If you’ve been following the apparent outbreak of a tic disorder in a New York high school, you know that investigators there have ruled out environmental causes linked to the school itself. Parents, outraged by the Tourette’s sydrome-like symptoms that have plagued twelve teenage girls in the past several month, are demanding answers. Unsatisfied by the lack of results from school investigators, public health officials, and the victim’s own doctors, they recently brought in the Erin Brokovich team to explore the test the ground water and more.

Health officials are now calling the illnesses with which the young women are presenting conversion disorders. Conversion disorders are psychiatric illnesses in which a person experiences physical symptoms without a physical cause. People with conversion disorder can demonstrate things like blindness, lack of muscle function, paralysis, or seizures.

Parents are reportedly not satisfied with this explanation for their daughters’ and community members’ illnesses. Indeed, watching video of the young women unable to talk, write, or function normally is disturbing, and it’s easy to see how the Le Roy High School community would be frustrated.

As I watched the Today Show’s interview with a few of the young women and their mother’s, you could see the visible vehemence when Dr. Nancy Snyderman suggested that the root of these issues could be psychological. The parents and teenagers quickly denied that this was possible, their justification that they weren’t under any stress and that their symptoms were real.

The thing is, the symptoms in a conversion disorder are real too. The person truly is experiencing tics, or muscle weakness, or difficulty walking. They really do seize – anyone can watch. These individuals are not making up their symptoms (that happens when someone malingers), and their development is not in the person’s conscious awareness.

This last piece is the rub, of course. If it’s not under conscious control, the person isn’t aware that there’s a psychological cause, and so there’s no way for them to deny or disprove it. Patients sometimes say things like, “But I just know something’s really wrong. I just know!” And the thing is, they’re right. There’s something wrong, really wrong. The only difference between the symptoms of conversion disorder and the symptoms of a physical illness is in the treatment. Conversion disorder symptoms are not going to respond, at least not long term, without psychological help.

I admittedly have no idea about the origin of the symptoms among these New York teenagers, and I would never purport to know. But what I am very aware of is the cultural backlash against the idea that our minds can produce physical symptoms.

It’s actually a bit dismaying to see how negatively people react to this idea, and how vehemently they deny it. I want to ask these individuals where they think all physical issues originate – in our brains! Why is it so unimaginable to think that psychological stress could create physical symptoms?

Our brains regulate our hormones and every function of our body, and yet we tend to see our minds as distinct from our bodies. The effects of this disconnect are far-reaching. I think that this contributes to everything from fertility issues to the flu to problems with our sexuality to distorted relationships with food. This is not to say that that all of these things have only psychological bases – certainly, that’s not the case. But we often fail to see how our psychological functioning influences these processes, and in doing so miss out on a real chance of improving our health.

My hope is that, regardless of what is determined to be the cause of these Tourette’s sydrome symptoms in New York, the parents will encourage their children to seek psychological treatment. Even if the cause is environmental, these young women could likely benefit from support around the trauma of the past several months.

you might be as outraged as the community.

{image via pinterest; originally found at The Quilted Castle}

Despite having been one half of hundreds of therapeutic relationships over the years, I work hard to remember that for many individuals who sit down in my office, this could be the first time that they’ve entered into this experience.

I recognize that making the decision to go to therapy isn’t an easy one. It usually comes on the heels of deciding that something significant in one’s life isn’t working as she thought it should. Sometimes what isn’t working is incredibly profound, and touches nearly all aspects of her life. Or it may seem on the surface to be minor, trivial even – but hits on such valued parts of an individual’s life so as to push them into my office. Whatever the reason that someone decides to enter treatment, it’s a big decision and one that is never taken lightly.

So if you’re that person – you’ve decided to allow a trusted professional to help you make important changes in your life – you might want to know what to expect. While sitting down in a stranger’s chair is never easy, per se, being armed with an understanding of the process is key to developing the trust that is vital to the process.

Here’s what you can – and should – expect when starting therapy:

1. You’ll be asked why you’re there. It may sound obvious, but the therapist will want to get a thorough understanding of what brings you to treatment. Even if you’ve alluded to “relationship issues” on the phone, he will want to hear in your own words (and in more detail) how you think about the problem, and why you’ve chosen to get help now. Even if you think that certain parts are irrelevant, share them. It helps the therapist to help you if he has a richer context in which to understand the issue that concerns you.

2. You’ll be told about your rights as a patient. The therapist will spend some time letting you know about what you can expect from her and the process of therapy. She’ll likely explain that you can expect your information to remain confidential and secure, unless you are at risk of seriously hurting yourself or someone else. She should generally also let you know things like her fees, cancellation policy, how you can access your records, and more. The specifics will be based on the laws of your area and the specifics of her profession.

