Bipolar 2 From Inside and Out

Posts tagged ‘online psychotherapy’

In One Side and Out the Other

For a while, I managed to do it. I spent literally years writing a mystery novel. Optimistically, I sent it to over 180 agents. A lot of nothing. At last, one of them was honest enough to tell me what was wrong with the manuscript, instead of just saying, “not right for us” or not answering at all.

And they were absolutely right. Once it was pointed out to me, I could see exactly what they were saying. I had had beta readers vet the first four chapters and gotten positive responses. They didn’t know anything about writing, or possibly even reading with a writer’s perception. But that wasn’t their fault. It was mine, for not selecting my readers more carefully.

Did all this depress me? Hell, yes, it did. I wouldn’t be human if it didn’t.

But I’m also bipolar. Depression for me isn’t just regular depression. Bipolar depression is something different. A darker place. A deeper pit. One that can be almost impossible to claw and climb one’s way up from.

When I was a teenager and undiagnosed and unmedicated, I had several major depressive episodes, and any number of smaller ones. Since at that time I had no idea what was going on or how to get help, I developed a philosophy: Go through it until you come out the other side.

Basically, it meant that I was staying depressed until I magically became un-depressed, whether it was because my brain chemistry backed off enough to let me see a way out, or hypomania kicked in (though I didn’t know what that was at the time). Basically, I suffered through it until I didn’t anymore.

And I thought that was the way it had to be. In one side, wait till I came out the other.

Later in life, I had other major depressive episodes. I tried a lot of things for them, including therapy and medication, but still the best I could manage was to wait it out – even though it took literally years.

Right now I’m in a similar position. All the rejection has put me back in that deep pit, and I don’t see a way out of it. I can’t even think of a new thing to write. Or a way to fix the book that failed. I am even applying for other writing gigs, but so far they have brought only more rejection. I don’t want another major depressive episode, but I can feel myself slipping. It does sound like reactionary depression, a result of the rejections, the realization of bad writing, and other recent blows involving deaths and other traumas. But it feels like endogenous depression, the kind that comes from inside, with wobbly neurotransmitters the major cause.

Of course, I’m a little better off than when I was a teen. I have a proper diagnosis – bipolar type 2 – and proper medication. I still have work that I can do – transcription – which is boring and ill-paying, but keeps me from sitting all day in front of the TV, watching train wreck shows that remind me that other people have more screwed-up lives than I do. I have self-care. I have my husband to be my caregiver.

But basically, I am just waiting to come out the other side.

I am doing the things I ought to do to get me out the other side. I am taking my meds. I have an appointment next week – a telehealth session with the psychologist that I haven’t seen in a year. In the past, she has done phone sessions with me when I wasn’t physically or mentally able to come in, so I know those do me good. And at the end of the month, I see my psychiatrist for a med check (15 minutes). I’m not sure how a session that short will help me in finding the other side to come out of.

I just wonder how far away the other side is.

Distance Psychotherapy: Is It for You?

By Alice / adobestock.com

I will make a confession: I have never used distance therapy, except for when I couldn’t drive to my therapist’s office, my husband wasn’t available to drive me there, or when I had the last-minute I-just-can’t-go-today feelings or I’m having-a-crisis feelings. This was in the days before teleconferencing, texting, and other long-distance forms of therapy, so occasionally my therapist would agree to do a telephone session, which I appreciated greatly. In general, they didn’t last as long as the standard psychotherapy 50-minute hour, but at times they were lifesavers.

Now, when everything seems to be online, and especially during pandemic lockdown, quarantine, or simply fears of going outside, tele-psychotherapy seems to be becoming a thing. Many services are now available via the internet, smartphones, and whatever way you pursue your online life.

I’ve been looking at these services, not because I need one now, but because I want to know what’s available in case I ever should. The APA (American Psychological Association) provides a lot of helpful information on the subject. Their site has provided a list of pluses and minuses regarding telehealth for psychology. They note: “With the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy…Research does show that some technological tools can help when used in conjunction with in-office therapy,” though “There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people.”

Inc.com provides a helpful list of the pros and cons of online therapy. Some positive aspects are that:

  • People in rural areas or those with transportation difficulties may have easier access.
  • Most online therapy services cost less than face-to-face treatment.
  • Scheduling is more convenient for many people.
  • Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

among the negatives are:

  • Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
  • Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren’t conducive to treatment.
  • Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
  • A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person.  The two settings were shown to be equally effective.

One possible pitfall, warns APA, is that “online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.” The services I explored charge about $35 to $80 per week for unlimited messaging and one live session per week. MDLive provides a psychiatrist at $284 for the first visit and $108 afterward. (They have lower rates for seeing a therapist rather than a psychiatrist, and do accept insurance.)

Business Insider, in its article on the subject, dealt specifically with a service infelicitously known as Woebot. Unlike the other services, Woebot is a “chatbot” that substitutes artificial intelligence and natural language processing for a real, live therapist. It uses cognitive behavioral therapy. Their website claims that Woebot “is the delivery mechanism for a suite of clinically-validated therapy programs that address many of today’s mental health challenges, from generalized anxiety and depression to specific conditions like postpartum depression, adult and adolescent depression, and substance abuse.” Like a non-directive therapist, it asks probing questions and responds to questions and answers from the user. For now, it is free to users, though they seem to be exploring a paying model.

Other telehealth counseling services include:

Amwell

Betterhelp

Brightside (depression and anxiety, not bipolar or mania)

Online-Therapy.com

ReGain (couples therapy)

Talkspace

teencounseling (will consult with parents)

If you decide to try online therapy, it’s best to compare services and determine what services they offer, at what price, and what the credentials of their therapists are. If you have already tried it, I would be glad to know the results. Feel free to comment.

 

 

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