Elliott, LPCC, NCC : Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.
Elliott, LPCC, NCC : Dear friend,
Elliott, LPCC, NCC : I believe that I can help.
Elliott, LPCC, NCC : This is not unusual behavior and does not indicate any kind of aberration or mental disorder.
Elliott, LPCC, NCC : It is merely a conflict between what you feel you are "supposed" to to do (often things that are chores,such as do you healthy walk, which you are not always in the mood to do, and pass them up with something you would might rather do and is more important to you, such as have lunch with your daughter.
Elliott, LPCC, NCC : It is the same for when you go in to wash the dishes. Entering the kitchen, you feel a bit hungry and go to the fridge instead. It is much more rewarding to have a snack then to do the dishes. There is nothing wrong with that.
Elliott, LPCC, NCC : What makes you think that you need to do those things if you change your mind?
Customer: Actually, for instance with the walk, I was completely happy about doing it. I felt enthusiastic about it. But I just kept driving. I only had lunch with my daughter because I ended up in her neighborhood. I thought I should try to get something out of the outing.
Elliott, LPCC, NCC : Are you talking about short term memory loss rather than changing your mind? Is it possible that you unconsciously wanted to go to see your daughter and just kept driving until you got there?
Customer: It is not short term memory loss. And it isn't just about my daughter. It is as if I am one person in my head knowing what to do and how to do it and another person in my behavior acting in behaviors that confound what I am trying to do.
Elliott, LPCC, NCC : Do you feel that you may be lapsing into a second persona?
Customer: I feel like I am sleepwalking. Some days I am right on target though. It doesn't seem that I have any control over my actions. I just go about doing whatever I do in the moment without regard for what I was planning to do. Don't panic though. I am not dangerous to myself or others.
Elliott, LPCC, NCC : Do you have any memory lapses when this occurs?
Customer: No I don't.
Customer: Actually, maybe a little.
Elliott, LPCC, NCC : In which way?
Customer: It is like my mind starts wandering and then I have to ask myself what was I doing or planning to do.
Customer: I may even wonder how I managed to get to where I was going.
Elliott, LPCC, NCC : Do you have a lot on your mind now? A lot of stress or worry?
Customer: Yes I do and that is always the case. My life is busy and complicated.
Elliott, LPCC, NCC : Have there been any changes recently, in your health or the health of someone close, or extra burdens, financial or emotional?
Customer: Not really. I would welcome change. My life situations are overwhelming and the things that I need and want do to change that are not what I do. I make plans to correct situations but actually do things that aggravate the situations.
Elliott, LPCC, NCC : Can you illuminate that last statement please?
Customer: For instance, I have gained alot of weight and have terrible food habits. I use to eat very healthily. But instead of eating right I eat junk which aggravates the weight problem. I have financial problems and need to get a job, but instead of job hunting I go shopping and overspend. My house is a wreck but instead of cleaning it I add more mess. I want to go see my baby grand daughter but have yet to book the ticket.
Elliott, LPCC, NCC : Do you have racing thoughts?
Customer: I don't know what that means
Elliott, LPCC, NCC : Thoughts that come in rapid succession or flights of ideas?
Customer: I don't think so. I do get lots of ideas though
Customer: Mostly my thoughts are redundant. I keep telling myself over and over what I need to be doing and how to do it. I just don't do it.
Elliott, LPCC, NCC : Do you have a reduced need for sleep?
Elliott, LPCC, NCC : Do you sometimes feel an exaggerated self-esteem?
Customer: I don't feel like my self-esteem is what it should be. I think less of myself for not taking better care of my life.
Elliott, LPCC, NCC : Do you sometimes get very talkative?
Elliott, LPCC, NCC : More so than usual?
Elliott, LPCC, NCC : Do you sometimes seem to feel that your activity is speeded up?
Customer: No. Once in a while when I am focused I become very productive and do things that help improve my life. But mostly I have little energy and motivation.
Elliott, LPCC, NCC : Do you feel sad or depressed sometimes?
Customer: Yes, but not always. Actually I think I am fairly happy. But I always feel that nagging feeling because I know that I am not taking care of business.