3. You’ll learn about the nature of the therapy relationship. The therapeutic relationship is quite different than other relationships that we are used to. When you think about it, it can actually seem a little strange. You’re pouring your heart out to a person who just met you recently and you know nothing about. But certain therapeutic boundaries are in place for a reason. You should be able to trust that you will not have to take care of your therapist’s needs and feelings. You’ll learn, likely quickly, what your therapist’s style is when it comes to this. Some may disclose some personal information about themselves, and you’ll need to decide what you feel comfortable with.

4. You’ll learn about the therapist’s approach. There are more styles and approaches of therapy than we could possibly discuss here, but they often fall along a continuum of directiveness. Some therapists will take a more active approach, asking you to do things like monitor and challenge thoughts and feelings and experiment with changing your behavior. Others will spend time helping you to develop insight into your patterns of functioning and work to provide a new relationship experience via the therapy itself. Others will do a bit of both. While it’s not always important to know precisely how things are working (in fact, it can sometimes steer you off course to get caught up in the details), you should check in with yourself to determine how comfortable you are with the therapist’s style.

5. You’ll be invited to ask your own questions. I encourage you to use this space to really be a savvy consumer. Questions that can be helpful to ask include: What kind of license do you have to practice? Do you have a supervisor or will you be consulting about my case? Have you worked with others who have my issue? What can I expect from therapy? Can I call you between sessions if I need to? How will I know if things are improving? If the therapist avoids these questions or doesn’t give you the answers you are looking for, I suggest proceeding cautiously.

It’s important to remember that the effectiveness of therapy is based heavily (very heavily, in fact) on the therapeutic relationship, so it’s vital to feel a good fit is in place. If you don’t initially, however, that might not mean the therapist isn’t for you; it could mean that you need to give the process time. Unless there is a significant issue, I always encourage patients to give a therapy relationship at least a few weeks for trust and rapport to develop. If these things don’t happen, I urge you to seek a therapist who will meet your needs. Remember, this is your treatment and your mental health.

If you’ve been to therapy, what has your experience been like? What would you ask a new therapist?

In a recent act of significant courage, Dr. Dana Udall-Weiner came out of the proverbial closet. A psychologist who blogs about food, family, and culture at The Body and the Brood revealed both on her website and through a guest post on Blogger Body Calendar that she has suffered from an eating disorder herself. As Dr. Udall-Weiner admits, this was not an easy decision.

Coming forward about having suffered from an eating disorder or disordered eating is difficult for anyone, and I commend the many bloggers who have done so bravely on their websites or in other forums. {Some of these rock-stars include Christie, Katie, Dorry, and Kendra, among many others.}

But when it comes to psychologists, the stigma seems to run even deeper. Our field is one of professionals who, in most cases, tend to keep their personal lives very close their chests, and at times even lambast those who do not. As psychologists, we are both implicitly and explicitly reminded that self-disclosure can come at a very high cost.

This isn’t simply so that we can seem holier-than-thou and deny that we have real lives with real problems, but rather to allow us (and the patient him- or herself) to focus our energy and attention on the patient. A more traditional view of self-disclosure suggests that being conservative in this area protects boundaries in the therapeutic relationship and allows the patient to work through issues. Some also suggest that it’s not usually in service to the patient to self-disclose, and that it may be done more for the sake of therapist.

A more relational and feminist view of psychotherapy would suggest that mindful and appropriately timed self-disclosure can foster a good relationship between the patient and therapist. Some studies suggest that patients tend to view their therapists more positively following self-disclosure, though research is mixed here. The idea is that the therapist becomes a real person who is on a equal playing field with the patient. The patient may see the the therapist as more genuine, able to understand, and connected.

So what if you learned that your therapist had, in the past, had suffered from an eating disorder? Would you feel uncomfortable knowing that information? More connected? Worried that they might not be recovered enough to help you? More or less inclined to share your symptoms?

Please participate in the poll below. Because this issue is so complex, please also share your thoughts in the comments so that we can all learn from each other.

Other questions to consider:

If you are comfortable, would you want your therapist to tell you him- or herself?

Would your response change if the issue were different (e.g. Bipolar Disorder, ADHD, depression)?

Are there any other factors that might might make your opinion above different?

How much does a therapist’s ability to relate to your specific circumstance impact you (e,g. being married or divorced, being of same ethnic background, sharing religious beliefs)?

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Come join the fun on the NTS facebook page here.