Are we therapists at risk of working with clients only from an emotional perspective?

by Margaret Parkes: Systemic Psychotherapist, Supervisor and Management Consultant.

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Would it be helpful to our clients if we were more aware of the possible need for early medical or neurological intervention?

Could we as psychotherapists and those of us in the helping professions be at risk of trying to get the client to fit into ‘our theory of thought’, thus causing us to overlook signs and symptoms that do not coincide with our belief systems.

In my psychotherapy practice I am meeting more and more clients who are presenting with issues that appear emotional but upon further investigation can require neurological or medical intervention/investigation. If we practitioners miss the requirement for the possible intervention of a helpful third party it could be detrimental to our clients and their ‘emotional illness’ could become more complicated due to compounded neglectful diagnosis. Due to their lack of recovery the client can be labelled as resistant to therapy, whereas they were possibly not getting the necessary treatment to fully recover.

Medical and emotional Intervention
For example, a client I finished with recently who had presented with severe depression, was a beautiful young 18 year young lady – had been a champion dancer – and had been unable to attend school for all of 5th and 6th year, due to her depression, anxiety and exhaustion. She had been attending an eminent psychiatrist and was prescribed antidepressants. When she came to my practice she was unable to get an appointment with him for another two months. She was unable to get out of the bed and the medication was making her feel worse.

Her mother brought her to see me in desperation – yes there were emotional issues we needed to process – but my gut told me there was something medical going on – and recommended she see a particular GP – who carried out a series of blood tests on her – and it was discovered that she had had graves disease for two years or more – causing her thyroid to be overactive ( thyroid symptoms can mimic those of depression) – when this illness was treated my client was able to resume normal living again and continue with her studies. This is an example of a medical/emotional intervention – whereas if I had focused on the ‘emotional’ alone the outcome would not have been successful.

Neurological and emotional interventions
Another recent case I worked on where a young man – a 19 year old male – client presented along with his mother. He was a boxer and had won many competitions but of late was losing interest, as he was finding it more exhausting to plan and focus, as a result of which he became depressed. This was affecting other areas of his life. When we explored his history, this difficulty focusing had also been an issue for him in school, though he worked really hard to get good results – he didn’t feel he got the results he deserved for the effort. In his early years, and had been found to be on the ADHD spectrum and had difficulty focusing, sequencing and planning. But he hadn’t understood until today the impact of his condition on his studying and exams, and realised that the same thing was now happening in his boxing career. He acknowledged that all of this really affected and continues to affect his confidence.

In the past he had been put on an antidepressant which didn’t agree with him and he started to self-harm – again my experience has been that few ADHD people require antidepressants and if they do it must be one that suits their particular condition. It is my experience that many GP’s do not fully understand this and I also wonder if psychiatrists do too. I have found that ADHD young people respond really well to specific drugs that help them with their neurological development if that is their choice. They also respond well to gaining an understanding of their condition and what is going on with them, as they are very often highly intelligent. Upon further exploration I found that this client was starting to drink more, to calm his brain – which is often what ADHD people do – they self-medicate.

When I explained to him what was possibly going on he looked visibly relieved, we set out a plan of action which included an assessment with a psychiatrist who specialises in ADHD in the autism centre in Naas, Dublin. He promised he would make a daily plan (as he needs structure) and get back to his boxing but on a lesser scale (as he tends to overdo everything- typical ADHD behaviour, and that he would stay off alcohol and keep a mood log). His mum who was present in the session at his request, texted me afterwards to say he was much happier in himself after the session and that they had already sent an email to the psychiatrist.

Another example comes to mind of a 48 year old woman who presented very stressed seven months ago, as she had gone to college for the first time – to achieve her lifelong dream to gain a college qualification. This woman had been on antidepressants for over twenty years for anxiety. Though clearly a very smart woman – she struggled to get the information from her head on to paper. To write a paragraph was impossible for this intelligent woman. This increased her anxiety and was also causing her to drink more heavily. As I suspected this might be a neurological issue I explored her history and found that ADHD and Asperger’s ran through her family of origin and one of her children was high on the autistic spectrum. (Autism is one of the most inheritable mental disorders if one child has it in a family, siblings have 35 times greater than normal risk of symptoms. It is important to know if anyone in your client’s family has a diagnosis of autism spectrum disorder).

I worked with this client on her emotional issues and she agreed that she would like to attend a psychiatrist for a diagnosis regarding her difficulty focusing and sequencing. She was diagnosed with complex ADHD (this is ADHD which is mixed with an Asperger element). She is now on a different antidepressant for her serotonin issues which are particular to her, and a medication for her focusing difficulties which had caused her anxiety. After a number of months she says she feels confident for the first time ever and more focused, and has applied for a course more suited to who she is because she now knows who she is for the first time in her life. Also her life now makes more sense to her and she is no longer beating up on herself for her lack of action or success in the past. And interestingly she doesn’t think of a drink these days now because she doesn’t have to medicate herself for her ADHD anxiety. (ADHD people are at high risk of addiction – they unconsciously try to find a way to self-medicate to calm their minds down).

Moving Forward
Though I acknowledge that emotional issues accompany all clients that present to us practitioners, it is very important to look out for neurological or medical issues that can accompany the emotional which often can be easily solved but yet overlooked.

I as a systemic practitioner and psychotherapist find it very helpful to approach my work in this way. And it is my belief that all mental health professionals today must look at things in a more holistic way – keeping an eye on the medical, neurological, emotional, and nutritional health of the client. It is also helpful to always be aware of substance abuse or other addictions which will bring on depression. I am not suggesting that you give clinical advice but it is helpful to be aware of clinical treatments, and refer when necessary.

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