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Bipolar and Schizophrenia – Symptoms, Treatment and Recovery

Bipolar and Schizophrenia – Symptoms, Treatment and Recovery

Written by: Dr. Joseph Leong Jern-Yi

Understanding Bipolar & Schizophrenia

Both bipolar disorder and schizophrenia were considered severe mental illnesses with no recovery in the past. This is not true in modern psychiatry as we have developed more effective treatments such as medications (psycho-pharmacology) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) which help patients improve their quality of life as well as reduce symptoms and restore function.

Bipolar disorder and schizophrenia may have similar symptoms which are disturbances in thinking, feelings and behaviour. The major difference is that bipolar disorder is classified as a mood disorder whereas schizophrenia is classified as a psychotic disorder. Mental healthcare professionals make diagnoses based on reports of patients, caregivers, or other information sources as well as observations made during the assessment interview.

Experts have also formulated that schizophrenia and bipolar disorder may be a spectrum disorder with schizophrenia on one end and bipolar disorder on the other end with schizoaffective disorder in the middle of the spectrum.

What is more important however is not the exact diagnosis alone but rather the identification of symptoms so that treatment can be effectively targeted at the relief of the symptoms, restoring function and improving quality of life. This targeted symptom approach has proven to be one of the most effective ways of helping persons recover from these brain conditions.

Let’s discuss some of the common symptoms –

Delusions, which are untrue, unshakable, and unshared beliefs which can exist in both brain conditions.

For example, delusions of persecution which are beliefs of being targeted, being followed, being sabotaged (persecutory) are common in schizophrenia while delusions of grandiosity such as believing that they are particularly important persons and have special powers or ability to save the world (grandiose delusions) are more common in bipolar disorder. For persons with schizoaffective disorder, they might have both persecutory and grandiose delusions at the same time. It also has an underlying co-occurring mood disorder.  

Hallucinations which are perceptual disturbances such as hearing voices which are not heard by others, seeing, smelling, tasting or feeling things which are not present are more likely to happen in schizophrenia.

Severe mood swings and manic episodes where the person has fast speech and high energy levels are associated with abnormal spending, socialising, exercising, or expanding businesses with the need for very little sleep over a few days and weeks are more likely to happen in bipolar disorder.

More than half a century ago, most persons suffering from these brain conditions were isolated and confined to asylums as there were no effective treatments until the discovery of medications that can change brain chemistry. Neurotransmitters which are chemicals responsible for brain and other bodily functions were discovered. Noradrenaline, serotonin, and dopamine disturbances were more likely causes in bipolar disorder while dopamine imbalance was a more probable cause of schizophrenia. See https://dana.org/article/neurotransmitters/

 

The Help Of Modern Medicine

Modern psychopharmacology offers an array of medications which can act on various neurotransmitter sites in the brain. Several medications and several rounds of adjustment and fine-tuning may often be needed to achieve stabilisation with medications with relief of symptoms. This is best done collaboratively with the patient, psychiatrist, and caregiver at the consultation with all the medications brought in for review.

Adjusting to a new medication through an effective therapeutic trial may take at least 2 weeks, starting with the lowest dose and increasing dosing to a maximised symptom relief dose over 2 months. 

Medications need to be taken daily to be effective, and this is best done using a pill box and with supervision from a loved one. Medications are served by nurses in the inpatient hospital setting who ensure that the correct dose is directly observed to be taken by the patient – however, this is often lacking in the outpatient setting leading to the return of the symptoms causing distress and dysfunction.

 

Bipolar & Schizophrenia Treatment Methods

Comparing bipolar disorder and schizophrenia to other brain conditions may be helpful in understanding how one can better achieve remission and recovery. 

Epilepsy is a brain condition where there are electrical firing of neurons causing disturbances in thinking, feeling and behaviour. To stay in control of oneself, the doctor may recommend various combinations of anti-epileptic medications to prevent another seizure. In fact, the model of kindling in epilepsy has been used to understand mental health treatment in this highly readable resource essay – https://aeon.co/essays/should-the-kindling-concept-direct-mental-health-treatment

If you speak to someone with experience with epilepsy, they will tell you about ‘warning signs’ and the ‘confusional state’ after a breakthrough seizure.