Elliott, LPCC, NCC : And you have already established that you are easily distracted.
Customer: Yes, I am very easily distracted.
Elliott, LPCC, NCC : And you are not functioning as well as usual?
Customer: I am not functioning as well as usual.
Elliott, LPCC, NCC : From all that you have told me, I strongly suspect that you have a mood disorder that has two sides or poles to it, and it is called bipolar disorder.
Elliott, LPCC, NCC : It is common and treatable.
Elliott, LPCC, NCC : Are you taking any medications now?
Customer: I am not taking medications. And it is not likely that I will be able to if I need them because I do not have health insurance.
Elliott, LPCC, NCC : One thing that you must NOT do: Do not take any antidepressant medications as this may make your symptoms worse.
Elliott, LPCC, NCC : I do urge you to get an assessment and discuss this with a specialist who will have the best options for you. That would be a psychiatrist.
Elliott, LPCC, NCC : I also can give you an excellent self-help workbook for better understanding and some things you can do at home.
Elliott, LPCC, NCC : Give me moment to give you the suggested workbook please. I will give you a link and you can virtually look at the book, in part:
Elliott, LPCC, NCC : The Bipolar Workbook: Tools for Controlling Your Mood Swings by Monica Ramirez Basco PhD
Elliott, LPCC, NCC : http://www.amazon.com/The-Bipolar-Workbook-Controlling-Swings/dp/1593851626/ref=sr_1_1?ie=UTF8&qid=1368844633&sr=8-1&keywords=bipolar+disorder+workbook
Customer: I don't think I actually have mood swings. I seem to have the same mood most of the time.
Elliott, LPCC, NCC : Most of the time.
Elliott, LPCC, NCC : You can have bipolar and be depressed 90% of the time or manic 90% of the time, or swing back and forth quickly or have both at the same time.
Elliott, LPCC, NCC : You have many symptoms.
Customer: Yes. Each day I wake up with a smile and positive thoughts about the day. But then I get up and although I feel okay, I just let everything go.
Elliott, LPCC, NCC : Big clues are the distractability, the reckless spending, the talkativeness, the reduced need for sleep, and others you mentioned.
Customer: Well maybe I will look into it further. Maybe I don't actually understand it. But then again, maybe I actually have a depressing life. I often do things to distract me because I don't always like the things I am thinking about. Like not taking care of business.
Customer: It is like a fire feeding a fire. I don't like how things are going, I get depressed about it, that makes me less likely to act on fixing it, which then makes my life more depressing. It seems like a rut.
Elliott, LPCC, NCC : You have a depressed side, being in a rut, and the manic side, going out and spending money you don't have.
Elliott, LPCC, NCC : Here are the official criteria from the psychiatric manual DSM-IV for mania, one of the two poles (the other being depression):
Customer: I think it all boils down to guilt. I feel guilty for letting my life get out of hand. So, I don't think I deserve a good life. Therefore, I don't fix my life to make it better. I punish myself instead by making it worse.
Elliott, LPCC, NCC : Mania DSM-IVA) A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:1) inflated self-esteem or grandiosity2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)3) more talkative than usual or pressure to keep talking4) flight of ideas or subjective experience that thoughts are racing5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)C) The symptoms do not meet criteria for a Mixed EpisodeD) The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.E) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
Elliott, LPCC, NCC : I urge you to get a face to face assessment. It won't hurt you and may help you to get out of the rut and move forward. You could perhaps use a helping hand.
Customer: You are right about that. I do need a helping hand. I don't actually have any friends right now so I am on my own. But without insurance, I am not sure how to go about getting help. But self-help books might be a good starting point. I will look into the one you suggested.
Elliott, LPCC, NCC : I shall keep you in my prayers. You should not let this go without looking into it and I am so glad that you will get the book I suggested. That is a big positive step towards healing.
Customer: Thanks for you help and good night.
Elliott, LPCC, NCC : Good night. You are quite welcome. I am so glad to help. Warm regards, XXXXX XXXXX LPCC, NCC, CCMHC