Frequently Asked Questions

1. Emotions and Illness
2. What is psychotherapy
3. How to choose a therapist
4. Psychotherapy Groups and Support Groups: similarities and differences
5. Treatments Available to Improve Your Mood
6. Tips on How to Improve Your Psychological Health

Emotions and Illness
A positive attitude can contribute to anyone's good health. However, that sort of attitude can be difficult to maintain when one is faced with a chronic illness. Such illness produces emotional reactions such as anger, sadness, frustration, and especially fear. These add to the distress and suffering, and may actually make physical symptoms worse. Sometimes people are ashamed of these feelings, or do not know how to express them.

Many people do not realize that depression is a coping mechanism (believe it or not!) that humans have developed, as a response to many stressful life situations, including chronic illness.

Most people make sure they get the best possible modern treatments for their physical symptoms, but the psychological consequences (the uncomfortable feelings and the resulting depression) often go unnoticed and untreated.

This is tragic, because appropriate treatment can pay huge dividends:

• being depressed is depressing - who needs it, on top of the difficulties posed by the illness
• depression impairs the immune system, possibly worsening the current illness, and predisposing to new ones
• four scientific studies in patients with life-threatening illness have shown that psychological treatment prolongs life.

Many people are depressed and don't know it. Sometimes, we don't notice how distressing a background noise is until it stops. The good news is that, although depression is very common, it usually responds well to psychological treatment, without the use of medication.

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What is Psychotherapy?
Psychotherapy simply means treatment by psychological methods, in contrast to physical methods (e.g. physiotherapy, acupuncture, surgery) or pharmacological methods (e.g. medication or herbal remedies ). The purpose of psychotherapy is to help people with emotional difficulties learn ways to feel better. The emotional issues may arise from abuse, relationship problems, job stress or chronic medical conditions. The symptoms that the person experiences because of these issues might be depression, anxiety, panic attacks, sleep problems, appetite disturbance (either way!), headaches, just to name a few.

Psychotherapy for medical conditions is a specialized field. Such treatment consists of some or all of the following: mind/body medicine, guided imagery, relaxation/meditation, emotional support, and relationship counselling. The goals should include more than support, and should be clearly defined, ideally by the patient, with the therapist's help. Relationship counselling for partners and family members should be part of the process whenever possible; this is because illness/disability affects the loved ones as well, and puts a strain on even the strongest relationship. But these are times when a solid support system is vital, and strengthening the relationship, with the help of the therapist, can make a huge difference. People often report that the crisis actually helped them to grow closer.

As distinct from psychotherapy, counselling is more of an educational process, which sometimes includes emotional support. Counselling might be for emotional or other kinds of problems (e.g. career, infertility, finances). Good psychotherapy also includes some education and emotional support, but is a much more in-depth process that should challenge you.

Unfortunately, the words psychotherapy and counselling are often used interchangeably, and this causes confusion.

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How to Choose a Therapist
A psychotherapist is anyone who practices psychotherapy. In more practical terms, a psychotherapist is someone who helps you with your feelings. Psychotherapists come from diverse educational backgrounds. Many are non-physicians: psychologists, social workers, nurses, educators, clergy. Most family physicians do some counselling. Some devote part or all of their practice to more in-depth psychotherapy, and call themselves G.P. Psychotherapists or Physician Psychotherapists. Psychiatrists are specialist physicians (like pediatricians, for example) with expertise in the diagnosis and treatment of mental illness; their treatment usually consists mainly of medication, sometimes with psychotherapy.

One clear advantage of having a medically qualified therapist (at least in Ontario) is that our services are covered by OHIP. Another reason is that a physician therapist will be knowledgeable about medical conditions, medications, and the health care system. Inquire about what special training the physician has had in the field of psychotherapy for medical patients.

Ask if group therapy is available. Even though you might be uncomfortable at the thought of talking about your medical problems in front of others, most experts recommend the group format for medical issues, because it seems to work much better. A private session for initial assessment and some preparation for group therapy should be part of the process.

