Hello and welcome to episode 7 of the podcast Tips and Tricks on How to Be Sick.
I’m Eirenne and I will be your host as we talk about navigating the world as people with chronic illnesses, both physical and mental, disabilities, and the ways in which the world isn’t necessarily designed for us.
In this episode, we are going to be talking about mental health, why therapy could be helpful to anyone — mental health diagnosis or not — and ways to make therapy more accessible to people with disabilities. For this, the interview will be with a clinical psychologist who, in the interests of full disclosure, I will tell you now has been my closest friend for almost 25 years.
Many of the tips and tricks on this podcast come from other chronic illness warriors and folks with acquired disabilities, but it is also helpful to hear from medical professionals, particularly in a dialogue with the disability community, so that we are able to increase that communication for all sides. Now with that in mind, let’s go to the interview.
[Eirenne]
Okay, so this month we’re going to be talking to one of my oldest friends. Dr. Erica Essary, PsyD, is a clinical psychologist in the Chicago area, but she also takes clients through teletherapy, so she can take clients from anywhere in Illinois or Iowa. Dr. Essary, welcome to the podcast.
[Dr. Essary]
Oh, thank you so much for having me.
[Eirenne]
I know your background, but can you share a little bit about your background with our listeners?
[Dr. Essary]
Sure. So, I would say I took perhaps a slightly meandering road to clinical psychology, because that’s not how I initially started my education. Academically, I have a background in ancient history. I have a bachelor’s degree from DePaul, and then I actually was going to pursue a PhD in Egyptology at the University of Chicago, and I did get my Master’s Degree there, but I didn’t continue to get a PhD. I spent some time working in the mortgage industry, so I learned a whole lot about buying houses and credit and paperwork, and then I decided I would return to school to pursue pursue a Psy.D in Clinical Psychology, so I have a doctorate in Clinical Psychology. I also got my masters along the way, and I also have a certification as an advanced alcohol and drug counselor, so one of my specialties is actually substance use disorders.
[Eirenne]
If you’ve got patients that are coming in with a new mental health diagnosis, or who suspect they have a mental health issue that needs treatment, what are the top two or three things that you would like them to know, coming into this?
[Dr. Essary]
Well firstly, I think I’d like to say that anyone can go to therapy. And I believe that anyone has the potential to benefit, in some way, from therapy. I don’t think you need to have it all figured out before you go, I don’t think you need to have quote-unquote “a serious diagnosis” or an official diagnosis to start going to therapy. Part of the whole therapeutic process is that figuring out what’s going on and how we can help you.
Which leads me to something else that might happen, or perhaps has already happened with people, maybe more in the medical side as well as on the mental health side: to be aware of that the diagnosis may change over time, perhaps with the information that was known to us at the beginning, later information paints a different picture. We might need to update that diagnosis, and I don’t think there’s anything wrong in that. Sometimes we don’t have all the information that we need to make adjustments later, or things happen to people over time, and certain events can cause additional things to be touched off, which then paint a different clinical picture that needs to be worked on with people, new symptoms that need to be addressed. So I would say sometimes diagnosis is a more fluid process. It isn’t necessarily static. In a certain sense, I feel like we as clinicians are always assessing, every session. It doesn’t mean we’re going to change the diagnosis all the time, but we’re constantly looking at all of the pieces and making sure that we have a cohesive understanding of what’s going on. And that we communicate with our clients about potential for a new direction in treatment, if we’re meeting your goals, if you want to change your goals and adjust them, and just the fluidity of that process is something to keep in mind.
[Eirenne]
Oh that makes total sense. And particularly with people who have disabilities, there’s all kinds of things that can affect mental health, temporarily or more permanently. The idea that, just the same way physical diagnoses can change over time, that mental diagnoses are the same way. Things are not, “You have THIS and now it’s chiseled in stone and it’s never changing.” It’s not that way, body or mind. That makes absolute sense.
[Dr. Essary]
Or maybe we never had a discussion about a particular symptom that a client has, and I never observed it, but then I do and all the sudden that’s new information.
[Eirenne]
That’s true; you can only work with what you have.
[Dr. Essary]
Because not everyone presents the same way at every session.
[Eirenne]
That also makes sense. Good days, bad days, days when some symptoms are more prominent than others. What would you suggest for people who have disabilities, particularly acquired disabilities, which is one of our focuses here on this podcast — people who have gained a disability that they didn’t have in the past, or a chronic illness that they either didn’t have, or didn’t have as severely. What’s something you would recommend for people facing those kind of new diagnoses, when it comes to considering their mental health, if their diagnosis isn’t mental health-related, specifically? What would you recommend for them to think about or do proactively or preemptively if this isn’t the focus of their disability?
