Psychologists Debunk 25 Mental-Health Myths

Summary

Psychologists Laura Goorin, Jillian Stile, and Neil Altman debunk common mental health myths in a studio discussion. They clarify that neatness doesn't equate to OCD, there are no five stages of loss, and schizophrenia isn't about multiple personalities. They also address misconceptions about bipolar disorder, anxiety versus stress, the transition from sadness to depression, and the role of therapy and medication in treatment. The panel challenges the idea that bad parenting causes mental illness, the gender bias in depression rates, and the outdated views on LGBT mental health. They also discuss the complexities of grief, the misuse of Myers-Briggs in personality assessment, and the importance of privacy and readiness in therapy.

Takeaways

• 🧼 The myth that all neat freaks have OCD is debunked; cleanliness doesn't equate to obsessive-compulsive disorder.
• 💔 There are no five stages of loss; this is a common misconception and not based on factual evidence.
• 🌀 Schizophrenia is not characterized by multiple personalities but by a break with reality and potentially delusional beliefs.
• 🌡️ Bipolar disorder is distinguished from mood swings by its severe and cyclical nature of extreme mood elevations and depressions.
• 🤔 Anxiety is a continuous worry loop, whereas stress is a response to specific stressors and is a natural part of life.
• 😔 Sadness is a fleeting emotion, whereas depression is a more persistent state often involving rumination and significant impacts on daily life.
• 💊 Antidepressants are designed to regulate mood symptoms and do not change one's personality.
• 👨‍⚕️ Therapy, not medication, is currently the most effective treatment for depression, although a combination of both can be beneficial.
• 🚫 The myth that bad parenting causes mental illness is harmful and not supported by evidence; focusing on present coping is more productive.
• 🏳️‍🌈 Homosexuality and being transgender are not mental disorders; only specific related anxieties or gender dysphoria are considered in diagnoses.

Q & A

What is the common myth about neat freaks and OCD that Laura Goorin addresses?

The common myth is that all neat freaks have OCD. Laura Goorin clarifies that most people who are clean simply care about cleanliness, which is different from having OCD, where the obsession with cleanliness must be at an obsessive level and constantly on one's mind.

According to Laura Goorin, what is the myth about the stages of loss?

Laura Goorin states that there is no scientific basis for the myth that there are five stages of loss. This concept is often mistakenly used to categorize people's grieving processes, but it is not supported by evidence.

How does Jillian Stile differentiate bipolar disorder from regular mood swings?

Jillian Stile explains that bipolar disorder involves severe forms of elevated mood (mania) and depressed mood, cycling through these states. It is not just mood swings, but rather extreme and disruptive changes in mood that can interfere with daily functioning.

What is the difference between anxiety and stress as described by Laura Goorin?

Laura Goorin distinguishes anxiety as a continuous state of worry and 'what if' thinking, while stress is a natural response to stressors in life, such as work or daily commutes. Anxiety can lead to conditions like panic attacks, whereas stress is a more general reaction to life's challenges.

What does Neil Altman suggest about the initial pain in therapy and its long-term benefits?

Neil Altman suggests that discussing painful past experiences can initially cause more pain, but it is essential for long-term healing. He emphasizes that a therapist's ability to handle a patient's despair is a significant step towards the patient handling their own emotions.

How does Laura Goorin explain the transition from sadness to depression?

Laura Goorin explains that sadness is a temporary emotional reaction, while depression often results from rumination on the cause of sadness. She notes that dwelling on negative thoughts can lead to a state of depression, which is a more prolonged and intense emotional state.

What is the myth about antidepressants that Laura Goorin debunks?

Laura Goorin debunks the myth that antidepressants change one's personality. She explains that they are meant to regulate the symptoms of depression and anxiety, helping to bring individuals back to their baseline mood, without altering their core personality.

Why does Neil Altman say the myth that bad parenting causes mental illness is a trap?

Neil Altman argues that the myth that bad parenting causes mental illness can lead to unnecessary guilt and damage the mental health of parents. He suggests focusing on dealing with the present effects of past experiences rather than blaming parents for mental health issues.

What does Laura Goorin discuss about the myths surrounding LGBT adults and youth in relation to mental health?

Laura Goorin discusses that there are many myths associated with the mental health of LGBT adults and youth, often stemming from historical misconceptions, such as homosexuality being listed as a disorder until 1973. She emphasizes that being LGBT in itself is not a disorder and that mental health issues should be addressed individually without prejudice.

How does Jillian Stile counter the myth that only women get depression?

