- I think that self-awareness is really important.
And also people are uncomfortable
when they feel like they have to be taken
out of their natural environment.
- Yeah.
- But sometimes that is the kick in the butt that you need
to reset things.
When you take yourself out of your natural environment,
also the bad habits, they sort of get a break.
The types of people that maybe you were hanging out with
that maybe were bad influences.
You're not around them anymore.
And oftentimes,
especially when there's a co-occurring
substance abuse issue,
I find that that can be really helpful.
(bright music)
- There's a lot of treatment options.
You can go one on one therapy, group therapy,
treatment centers.
How do you navigate that?
- Well, I always like to think about it
in terms of level of support.
So how much support do you need at this time?
Sometimes people really need a lot of support,
around the clock support,
and that's when they might go
to residential treatment centers.
This is sort of, you go and live in a whole different place.
And the treatment comes to you.
The providers actually come to the house,
or the facility that you're living in,
and it includes a number of different things.
It includes psychiatry.
It includes individual therapy multiple times a week.
It includes group therapy of different kinds,
multiple times a day.
And sometimes family therapy as well.
If people are needing sort of that support from that angle.
And most of the times they do,
because the family is going to be helping this individual
when they come out.
There might be hurts and pains that they need to deal with.
And it's a great, safe place to do that.
That's really the highest level of support is sort of
that round the clock care.
There is technically one even higher than that,
which of course is hospitalization.
This would be that you're in a medical hospital,
because something needs to be stabilized,
before you can even be transferred
to a residential treatment facility,
where you don't have a medical staff there 24/7.
You have your providers coming in, but you know,
now you go to sleep and it's just regular staff
who may not be professionals.
And so that's part of the issue
is understanding when you might need that,
because it does mean
that you have to leave your surroundings.
You might have to tell your job you're taking a leave.
You do have to arrange things for that to happen.
And usually residential treatment centers will go on
for anywhere from 30 days to maybe 90 days is very typical.
After that there is sort of a lower level of support
called partial hospitalization.
It sounds scary,
but what it is is that you're basically going to treatment
like a job.
So you go five days a week, seven to eight hours each day.
And again, you get psychiatry,
you get individual therapy,
and you get various group counseling sessions.
Intensive outpatient programs are the next level down.
This is when you need a little bit more support
than just seeing your counselor maybe once a week,
or once every two weeks.
But it's not so much that you can't also continue
to have your life, living at home.
You're probably going to work,
because most intensive outpatient programs
happen in the evenings.
So they'll happen two to three days of the week,
for about two to three hours each time.
And usually you get a combination, again,
of individual therapy, and group therapy during that time.
And then the lightest level of support, of course,
is just regular outpatient therapy,
where you go see your counselor maybe once a week,
and maybe you see your psychiatrist once a month,
or once every two months.
And you're managing everything else,
and you're feeling pretty good about it.
- A perfect breakdown.
- (laughs)
- And in terms of people deciding what they should go to,
or helping a loved one decide which one they should go to.
Is it kind of just whatever they feel like they need?
- Well, I think it's always good to think
about starting at the least restrictive level of care.
- Okay.
- So can you be managed,
just doing a counseling session once a week?
And if you're not getting the results that you want,
or you're feeling like you're still having problems,
maybe step it up to the next level.
- Or see a different therapist.
Try that first.
And then try different medication,
try a different therapist.
If that's not working,
and you feel like you just need more support,
maybe more intense therapy,
go to an independence of outpatient program.
Most cities and towns do have them somewhat nearby
that can be workable.
And a lot of them are dual diagnosis serving.
So they deal specifically with individuals
with both depression and anxiety,
and also substance abuse components.
If that still doesn't work,
then you move up, and you move up, and so on.
I think the only exception would be
that the person's life is clearly
has spiraled out of control.
Perhaps they were even just hospitalized
because of the withdrawal symptoms they had from alcohol.
Maybe they even had delirium tremens.
Well, at that point,
you really should go straight from there
to a residential treatment facility,
once you're medically stabilized,
because you clearly need to have a lot more support
during that time to make sure that you stay on track.
And then from there you can move on slowly down the ladder.
- It's really important that people
are honest with themselves on what they need.
- Yes.
- I can see even myself going, oh, well,
I don't need that, I can handle this over here.
When really I know I should probably take option B or C,
instead of A.
