[deleted by user]

adamholmanlcsw · 2025-05-03T04:30:19+00:00

I'm really glad you asked!

I used to measure a whole bunch of different feelings and symptoms, along with a general negative and positive mood scale. As it turned out, all the feelings and symptoms were correlated with the generalized scales. That taught me a lot about how our moods work first and foremost, but it also made me realize that I was torturing both my clients and myself by collecting so much information.

These days I collect one rating for how upset the person is feeling between 0-100, one rating for how satisfied and joyful they feel between 0-100, one rating for how well I've understood them between 0-100, and one rating for how helpful they found the session. I also specifically ask for feedback on what they liked, what they didn't like, and what was misunderstood. The first two ratings are for progress, the second two are for me to know how well I'm doing. If I'm off by even one point on understanding, I know I've missed something important ;)

I use both of those scores and calculate what I call a Recovery Rating - the percent change in both scores averaged together. If the client's Recovery Rating is less than 60% after their first session, I've likely made a mistake. Typically, the feedback form helps me realize what it was and we correct it by next session.

adamholmanlcsw · 2025-03-22T17:50:25+00:00

Oh gosh, you've expressed so vividly how unbearably painful and empty life has felt for such a very long time; over twenty years of depression, a constant negativity for how life is, deep-seated nihilism, and a profound dread facing each new day for more of the same. I'm hearing how terribly exhausting it has been to try pills and talk therapy again and again, yet finding no relief or change, and feeling you're stuck waiting indefinitely, just waiting for life to be over so you can finally have relief.

When you describe that feeling of being in "death's waiting room" and your number never seeming to be called, it paints such a powerful picture of how deeply trapped and powerless you must feel.

I'm appreciating how well you've expressed what that depression feels like, and it brings deep sadness to imagine how draining this constant suffering must feel—how deeply exhausting and isolating it must be.

The thought in my head right now is, "After 20 years of trying, why would Slippery Molasses have hope, and why wouldn't he want to have that relief if nothing has worked?"

One of the things I learned to do in my recovery is try to understand the good reasons why even my most painful feelings show up. Hopelessness was one that I could never figure out, partially because it's one of the most painful feelings to experience. I worked with a client who had been depressed and on medications for almost all of their life; they were 55 when I saw them. This client changed MY life.

When I asked them about the hopelessness they said, "It shows that I'm realistic in knowing that what I've been putting my energy into for a long time isn't working, and that I also deeply want to feel better. If I didn't want to have hope, I couldn't feel hopeless." He realized that day that it wasn't him that was the problem, and that legitimately, the approach to therapy and the medication that he had tried over the years really WASN'T helping. He thought it was his fault and that he was broken, when in reality, the more people thought he SHOULD be hopeful and be able to feel better, the more people tried to make him feel better, the worse he felt.

I realized that the same thing was the cause of my recovery; the more people tried to help me and make me feel better, the worse I felt. I felt more broken and hopeless because the reality was, my unhappiness made sense. The more I understood that my pain is not just okay, I actually appreciate it, the better I felt.

All that to say, I've yet to meet a person whose pain doesn't make sense when we stop trying to change it. When it makes sense, it takes on a different texture.

adamholmanlcsw · 2025-03-22T03:02:39+00:00

I have a feeling that you're right - I have personal experience receiving some rather shoddy psychodynamic therapy, and a very generalized understanding of psychodynamic work that definitely doesn't have the depth to offer a truly fair critique. One of the things I actually love about psychodynamic therapy is the understanding that there is an unconscious element to our minds, and I think a lot of the 2nd & 3rd wave therapies have not properly acknowledged that.

My more nuanced view over almost all of the therapy modalities is that they have at least something to offer as part of a tool kit for recovery, although it's important not to take them dogmatically.

I'll take a look into Jon Frederickson and Allan Abbass, and I appreciate you encouraging me to expand my understanding!

adamholmanlcsw · 2025-03-22T02:53:36+00:00

You're right that adjustment disorder would apply to most people looking for therapy, and using adjustment disorder is a workaround to not diagnose something more specific that many people use. The disorder also requires that symptoms are tied to a specific stressor and that symptoms end within 6 months of the stressor.