Jillian Stile counters the myth by stating that while women are twice as likely to experience depression due to factors like hormonal changes and life circumstances, it does not mean that only women get depressed. She highlights that men also experience depression, but the expression and recognition of it might differ.

What is the myth about therapy and its focus on the past that Neil Altman addresses?

Neil Altman addresses the myth that therapy is exclusively about the past. He explains that while past experiences can provide perspective on current issues, therapy should not be limited to discussing the past. The focus should be on helping individuals understand and address their current problems.

Outlines

00:00

🧠 Debunking Mental Health Myths

Psychologist Laura Goorin addresses common misconceptions about mental health. She clarifies that cleanliness does not equate to OCD and that there are no five stages of loss, contrary to popular belief. Goorin also dispels the myth that schizophrenia involves multiple personalities, explaining that it is actually a break with reality. Jillian Stile adds that bipolar disorder is not just mood swings but involves severe mood elevations and depressions. The paragraph emphasizes the importance of understanding the complexities of mental health conditions rather than relying on stereotypes.

05:00

💊 Understanding Depression and Anxiety

The paragraph delves into the differences between typical stress and anxiety disorders, with Goorin explaining that anxiety is characterized by relentless worrying, whereas stress is a natural response to life's pressures. Stile points out that while everyone feels anxious at times, an anxiety disorder significantly interferes with daily life. Goorin further discusses the transition from sadness to depression, noting that rumination can lead to a more debilitating state. The paragraph also touches on the effectiveness of therapy and antidepressants in treating depression, challenging the myth that medication changes one's personality.

10:01

🌈 Mental Health Misconceptions Across Demographics

This section challenges several mental health myths related to gender, sexuality, and parenting. Stile refutes the myth that only women get depressed, noting that while women may be more likely to experience depression, it is not gender-specific. Goorin discusses the historical misconception of homosexuality as a mental disorder and the current understanding that being transgender does not constitute a disorder unless accompanied by gender dysphoria. Altman counters the idea that bad parenting is the sole cause of mental illness, emphasizing that focusing on present coping strategies is more productive than blaming the past.

15:03

🔮 Exploring Therapies and Their Impact

The final paragraph discusses various aspects of therapy, including the importance of discussing current issues rather than an exclusive focus on the past. Altman stresses that therapy is not a one-size-fits-all approach and that it should be tailored to the individual's needs. Stile highlights the distinction between therapists and friends, emphasizing the professional training and confidentiality that therapists provide. Goorin explains the role of psychiatrists in prescribing medication and the preference for trying therapy before considering medication. The paragraph also advises on how to end therapy appropriately and mentions the availability of affordable psychotherapy options.

Keywords

💡OCD

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by recurring, unwanted thoughts (obsessions) and repetitive behaviors (compulsions). In the video, it's clarified that being a 'neat freak' or simply caring about cleanliness does not equate to having OCD. The video emphasizes that OCD is an illness with specific obsessive-compulsive components that significantly interfere with daily life, unlike the common misconception that it's just about being tidy.

💡Schizophrenia

Schizophrenia is a chronic mental disorder affecting how a person thinks, feels, and behaves. The video script debunks the myth that individuals with schizophrenia have multiple personalities, explaining that it is actually a break with reality. The script mentions that it's not about having another personality but rather experiencing symptoms such as paranoia, which is a common misconception about the condition.

💡Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is characterized by extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). The video clarifies that it is not just mood swings but represents severe forms of elevated or depressed mood. It also addresses the misconception that these mood episodes are simple fluctuations in mood, likening them instead to more extreme and disruptive episodes that significantly impact daily functioning.

💡Anxiety

Anxiety is a feeling of worry, unease, or nervousness about something with an uncertain outcome. The video distinguishes between everyday stress and anxiety disorders, explaining that while everyone experiences stress, an anxiety disorder is characterized by excessive, uncontrollable worry that interferes with daily life. The script also clarifies that anxiety is a persistent state of worry, not just a temporary stress response.

💡Depression

Depression is a common mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. The video script counters the myth that depression is not a real illness, emphasizing that it is a serious condition with symptoms like lethargy and neurovegetative symptoms, which can be debilitating. It also explains the difference between transient sadness and clinical depression, noting that the latter involves a more prolonged and severe reaction to life events.

💡Rumination

Rumination refers to the tendency to repeatedly think about one's negative emotions and the situations that caused them. In the context of the video, rumination is identified as a process that can lead from sadness to depression, as it involves excessive and persistent thinking about negative experiences. The script uses rumination to illustrate how dwelling on negative thoughts can exacerbate feelings of sadness and contribute to the development of depression.