Similarly, for those struggling with bipolar disorder and schizophrenia, one becomes more aware of ‘warning signs’, and ‘confusional states’ through direct feedback from loved ones who are observant and psycho-educated by healthcare professionals. Charting, monitoring and sharing your experience are key to success in achieving remission and recovery. Use this mood chart and share it with your mental healthcare professionals for more in-depth analysis – https://loricalabresemd.com/wp-content/uploads/2017/12/Personalized-Mood_Chart.pdf

Symptoms management starts with monitoring your symptoms and the response to the treatment – what makes it better, what makes it worse, whether it is mild, moderate or severe. The frequency, intensity and severity can be charted so that effective treatment of psycho-pharmacology (active use of medications) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) can be targeted to achieve the best outcome for you.

 

Recovery Is Possible

Your mental healthcare professional can coach and pace you so that it will not be overwhelming. Recovery starts with taking it one day at a time. Be gentle with yourself. Learn to trust and entrust your healing to people who care about you. Learning from feedback as well as charting, monitoring and sharing your experience with loved ones – trusted family or friends or co-workers greatly enhance effectiveness.

Atomic habits by James Clear is an excellent book which illustrates the importance of charting, monitoring and shaping your habits, on the premise of improving 1% daily leading to more than 365% improvement in one year. This is Youtube illustrates how that can happen – “How to become 37.78 times better at anything”. 

There are many services available at Promises Healthcare and Community Partners which can help reduce symptoms, restore function, and improve quality of life. Recovery is possible and becomes a reality with appropriate support and adequate skill training. With the right help and support, persons in recovery can live meaningful and satisfying lives.

Here are some real stories that illustrate many facets of mental health and recovery:

The Neurobiology of TMS

The Neurobiology of TMS

Written by: Dr. Sean David Vanniasingham

Principles of Transcranial Magnetic Stimulation (TMS)

In the 1800s, world-renowned English physicist Michael Faraday discovered the principles of electromagnetic induction. Fast forward to the 21st century, Faraday’s discovery was harnessed into the clinical practice of transcranial magnetic stimulation (TMS) for the treatment of mood disorders. Based on Faraday’s Law, TMS can stimulate brain neuronal circuits with tiny electrical currents induced by a changing magnetic field.

 

Application of TMS in Singapore 

In Singapore, the practical application of TMS is employed in the form of repetitive transcranial magnetic stimulation (rTMS). In rTMS, magnetic pulses are delivered in trains at specific frequencies. “Fast” (high frequency e.g. 10Hz) stimulation increases cortical excitability for the treatment of depression. Whereas “slow” (low frequency e.g. 1Hz) stimulation reduces cortical excitability for treating anxiety disorders. Furthermore, TMS can be targeted at focused regions of the cortex for superior precision treatment of specific conditions e.g. rTMS at 1Hz to the right orbitofrontal cortex (OFC) reduces intrusive obsessions in obsessive-compulsive disorder (OCD).

Mood disturbances such as depression are increasingly understood as disorders of connectivity in neural networks linking cortical and subcortical grey structures of the brain. Functional brain imaging has shown dysfunction in cortical regions such as the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), as well as deep grey matter structures including the amygdala, nucleus accumbens, hippocampus and hypothalamus. These brain circuits are pivotal for executive functioning, regulation of emotions, reward processing and preservation of memory and cognition. They also link the nervous system to the endocrine system, which mediates the body’s response to stress. 

 

Neuroplasticity and TMS

Evidence suggests that TMS induces neuroplastic changes in these circuits. Neuroplasticity is the ability of the brain to reorganize itself by forming new neural connections. TMS helps readjust neurotransmitter (e.g. serotonin and dopamine) levels in a variety of brain regions. TMS also appears to exert a neuroprotective effect on the brain. Research has shown that TMS decreases brain inflammatory factors reducing oxidative stress on the brain. TMS also boosts the levels of brain-derived neurotrophic factor (BDNF), encouraging neuronal growth in regions such as the hippocampus which is vital for learning and memory. It is postulated that the anti-depressant properties of TMS may also help in normalizing the body’s neuroendocrine stress response system.

 

rTMS has achieved its place on international treatment guidelines as an augmentation treatment modality to be strongly considered in treatment-resistant depression. It is reported that 30-40% of depressed patients may have inadequate responses to anti-depressant medication treatment. The direct neuronal effects of rTMS may explain why rTMS may work for this group of patients. 

 

rTMS for OCD Treatment and other neurological disorders

In May 2022, the U.S. Food and Drug Administration (FDA) approved the use of the NeuroStar TMS system as an adjunct for treating adult patients suffering from OCD. Promising research is ongoing for the clinical application of TMS in treating Post-Traumatic Stress Disorder (PTSD), addictions, chronic pain, insomnia and many other neurological disorders.