[Dr. Essary]
So of course there’s an adjustment period to learning about any type of diagnosis especially when it comes to areas of disability and I think that a lot of the times people to use more support right after that sort of drops into their lap. I mean, essentially, I think there’s a lot of people that go through a similar process to what people experience when they’re grieving. Because there can be, of course, a loss. Maybe a loss of mobility, other functioning, whatever their usual standard was, and there is an adaptation that needs to take place. And so, within that it might be helpful to talk to a professional that can be that support and help give you coping skills and tools to help guide your way through that process of accepting where you are on any given day, at even moment, and to show yourself some compassion along way. But also look at where your strengths still are, because everybody has strengths, everybody still has things they can do, and it’s important to remember that especially on the bad days.
[Eirenne]
That is absolutely true. It took me years to adjust and to accept the new way my life was shaped, and I expect most people go through a similar process. It didn’t occur to me at the time that maybe therapy would be a good idea for dealing with this stuff. I think it’s really important that you’re suggesting this, that this be a thing people consider as an option, even if it’s not something that they were initially told, “Hey, you should go do this.” Especially with new physical disabilities, we’re often directed to physical therapists, and all kinds of specialists and all kinds of tests, but it’s much less frequent, the referrals to mental health care on top of it. I think you’re right, I think this is something that could be hugely beneficial for a lot of people. There is the fact that there’s a general shortage of qualified people to go to, depending on where you’re located, of course. But it’s still a good idea to think about.
[Dr. Essary]
One of the other things that I think is worth noting is getting ahead of things. I mean, I’m a huge fan of prevention, or at least early intervention. And, when this is still fresh and new, to be able to get your support system together as soon as possible can actually help stave off symptoms which might worsen with time with no intervention whatsoever. If you can work through an adjustment period with this diagnosis, with professional support, with personal support, you may be much better off than someone who doesn’t seek and doesn’t have an adequate support system, where then additionally they start to experience symptoms that are more severe in terms of depression symptoms and anxiety symptoms, and that’s a worse prognosis in those cases.
[Eirenne]
Oh, definitely. And I hadn’t really thought about it, but when someone is facing a new disability or a new diagnosis, they’re not typically the only ones adjusting. Not that anyone around them is going to have a /worse/ time, we’re not really ranking these things, but the person who has the disability is the one that has the worst time with the disability.
[Dr. Essary]
The person is obviously the most impacted.
[Eirenne]
Yeah. But the people around you are also adjusting and may not be able to be all the support that you need during that time. The idea of having a professional who can support you, who isn’t also adjusting to some change in not their own life, but the periphery of their life at least, seems like it would be a more stable way of approaching things than just relying on people who are going, “Oh, this person in my life has all these things that are happening,” and maybe doesn’t have their own head in the right place to be able to provide support.
[Dr. Essary]
And that’s why I think one of the wonderful things about therapy is that is your time. It’s 100% your time, it’s 100% about you. You do not have to worry about taking space and voice away from anyone else, it is just for you. And you can let out whatever it happens to be, especially if it happens to be about loved ones, and other supportive people in your life that you might be struggling with. There might be tension for whatever reason, maybe doesn’t have anything to do with your diagnosis, maybe you’re just not getting along with someone in your life and it’s causing stress. You will have an outlet for that, for someone that will not only keep all of your information confidential, but also again doesn’t have a personal bias or stake in the outcome of those events. They are your advocate and your advocate, alone.
[Eirenne]
Why doesn’t everybody have a therapist? [laughter] This seems like a thing that everybody needs. Everybody needs this. Okay, so shifting a little bit from general reasons why therapy is a good thing to specifically a feature of your practice, teletherapy. Tell us a little bit about what teletherapy is.
[Dr. Essary]
Here at my business, Spectrum Psychological Services, I do face-to-face therapy as we were just talking about, but one of the other ways I can provide therapy to people is through teletherapy. It has many names at this point; it may be referred to as online counseling, or video counseling. video therapy — all of those are words for the same concept. Where we use some type of digital device, whether it’s laptops, tablets, or phones, and we’re visually connected with each other, where there’s a video feed going on between us, over the internet, and we’re communicating with one another. I will be in my office where I hold therapy, and you may be in your own home or another safe place for you to have therapy, maybe your office or some other area where you have a bit of privacy. The session length is exactly the same, the therapy would be the same, we’re just not both occupying the same physical space.
[Eirenne]
That sounds so nice. I’ve got my own immune problems as part of my constellation of chronic illnesses, and I can’t go out around people all that much without getting very sick. The idea that I could have therapy through my computer or through my phone, and not have to risk making my problems worse. That sounds so nice. And so many other issues could be addressed this way. People who don’t have transportation, or live too far away. People who have mobility concerns for whatever reason that makes it difficult for them to get out to a physical Therapist’s Office. It’s– wow. Teletherapy sounds awesome.
[Dr. Essary]
And, you’re right, and you’ve mentioned a lot of great reasons that it would be beneficial for people, because really, I feel that while I still love and enjoy face-to-face therapy, and I imagine I will always do it, teletherapy will allow me to have a broader reach to people that might not otherwise be able to come see me or maybe any other clinician. This is especially important for people who are in rural areas and just have a hard time getting by, like you said. Maybe they don’t have transportation, or there’s no reliable transportation available. Maybe public transportation isn’t something in their area, or maybe it may not even be affordable to them.