💡Antidepressants

Antidepressants are a class of medications used to treat depression and other mood disorders by altering the balance of neurotransmitters in the brain. The video script addresses the myth that antidepressants change one's personality, clarifying that they are designed to regulate the symptoms of depression and anxiety, not to alter one's core personality. It also mentions SSRIs (selective serotonin reuptake inhibitors) as a common type of antidepressant medication.

💡Therapy

Therapy, particularly psychotherapy, is a treatment method that aims to help individuals resolve psychological issues and improve their well-being. The video script emphasizes the effectiveness of therapy in treating depression and anxiety, often in conjunction with medication. It also dispels the myth that therapy is solely about discussing past issues, highlighting that it can also provide tools and strategies for managing current life challenges.

💡PTSD

Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. The video script challenges the common misconception that everyone exposed to a traumatic event will develop PTSD, pointing out that many people show resilience and do not develop the disorder. It also critiques the idea that there is a uniform response to trauma, emphasizing the diversity of human reactions to such events.

💡Myers-Briggs Type Indicator (MBTI)

The Myers-Briggs Type Indicator is a personality assessment tool based on Carl Jung's theory of psychological types. The video script critiques the MBTI for lacking empirical validation and being misused to make definitive claims about personality. It suggests that while such assessments might resonate with individuals, they should not be taken as definitive psychological measures due to the lack of scientific backing.

💡Grief

Grief is the natural response to loss, particularly to the death of a loved one. The video script dispels the myth of the 'five stages of loss,' suggesting that there is no standard way to grieve and that people's reactions to loss can vary widely. It emphasizes the importance of recognizing the individuality of grief responses and challenges the idea that there is a single, correct way to experience and express grief.

Highlights

The myth that all neat freaks have OCD is debunked; cleanliness does not equate to OCD.

The concept of five stages of loss is a myth; there is no standardized grieving process.

Schizophrenia is clarified as a break with reality, not multiple personalities.

Bipolar disorder is distinguished from mood swings by its severe and cyclical nature.

Anxiety is characterized by relentless worrying, unlike stress which is a response to specific stressors.

Sadness is a fleeting emotion, whereas depression is a more enduring state often linked to rumination.

Depression is a real illness with symptoms like lethargy and neurovegetative changes.

Therapists can handle patient's despair, aiding them in processing their emotions.

Depression has multiple causes, and addressing them is key to recovery.

Men and women experience depression differently, with women being more likely to seek help.

Antidepressants regulate symptoms of depression and anxiety without altering one's personality.

Therapy is the most effective treatment for depression, sometimes in conjunction with medication.

Bad parenting is not a direct cause of mental illness; it's more about dealing with present issues.

LGBTQ+ individuals' mental health is not inherently tied to their sexual orientation or gender identity.

Mental illness is not directly linked to gun violence; self-loathing and access to guns are better predictors.

PTSD is often mischaracterized; not everyone exposed to trauma develops it, and resilience is common.

Grief reactions are diverse; there are no five stages, and relief can be a common response to a death.

Myers-Briggs is not a validated personality test and should not be used as a definitive measure.

Therapy is not just about the past; it should also provide tools for dealing with current issues.

Therapists are trained to handle sensitive issues confidentially, unlike friends who might not be.

People who seek therapy are often the strongest for having the courage to confront their issues.

Therapists should respect patient's privacy and readiness to discuss painful topics.

Psychiatrists are the only professionals who can prescribe medication in the U.S.

Therapy does not necessarily have to be a lifelong commitment; discussing its duration is important.

Psychotherapy at a reduced fee is available through training clinics associated with educational institutes.

Transcripts

Laura Goorin: So, the myth that all neat freaks

have OCD is a common one.

Most people who are clean

just actually care about being clean,

and that's totally different than having OCD.

Also, there are no five stages of loss.

It's just a myth.

Narrator: That's Laura Goorin,

one of three psychologists we brought into our studios

to debunk some of the most common mental-health myths.

Goorin: So, the myth that most people with schizophrenia

have multiple personalities,

that was a very old way that it was understood,

and it's been proven to not be true.

So, with schizophrenia, it's not another personality.

What it is, though, is a break with reality

and a part of ourselves, maybe, for instance,

that believes that someone is out to get them.

OK, so that's a really common one with schizophrenia.

So the myth that all "neat freaks" have OCD is a common one.

