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How do I know if I need professional help with a behavioral, emotional, or life problem?

When difficulties are very severe there is little question about the need to consult a mental health specialist. For non-obvious situations, the basics are to examine the following parameters – how much time is consumed by the problem, how much does the problem interfere with normal life activities such as school, work, or relationships, and how much distress is the problem causing, either to the person him or herself or to those who are involved in that individual’s life. Technicalities aside, sometimes the best answer may be found by honest and accurate self-examination or by heeding the concerns of loved ones. Remember, it is better to find out your difficulties are not as bad as you think than delay needed treatment and wind up in an increasingly serious condition. For mental health issues, the earlier that intervention occurs, the greater the chances of success.

How do I know if my child’s condition warrants professional evaluation and/or intervention?

Essentially, the answer here is about the same as to the question above. However, children, particularly very young children, often lack the self-awareness needed to tell when they are in real psychological trouble. They also may not have the communication skills to convey the extent of their difficulties effectively to those in a position to help them, like their parents or teachers. It is important not to explain away or otherwise minimize the need to seek professional assistance if your child asks for help or appears to be in continued distress or is showing declines in their functioning.

What steps do I need to take if a member of my family or I need psychological care?

Deciding that professional assistance is needed leads to the very complex matter of how to obtain such help. For many, it begins with asking for a referral from a family medical practitioner (It’s always a good idea to have a physical check-up to rule out a specific physiological cause.) Others look for guidance from their health insurance or employee assistance plan. Still others ask trusted friends or neighbors. Some spend time researching on the Internet. Whatever your path, it is important to make that first appointment. Procrastination can result in the exacerbation of psychological issues. Sometimes it is necessary to speak to a number of clinicians before finding the best approach for yourself or a family member. Whether to consult a psychiatrist, psychologist, or social worker is complex as well, and should be carefully considered.

What do I do if I think that another adult in my family needs assistance but other people in the family don’t agree?

Differences of opinion regarding whether a member of a family has clinically significant mental or behavioral health issues is actually quite common. Even within the same family there can be major differences in levels of education and awareness of psychological problems, tendencies to react to certain kinds of life problems with minimization or even denial that they exist, and willingness to address mental health difficulties. Stigma is another issue. For some, having a mental health issue in a family member is a cause for embarrassment and shame.

It takes a lot of conviction and courage to do what is needed in the face of opposition from loved ones but sometimes there is no other choice. As they say, “you can’t go wrong doing the right thing.” If you are convinced that your family member needs help, do your research then speak to your relatives personally in a calm, non-judgmental way. It helps to have some written material or websites to discuss with them. Then you can give them the contact information for the resources you have found. Of course, if they are incapable or refuse to participate in this process you will probably have to do what is needed without their consent. Try to not focus on the resentments you may be getting now but on the thanks, and if not, the self-satisfaction that you may receive in the long run from having acted in your loved one’s best interest.

What do I do if I think my child, teenager or an adult in my immediate family needs treatment but they are resistant?

First, let’s consider very severe situations with adults. Unfortunately, there are times when intervention is necessary to take against a person’s will. Although some would argue that there are no circumstances that warrant such kinds of action, this philosophical position tends to be untenable if someone in one’s own family is acutely psychotic, dangerous to him or herself or others, has become unable to function, or has life-threatening health problems (e.g. they are not eating). Usually, the best course of action is to call for emergency help from the local health/legal authorities. The medical and mental health professionals who have the training to determine the proper course of action may then evaluate your loved one.

Don’t expect gratitude, to say the least, from your family member if you have to have them receive intervention to which they are opposed. Try not to take any hostility that they show at the time personally, this is to be expected given the circumstances. However, in the long run most will understand your actions.

For less emergent, but still problematic situations, you cannot have the authorities intervene against an adult’s will. There are many instances when an adult has severe depression, anxiety, obsessions and compulsions, eating issues, substance abuse problems or other difficulties but is against getting help. Reasons for this include fear of loosing control over their lives, distrust of health professionals, lack of insight, and maladaptive coping mechanisms such as rationalization and denial. This, of course, can be very frustrating. It must be recognized that, even for someone you love, there are limitations to what one can do. It is important to stay patient, try not to be an enabler, and not neglect your own life and health. Sometimes it is a good idea to talk about the situation with a mental health professional on your own. They may be able to generate ideas and assist in mediating the situation.

Teenagers, not surprisingly, present a great dilemma when it comes to how to deal with resistance. Your leverage to get them into treatment is higher if they are under eighteen. Calmly withholding privileges until they are compliant can be a good strategy. Yelling, threatening, and guilt tripping are usually counter-productive. Strategizing with a clinician who is experienced in these matters can often help. You may also want to model the behaviors that you want to see in your child by going to see the therapist when he/she refuses to go. It will help your child see how much you believe that getting help is at this point in their lives is essential. It gives the message that “if you not ready to go for help, I am still ready to do anything to help you.”

In regard to resistant children, the key is to think of their resistance the same way you would if they did not want to go to school, the doctor, or the dentist. What would you do in these instances? Like most parents, you simply would have to get the child to where they had to be, regardless of the fuss or comments they make. When parents state they cannot “force” their child to get help, it says something about their own resistance or priorities that needs to be reflected upon. Sometimes a child will stonewall or complain in the initial stages of treatment in order to escape. For your child’s sake, as long as you are confident in the professionals with whom you are working, it will better to hang in there and not let this happen. Many times the resistant child becomes the most successful and engaged patient over time.

How do I know if the person who is evaluating a member of my family or me is qualified?

Mental health professionals are required to display their licenses to practice. You can check the practitioner’s status with the appropriate state licensing board (usually this is in the Department of Health or the Department of Education). However, licensure alone does not insure that the practitioner is qualified in the area that is of concern. You can inquire about the professional’s participation in subspecialty organizations and ask them directly about their experience level in a given field. One idea is to attend a support group and ask the members about practitioners they have found knowledgeable and helpful. Sometimes the true test of qualifications occurs only in the privacy of your sessions with the practitioner. This does not mean that you will necessarily like what you are hearing or even like a particular clinician at first, just that they have an evidence-based approach and a high level of scientific knowledge in your area of concern.

Is it O.K. to ask questions?

Not only is it appropriate to ask questions and clarify your concerns with your behavioral and mental health practitioners, it is also advisable. Having numerous questions is the norm rather than the exception when it comes to the field of behavioral and mental health. In fact, it is typical to have a chance for “questions and answers” as part of the initial consultation. There are no restrictions on the kind of questions you may ask. The whole concept actually is that “here is a place that anything may be discussed, no matter how unusual or potentially awkward”. By definition, sessions are totally confidential (with the major exception being if there is imminent and specific threat to self or others). Remember, you have sought out your practitioner because you are looking for answers. So ask your questions without hesitation.

What happens if I want a second opinion?

Given the complexity of many cases, it is perfectly appropriate to seek a variety of perspectives, just as you might if you needed surgery. Also, different clinicians may be able to offer alternative treatment options. It is not a good sign if a practitioner does not respond to your concerns about their diagnosis or recommendations in a straightforward manner, even if it concerns seeking other opinions. Ethical clinicians are not threatened by other opinions- to the contrary they are welcomed. Responsible practitioners will even offer to assist you in getting the best second or third opinions, if that is your wish. There are many times when the clinician him or her self suggests that getting another opinion is indicated. After all, nobody, however well trained or experienced, has all of the answers all of the time.

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