 

TMS and recovery

With further advancements in TMS research and the incorporation of TMS in routine clinical practice, there is strong hope for recovery and the regaining of optimal functioning for patients afflicted by complex neuropsychiatric conditions.

 


References

1) Transcranial Magnetic Stimulation

Clinical Applications for Psychiatric Practice

2018 American Psychiatric Association Publishing, First Edition

2) The Science of Transcranial Magnetic Stimulation 

William M. Sauvé, MD; and Lawrence J. Crowther, Meng

Psychiatric Annals, Vol44, No.6, 2014

3) Repetitive transcranial magnetic stimulation increases serum brain-derived neurotrophic factor and decreases interleukin-1b and tumour necrosis factor-a in elderly patients with refractory depression 

Xiangxiang Zhao, Yanpeng Li, Qing Tian, Bingqian Zhu and Zhongxin Zhao

Journal of International Medical Research 2019, Vol. 47(5) 1848–1855

4) What is repetitive transcranial magnetic stimulation and how does it actually work?

Paul Fitzgerald, Professor of Psychiatry, Monash University

The Conversation AU, published May 13 2021

Dr Rajesh Jacobs Speaks with Expat Living on the misconceptions of psychiatric medication

Dr Rajesh Jacobs Speaks with Expat Living on the misconceptions of psychiatric medication

There are many stereotypes about mental health medication. One acute misconception is medication dependence and addiction – that it’ll be difficult to stop these medications once people with mental illnesses get well and recover.
Dr Jacob Rajesh from Promises Healthcare speaks to the editorial team from Expat Living to help debunk some of the myths and tells us more about new techniques like Transcranial Magnetic Stimulation.
The Power of Physical Presence in Therapy

The Power of Physical Presence in Therapy

Therapy is an indispensable tool to recovery, or in helping one gain deeper insights and achieve self-actualisation. In light of the ongoing COVID-19 pandemic, traditional face-to-face therapy has been forced to take on various forms, including sessions conducted via telephone or through video-calling platforms. Of course, therapy serves the same purpose, regardless of whether it is conducted in person or otherwise. However, there is definitely something restorative about being able to connect with a therapist physically. Humans are innately social creatures after-all, and sometimes when things get tough, a little more human interaction and comfort can go a long way. 

 

Physical presence in therapy certainly provides a deeper sense of connection, in contrast with virtual therapy where one might feel more distant and detached. It may seem bearable at the very beginning, but as you progress through the sessions, having to interact with your therapist through a screen all the time can get frustrating. Similar to how students may have trouble coping with online school and home-based learning, virtual therapy has some form of hindrance when it comes to relationship-building with your therapist. For most psychotherapy methods, it is indeed possible to shift them online. However, for others such as psychodrama, it may not be entirely ideal. How expressive and comfortable can you get, when you’re struggling to follow your therapist’s directives through the small screen and having to deal with technological lags? 

 

Seeing your therapist in person also allows for him/her to detect any subtle body language and somatic movements. These are all non-verbal cues that may be lost through telecommunication. Non-verbal cues are just as important as verbal ones, and can provide your therapist with greater insights. Non-verbal signals can serve to convey your feelings along with what is being said, and can either reinforce or contradict verbal messages. Ignoring them would be very much a failure to be fully engaged in a conversation. Moreover, seeing you in person provides therapists with the ease to identify any form of dissociation. During the session, clients may not necessarily attune well, and may not be fully present in the moment. The client may be engaging with the therapist, but seemingly thinking about something else that is going on in their life at the same time. This does not mean that the session is unhelpful or “boring”. While this could simply be attributed to the lack of presence, it could also point towards other concerns regarding the client’s state of mind. Fragmentation can occur especially when one is recovering from a past trauma and can be brought to the forefront, causing incomprehensive emotional reactions when triggered. Fragments of self are usually suppressed, often attributed to the lack of a sense of safety when it comes to expressing their inner needs or desires. When these feelings start to show during therapy, therapists can identify them through common tell-tale signs such as a switch into dissociation, noticeable body movements (twitching, scrunching of fingers or toes etc.). Body language is not definitive, but can offer clues about one’s thoughts and feelings. With telecommunication, it is more often than not impossible to see the client below shoulder-level, thus making it difficult for therapists to assess any somatic movements that may be occurring. 