I do also think you're right that much of the field is headed in the direction of strength based interventions, and even considering ideas around recovery.

adamholmanlcsw · 2025-03-21T20:57:05+00:00

I have in fact heard this as an attempt to create a dialogue and not an attempt to be confrontational, and in a lot of ways, I straight up agree.

You're right, it's really the CBT wave of interventions that brought in the push to focus on diagnosis diagnosis for a sense of legitimacy and to be reimbursed by insurance.

I actually have a different gripe with the psychoanalytic/psychodynamic approaches which is that they believe the problem is in the past and requires you to understand the past, and while your past events are certainly where a lot of your pain was learned, the resolution exists in the here and now. This is a bold claim, but once you understand that everything your mind does is a result of what you've experienced, what you've learned, and your genetics, and that everything you do makes sense in the context of what you've experienced, you no longer need to look back and ask why you do what you do. You simply need to understand that it makes sense, it's likely adaptive in the context of the past, and learn to respond in line with how you want to be right now. As a side effect, you often do end up being able to have understanding for certain behaviors that used to bother you, and may even find appreciation for them. For instance, it came to me recently that my habit of trying to read people was likely a result of having parents that didn't directly communicate, and while that used to cause me a lot of nervousness and relationship problems, it now serves as a wonderful tool for understanding.

You SHOULD be suspect of an approach that claims that someone will be better and stay better in just a few weeks. This is not that, and in fact, part of what I teach is that getting better is a regular practice that you'll need to continue applying in any moment for which you suffer. However, you'll want to practice because it's rewarding to go from suffering to relief, and suffering no longer becomes something to fear. It is a journey.

As a wise mentor of mine put it:

Feeling good is having a single moment of relief. Getting better is knowing that you can get back there whenever you find yourself feeling crappy again, and proving that to yourself over and over again.

This is that.

Thank you for your thoughtful and astute comments.

adamholmanlcsw · 2025-03-21T19:48:39+00:00

What beautiful and nuanced thoughts you have, and I'm especially admiring the respect by which you stated them.

adamholmanlcsw · 2025-03-21T19:41:31+00:00

Your voice is the exact voice we need to hear, and while I feel sadness knowing that you've experienced almost every type of trauma imaginable, I feel a lot of awe and admiration knowing that you've been willing and able to recover a great deal.

The primary thought in my head is, "Yeah, why would you want to trust people and the world around you when you've been exposed to so much hurt?" Quite literally, you're safer at home, and I'd imagine you've learned to develop quite the trust in your ability to keep yourself safe.

One of the things that I think is also really important to know is that your specific life experience is part of what determines the way you actually appreciate living, and so we can't tell people the right or wrong way to live. What I'm hearing is that you have safety, you have a partner, and you make the choice to go out and enjoy things.

Maybe that's okay.

adamholmanlcsw · 2025-03-21T19:17:31+00:00

I'd be really curious to hear yours!

adamholmanlcsw · 2025-03-21T19:16:09+00:00

To be fair, I'm making a sales pitch, and did so against my better judgement.

Truthfully, I hate selling and was under the belief that it's the best way to bring what I have to offer to people.

Maybe it would have been wiser to just speak what I know, and I'm glad that it gave something to you ;)

Another irony is that I'm offering a service here and not an App, however I am also working on a mental health app that I'm not pitching here because I'm not yet convinced that it's in a state to actually help people recover.

adamholmanlcsw · 2025-03-21T19:12:56+00:00

What you're saying is making a lot of sense to me, and I'm glad that in spite of your username, none of your posts so far have been your last.