- Absolutely.
And I think that self-awareness is really important.
And also people are uncomfortable
when they feel like they have to be taken
out of their natural environment.
- Yeah.
- But sometimes that is the kick in the butt that you need
to reset things.
You need a reset.
And when you take yourself out of your natural environment,
also the bad habits, they sort of get a break.
The types of people that maybe you were hanging out with
that maybe were bad influences.
You're not around them anymore.
And oftentimes,
especially when there's a co-occurring
substance abuse issue,
I find that that can be really helpful.
- What are some realistic expectations for improvement
when someone first starts whatever treatment plan
they've gone with?
- I think a realistic expectation
is that you start to feel a little less hopeless.
It doesn't mean that all your problems are solved.
But what I hear most from clients
who maybe finally took that step is,
once they're integrated into that community,
whether it's seeing their provider consistently,
or they're part of an intensive outpatient program,
or a residential program,
is that they feel like,
maybe there is a way out of this after all.
And I think that that is the kind of support
that professionals can give you,
and the kind of encouragement that they can give you,
when they start to give you insight and techniques
that can help manage your issues.
A lot of times people find that the hopelessness
is really what keeps them from getting better.
Because if you believe that nothing's going to change,
why would you do anything about it?
And I think that's part of the issue
with a lot of individuals who are reluctant
to go to therapy in the first place.
- What about parents of children who are in therapy,
and those kids are coming home after a session,
or after being in a treatment center,
and saying, oh, it's dumb.
I hated it, it was stupid.
I didn't learn anything.
How do we know if it's working or not
if that's the feedback?
- Well, I think as a parent,
you definitely need to be talking
to your therapist regularly.
- Yes.
If your child is under the age of 18,
you actually have full access to their records,
and you should use that access.
You should be asking that therapist questions.
You should actually be asking for alone time
with a therapist.
Oftentimes I encourage parents of my clients
to come in 15 minutes before the session is over,
so that I can spend the last 15 minutes with them.
And it's important.
You've got to keep them on top of it.
You've got to make sure
that they have a forum to ask questions of you,
and also because they are supporting the child,
you need to give them some insight
into what you've been working on,
so that they can try to replicate,
and reinforce that at home.
- For an initial therapy session,
or actually at any point during therapy,
can a loved one be in the session with the patient?
- I think when a person is an adult that is up to them.
So the client will say, you know what?
I think it would be really nice to have my mom in here
for this one, or my husband in here for this one.
And sometimes the therapist can also gently suggest it,
but that's ultimately up to the client to decide.
When the client is a minor, absolutely.
I think that that should be a part
of the therapeutic process.
I think that they should be involved to some degree.
And obviously the older the client gets,
maybe the less involvement there is,
to sort of match that developmental trajectory.
But I think that they should always be involved,
because again,
that person is living under their roof,
and they need to work out any conflicts
that are possibly causing some of these emotional symptoms.
- When does treatment fail?
- Hmmm.
I think it can fail in a couple of different ways.
I think one could be that the client
is not really that motivated.
- Okay, but what 16 year old is motivated
to not go out and party with his friends?
- (laughs)
- That's what they want to do.
- Right, no, it's a good question.
And I think that a lot of clients who are minors,
their motivation comes from a different place.
You know, it's not so much, well,
I want to go out with my friends
instead of being at therapy,
and that means that they're not motivated.
but it means that,
are they spending time developing a positive relationship
with this therapist,
and do they care about that positive relationship?
That could be an area in which people do falter.
And I think when that happens,
then the kids are just going through the motions,
and therapy is failing,
because they don't feel particularly connected
to the therapist.
They don't necessarily care
about what the therapist has to say.
And if that type of dynamic exists,
then treatment probably is failing.
- Hmmm.
- I think that it's also failing
when you are not seeing any improvements in your life,
and yet you stick with it.
You're like I'm going to therapy.
Well, but if it's not working, why are you still doing it?
Go to another therapist, find out another technique.
You know, try something different.
And a lot of times people will say, well,
I've been going to a therapist for five years,
but it's not working.
And I ask them, what do you mean by that?
What do you mean by it's not working?
Are your emotional symptoms not improving?
Is your life not getting better?
Or your relationships not improving?
If all of their answers are no, then it isn't working.
But sometimes they say it's not working.