It seems like it's almost a popular cultural thing

that people say to each other, "You have OCD,"

when somebody is, like, organizing their bag.

And, in reality, OCD itself,

the illness has different components.

And one of the subsets

is the keeping things organized and clean.

But it has to be at an obsessive level,

where people are thinking about it all the time.

And so that itself is really uncommon.

Most people who are clean

just actually care about being clean.

And that's totally different than having OCD.

Jillian Stile: Bipolar disorder is not simply mood swings.

It's a very high elevation of maybe a positive mood

and a very low, negative mood.

Everybody has mood swings.

But with bipolar disorder, it's not just that.

It's severe forms of elevated mood or depressed mood,

and they cycle through that.

And so sometimes it could be shown

as symptoms of, like, a manic episode,

might be somebody, like,

hypersexuality or not sleeping at all

and things like that.

It's not simply feeling good.

Goorin: This is a common myth,

and I hear people throw this one around a lot too.

Anxiety itself is thinking, thinking, thinking.

And just imagine yourself

going into the worry thoughts of "what if."

What if, what if this happens, what if that happens.

And it's unremitting,

and it goes on for hours for some people.

Sometimes it's more passing for others.

But being stressed out about something,

as humans, we're wired to handle stressors,

and we've been dealing with an onslaught of stressors

since the beginning of time.

You know, going to work, taking the subway,

coming in contact with other people. You know,

that can be stressful. That can be stress-inducing.

Unless you have an actual, like, panic attack

while you're taking the subway,

that would be more of an anxiety reaction,

whereas the stress of taking the subway

is more stress-based.

Stile: You know, everybody feels anxious, let's say,

before a presentation or before an exam.

But an anxiety disorder is the extreme form of that

where it becomes, you know,

it interferes with somebody's daily functioning.

Goorin: This is actually a really important myth.

Sadness is an ephemeral reaction to something.

It's an emotion and, by definition, lasts a few seconds.

It can last, like, 10 minutes, but on average,

we have an emotion, it passes,

and then we have another emotion.

The thing that tends to bring us

from sadness to depression is rumination,

which means thinking and thinking and thinking

about the thing over and over and over again.

And that's how we then go from sadness to depression,

but it's not an immediate thing.

We all have moments of sadness,

and we just allow them and let them pass.

We tend to be OK.

But if we get caught up in getting ruminating

and thinking about all the reasons why we're sad,

that's when we tend to go into depression.

So, to the myth that depression is not a real illness,

it is a real illness,

and, in fact, it can be incredibly debilitating.

In order to classify as having depression,

we have to have some kind of a lethargic kind of behavior

where we have trouble getting out of bed.

I mean, there are different ways of depression,

but one of the primary ones has this,

what they're called neurovegetative symptoms,

like, where we can't sleep, where we can't eat.

There's also a kind of depression which is dysthymia,

which has an anhedonia component into it,

which means less pleasure in things that we used to enjoy,

which is another kind of depression.

And a lot of people will describe, like,

"Oh, I used to love pottery,

and now I can't even look at pots."

You know? Like, something just totally changes for them

when they're deeply in this state of depression.

Neil Altman: Talking about painful things

that you've learned how to sort cover over

can initially be more painful

but in the interest of working out things

that if not dealt with straightforwardly

are gonna come back to bite them.

I'll say another thing about that

is that sometimes patients wonder,

"What's the therapist gonna feel if I say thus and so?"

Like, "Can the therapist handle

the level of despair that I sometimes feel?"

And on those occasions,

when the patient has the strength to put it out there

and see how the therapist responds,

the fact that the therapist can handle it

is a big step toward

the patient then being able to handle it.

There are reasons, and they may change over time.

But I think the thing that I would want to debunk

in that respect

is the idea that there's a single reason.

So that if you handle that,

then you're gonna be freed of that.

And there's not.

In most cases, there's not.

You've got to discover the reasons, in the plural,

that you're depressed and what you can do something about.

And what you can't.

Stile: The myth that only women get depressed

couldn't be further from the truth.

However, women are twice as likely to experience depression.

So, the reason why oftentimes people think

women have a higher rate of depression than men

is because of maybe hormonal changes,

life circumstances, and stress.

The other thing that I like to think about

is that women might express their feelings

in a different way than men do.

So, sometimes men might, you know, act out behaviorally,

whereas women might focus on their internal experience.

And so they might be more likely

to see a therapist if that's the case.

