Any Psychologists/Psychiatrists here?

I'm a psychiatrist but I don't think this needs a psychiatric mindset, more of a psychotherpeutic one.

I'm going to start with the assumption that Jane isn't actually depressed or suicidal. If she is then my answer would change.
You also need to decide if she's seeing someone who is going to work in a solution focused way (bordering on cognitive behavioural therapy way) or a psychodynamic way.

If it's psychodynamic (the one that seems to me to be the best fit) then your counsellor's meetings with Jane will go through a number of stages.

1. What does she want to achieve through counselling?

Jane's answer to this will flavour the direction things take. She might want to overcome her inability to communicate with Mike or she might want to be able to forget him and move on. It's a real possibility that she'll say the latter but mean the former.

2. Next comes the thinking.
A psychodynamic psychotherapist doesn't propose solutions, they ask questions. The idea is that thinking about the patterns we get into and understanding them will help us to break them.....the therpists skill is picking up on the right cues, even nonverbal and subconscious ones and asking the right questions to get the thinking done. The most they'll do is point out if things seem to contradict or don't make sense. They will draw attention to patterns of behaviour.

There would be lots of time to just talk about Mike and their relationship. Jane will have the chance to actually be honest about her actions. She'll be asked a lot how something makes her feel. She'll be asked if she wishes she'd done anything differently and if so, what she wishes she'd done. She'll be asked about her childhood and the therpist will be on the lookout for things that might be repeating patterns....eg if she "can't talk" the therpist would be interested if her mother used to punish her by not talking to her (or something more extreme like washing her mouth out with soap), or if she was bullied by being ignored. The therapist would be interested in any times when saying something has caused problems for Jane.

The idea would be for Jane to reflect on these things and figure out if her reactions help or harm her. This might motivate her to do it differently and think about what she would do differently.

As an aside, a therpist working in this way doesn't tell their client anything about themselves. They try to keep themselves as a blank slate as they use the way the client relates to them to understand a little about how the client relates to people in general.

If Your therapy is solution focused or CBT then think of it as a series of experiments.

1. Question 1 is the same. What does she want to achieve.

2. Next comes a lot of of what happened when and what would happen if? questions. What would happen if you did talk to Mike? What's the worst that could happen? What's the reality of not talking to him? What makes you think he'll react badly? What is the evidence to suggest you're either right or wrong?

3. Then you experiment. You choose an action, do it and see how it goes.....but you start small. If Jane has a problem talking to people then we start by either getting her to email people of make up reasons to talk to them. As an example, i've got very anxious people to phone up cinema helplines before to ask about the time of films that they aren't going to see.

If the person completes the task you move on to the next. If they can't then you pause, think about why it was too hard and either keep going at it or pick something else.


Making a diagnosis wouldn't be my first choice here. A formulation (exactly what you've done in describing the problem and the reasosn for it) seems a better fit. In your scenario either depression or anxiety are possible, but understanding the problem is much better than worrying about what to call it and so we formulate more than we diagnose.


Mike's process would be the same if he went to counselling....except in solution focused work Jane might be working towards being more confident while mike might be working towards being less dominant and demanding. A therpist might be interested in why he can't move on without an answer, and whether his pattern of behaviour is hurting someone he loves...and if this might actuallly be a subconscious punishment.

Craig

Hi Dario and Wiskel,

I also wanted to add that if the therapist is modern psychoanalytic, the therapist would wait for Jane to be ready to talk about Mike and want to approach him. Which could be a very long time. If it has taken Jane two years to seek counseling in the first place and she happened to get a psychoanalytic therapist, it could be longer before she is ready to even discuss how to talk to Mike about anything, especially considering that she avoids communicating with him online, but continues to "see" him.
As for Mike, the other therapist would probably help Mike explore why HE wants to get her to come forward. It would really be based on the event that happened between them. The therapist would also explore ways that Mike could cope with not knowing her side of things because Mike cannot impose his will on anyone else. Hope this helps.

You have psychologists who, depending on their tradition and personal appraoch, will take pretty much any tack you might need for you story, including a confrontational tactic.

