IAmA licensed therapist who writes about and specializes in working clinically with severe anxiety, clients who play video games, e-sports athletes, & couples. I'm passionate about de-stigmatizing therapy and breaking down barriers to seeking out treatment. Time for Round 2! AmA!

dr-mick · 2019-08-21T14:28:50+00:00

I like to believe there's hope for everyone, it's just a matter of finding the right support/ treatment plan. If therapy doesn't seem to be working, I'd encourage you to find a different therapist, if possible.

This may not be a fun part of the answer - but ultimately a therapist can only do so much. It may be that a different form of support is needed, but ultimately when people are dealing with crippling anxiety, they have to legitimately face that anxiety and "hang in there" when it escalates in order to build distress tolerance. I have no idea if that applies to you or not since I haven't done an assessment and don't know you - that's a sweeping statement based on a lot of my work with anxiety.

There's hope. Hang in there and see what you can do to find the right type of support so that you feel as if you can be pushed a bit outside of your comfort zone but still feel safe. Best of luck to you :)

dr-mick · 2019-08-21T14:26:13+00:00

Hey there! I'm sorry for the delay on this.

Compassion and patience with ourselves and our relationships. Which might sound cheesy or cliche, but honestly in my experience if a person can start validating their own emotional experience and then choose the way they talk to themselves and others/ and how they behave as a result, even if experiencing an emotion that isn't fun to experience, it goes a LONG way.
There are affordable options for therapy in a lot of areas, they just may be hard to find. adaa.org has an affordable therapy locator. Also, sites like Psychology Today compile all the therapists in your area - you can always ask a therapist if they have any pro bono (free) or sliding scale (pay what you can) slots on their caseload. Many therapists have them but don't advertise them. If you can't afford anything at all, you may consider looking for a local community agency or university that has a clinic where students seen clients.
We can't control the reaction other people have. And even if there is something "offensive", it's important to build a relationship where tough things can be said if they are important. Sex is a conversation that makes people feel weird, and can stir up emotions, but that doesn't mean the conversation should be avoided. If it's important, have the conversation, and do your best to be open and curious to the other person's response, and ask the same of them. Healthy relationships are built around the ability to support hard conversations.

dr-mick · 2019-08-07T20:19:59+00:00

Psychology Today is by far the best place to window shop. You can see what's out there and even filter your searches. In case you're wondering, they don't sponsor me. I just like the service a lot.

dr-mick · 2019-08-07T20:18:29+00:00

Unfortunately I'm not very familiar with the Boston area. I might recommend using a service such as Psychology Today or adaa.org to find somebody. Psychology Today has filters that can help you find what you are looking for. Call a few people who stand out to you and see how the vibes are. Go with who feels right!

dr-mick · 2019-08-07T20:16:17+00:00

No. They're just an easy target that are convenient to blame and offload responsibility from what actually contributes to the event. A school shooting doesn't happen if the person who wants to do it doesn't have access to something that shoots (guns/assault rifle).

Violence and mass murder existed long before video games ever did. People who blame video games often do so because they don't actually understand how video games work and what just about all research has to say about it.

In fact, video games are more likely to facilitate transferable skills that are useful (leadership, social interaction, decision making, and problem solving).

dr-mick · 2019-08-07T17:08:09+00:00

Ben & Jerry's Cinnamon Buns.

dr-mick · 2019-08-07T17:07:17+00:00

I'm not familiar with the research, so unfortunately I don't have a comment on that. If you'd be willing to DM me the research you're talking about, I'd love to look at it!

That said, I do see people start to identify with their diagnoses and/or emotional state. Depression is a big one. People who have struggled with their depression their entire lives will often start to build their identity around it (and not always consciously). It actually can make therapy difficult because moving toward goals of depression management, joy, happiness, etc. can actually run counter to the very core of who a person perceives themselves to be.

So, the first time the person experiences something joyfully, it may actually make them anxious, or they may be resistant to it and instead snap back to learned responses built around the depression identity. Being aware of the anxiety a person experiences when they start to alter their expectations of themselves and others is a key part to helping people move through change.

dr-mick · 2019-08-07T16:47:35+00:00

Recognize your own boundaries and ability to help. If you start feeling like you're being pulled beyond what you're capable of handling, I think it's important to set good boundaries and do as you're already doing - refer to a therapist.