Goorin: When people have gone down the road

of eventually deciding to go on medications

for antidepressants,

they don't change your personality;

they change the symptoms of depression.

They can also work for anxiety.

So, typically, if you have

just typical symptoms of depression and anxiety,

we'll be given an antidepressant

is what it's called, an SSRI.

And that will help us regulate the symptoms

of our, just, up and down of moods.

And the way I describe it to people is

it's like going back to your baseline you

when it's the right medication.

But it doesn't change your personality.

Your personality, you're you.

So, in terms of the myth that we'll always be cured

from depression by antidepressants,

the research shows that the most effective thing right now

for depression is actually therapy.

And then for people who need antidepressants,

therapy and antidepressants together

are another effective form.

And not everybody has to take it.

So even with people who are taking antidepressants,

it's important to still be in therapy.

Altman: The myth that bad parenting causes mental illness

I think is a trap.

Because parents are all too ready

to take responsibility and to feel guilty

about all sorts of problems that their children have.

So there's no point in reinforcing that

and harming and damaging the mental health of parents.

If you think that your parents caused your mental illness,

you're gonna end up endlessly complaining about your parent.

What can you do about the way you were raised?

You can do something about what it's left you with

in the present.

Goorin: Around LGBT adults and youth,

there's so many myths associated with mental health.

And a big part of it I think is,

unfortunately, because the profession that I'm in

had a really dirty history along these lines in the DSM,

which is our Diagnostic Statistic Manual, until 1973,

homosexuality was actually listed as a disorder.

And after a lot of pushback and studies

and LGBTQ rights being integrated into theory,

we realized that that was really outdated.

And since then, in DSM-3, it stopped being,

unless somebody has specific anxiety related to being gay,

then they're not diagnosed ever

with a mental-health-related disorder associated with it.

The same is true for being trans, actually.

That it's only if somebody has what's called dysphoria,

where they don't like their body,

that they then have a diagnosis.

But just being trans in and of itself

isn't a disorder anymore.

You know, to the question about what role

mental health plays in the attacks of gun violence,

unfortunately, that's been a mischaracterization

of people who have severe mental illness,

is that they're more likely to commit crimes and with guns.

It's not that people with mental illness

are more likely to be aggressive.

It's the people who commit these crimes have access to guns,

and they tend to be really self-loathing.

Like, that's kind of the primary thing

that makes people have a lack of empathy.

That seems to be the things

that make them be more violent and aggressive.

Those are better predictors

than any type of a mental health disorder.

People talk about a whole town, like, on the news,

"A whole town was traumatized by the shooting,"

for instance. Right?

And it doesn't work that way, and that's actually

one of the most common mental-health disorders

that I've seen mischaracterized

in that particular way, is PTSD.

People seem to think that by virtue of having the experience

to a potentially traumatic event,

that you'll have these particular realm of symptoms

that include hypervigilance, there's impulsivity.

There's so many different realms

of what comes up for people after trauma,

and I've heard people say, you know,

"Because I was traumatized,

because I was there at 9/11," for instance.

Well, a whole city was there,

and we have really good numbers

about the number of people who ended up having PTSD,

and they're actually really small.

When something like this happens,

a major tragedy like a gun shooting or a 9/11

or any other type of tragedy like that,

people tend to be resilient.

There's a big myth, actually,

even within the mental-health field

saying that there are prototypical ways

to respond to grief and loss.

And that's in pop culture as well,

that people have these ideas

that there's one way to grieve

and if we're not devastated and deeply traumatized

that somehow we're in denial or unfeeling.

And that's not true.

In fact, since the beginning of time,

we've been dealing with death.

We have different ways of dealing with it.

And sometimes we're relieved that the person dies

because we didn't have a very good relationship with them.

Or even if the person, if we love them

and we feel really connected to them but they were sick,

we're relieved that they're dead

because we don't want them to suffer anymore.

People tend to feel really guilty

about being relieved after a death,

which is a very common reaction to death.

There are no five stages of loss; it's just a myth.

And it's one of the most popular myths out there.

And it's one of those things

where people who aren't very psychologically minded

will come in and say,

"Oh, my gosh, I must be in the denial phase of loss,"

or, "I must be in this phase

because I'm not dealing with it yet."

In reality, I just think it's one of those things

that makes us feel safe.

Like, if we can imagine these stages are ahead of us,

then we can feel better about where we are,

and so I think that's why it's so popular.

However, I've seen the flip side,

which is why it can be damaging,

when people have losses and they're judging themselves

for not having this prototypical series of stages,

and they're not based on reality or evidence or anything.