 

Another issue with telecommunication is the lack of control over the therapeutic environment.  In a traditional face-to-face session, the clinician has considerable control over the environment, and is able to ensure a private, safe and quiet space for the entire duration of the session. This limits the number of distractions and allows for both the therapist and the client to concentrate on psychotherapy. Moreover, in a clinical setting, furniture is often set up in particular ways to facilitate clinician-patient interactions. For instance, seats may be arranged such that the clinician would be facing the client at an angle of 45 to 90 degrees, and approximately 2 to 3 feet away. Facing the client directly can feel somewhat threatening for some, and this angle allows for the client to feel more at ease. Additionally, it allows for both parties to break eye contact naturally (intermittently) without seeming antisocial or distracted by having to do so actively. In contrast, having a session online or through telephone allows for less control over interactions and the client may be more exposed to external distractions or undesirable interruptions. This also leads us to our next point, where teleconsultations also increase the risks of privacy breaches. 

 

Due to the lack of environmental control, having a consultation via telecommunication methods can be a challenge especially for those who do not have access to their own private space. For individuals living with others, there could be situations that compromise client confidentiality, including potential eavesdropping or having others walk in on them. Not only does this make the session extremely disruptive, it can be a huge concern for many considering that mental health concerns are sensitive topics. Clients must make the extra effort to find a suitable place and time for them to speak with their therapists freely and with ease. As such, physical presence in a controlled clinical setting may have the upper hand.

 

Nevertheless, this article in no way aims at undermining the efficacy of tele-health, nor to allude that tele-therapy is ineffective or pointless. Considering the need for physical distancing during the pandemic, telecommunication is undeniably crucial in limiting the spread of the virus. Putting that aside, traditional in-person therapy can have its barriers too, limiting people from attaining the mental health support they need. Individuals with disabilities may find accessibility to be a significant problem at hand, and find it difficult to travel for therapy without having others to rely on. Others include parents who are unable to find suitable childcare options, all while juggling work and mental health care. For those struggling with social anxiety and agoraphobia, it can also be extremely intimidating and overwhelming for them to step out. In fact, some research has shown that virtual and in-person therapy, depending on the treatment goal, can be equally effective. In adults, cognitive behavioural therapy was shown to be similarly effective both in vivo and virtually (Khatri et al., 2014). There is also evidence that youth with anxiety disorders respond positively via telehealth (Khan et al., 2020). Traditional face-to-face therapy and tele-therapy both have their perks, and we acknowledge that it also boils down to individual preferences. If you’re unsure as to which treatment option to opt for, do feel free to contact us.

 

References:

  1. Brenes, G. A., Ingram, C. W., & Danhauer, S. C. (2011). Benefits and Challenges of Conducting Psychotherapy by Telephone. Professional psychology, research and practice, 42(6), 543–549. https://doi.org/10.1037/a0026135 (Accessed 06/09/2021)
  2. Khatri N., Marziali E., Tchernikov I., Shepherd N. Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: A pilot study. Clinical Interventions in Aging. 2014;9:765. (Accessed 09/09/2021)
  3. Khan, A. N., Bilek, E., Tomlinson, R. C., & Becker-Haimes, E. M. (2021). Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19. Cognitive and behavioral practice, 10.1016/j.cbpra.2020.12.002. Advance online publication. https://doi.org/10.1016/j.cbpra.2020.12.002 (Accessed 09/09/2021)
  4. https://www.nataliarachel.com/articles-practitioners/shifting-to-tele-therapy-attuning-without-physical-presence (Accessed 07/09/2021)
What Does Journeying with a Psychiatrist for My Mental Health Issue Look Like?

What Does Journeying with a Psychiatrist for My Mental Health Issue Look Like?

For many people, when they hear the word ‘Psychiatrist’, it would instantly conjure up an image of a doctor prescribing medicine for someone with a mental health condition. This is true to the extent that a psychiatrist is a medical doctor who has undergone training to become a mental health specialist. While prescribing medications are indeed part of the treatment process, what really goes on in between – from the first session to the very end? 