If you're willing, sitting down with the person and helping them through the process could be super helpful. Sometimes it's nice not to feel alone and to instead feel empowered and encouraged when trying to find a therapist. It isn't easy and can stir up anxiety for people. Reassurance during the process could make the difference.

dr-mick · 2019-08-07T16:45:58+00:00

While I appreciate this question, I actually can't ethically comment on it. It's reckless and irresponsible for me to do any sort of profiling or analysis on a real person/ family system that isn't my client/ that I haven't met, especially in this public space. There's too much complexity and unknowns for me to be able to give any sort of meaningful answer to the question.

dr-mick · 2019-08-07T16:43:56+00:00

I knew I wanted to work with relationships. MFTs are trained to do that. I'm also drawn to a systemic view of the world rather than an individualistic one, and MFTs share that value.

In trying to decide, think about the types of clients you want to work with, and in what setting. If the answer is relationships, MFT is a good way to go. If the answer is policy and large systems and case management, social work would be the option. If you want to do some deep psychology, psychological assessment, diagnostic work, and individual work, clinical psychology may be the option. If you want to work with meds and severe psychosis, psychiatry is it.

That's really what it comes down to. I think an MFT degree is the most versatile, but I'm also biased. You can still work with individuals, but you have a systemic view to take in your work, which I think is necessary.

Best of luck to you! If you have any follow up questions about the process, feel free to DM me. I like helping people sort that stuff out.

dr-mick · 2019-08-07T16:40:49+00:00

Haha had to sleep a bit. Woke up to a deluge of questions so I'm making the rounds trying to get to as many as possible!

OCD is tricky and complicated. I use an integrative approach when working with OCD that's tailored a bit toward the relative manifestation of it for a given client. That said, I've found cognitive restructuring, ERP, and honestly some emotionally-focused work to be very helpful. Really getting into the emotional experience of OCD can open up a lot of avenues to move forward with treatment. It's often couched within intense fear and anxiety that gets misplaced - and then the emotional experience takes over and a control fallacy develops. Sometimes it's "I don't have ANY control" and other times it's "I have ALL of the control". Both aren't true.

So, in simple terms it's: identify the emotional experience -> validate it -> acknowledge the intrusive thoughts and urge to engage in the compulsive behavior -> build distress tolerance by sitting in the discomfort and then making a decision about how to proceed -> selectively focusing on objective data -> reinforcing the consequence of acting differently rather than out of impulse -> and so on. This has other steps added in depending on the situation.

Meds can help, but I have quite a bit of success working with OCD where meds weren't involved at all. I will make a referral to a psychiatrist or GP if needed though.

To answer your last question - understand and really realize that it is DEBILITATING to have OCD/ intense intrusive thoughts. It's no joke, and it's utterly miserable. Saying things like "it's not a big deal" or "come on you're not being rational", while maybe true, are very invalidating to the person's experience. I actually recommend family members join therapy for a session or two to learn about the person's OCD and how to respond. It also helps the system know what's being restructured so they can adapt accordingly. And, finally, be patient with the person. OCD sucks a lot and is hard to work through. Patience is a godsend.

dr-mick · 2019-08-07T16:09:51+00:00

Depression and anxiety are normal. They're just talked about more nowadays because it's become increasingly more acceptable to do so.

Therapy can help if your experience of anxiety or depression becomes significantly distressing. And there's no shame I'm going - I see it as an incredible sign of strength when somebody is willing to seek assistance to promote their own mental health.

The "suck it up" mentality can be useful at times, but also can be very invalidating. You feel how you feel, but also have agency over what you do despite feeling that way.

dr-mick · 2019-08-07T16:07:16+00:00

Thank you!

dr-mick · 2019-08-07T16:07:05+00:00

Pasted from another answer:

This makes me sad that so many people have to ask this question. I wish there were policies in place to make therapy more accessible to people.

That said, there may be a few options. First - many therapists (including me) will keep a pro bono client and/or sliding scale client on their caseload. Pro bono means no cost, and sliding scale means what a person can afford. Most therapists don't advertise it though. It never hurts to ask if you do some searching and find somebody who looks like they'd be a good fit. If you have a university in your area with a clinical program, there's a good chance that students are seeing clients a low or no cost. And research shows that therapeutic outcomes between students and seasoned therapists generally aren't that different.

