MDA / Quest Vol 11 No 2 /Therapy Is Where You Find It

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QUEST Volume 11, Number 2, MARCH/APRIL 2004

Anxiety, depression, stress, fatigue — for those in a world of hurt, there's a world of help.

by Jan Blaustone

Everyone can use a mental health boost now and then. Sometimes a few laughs or a prayer will do it. At other times, you can try all your usual coping methods yet still have irritable mood swings nearly every day.

You may find you cant concentrate or have no interest in doing things you once enjoyed; your sleeping or eating habits change; you feel either fatigued and emotionally drained or restless; you have feelings of sadness, hopelessness or helplessness.

Sounds like a television commercial. True to the commercials, these symptoms can be signs of depression or anxiety. If you have symptoms like these, dont assume theyre just part of having a neuromuscular disease. Many things can cause depression, anxiety, anger, frustration, helplessness including organic problems unrelated to neuromuscular disease, or an accumulation of stresses from many sources.

Help Is Out There

Whether you can identify one of these conditions as whats ailing you, or you just feel the need to discuss your feelings about your life, counseling is a helpful tool. Basically, psychotherapy and other forms of counseling are aimed at helping you develop new ways to cope with problems, and to identify and understand more about the way you feel, so youre better prepared to avoid its complications in the future.

Nancy Nereo is a clinical assistant professor at the University of CaliforniaSan Diego School of Medicine and a clinical psychologist at Childrens Hospital and Health Center in San Diego. She makes the point that just having symptoms of mental or emotional distress doesnt necessarily mean you have a clinical diagnosis.

Nereo has been a guest speaker at the San Diego MDA parents support group and often works with families and children served by MDA.

"People may have a full-blown depression or anxiety disorder, or may experience just some of the symptoms. Either scenario may cause distress significant for seeking help and [they] may benefit from intervention," Nereo says. "If these sorts of symptoms are causing distress or interfering with usual activities work, spending time with family and friends, etc. then a person could consider seeking help."

Depression is an equal opportunity medical illness that changes the way a person behaves and thinks, and it should be treated by a professional.

"With regard to anxiety," Nereo says, "people may feel on edge or may worry excessively about particular issues without being able to control that worry. Sometimes they avoid certain situations because of fears of what might occur."

Stressful events such as divorce, job loss and changes brought on by chronic disease can trigger depression or anxiety that doesnt seem to go away.

Talk to Somebody

Gloria Hamilton, professor of clinical psychology at Middle Tennessee State University in Murfreesboro, advocates a holistic approach to recovering your mental health. It often doesnt matter whether you talk with a family therapist, a religious adviser, a psychologist, social worker, psychiatrist or friend, says Hamilton, who has spoken at MDA seminars and support groups.

MDA provides nearly 300 support groups nationwide where you can share your feelings and exchange resource information with others affected by neuromuscular diseases. Theyre offered at no cost to people registered with MDA, their families and caregivers. In addition, the MDA Web site offers numerous online chats, some of them clinical in nature, others purely for resourceful support and socializing (www. mdausa.org/chat).

"Whats important is that you talk about your feelings, and a good friend can be the best therapy around," Hamilton says. However, she adds, "Everyone who is alive goes through times and situations that would be helped by counseling."

Those situations can include the losses of ability and strength that come with a progressive neuromuscular disease. One man said that having a form of muscular dystrophy is "like someone you love and care about deeply dies each and every year."


	Laura A. Frobel, a licensed social worker at Rhode Island Hospital in Providence, leads an MDA parents support group in Warwick. Photos by David Witbeck

Find a Professional

How can you tell when you may need help beyond that of friends and your usual coping mechanisms?

"I advise people to seek help when their feelings are affecting their daily functioning, when they are feeling overwhelmed, having feelings of hopelessness, hurting themselves, or hurting others," says Laura A. Frobel, a licensed social worker who works with the Pediatric MDA Clinic at Rhode Island Hospital in Providence and facilitates the MDA parents support group in Warwick, R.I.