And this allows someone to be able to to see a professional, especially if you’re looking for someone with particular expertise. One of the major populations that I work with are fellow members of the LGBTQIA community. And, if you’re living in a rural town, sometimes it’s not safe. I want everyone to be as safe as they can be, so maybe this is a way for people to get some support and help that they need without ever having to leave their house. And they can be assured that they are going to be able to find a clinician that is licensed and that is knowledgeable, aware, and affirming of them and no one has to know about it if they don’t want to tell anyone.
[Eirenne]
I was just thinking about that. When you were talking about access for people in areas where there maybe isn’t the therapy available, or it’s not accessible to them. The idea that, yeah, in small communities where people may not be accepted completely for who they are, this seems like a very safe and reasonable alternative to, “Oh, I need to drive an hour away and like four towns over so that nobody knows who I am.” Look, you can get therapy without going through all that hassle! Which, I imagine, makes people much more likely to actually do it.
[Dr. Essary]
Believe me, I am a major proponent of reducing the stigma of therapy and any type of therapeutic services people might want to engage in, and I don’t think there should be any shame or guilt about going, But, for some people in some circumstances, like I said, talking about gender and sexual minorities, it may not be safe in a different way. I’m just trying to be cognizant of that fact with people who live in certain areas. But teletherapy can also protect people who are, as you mentioned yourself, immunocompromised. Even if someone happens to just generally have a lot of illness or chronic illness, if they have the resources to be able to do the therapy session, but maybe not to transport themselves there, teletherapy may be a good option for them, because I understand that maybe you would use up all of your available resources if you went to make this drive to the office, but otherwise you’d still have some resources left to do something else with your day.
[Eirenne]
Oh yeah. The idea of running out of spoons before you get to the end of the things you need to do. That is a very common thing for people with chronic illnesses. It’s the, “I have a very limited supply of these things and I have to make some ruthless decisions about what is worth spending them.” The idea of spending an hour talking about myself or my issues is great, but maybe I’d like to also be able to eat dinner.
All right, we’ve covered why therapy is good, and what teletherapy is and how it’s gonna be helpful for disabilities and chronic illnesses, and the fact that pretty much anybody can benefit from therapy, whether or not they have a major psychiatric diagnosis. I’d like to touch on briefly, before we end, the idea of comorbidities, and the idea of mental health diagnoses that tend to come along with other problems, with other illnesses, or other disabilities. Depression and anxiety are pretty high on that list; the idea that when things change so drastically in your life, as you mentioned, there’s a grieving process. But then, after that grieving process is done, and you’ve sort of reached an equilibrium, people will sometimes still find themselves facing an increased amount of anxiety or depression in their lives, and maybe other symptoms as well. Whether it’s because of the problems specific to them, or whether it’s maybe some side effects from medications. How do you suggest addressing some of that? Is therapy the only way to address it, or would there be another tip or two you could offer to people that are having that kind of problem? Something they could do in the interim?
[Dr. Essary]
I do think that there are other helpful things out there that can work, either conjunction with therapy, or that can be a first step toward helping yourself. There are a number of good apps that you can get on your phone. Ones that work for anxiety, there’s one in particular that some of my clients have used who either have history of self-harm or substance use, called the Calm Harm app [Apple Store] [Google Play], and it just gives people additional ideas to do instead of engaging in that behavior that will hurt them. And, I think some of these apps do have– or, Headspace [Apple Store] [Google Play] is another app that people use to kind of learn how to do meditation.
[Eirenne]
Okay
[Dr. Essary]
I think all of these are like the beginnings of tools you would learn more about in therapy and can use in addition to the talk therapy piece. Really, the kind of therapy that I think is most effective is, if you don’t have the tools already you need to learn the tools first and get some of that and practice and learn a little bit of that skill. And then, from there, you can work on starting to get into and dig into more of the process piece, more of the whys and hows of things and get a better understanding of yourself. I mean, really, I think that knowledge is the most powerful thing that we can have, and anyone can get more knowledge about themselves. And I think knowing about yourself –really knowing about yourself– is kind of like a superpower. It’ll allow you to do things and think of things in a way that you never thought about before.
[Eirenne]
Dr. Essary, thank you so much. This has been a very enlightening talk, and I’m sure it will be very helpful to a lot of our listeners. Thank you so much.
[Dr. Essary]
Thank you.
If you check the website for this podcast, you’ll find a full transcript of this episode, plus links to all the things we talked about today, including links to Dr. Essary’s [website] and [Twitter] [Facebook], as well as the apps she suggested. As noted in the interview, she is accepting new clients located anywhere in the states of Illinois or Iowa in the United States for teletherapy sessions, as well as face-to-face sessions at her office in Darien, IL.
Please, continue to join me here every month for a different topic and set of tips and tricks. You can find us on the web at http://www.sicktipsandtricks.com, on Twitter @HowToBeSickTips, and on Facebook at SickTipsAndTricks. As always, a full transcript of this and every episode is available on our website.
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Tips and Tricks on How to Be Sick 