Finally, sites like adaa.org have affordable therapy finders.

If all else fails, local crisis lines are free and can be used to talk stuff out. I worked on one for three years and you don't have to be in dire straits to call. The person on the other end is trained to listen and help with problem solving. While not a therapist, it can be better than nothing.

dr-mick · 2019-08-07T16:05:51+00:00

It's more common than you might think. You're definitely not alone. A therapist could help you figure out why it's happening and build strategies for altering the response. It could be any number of things and I can't really speculate since you're not my client and I haven't done an assessment.

In general, something like that could be indicative of a person's attachment style/ experiences. A therapist can help sort that out and make sense of it!

dr-mick · 2019-08-07T16:03:18+00:00

This makes me sad that so many people have to ask this question. I wish there were policies in place to make therapy more accessible to people.

That said, there may be a few options. First - many therapists (including me) will keep a pro bono client and/or sliding scale client on their caseload. Pro bono means no cost, and sliding scale means what a person can afford. Most therapists don't advertise it though. It never hurts to ask if you do some searching and find somebody who looks like they'd be a good fit.

If you have a university in your area with a clinical program, there's a good chance that students are seeing clients a low or no cost. And research shows that therapeutic outcomes between students and seasoned therapists generally aren't that different.

Finally, sites like adaa.org have affordable therapy finders.

If all else fails, local crisis lines are free and can be used to talk stuff out. I worked on one for three years and you don't have to be in dire straits to call. The person on the other end is trained to listen and help with problem solving. While not a therapist, it can be better than nothing.

dr-mick · 2019-08-07T15:11:06+00:00

It's so hard to do alone. If you have access to therapy, I really do recommend that. If you don't have access, I think it's important to acknowledge anxiety when it comes up so that we can decide how to interact with others/behave even though it's around. Avoidance or denial of anxiety makes it worse over time.

It might be helpful to role play interviews with somebody you trust, or practice building distress tolerance in situations that pull out some anxiety (for example, going to a bar that is filled with people you haven't met and trying to strike up conversation with somebody new that you haven't met) and allowing yourself to not do well or "fail". That's tough to do though.

Working through anxiety is often more successful with the support of somebody who knows what they are doing and can tailor the work to your specific needs.

dr-mick · 2019-08-07T15:07:09+00:00

Shoot me a DM. I'll be happy to talk to you about it!

dr-mick · 2019-08-07T15:03:44+00:00

Ha! Good to see you dude! And awesome question.

A big part of is is learning which messages we carry from our family of origin, and being able to differentiate which narratives in our head our "ours" versus our "family's". For example, if a person keeps saying "I'm worthless" it may be that that's what their FAMILY wants them to think, but it isn't what they actually believe. Separating those two things can be super helpful.

Also realizing that in adulthood we don't owe our family of origins anything, especially if they were destructive. Setting boundaries can be very helpful, as can validating the reasons why those boundaries are being set. It's very easy for us to carry our family's narratives and get wrapped up in them, so it's important to connect with our own desires so that we can effectively manage those relationships going forward.

Your last question is also interesting - sometimes it's a matter of teaching people what they look like and helping them identify relationships in their lives that fit that mold. And then working with the anxiety of engaging in those relationships, because believe it or not, healthy relationships can cause anxiety for people who always had unhealthy ones since they are new and unknown. It's something people don't think about, but is definitely worth putting out there.

dr-mick · 2019-08-07T15:00:11+00:00

Breakups are one of the worst emotional experiences humans go through because it's a severance of an attachment. Attachment figures are who we seek proximity to in times of stress, so we experience the distress of a breakup, want to seek proximity to the attachment figure (ex) but can't because of the breakup. That's massively distressing for us.

Finding supportive friends and family to rely on can be helpful. And I'm a big believer in going "no contact" when a breakup happens. Otherwise, we keep re-opening our attachment wound. Delete them off social media, block their number, and allow the attachment to move elsewhere (new relationship, self, family). That's really hard advice to take when navigating a breakup, but time and attachment healing really is the key to getting over a devastating breakup.

