are specific resources that you would like to see, please let me know, and if I have the appropriate skills and knowledge, I will do my best to make it happen.
Thank you for joining me during these interesting times. Follow my site to stay up-to-date with resources.