Mara Rubio, a licensed clinical social worker and licensed marriage and family therapist in the Department of Family Medicine at Texas Tech University Health Sciences Center in El Paso, says, "Its so common and natural for patients to dismiss their gut feelings that a problem exists. They tend to wait it out, thinking theyll get past it or it will just go away on its own.

"I urge my patients to pay attention to their gut feelings because they usually are a clue that help is warranted. Rather than feeling weak or ashamed to ask for help, its really a sign of maturity to recognize the need."

Frobel adds, "Assistance can be in a group or individual counseling.

"A group would be most advantageous for those who feel they need added support to discuss common issues. Individual counseling is best for those who do not feel comfortable speaking in a group, who are experiencing significant difficulty coping, and when further psychiatric assessment may be needed."

Choose the Right One

Which type of counselor should you choose? How can you tell whether someone can help you?

Studies show no differences in effectiveness of counseling across degrees, licenses or years of education, Hamilton says.

"Characteristics of the counselor and counselee make the difference in the outcome of counseling," Hamilton says. "Asking the professional youre considering for a brief telephone conversation to see if you may be a good fit is not uncommon."

Social workers have a two- or three-year graduate degree in social work (M.S.W. or L.C.S.W.) and three years applied experience, which may include training in conducting therapy. Psychiatrists have a medical degree and have completed a three-year residency (post-medical school) in psychiatry; they can prescribe drugs or other medical interventions.

Clinical or counseling psychologists have a doctoral degree (Ph.D. or Psy.D.) that involves five or more years of graduate study after college. The focus of their training is usually therapy and research.

Marriage or family therapists (often referred to as counselors) have a two-year masters degree (M.F.T., M.F.C.C.) and their training focuses exclusively on therapy. Counselors who have masters degrees in counseling, including pastoral or family counseling, can be licensed to practice independently.

Religious counselors may have a degree (usually a bachelors) in any of these fields, along with religious training. Or this professional may get a masters degree in pastoral counseling.

Each type of counselor is licensed by a professional group or board with a state or national license that can be verified over the Internet.

Whomever you may choose as your counselor, your comfort level with the person is probably the most important factor for getting the help you need. Your willingness to discuss feelings is perhaps the best gauge of success.

Heal the Family

Rubio, who teaches behavioral medicine and sees patients, advocates that good family support is a big plus for healing. But sometimes it takes more.

"Sharing your feelings is the first step to healing but it also means youll need a good listener on the other end. Try as they will, sometimes our family and friends dont understand or appreciate what an individual may be going through, which only adds to that persons pain and frustration," she says.

Sometimes emotional pain involves more than one member of the family.

"Its important that parents first address their own emotional issues because kids learn from example," Rubio says. "Dont feel that its bad to cry in front of your children, for example. Explain that you are sad so your children learn that its safe to express and talk about their feelings."

Nereo adds, "When working with children with chronic medical illnesses, especially those illnesses that come with a lot of daily care requirements, family therapy can be helpful for encouraging improved family communication and cohesion."

Pick an Approach

Besides the variety of counseling professionals available, there are also many techniques that can be applied in addition to, or in lieu of, traditional psychotherapy (sometimes called "talk therapy") or drugs. Such options may include relaxation training, stress management, positive psychology, nutritional counseling, coping skills training or spiritual counseling.

"You dont need a severe psychiatric condition to benefit from treatment (psychotherapy)," Nereo says. "Often new transitions or adjustments can take their toll, and a little extra support can help people get through it and develop new skills for the future."

"Good therapy changes the brain just as drugs do but without the adverse effects," adds Hamilton.

Drug therapy today is big business, but it isnt always the best medicine for emotional anxiety.

"With the advent of consumer education for pharmaceuticals," says Nereo, "I have concerns that people may think a pill can fix any negative symptom or that we shouldnt have any negative feelings. We all do, and for perfectly good reasons.