And then when I ask them those specific questions,
they're like, well, yeah, my mood is better.
It's just not perfect.
I'm like, okay, but that means it's working,
unless you hit a stalemate,
unless you've improved for a bit,
and now you're not making any improvement at all.
And at that point, you know,
it is a time to discover to discover whether or not
this therapist is still right for you,
or maybe it's time to try it on your own.
Maybe you've gotten the improvement you need from therapy,
you don't need your handheld anymore.
And in fact, I love it when my clients graduate therapy,
I don't want to have them be in therapy
for the rest of their lives.
I would hope that they leave, you know,
and feel better.
- What qualities do you see in patients who have depression
and substance abuse, that overcome it?
- I think the people that tend to overcome it
when they have the co-occurring issues,
are people who feel like the control rests within them
to change their lives.
I think when they feel like outside factors are the reasons
for why they have depression,
or outside factors are the reasons why they drink,
it takes a longer time for them to get to a place
where they feel better.
I think once you start taking responsibility
that these are my decisions,
and these are things that I can do,
it makes the therapeutic process so much faster,
because then they're also more likely to take in your advice
and try your techniques,
because they actually feel like they have control
of the situation.
So I sometimes find that people will blame other people
for their problems.
Well, it's because my parents treated me badly, and oh,
because my boss is terrible.
But that type of stuff
can really perpetuate the cycle of helplessness.
Like if the person is at the whim of everybody around them,
- It's not a life.
- Yeah, and then you always just feel
like you're kind of floating around with no anchor.
And that really messes with somebody
when they're trying to get treatment,
and trying to start taking more responsibility
for what they can do.
- In our first episode, you said, stress is normal.
Stress happens.
- Yes.
- We act like we're not supposed to be stressed.
- Yes.
- And when you said that.
I go, oh, you're so right.
I'm going to take that away for me.
- Yes.
- Because we act like, oh, well,
if we have stress, we're doing something wrong.
Something's bad.
We screwed up.
No, it's just because we're alive.
That's what happens.
- Right, that's exactly.
- It just reminded me of, you are going to have bad bosses.
- Yeah.
- You're going to have bad things happen in your life.
It is up to us to handle those things correctly.
- Absolutely.
And I think that that is exactly what, you know,
people should remember,
that emotions, positive and negative,
are just part of the human experience.
If you don't have any negative emotions,
how do you know when you're having a positive emotion?
- Yeah.
- Like you really don't.
- And who are you?
- I know, and also, who are you?
You're not a real person.
- Get away from me.
- You're not a real person.
And I think people become so frightened
of negative emotions,
like they have to push it away, they have to avoid it,
they have to escape it.
But why, why?
Because the more you struggle with it,
the more you're going to have that emotion again.
And by the way,
anything that's meaningful to pursue in life
is going to be wrought with some negative emotions,
whether it's stress or worries.
I mean, think about anything, like moving to a new place,
starting a new job, starting a new relationship,
getting married, having kids.
They're all very meaningful things to do.
And yet there's ups and downs.
- Yep.
- That's life.
And if you're actually pursuing the values
that are most important to you,
you're going to have negative feelings.
So it's okay to have them.
- Final thoughts on treatment.
What, what do you wish every single person
who came in to see you
for depression and substance abuse, knew?
- That there's many ways to skin a cat.
So you don't have to worry if one or two,
or even three treatments didn't work for you.
There's so many other ones,
and you are a unique individual
with your own personality traits, your own tendencies,
your own reasons for why depression and substance abuse
became a problem for you in the first place.
Why do you expect
that there's a one size fits all treatment?
People sometimes take treatment once.
They say, well I went to one rehab center,
it didn't work for me.
So I'm just going to be an alcoholic
for the rest of my life.
- No.
- That's absolutely not the case.
You maybe did not find the best treatment center for you.
Yes there's bad treatment centers out there,
but there are perfectly good ones
that just weren't a match for you.
And you have to keep trying,
you have to keep trying different methods, different people,
And you will find the one that works for you.
So don't give up.
There's so many different ways to get good treatment.
- You guys better time code that, and save that video.
when you need a little boost from Dr. Ho,
and you wake up and go, I don't know about today.
She's going to go, don't give up,
there are different treatment options.
- Don't give up.
- I love that.
As I tend to do towards the end of each series,
I like to open it up to our camera crew, our producers,
to see if they have any questions for you
on this topic, of course.
