16 Things Your Therapist Might Not Tell You . . . and Might Not Know

Got a personal problem? You could book an appointment with a therapist. But what if your issue is not ‘all in your head’? What if you, or the therapist, for that matter, are not aware of extraneous variables that could be driving, or contributing to, your problem? And what if there are strategies you could use to address your problem — on a shoestring budget? Before enlisting costly help, let’s look at often over-looked contributing factors and consider DIY solutions that are easy on the pocketbook.

1)Mental health symptoms may be directly caused by clinical or subclinical nutritional deficiencies. For example, the client who experiences panic attacks, muscular tension and also intermittently notices spasms in the extremities may be deficient in magnesium. If so, even just taking one dose of a supplement may bring trigger feelings of relief. Depression may relate to life circumstances post COVID, but may also be related to Vitamin D deficiency if you have been mostly indoors, at home, for months.

Many psychotherapists — and medical doctors — lack training in nutrition and are often unaware of the range of deficiencies that affect mood (see Christensen, 1996). How can you get a sense of whether any of your symptoms relate to nutritional issues? There are questionnaires which cluster symptoms loosely associated with different deficiencies. Using something like David Rowland’s questionnaires, though not decisive, might point you to foods you could include in your diet to address potential deficiencies.

Also, if you have been through an extended series of medical treatments or drug therapies, it is possible that you have clinical or sub-clinical deficiencies that are a direct result of the strains associated with such treatments (radiation, chemotherapy as classic examples). If the body has been weakened by illness or arduous treatments, it’s important to consider whether shoring up nutrients is the obvious next step. If it is, get some guidance about how to proceed! And don’t load up on too many, lest you overwhelm your system!

Bear in mind that nutrition problems could be a function of poor digestion. Your digestion is strongest between 9 AM and 11 AM each day. If you skip breakfast or eat low quality food in the morning, your access to and absorption of nutrients may not be optimal. Natural digestive aids may help here. Some people boil fresh ginger and drink a small amount of ginger tea after a meal to aid digestion. As well, drinking at a meal may hinder digestion. If you suspect that your absorption is weak, try drinking at times other than meal time.

2) Explore inexpensive ways to improve or resolve your mental health symptoms. For example, Chinese medicine, naturopathic medicine or massage therapy may help. Local schools that teach these disciplines have student clinics staffed by well-trained, supervised interns. You can get a comprehensive assessment and treatments, all at a very low cost. Talk therapy need not be your first plan of action.

3) Mental health symptoms may be caused by undiagnosed medical conditions or other issues. A Holocaust survivor experienced despondency, delusions and fever every spring despite her success, professionally and personally. Her psychiatrists, assuming trauma as the root cause, prescribed therapy and antidepressants. It took 25 years for her to get diagnosed with Brill-Zinsser disease, a parasite she had acquired in the concentration camps. The remedy: 10 days of antibiotics. (Walker, 1996). Imagine 25 years of hell, only to learn of a simple solution.

Don’t assume that your problem is necessarily psychological. Is it possible a long forgotten head injury or neck injury contributes to the depression you experience? Might you have hypoglycemia, often difficult to diagnose, which plays out as “test anxiety” at school or nervousness when public speaking? Is your fatigue a symptom of depression or could that depression be a symptom of fatigue, a medical problem that hasn’t yet been detected? Could your diet be lacking, resulting in energy issues? Could your symptom be a side effect of a medication you take? In his book, Walker (1996) provides a comprehensive questionnaire which surveys your overall health and lifestyle so you can give relevant information to your doctor. Get a thorough medical work-up. Don’t assume that the issue is ‘all in your head’.

Bear in mind that life circumstances may also be contributing to mental health symptoms. Take a good look at what you are up to. In one of my clinical internships, I worked at a university counseling centre. A vocational counselor referred a student struggling with depression. He explained the issue: Each fall she experienced depression. According to her vocational assessment: she was a poor fit for engineering. She belonged in nutrition sciences. I provided counselling. Midway through the term, she transferred into nutrition. Problem solved! I never saw her again.

4) Trauma affects the body. A leading trauma expert asserts that treatment which only addresses the psychological symptoms of abuse without addressing the physical aspects is insufficient (Van Der Kolk, 2014). He recommends body-based therapies alongside psychotherapy.