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Psychotherapy Groups and Support Groups: similarities and differences
Support groups are most often led by a peer, usually with no special training. They are typically homogeneous (i.e. every member has the same diagnosis). This type of group has limited goals, mainly information and mutual support.

While there are many types of psychotherapy groups depending on the therapist's personal preference, all are led by professionals and have broader scope: in addition to support, there is a goal of improved emotional functioning, leading to a more fulfilling life. Psychotherapy groups may be heterogeneous (members have different problems, but with some commonality) or homogeneous.

There is great variation in the quality of support groups, and some people find them useful. Scientific studies, however, have failed to show measurable benefits. On the other hand, four excellent studies with patients with serious illness have documented that substantial improvements in quality and duration of life can be achieved with specialized psychotherapy programs.

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Treatments Available to Improve Your Mood
a. Medication
There are many different types of antidepressants and tranquilizers; all must be prescribed by a physician. Most have side-effects. Some are addicting, especially the benzodiazepine family of tranquilizers, e.g. Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Serax (oxazepam). The newer antidepressants seem fairly safe, but the long-term effects are unknown. Patients already on medication for a medical condition must be careful about drug interactions; they may also be reluctant to take any more pills than they already are. There is also the cost to consider. My concern about medication as a treatment for depression or severe anxiety is that we cannot learn anything by taking a pill. As we grow older, we can be sure that there will be stress of many types ahead. Psychotherapy is a good way to learn healthy coping skills, which will serve us well in the future.

b. Complementary/alternative therapies
There are dozens of chemical and physical treatments available. Most, but not all, are safe. As with prescription drugs, these methods teach us little about ourselves, and are often costly.

c. Medical Psychotherapy
Such treatment encompasses some or all of the following: mind/body medicine, stress management, guided imagery, relaxation/meditation, emotional support, and relationship counselling. The goals should be clearly defined, ideally by the patient, with the therapist's help. In the face of illness or disability, a solid support system is vital; but such illness puts a strain on even the strongest relationship. Therefore, relationship counselling for both the patient and his/her loved ones is often very helpful. Both the patient and the 'bystander' gain from learning to transcend their sadness, frustration, and anxiety; the result is that the relationship often becomes closer than ever before.

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Tips on How to Improve Your Psychological Health
1. Think positive.
Many distressing feelings are triggered by negative thoughts. You can learn healthy thought management from books, courses or a good therapist.

2. Meditate daily.
Find a type of meditation that you enjoy, and do it about 5 times each week. Some days, it just doesn't work! There are many different types of meditation, equally beneficial. Meditation has measurable physiological effects. A calm mind calms the body. Only a calm body can heal.

3. Improve your communication skills.
Everyone can benefit from this, but for people with illness, this skill is essential, so that you can get your special needs met, from professionals, family, and friends.

4. Feelings are OK!
Give yourself permission to have ALL your feelings, including so-called negative ones. We all have feelings, there's nothing WRONG with any of them. The only bad feeling is a stuck feeling.

5. Separate feelings from behaviour.
If your are angry, allow yourself to FEEL your anger. A feeling is an inner experience. BEHAVIOUR is a separate thing. You can feel angry, that doesn't mean you have to act out, yell or hit. There are no negative feelings, only destructive behaviour. Sometimes, you may want to tell the other person. Other times, it's better to go for a walk, draw a picture, or write the person a letter, then don't mail it.

6. Understand depression and panic.
Neither of these is an illness, and nor any cause for shame. These are unhealthy responses which unfortunately take us away from our authentic feelings. Learn to ask yourself: what is it that I am trying to avoid feeling? Once you know what it is, it might not be so scary, or you might find a creative way to make it more tolerable (e.g. let your sad feelings come up, while you listen to your favourite music or walk in a beautiful garden.)

7. Invest in your relationships.
Healthy relationships are essential for our psychological health. Even good relationships need work to keep them that way. When a relationship is in a rough patch, as often happens when one person has a chronic illness, a professional can help.

8. Develop your spirituality.
This doesn't mean you have to be religious, or even believe in God. To be spiritual means to feel a connection to the universe and to find meaning in your life.

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