Hello Dario,

I'd agree with everything Wiskel said.

Also veinglory's point is true in real life (there are all sorts of different therapists with different approaches) but this doesn't just mean you can lightly throw in any approach that suits you. Every therapist, no matter how conventional or off-the-wall, has his/her own dearly-held theories and models of the psyche and of how therapy works, so if you're going to invent a bespoke therapeutic stance to suit your story then you'll also need to invent the therapist's whole outlook that lies behind it (at least in your own mind as the author, so that the therapist comes across to the reader as consistent).

As a psychologist myself (cognitive-behavioural, but I'm sure this would apply to any style of therapy) I would add that the process in the room between the therapist and client invariably replicates aspects of the client's relationships outside the consulting room, and the therapist will explicitly reflect on and make use of this. So if Jane can't talk to Mike, then it's likely that she will also have trouble opening up to her therapist, who would be on the lookout for signs of this (e.g. obvious silences, or avoidance of certain topics by subtle deviation, or or emotionally incongruous body language such as inappropriate smiling that would suggest she's trying to cover up what's really on her mind) and would comment on these things and tentatively ask whether this is at all similar to what's going on with Mike. If she's prepared to consider this possibility, then this allows the therapist to ask things about the therapeutic relationship (e.g. Does the prospect of talking openly with me feel somehow frightening or dangerous to you?) as a way of identifying factors which might also apply to the relationship with Mike, or indeed other people in Jane's life.

Nice post . I am in the same situation but a bit different . One depressed sister is in UK
and her sister is taking her to USA for treatment . As VISA is for only six months what mental illness can i give ?
Of course I will give her hypnotherapy . Any suggestions are welcome.
padma

padnar said:

Nice post . I am in the same situation but a bit different . One depressed sister is in UK
and her sister is taking her to USA for treatment . As VISA is for only six months what mental illness can i give ?
Of course I will give her hypnotherapy . Any suggestions are welcome.
padma

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One very common theme on these forums is people looking for a diagnostic term - an identifiable "mental illness" that they can use.

I spend much more of my life telling people that they're normal than I do diagnosing them. Of all the things that screw people up, make them unhappy and lower their ability to function, "Mental illness" is one tiny part. It is completely normal to be sad and hopeless when you lose your job and your partner leaves you. You'll feel better faster if you find a new job and a new partner than if you take a tablet. If I gave you "therapy" it would be about how you could spend your energy doing those things instead of dwelling on the bad stuff.

I understand why we seek labels. Society uses more than just money as currency. Labels get you things from extra support at school through to justifiable reasons to miss work in a society where you can't take a day off work because you're sad but you can if you're depressed.

The best advice I can give anyone wanting to write about mental illness is don't make your problem fit the label, define your problem then see if any of the labels fit....if they don't then don't worry. you've just created a formulation and that's much better than a diagnosis.

I'd approach it by using two sets of criteria.

1. Predisposing, Precipitating, Perpetuating
2. Biological, Psychological, Social



A. Why is your character vulnerable to their problems?
Do they have a biological reason, such as a family history of depression? A psychological one such as a very sensitive and shy personality or a miserable childhood with screwed up relationships? or a social one such as a poor education that means they can't read so can't get the job they want?

B. Why do they have it NOW?
Why have problems now instead of a year ago?....they'd still had a screwed up childhood then. What life events have just happened? What illness did they catch that might trigger it? What change in their social situation is effecting them?

c. Why haven't they managed to beat it?
Do they need medication or some help solving problems? Is it impossible to beat until they leave their abusive partner? Are they waiting for a court case that might bring in compensation that would be harmed by them being too well?


It's very possible to create a very believable character profile for someone so messed up they need help and support without needing to use a single diagnostic term and it's possible for someone to need masses of help and support without them needing "treatment" - treatment is another term that gets misused. If a friend does my shopping for three months because I have a broken leg that isn't treatment.....so if they do it because I'm depressed it isn't treatment either.....just good old fashioned help.If someone is lucky enough to have good friends and family they might not need anything more. The culture of "treatment" and "therapy" has grown around the fragmentation of society as more and more people don't have enough friends, and their family live a hundred miles away instead of around the corner.