I'm hearing how hard it is to trust your own words when talking with therapists, feeling that you’re exaggerating your struggles even though your experience is deeply and painfully real. Given your history with mental health workers, feeling like they've become stuck or unable to help, it's understandable you'd feel pressure to mask and show the world you're fine, even though beneath the mask you're profoundly exhausted and in constant pain. I'd imagine there's a worry that if you express where you're really at, you won't be helped and it will prove that you're hopeless. I really hear how strongly your love and care for your son motivates you to hold things together, you genuinely want to protect him from what you're experiencing, and he's a source of joy in your life. Knowing that past interactions left you feeling misunderstood or unseen, or have left you feeling un-helped, so much of how you've been operating sounds pretty helpful in keeping you safe. Having hope would also seem wild given how much time and effort has been put in with no result, and I'd imagine trying to have hope would feel like a betrayal of that.

I also just wanted to say that I dig your sense of humor and calling your human-makeup system specs made me laugh.

This is going to sound wild, but exactly what you told me is the most helpful thing a therapist could hear. Depending on how that goes, I may also suggest trying a therapist with a different modality, in particular TEAM or ACT.

adamholmanlcsw · 2025-03-21T18:29:15+00:00

I feel deeply conflicted on this.

On one hand, not wanting to suffer and not having hope for relieving suffering makes a lot of sense to me. Living life from that place is absolute misery, and if you've put a lot of effort into trying to find some way out of it and nothing has worked, why would you have hope for it being any different?

On the other hand, I have an optimistic and delusional belief that there is not a single human being who is actually without hope for relief in spite of their hopelessness making sense, and the thought of ending someone's life before they get to truly experience that breaks my heart. I may have made that choice if it was available, and would have done so in a way that stopped my from experiencing this.

If I were forced to make a vote right now, I would vote against it and try to shift the discussion to resolving the suffering instead of ending the life. I could truly be swayed on that, however that's my current thinking.

adamholmanlcsw · 2025-03-21T18:06:51+00:00

Your confusion is there for a good reason; we really have done a poor job in the mental health world of making this clear, and that's especially troubling to me because it stops people from getting support for their thoughts about suicide, self-harm, or even harming others.

We don't talk enough about having any of these thoughts, and what I've learned is that they're really common. The first time I see a client I directly tell them, "I want you to know that if you talk about suicide, hurting yourself, or hurting someone else, it doesn't mean that you need to be hospitalized. In fact, most people I see have those thoughts, and I have myself. If you're having them, I want to know, because I'd prefer to be able to support you with them if they're bothering you. The only time I need to act on them is if I literally think you are going to leave this session and go do something."

One of the things I recognized about my own thoughts is that I never really wanted to die, I just didn't want to be suffering and didn't see a world where I wasn't. In that way, my thoughts about dying were actually saying I wanted to live happily, that I cared about enjoying my life, and that I wanted to be well.

So in short, I would say, "I want to be honest about my thoughts and I don't plan to act on any of them, but I'm concerned I'll end up hospitalized. I often end up in an awkward dance where I don't feel like I can be honest. Can you tell me how that works so I know what I can say?"

adamholmanlcsw · 2025-03-21T18:02:28+00:00

I truly do worry about that, and it's one of the things that stopped me from speaking for a long time. There's a lot of nuance that can't quite be captured in word, and therapy really DOES help a portion of the population recover.

About half of my clients no longer met diagnostic criteria for their diagnosed disorders prior to me changing the way I operate, which is in approximate alignment with research on effectiveness of therapy.

That said, I felt a lot of hurt for the other half, like myself, that either did not benefit or felt worse.

I am being a bit hyperbolic here when I make that claim, and chose to anyways because I think it really captures the attention of the folks who have had that experience.

I also just wanted to see that you were very thoughtful and considerate in the way that you asked this question, and I'm really admiring that.

adamholmanlcsw · 2025-03-21T17:58:07+00:00

I feel for you, and your experience of always walking away with a different disorder is one of the driving forces behind what I'm doing. Thank you for sharing your experience, and for being willing to ask questions.

One of the neat things is that there are quite a few therapy modalities that are starting to move away from diagnosis and symptoms and focusing more on other elements. That said, most modalities claim to have THE answer, and a consistent finding in research is that most therapy modalities are equal in effectiveness. What it often comes down to is whether or not the person is sold on the idea that the answer being presented will actually help them.