So if they do, speak now, and if not, you know,
I'll probably email her for you.
- (laughs)
- But I'd rather you ask me now, if you have any.
Do you have any over here?
- [Crew member] Something, let's say I'm the loved one.
or I'm the supporter of a recovering alcoholic or addict.
What are some things I can do to make it easier,
day-to-day.
- Wow, that's a great question.
- Just say it one more time,
in case they couldn't hear her.
She asked as somebody who is a supporter
of a recovering addict,
what are some things I can do to help them, day-to-day?
- That is a great question.
And I think actually the first thing is,
it's not your job to do their recovery for them.
- Isn't that such a great thing to hear?
- I think people do get into that sort of codependency
that happens a lot, with addicts and their loved ones.
And you want to take control.
You want to make sure they're going to be okay.
But no, that's actually terrible.
You have to let them pursue recovery on their own,
and be there as the backdrop, be there as the foundation,
as the structure.
But you are not doing that work for them.
So on a day-to-day basis, you check in with them,
you ask them how their day is going.
You ask them how their therapy sessions went,
how AA groups went.
Just check in to make sure again,
sort of that monitoring piece, you know, what's going on?
How's everything going?
And when they're having a bad day,
it's not your job to pull them out of it.
So it's not your job to go rescue them.
You ask them how you can support them.
But if they're just having a bad day,
you don't have to have a bad day along with them.
You just say, okay,
well it seems like you're dealing with some stuff.
I'm going just to be in my room.
You know, if you need me, I'll be there.
Just let me know how I can help you.
Be the supporter in a very empathic, and non-directive way.
But when they start to do behaviors
that fall back into addiction,
you do have to maintain that structure.
You can't hide for them.
You can't call in work sick for them.
You can't, you know, somehow,
because they ran out of money this month,
they've actually ended up drinking again,
and bought alcohol with it, give them money.
- That's enabling, that's not supporting
- You can't do that.
At that point, you say, well,
clearly you've fallen into some of your previous behaviors.
What can we do to get you back on track?
You want me to come with you to therapy?
You want me to go with you to AA today?
What should we do?
Right?
Problem solve everything as it comes up.
But you are not the first person
to come up with a solution yourself.
And you're not the person to enforce that
on a the day to day.
- Did you get it?
- [Crew member] Yes.
- Good.
- [Crew member] Follow up question.
So then, let's say they like, they run out of money,
they spent it, whatever.
So then how do they eat that month?
What's your, how do you figure out this way
that they can still stay alive,
but you don't give them anything.
- Ugh.
- [Crew member] Do you tell him to go to the food bank?
- Can I try to answer that first?
- Yes.
- I just want to see if I'm getting it.
- Yes.
- You, the question, the question he's asking,
the follow-up is, all right,
you're not going to give them any money,
but how do you make sure they eat that month, right?
You don't make sure they eat that month.
That's not your job to make sure they eat that month.
Is that right or wrong?
- Yeah, yeah,
because that is some of the own consequences
that they've caused.
And so you can give them ideas.
You can say, well,
maybe you can pick up an extra shift,
because obviously you run out of money.
So maybe you need to work double time.
I have a friend who is looking for somebody to help him
with a catering job this weekend.
You want to go do that?
And you know, that's sort of what you have to do,
because that's a realistic consequence, right?
Because you can't get into this weird parenting thing
where you're like, okay, well,
why don't you clean the house, I'll give you an extra $50.
- Yeah.
- You have to make them sort of go externally
to the real world,
and solve that problem.
And if it means food stamps, I guess it means food stamps.
Or I guess we're going to have to get real creative
about what's around the house.
I guess now you're going to eat that sort of, you know,
old cereal that's maybe expired.
- And they have food at rehab.
- They do have food or rehab.
- You got it?
- (laughs)
- All right, Dr. Judy Ho has been so amazing.
I know that you have touched so many people
in a meaningful way.
You do this all the time.
So I know you're used to it.
But truly this series has helped so many people
understand what they're going through,
and understand what they can do.
So very, very excellent.
I'm sure we'll be seeing more from you very soon.
Remember, one of the best things that you can do
is share medcircle.com with your friends and family,
so that they can start their mental health education,
and start making the next best right decision.
I'm Kyle Kittleson,
and remember whatever you're going through,
you got this.