Diagnostic labels are shorthand....they're telling, not showing. If you use your energy to create a believable character with well thought out problems then you don't need them. Use them if you want to, but you won't do any harm by avoiding them.

Craig

Ok Craig I will take up your suggstion and not label them .My character needs only love
and so she is depressed and thanks .
padma

First, a disclaimer - I'm not a psychiatrist. For either Dario or Padnar, if she sought out a solutions-focused therapist, they'd focus more on her present situation and how it's effecting her life instead of spending much time on her history. They'd most likely ask her some form of the miracle question, where if all her problems were miraculously fixed overnight, but she didn't know it, what would be the first thing she'd notice the next morning that would clue her in to the change?

Could also use a bit of info from a psychologist/psychiatrist on a character. In my current WIP that I'm editing, my main character was brutally assaulted by a man she trusted which left her disfigured. After being humiliated in public for her appearance, she great afraid to go out to public places, only able to drive to family and very trusted friends. What sort of techniques would a therapist advise she try when she's struggling with herself to go out? Right now, I have her doing a visualization of a trip to the grocery store, which fails, then mentally berating herself.

Collectonian said:

Could also use a bit of info from a psychologist/psychiatrist on a character. In my current WIP that I'm editing, my main character was brutally assaulted by a man she trusted which left her disfigured. After being humiliated in public for her appearance, she great afraid to go out to public places, only able to drive to family and very trusted friends. What sort of techniques would a therapist advise she try when she's struggling with herself to go out? Right now, I have her doing a visualization of a trip to the grocery store, which fails, then mentally berating herself.

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It feels like this is a bit of a two parter.

1. She'll need a little confidence back to be able to go out.
2. She'll need to be able to go out to get the bulk of her confidence back.

Start easy and gentle.
Visualisation and planning are a good place to start, as would be working on any post traumatic symptoms she may have. If visualisation is under her control, it can only fail if something is sabotaging it. Sounds like there is an automatic negative thought intruding that might even be akin to a flashback...something powerful enough to replace her intended outcome and derail her. A bit of cognitive behavioural therapy might help. Questions would be fairly obvious and try to figure out why she doesn't feel in control of her own thoughts. If she is experiencing flashbacks then some EMDR (eye movement desensitisation) might be useful.

Alongside this you do a lot of preperation.
What will you do if someone looks at you?
What can you do if someone says something?
What can you do if you have a panic attack?
What will you say if someone asks what happened to your face?


Once that's working then it's onto actually going out, but again start simply. I sometimes work out a points scheme when people get anxious going out, so, for example you get 1 point for going a little way down your street......and so on giving more points for more difficult things. Then you figure out how many points someone scored last week and set them that total plus 2 or 3. As an incentive you figure out a reward system for number of points gained (I work with children) Then week by week you up the total number of points they need to get.......it can be quite effective for very stuck cases as it does convince someone they are moving forwards and that gives them the confidence they need to do more.....people do feel pretty rotten if you set them a target they can't achieve so we try our hardest to avoid that.

Impatience is the biggest trap in this type of work. Someone ignores their therapists plan for them to walk halfway to the local shop and back because they think thy should be able to do more so theu plan a major city centre shopping trip. As a result you end up with a bad week where everything failed instead of a week with a few positives where you achieved a little. Sometimes the therapist's work is about slowing someone down and ensuring they don't fail.

Craig

Thanks, that some good information. The way the story is framed, she slowly regains her courage from finding acceptable from a child and his father (neighbors), after her love for animals pushes aside her fear long enough to have her help the child's puppy from a dangerous situation. I hadn't thought about PSD, but after what happened, she'd definitely be dealing with it. Also made me realized, I mentioned her having been to a therapist, but not what she's doing, if anything, after leaving the large city she was in to return to her more rural home town.

Thanks again, gave me a lot of places to research into