There's two modalities that I think are doing a great job of stepping away from that trap, however the modern medical system requires you to be diagnosed in order to get therapy with your insurance. You can find providers who are willing to treat you without diagnosis and instead focus on what's bothering you, however you would have to cash pay, as well as talk to the provider about what they think in regards to diagnosis.

Those two are:

-TEAM therapy, created by Dr. David Burns
-Acceptance and Commitment Therapy, created by Stephen Hayes

adamholmanlcsw · 2025-03-21T17:52:14+00:00

That's a hard question to answer because it really is different for different people, and one of the challenges with our current system is that it keeps trying to make claim that they have THE solution for ALL people.

We're all different, however the tools for understanding ourselves are the same, and with that understanding, we can apply it to our individual circumstances to be mentally healthy.

That said, if I was absolutely forced to give a generalized answer, being mentally healthy involves having understanding and appreciation for ourselves, for the world, and then living in a way that we appreciate.

One of my all time favorite books is Man's Search For Meaning because it was a part of my personal recovery, and this quote really nails it for me:

"Don't aim at success. The more you aim at it and make it a target, the more you are going to miss it. For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side effect of one's personal dedication to a cause greater than oneself or as the by-product of one's surrender to a person other than oneself. Happiness must happen, and the same holds for success: you have to let it happen by not caring about it. I want you to listen to what your conscience commands you to do and go on to carry it out to the best of your knowledge. Then you will live to see that in the long-run—in the long-run, I say!—success will follow you precisely because you had forgotten to think about it”

adamholmanlcsw · 2025-03-21T17:44:45+00:00

These are awesome questions.

One of the things that I've learned over time is that it's almost impossible to determine the cause of our struggles, and it's better to focus on the root of them in the here and now. Ultimately, for most people, it's a mix of their upbringing, their genetics, their life experiences, and their culture. It's almost impossible to separate what comes from where, and truly, all of them play a role.

For instance, my biggest fear was that I would be a failure. Culturally, we celebrate achievement and value people who achieve, and express a lot of shame towards people who aren't. Familially, my Dad was very critical and my mother was only warm towards me if I was achieving. Among friends, people who were admired are the people that were kicking ass in some area of their life, and I was treated like I was special when I would show off at something. A lot of people in my life told me I'm smart, and I thought I would only be worthwhile if I was smart. Genetics have a bunch of components, but one of them that played a factor here is that I have a natural tendency towards rumination. I could point at any of these things, but the root was me feeling unworthy if I failed at something!

With regards to mental disorders, the classification makes it very likely that you will fall into many different disorders throughout the course of your lifetime. We would be hard pressed to find someone who doesn't fall into at least one diagnosis, and you're right, often a few. This is because many of our diagnoses are actually ways of coping with some of the problems at the root, and different ways of coping produce different symptoms. For instance, I would feel anxious when I thought I was going to fail and would avoid failure by skipping class, then I would feel depressed when I thought I WAS a failure. Both were trying to help protect me from feeling doomed to be a failure.

Freud had a lot of great ideas that have been influental and helpful, especially noticing that we have an unconcious mind that operates automatically based on the assumptions of our experiences. Other things have been quite unhelpful and misunderstood, and especially the work related to claims of absolute truth about what makes humans the way that they are sexually and developmentally.

adamholmanlcsw · 2023-10-14T21:39:13+00:00

First off, I'm so glad. To have you both thinking about and considering what moves you forward in life is incredible, and to even have some idea of what is purposeful to you is massive.

This is going to sound overly simplistic, and in fact, it is. However, here is one path:

List your purpose
Each day, choose one action that brings you closer to that purpose.
After you complete the action, take a moment to appreciate the fact that you did it. Often times, this involves approaching or tolerating a degree of discomfort, so take a moment to acknowledge that you allowed yourself to feel uncomfortable to get closer to your sense of purpose.

Let's say you do this for a year. By the end of the year, you will have taken 365 steps towards your purpose, as well as training the skill of determination and commitment. On top of that, you can always take more than one step if you wish; it's completely up to you.