"The bright side," she adds, "is that the hype has led to greater education about psychological problems and greater acceptance, I hope, of the fact that many people experience such problems. I hope it leads to greater advocacy and greater access to services."

There are some effective antidepressants and anti-anxiety drugs on the market, nonetheless.

"Drugs today are much improved with far less side effects than they were just a few years ago," says Rubio. "Medicines can give patients a break, give them the energy to work on their skills and participate in their counseling sessions more efficiently. A combination of counseling and medicine is far more effective in most cases than relying on only one or the other."

Hamilton warns: "Dont expect all your ills to be gone after acquiring a prescription. It is important to remember that healing is not necessarily the same thing as total recovery. Healing occurs at many levels, including that of relationships."

Check Your Physical Health

Just as drug therapy and counseling often work well together, so is ones mental well-being affected by ones physical state.

Counseling can include motivating and educating the patient about making better living choices (appropriate exercise, not smoking, adequate sleep or respite, moderate or no drinking, better nutrition, etc.) which will lead to improved physical health.

"Once ones physical health improves, energy and self-esteem go up with a renewed sense of empowerment," Frobel says. "This is especially true for caregivers on overload."

One reason doctors and patients often choose drugs over counseling is because of the confusion about health insurance coverage for counseling sessions. Each type of professional accepts different coverage, so ask your insurer if it covers services by the counseling professional youd like to see.

Some insurance companies dont cover services from private practice professionals only those available through hospitals and clinics. Most insurance will cover six to 10 sessions of therapy and few have restrictions on prescribed medicines.

Medicaid recipients may find there are strict limits on the types of providers theyll reimburse for counseling. Medicare coverage can vary from one locale to another.

Sometimes churches pay counselors for services for their church members.

Many Web sites offer online counseling, but professionals dont recommend it.

"I dont see how anyone could possibly give a good assessment to a patient by merely chatting over the Internet," says Rubio. "I wont counsel over the phone unless its with someone Ive already assessed and they are in a crisis or emergency."

When seeking assistance for your mental well-being, a social worker can be the best "traffic director" at your intersection in life. Social workers have extensive resources and helpful information everything from health insurance assistance to community programs, therapist referrals, and local contacts who can cut through red tape.

Most MDA clinics have social workers available, and MDA clinic team members or support group facilitators usually can refer you to a professional counselor or social worker familiar with neuromuscular diseases.

Rubio says, "Ive volunteered with MDA for over 10 years, facilitating support groups, lecturing on stress, anxiety and depression. There is so much out there to benefit from, but these people cant help unless you ask."

Mental Health Resources

Books

Chronically Happy: Joyful Living in Spite of Chronic Illness, by Lori Hartwell. Poetic Media Press, 2002.

The Feeling Good Handbook, by David D. Burns, M.D. Plume, 1999.
Healing and the Mind, by Bill Moyers. Main Street Books, 1995.

Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, by Zindel V. Segal, J. Mark G. Williams and John D. Teasdale. Guilford Press, 2001.

The Parent to Parent Handbook: Connecting Families of Children With Special Needs, by Betsy Santelli et al. Brookes Publishing, 2001.

The Resilient Family: Living With Your Childs Illness or Disability, by Paul W. Power, Sc.D., and Arthur Dell Orto, Ph.D. Sorin Books, 2003.

Self-Coaching: How to Heal Anxiety and Depression, by Joseph J. Luciani. John Wiley & Sons, 2001.

Uncommon Fathers: Reflections on Raising a Child With a Disability, ed. by Donald J. Meyer. Woodbine House, 1995.

When Your Child Has a Disability The Complete Sourcebook of Daily and Medical Care, ed. by Mark L. Batshaw, M.D. Brookes Publishing, 2001.

You Will Dream New Dreams: Inspiring Personal Stories by Parents of Children with Disabilities, by Stanley D. Klein, Ph.D., and Kim Schive. Kensington Publishing, 2001.

For a related story see On Both Sides of the Therapy Room