OK, so, people are gonna hate me for saying this, but,

and this is so common in the dating world.

Like, if you ever look on people's profiles

on dating profiles, they always say, like, "I am an NYFB,"

or, I don't even know what they say.

But it's always about how they're

these certain, you know, Myers-Briggs score.

And it's really popular these days, Myers-Briggs.

And, in fact, a lot of organizations use it

and really base a lot of their testing on it.

Again, there's no validation around any of these studies.

And so while it might resonate for people,

and that is something that, you know,

just like when we talk about, you know,

"I'm a Gemini because I do this,"

you know, it resonates for you, the idea of being a Gemini,

and you might act in ways that remind you

of this description of what it is to be a Gemini,

but there are no empirical tests

to say that you are such this thing.

There are personality tests,

but Myers-Briggs isn't one of them.

Altman: The myth that therapy

is gonna be exclusively about the past

or predominantly about the past

and not help you in your current life

or not give you a form

for talking about what's happening today and yesterday,

there's a reason why people hold on to that myth.

And the reason is

that there was an early version of psychoanalysis

that held to the idea that people's personalities

were formed in their first five years

and that the past was strongly formative of the present.

It sometimes can be helpful to say

that there was a pattern that was established

in relation to people in the past.

And that can give you some perspective

on what's happening in the present.

So making reference to the past

is not necessarily a bad thing,

but it should never be because this happened,

therefore you're having this problem now.

It's not an explanation.

It's only a way of getting perspective on the present.

Stile: I think oftentimes people might say,

"Oh, why not go speak with a friend who's a good friend,

and they can keep things confidential?"

But therapists are trained to work in a particular way

to help people deal with specific problems they're facing.

Therapists are different than friends

because even though your friends might be willing to,

for example, hold a secret,

therapists really treat things

in a very confidential manner.

And they're willing to explore things

that maybe a friend would be uncomfortable exploring.

Altman: Actually, the fact is that most people

who come to therapy are among the stronger people.

And the reason is because they have the courage

and the strength to look at themselves,

which is not an easy thing to do in various ways.

I think it's because the people who come to me

are people who've already decided to work on themselves.

Good therapists don't force their patients

to talk about something they don't want to talk about.

To the contrary,

I think that even encouraging a person

to talk about something

that they're not ready to talk about is counterproductive.

The problem with hitting pain points right on the head

is privacy, for one thing.

People are entitled to their privacy.

Therapy isn't just an opportunity to spill.

So I think having people's privacy,

when their privacy is respected,

that makes them more confident to open up, actually.

But the other problem for that

is that the therapist needs to be thinking

that there's a limit to the tolerance of everybody,

including the therapist,

for how much pain they can tolerate at any given time.

And so respect for people's anxiety about getting into

some of the more difficult things in their lives

is also part of the process.

Goorin: Psychiatrists are the only ones

who are able in this country to prescribe medication.

They do what's called a psychopharmacological consult,

where they will go through all of your history.

And that's something they do if you want that.

And I say if you want that

because it's really important.

As a psychologist, for instance,

we always try therapy first.

It's the treatment of preference for all clinicians.

In fact, they've done all these studies that have shown that

therapy first for several months

before you then even think about a medication

is the best course of treatment for people.

Because that way you can really see what is what.

And if you then still want to do medications,

it's certainly something you can talk about.

But you don't have to do medications.

It's up to you and your therapist

if it feels like that would be beneficial to you.

Altman: I would not say that most therapists

consider that therapy has to go on forever.

But I think when you're interviewing somebody

and considering them to be your therapist,

that's one thing to ask about.

How do you think about how long this should go on,

and when do you start to think

that maybe it's time to end it?

How do you break up with your therapist?

Do not break up with your therapist

in an email or a text or a phone message.

You've got to be direct. You've got to say,

"I've been thinking that maybe it's time for us to stop."

But then that can't be the end of it.

If you haven't already said it,

hopefully you have already said it in one way or another

in the preceding sessions.

"What I've been looking for is this,

and I see how it's been happening in my life."

And maybe give an example or two.

But it's not like you feel

you have to convince the therapist.

I want to be sure to let people know

that there are lots of ways

of getting good psychotherapy at a reduced fee.

So, there are institutes

where people get advanced training beyond their doctorate.

And all those institutes have training clinics

where people are treated at a low fee.

And some people might think that the higher the fee,

the more skilled the practitioner,

which is not necessarily the case.

But certainly in that case it's not true.