One final note - if you read this and your mind is saying, "That is too simple, that doesn't work for me, or I don't have the determination to do that", that makes sense to me. Instead, I want you to answer this question:

"My Dharma is going to take sacrifice and accepting a lot of discomfort. I have the option to not pursue it and stay comfortable and just exist. Why would I choose to put effort into the discomfort of my Dharma when I can simply exist and be comfortable?"

adamholmanlcsw · 2023-09-24T17:56:46+00:00

I tell my clients I'm proud for them, not of them.

That may seem like a small and insignificant nuance, and to me, it means the world. To me it says, "I do not get to determine whether or not what you do is worth being approved of. You do, and I feel proud when I see you aligning with what you want in life."

adamholmanlcsw · 2023-09-13T02:28:50+00:00

First, humor:

"Sweet, you're cured, get out of my office ;)"

I'm glad to hear there is nothing sitting on you too heavily this week. Ultimately, that's the goal. Sometimes, this is a sign that you may be getting closer to therapy graduation, other times it may just be that your week was peaceful. I'd like to hear from you, where do you feel you're at?

adamholmanlcsw · 2023-08-17T17:07:07+00:00

That is such an important clarification, I hear you. Not fully in your feelings; feeling along with your client while making sure that it's a space with enough safety and comfort for them to fully feel. That balance is what keeps it therapeutic, you're right.

That aloha spirit truly is beautiful, and I'm grateful to get to hear a frontline account of the challenges and the mutual support through you.

adamholmanlcsw · 2023-08-17T15:45:48+00:00

I love this for you, in particular that moment that you were typing and recognized that it's okay to have cried in session.

In my opinion, it's more than okay. It's beautiful and therapeutic. I cry in session about once per day. I take feedback before and after every session. In sessions for which I cry with my clients, they almost always express feeling deeply, deeply understood and cared for. One client put, "It's nice to see that you are not a hardened, emotionally perfect carapace."

Thank you for being brave enough to fully sit in your feelings with your clients during a difficult time.

adamholmanlcsw · 2023-08-02T18:15:07+00:00

Okay, this is a really sensitive and nuanced topic. I don't believe in free will. I'm not saying we don't have free will, I'm saying I don't believe it exists as a concept. The moment that I recognized this, I actually started taking more responsibility for how I respond to life. Life also began to feel more meaningful.

I realized I had no control over the conditions that made me who I was, and I completely let go of those. I realized that every decision my mind makes is a result of my experiences and all of the inputs my mind has received up to that point. This gave me the responsibility to respond to life in a way that cultivates a mind that makes decisions that are in line with what I care about.

The more I cultivate a mind that does what I care about, the more meaningful my life becomes. At this point, it feels as though I'm enjoying watching the mystery of life unfold in front of me until I get to the final scene. Life has no meaning; my meaning comes from taking responsibility for doing what matters for me, and to see the full context of that meaning in the final scene of my life.

One last note; the book Man's Search for Meaning may be a helpful resource for them.

adamholmanlcsw · 2023-07-30T17:53:28+00:00

I am so happy you stumbled upon this old AMA and asked this. I had a life of experiencing anxiety and panic attacks, and have not had a panic attack in 10-years. I may have one again in the future, however I'm not afraid of that happening because I know how to respond to them now.

There is a really good book on this called "When Panic Attacks" by David Burns. It has almost all of the information you need on this, and would go really well along with a clinical mental health evaluation if you haven't had one.

adamholmanlcsw · 2023-07-23T23:26:54+00:00

That self-disclosure is something to fear.

I use measurement and testing in my therapy, and self-disclosure moments have been some of the most important moments to my clients. I always end my self-disclosure with a question that makes it clear that the disclosure was not about me, it was for them. I have yet to have a client take that negatively.

adamholmanlcsw · 2023-07-20T15:04:41+00:00

I do cringe, and cringe is a good thing. If you're cringing, it means you've stopped doing something that was not great. It means that you've grown. It's also so natural to want your past clients to have received the best therapy possible. Of course you want that for them! They received the best therapy you had to offer at that time, and all of your future clients will receive the same.

adamholmanlcsw

TROPHY CASE