 

On your very first session, your psychiatrist will most likely spend 1-1.5 hours with you to gain a better understanding of what you’re coming in for. Mental health conditions can be a touchy subject for many, and it is understandable that you’d feel hesitant to open up to a complete stranger right away. However, trust that your psychiatrist has your best interests in mind, and will do his/her best to provide optimal treatment. Don’t be afraid of being judged for your symptoms, rest assured that the psychiatrist’s office is a safe and non-judgemental space. The psychiatrist will want to know as much as you’re willing to share, and being honest with your psychiatrist will be extremely helpful for an accurate diagnosis and the development of an effective treatment plan. Just as what you’d expect when you seek a General Practitioner for physical conditions, your psychiatrist would start off by asking broader questions such as, “What brings you here today,” or “How can I help you?” For some individuals, especially if it’s their first time at a psychiatrist’s, open-ended questions like these may be nerve-wracking. You may feel a little overwhelmed, not knowing how to start or where to begin. However, there are no hard and fast rules as to how the session should flow. Simply communicating your symptoms and your concerns would be a great start, and your psychiatrist will guide you through the interview. 

 

Your psychiatrist will also run through a history-taking process, paying special attention to your medical history, family history, your current lifestyle habits and general patterns of sleep. It is important to let your psychiatrist know if you’re on certain medications, as some may have side effects that may fuel certain mental health conditions. Avoid downplaying or dismissing any information related to your physical or mental wellbeing, the clue to an accurate diagnosis may very well lie in the details. As such, going for your first session prepared with a complete list of medications, dosages, and your compliance with them can be very beneficial. Many studies have also shown that genetics play a role in mental health disorders. If you have a family member who suffers from a psychiatric issue, be sure to let your psychiatrist know for him to have a clearer idea of the situation. If need be, your psychiatrist may also ask permission to speak with other family members.

 

Depending on the patient’s circumstance, the psychiatrist may conduct a physical check-up if necessary, or possibly laboratory tests to exclude other possible causes for your condition. These are done to confirm that what you’re experiencing are not due to other medical conditions which may give rise to similar symptoms. Hence, if your psychiatrist asks for these procedures to be carried out, don’t feel too worried! Questionnaires to further assess your symptoms may also be given, so do make sure to answer them as truthfully as possible.

 

Depending on the complexities of your condition, medication options or other forms of treatment may be prescribed. If you are given medications, the psychiatrist would counsel you on how you can tell if the medications are working. Over the course of your recovery journey, take note of how subtle changes to the medications made by your psychiatrist affects you. Do they stabilise or improve your condition, or do they seem to send you on a downward spiral? How have you been feeling since you started taking them? Whatever the outcome, keep your psychiatrist in the know of how you’re coping. In the same vein, it is very important that you do not adjust your medications on your own without seeking professional advice! Patients may get impatient if they’re not seeing the desired change after a while, but constant and unregulated changes can cause undesirable fluctuations, potentially worsening the situation. We need to understand that there could be catastrophic, life-threatening consequences if we do not take them seriously.

 

In general, psychiatrists usually work closely with psychologists and therapists, as some mental health conditions are best treated with both neuropharmacological support and psychotherapy. Thus, your psychiatrist may also refer you for psychotherapy if deemed fit. Depending on the level of care required to address the patient’s symptoms, psychiatrists may recommend treatment programmes if more intensive care is needed. 

 

It is natural to feel nervous or uncomfortable about seeing a psychiatrist, but don’t let these emotions hold you back from getting the help you need. We hope that giving you a better sense of what to expect will help alleviate your concerns, and give you the courage to seek professional help.

 

References:

  1. Psychiatrists and psychiatry. Healthdirect.gov.au. (Accessed 21/05/2021)
  2. What Questions Do Psychiatrists Ask? | PHS San Diego (Accessed 21/05/2021)
  3. What to Expect During Your First Psychiatry Appointment (Accessed 22/05/2021)
What Does Journeying with a Psychologist for My Mental Health Issue Look Like?

What Does Journeying with a Psychologist for My Mental Health Issue Look Like?

So you are going to see a psychologist for the first time – now what should we expect? The thought of having to step into a psychologist’s room for the first time can be nerve-racking, and understandably so. Oftentimes, individuals may be apprehensive and would wonder if talking to a complete stranger is really going to help, or if opening up your innermost thoughts to a stranger was too much of a risk to take. However, rest be assured that these mental health professionals are well-versed in psychotherapy methods to help you manage your issues as best as possible, and will work closely with you at a comfortable pace. Just like in the treatment of physical illnesses by physicians, patient privacy and confidentiality are also primary obligations for psychologists. In this article, we hope to give you a clearer idea of what you can expect from your visit to a psychologist, especially if it is your first session.  