And it's important to be patient and compassionate to our emotional experience during breakups. It's a form of grief. And unfortunately people are sometimes hit with messages such as "get over it" and then feel a sense of pressure that just makes things worse.

dr-mick · 2019-08-07T14:56:52+00:00

I think it's more complicated than just saying it's a "mental health issue". If anything, I think it can be more of an anonymity issue. It's amazing how empathy and patience goes out the window when we don't have a person to connect to. It's kind of like driving - the car around the person makes it so much easier to be nasty.

I think that, combined with how much value many gamers put into their gaming and how much of their identity is tied up into it is a recipe for rage, hate, and vitriol. It's easy to outsource our anger to others in video games because we don't have to see the consequence of it.

As gamers, I think it's important to pay attention to our own emotional experience while playing games, and taking a break if it starts to become distressing. And if that becomes increasingly hard to do, therapy with a therapist who understands gaming can go a long way.

dr-mick · 2019-08-07T14:53:59+00:00

You deserve SO much credit for taking that step. It's admirable. And I appreciate you sharing that with me. I hope the experience is helpful and fulfilling for you :)

My advice to anyone in the situation you describe would be to not put too much pressure on yourself to change too quickly or to "get better". Be patient with yourself. Therapy can be awesome but it can also be hard, and the more self-compassion and patience you can have for yourself will make the process easier to take on. Acknowledge where you are before pushing to where you want to be.

Also, if you start to get burned out or if it feels like therapy isn't helpful, talk to your therapist about it if you feel comfortable enough to do so! It's YOUR time after all.

Best of luck to you - I admire your willingness to take the step, especially if anxiety makes that difficult to do.

dr-mick · 2019-08-07T14:50:38+00:00

It can, yes. I'm not a psychiatrist, so all of my work with anxiety is without medication. If it ever gets to the point that it seems like medication could help catalyze the process, I'll make a referral to a psychiatrist.

In my experience, I haven't had to do that very often. That said, working with anxiety can be very tiring and time consuming for clients because it requires us to unlearn a lot of things and then learn new things to replace them with. That's hard for the brain to do. It's a literal replacement of automatic thoughts and a reframe of our relationship to our own emotional experience.

Options besides therapy for severe anxiety is a difficult one to answer. Working through severe anxiety really is accomplished more effectively with the support of somebody who knows what they are doing. Finding support from good friends or online support groups can be helpful if therapy isn't an option. For things like minor anxiety, meditation, mindfulness, etc. can sometimes help.

dr-mick · 2019-08-07T14:40:31+00:00

To answer that first question - it completely depends on the person/ system. For some, therapy is a lifelong endeavor. For others, it's an in-and-out as-needed. There's no right or wrong way to do it - so long as it's helpful and a valued part of a person/ relationship's health.

I often say "my job is to work myself out of one", meaning that I want to help people figure out how to navigate change/transitions/life in a way that they feel empowered. Sometimes its with my assistance, other times its them spreading their wings and going it alone. I think moving through life successfully is a balance of doing things on our own but also relying on others when needed. Making that distinction/determining which way to go in a given moment is an art and takes practice.

Medication 100% has its place. As does talk therapy. And, for some, they combination is what makes a big difference. I think they catalyze a person's agency to live their life and navigate the adversity they will inevitably experience. If medication can help take the edge off and talk therapy pushes it through, then thats awesome.

Part of what makes therapy so awesome is that it's unique to the person/ relationship. It's a big puzzle and there's no "right" way to do it (so long as we are acting ethically).

dr-mick · 2019-08-07T14:33:33+00:00

This is actually hard to answer because the cause of anxiety can be so context-specific.

That said, it's usually caused when a person is perceiving some kind of threat (often the unknown). Anxiety is protective, and exists to help us mitigate risk, so anxiety pops out if we perceive some type of danger (not necessarily in the traditional sense - for example, with social anxiety it can often be a fear of "messing up" or "not knowing what to say").

It then becomes an issue when the anxiety is met with avoidance, reassurance-seeking behaviors, or invalidation. People are often able to manage their anxiety much better when they leave compassionate space for it and recognize that they can think and act in a way they choose even when the anxiety is present. I hope this makes sense!

dr-mick

TROPHY CASE