 

First things first, it is important to understand that psychotherapy isn’t merely a one-off session. While the duration of treatment may vary from one person to another, the American Psychological Association (APA) reports that “recent research indicates that on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures.” The type and duration of treatment also heavily depend on the nature and severity of each client’s conditions, and it would simply be unfair to make an overgeneralised statement. Regardless, it would be beneficial to go in with an open mind, and to have an honest conversation with your psychologist. It really helps to trust that the process works, while acknowledging that it takes time. 

 

Meeting the psychologist

At the beginning, the first few sessions would aim to help one identify the most pertinent issue that needs to be dealt with. The psychologist will talk through with you gathering some information on your life history, your family’s mental health history, the problems you are dealing with, and analyse those details – no matter how insignificant they may seem at first – that could have possibly led to emotional distress or coping difficulties. For the psychologist, being able to get a good grasp of the situation and seeing the big picture is vital for formulating the treatment plan and treatment process, as it will help to determine the type of psychotherapy that is best suited for you. The psychologist is trained to listen and analyse your conditions in order to help you with your recovery. As such, it is equally important that you don’t hold yourself back from being fully honest with your psychologist. To a large extent, the patient’s participation in the therapy is an important determinant of the success of the outcome. 

 

Goal-setting

While we fully understand that it can be unnerving, these mental health professionals are trained to help you work through the challenges you face, and the therapy room is very much a safe, non-judgemental space. Goal-setting is one of the key aspects of psychotherapy, and it is exceptionally important to set goals from the start that you can use to track your progress. You may start by identifying personally meaningful broad motives, hopes and dreams – having a clear direction in mind will better steer future sessions towards alleviating symptoms of distress and tackling the root cause of one’s concerns. Don’t worry if you feel the need to change your goals or take a different approach halfway through the treatment process. Psychotherapy is a dynamic process after all, and increased self-discovery along the way can certainly give you a better sense of what needs to be changed.

 

Different approaches to psychotherapy

There are several approaches to psychotherapy that can be implemented in the following sessions. Not strictly limited to one or the other, psychologists may make use of psychoanalysis and psychodynamic therapies, cognitive-behavioural, interpersonal, and other types of talk therapy. They can help you focus on changing problematic behaviours, feelings, and thoughts to build on healthy habits, or teach you emotion-coping strategies to cope with your symptoms. Forms of treatment like cognitive-behavioural therapy also aim to help individuals recognise negative thought and behaviour patterns, thereby working towards a positive change. Each session is essentially a problem-solving session. By allowing yourself to talk to your psychologist about your most difficult moments, your feelings and the change you want to observe, the psychologist is then able to make use of his/her expertise to assist you.  Many mental health professionals don’t limit their treatment to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each patient’s needs.

 

‘Homework’

To make the most of the treatment process, “homework” may sometimes be assigned as between-session tasks to clients as part of your treatment. A variety of homework assignments exist – sometimes in the form of practising new skills, habits, and other coping mechanisms, or someone who is dealing with complicated emotions could be asked to record your negative thoughts in nightly journal entries. When you return for your next session, the psychologist would then check in on your progress, and address any issues that may have arisen while you were completing your tasks. For some clients the benefits of therapy can be achieved in a few sessions, while for other clients they might need more to improve. Empirical evidence supports the benefits of homework in promoting positive symptom change and increasing patient functioning, that is, the quality of a client’s participation in therapy through active application of what they learn will lead to improvements in their conditions.  

 

Was the psychologist right for you?

Often during the conversation with the psychotherapist, or after the session, you may feel a sense of relief, elation, or anxiety and exhaustion. However you feel, it is important to take note of those feelings. Did the psychologist put you at ease? Did he/she listen to you carefully and demonstrate compassion? Did he/she develop a plan to guide you with your goals and show expertise and confidence in working with issues that you have? For the treatment to be effective, you need to be able to ‘click’ with the psychologist, that is you are able to  build trust and a strong connection with your psychologist.

 

To end off, the first session with a psychologist is understandably a bit intimidating and overwhelming, but the first step in the journey to recovery is a critical step to regain your mental wellbeing.

 


 

References:

  1. https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment (Accessed 24/04/2021)
  2. https://www.apa.org/topics/psychotherapy/understanding Accessed 25/04/2021)
  3. https://www.self.com/story/how-to-tell-if-therapy-is-working (Accessed 25/04/2021)
  4. https://www.researchgate.net/publication/281642213_Homework_in_Psychotherapy

(Accessed 26/04/2021)