5) The nutritional supplements that you are taking may be making you worse. That stress vitamin might be hurting your sleep. High doses of vitamins often have a caffeine-like effect. Or maybe you’re taking too many supplements which dry the body, creating a state that Chinese medicine calls “heat,” experienced as stress, racing thoughts and sleeplessness. Or maybe you were prescribed a particular supplement five years ago, and no one told you how long to take it for. You’ve been taking zinc for years — which gave you an iron deficiency! And with too much Zinc, your sleep is disturbed! Or you were taking iron — and calcium — at the same time, not knowing that iron blocks calcium absorption. What? You took Vitamin B on an empty stomach? That’s one way to get an ulcer!

It’s best to get vitamins and minerals through a varied and healthy diet and via naturalistic means. To get your daily Vitamin D, spend a few minutes sitting in the sun without sun block. Consult your doctor about the amount of time you may get direct sun light without incurring sun damage.

Remember when people used to use iron pots as a naturalistic means of getting iron in the diet? An interesting product on the market has you boiling a small iron pendent in water, broth or with food. Users can titrate how much of the mineral they ingest by adjusting the boiling time. One can, then, get small, absorbable amounts of the mineral without taking a pill that (as per Chinese medical theory) may trip the body into a heat condition triggered by fillers that may dry out the body.

This method of iron supplementation is useful for vegetarians, picky eaters and those with specific dietary requirements that sometimes have them avoiding meat. I’ve used it personally, as someone who finds normal supplements over-stimulating. I’ve been watching very obvious improvements in my health and energy levels (that crack in my tongue is disappearing, a crack the Chinese doctor says relates to energy problems. Is the iron helping here?). I recommended this format of supplementation to a psychotherapy client who is always borderline anemic. She has reported that this form of iron is clearly more easily absorbed than the pills she was taking. The energy boost was immediate and discernible.

Having said all that, you might want to know from your doctor whether supplementing with iron would be useful for you or ill advised, and otherwise continue getting blood tests over time to monitor iron levels. (As Alexander Dumas wrote, “ Any virtue in excess becomes a crime!” You don’t want an excess of any mineral, which can then create imbalance relative to other minerals in the body.)

If you do feel you need to take a handful of vitamin supplements or herbal remedies, a trained practitioner who understands your constitution will best tailor a protocol for your condition, telling you how much to take and when to stop taking them. Don’t let anyone hand you 10 bottles to take all at once! Always get on supplements gradually, one by one. No point throwing the body into overwhelm!

6) Sugar and caffeine promote depression. Research has demonstrated that some who suffer with depression improve in short order if they remove all caffeine and sugar from their diet. Not every therapist knows the dietary factors that could be making symptoms worse and the protocol for addressing the problem. See Christensen for instructions how to work with this problem but one easy piece of advice, courtesy of Dr. Jordan Peterson, is to eat a high protein/high fat breakfast every the morning and avoid carbs, particularly in the morning meal.

7) Research shows that exercising helps treat mild to moderate depression, but too much exercise can backfire. Extreme sports produce endorphins in the body that feel wonderful. You might not initially notice when you do too much exercise. Too much can deplete you and trip you into deficiencies. You can wind up with symptoms that include fatigue and . . . depression! Know your limits! Don’t over do!

8) Little-known lifestyle factors may contribute to your mental health symptoms. According to Chinese medicine, letting the body get cold (cold hands or feet, not dressing warmly enough in winter) weakens the kidney meridian, the system that produces anxiety feelings when it’s out of kilter. Another condition, dampness, is caused by a poor diet, too much raw or processed food, all of which creates lethargy and depression. If you medicate with an antidepressant, then continue eating poorly, the dampness only worsens with time. Eating hot spicy food also weakens that system and produces insomnia.

According to the Chinese masters, living without routine — an established schedule where rising time, bedtime and meal times occur with predictable regularity — is destabilizing and can promote anxiety or moodiness. How you live and how you take care of your body (or don’t) can affect your mental health.

9) If you experienced trauma when you were very young and pre-verbal, talk therapy may not help you. If talk therapy doesn’t seem to help, try a nonverbal body-based modality such as massage. This writer/therapist has found that for some clients six months of weekly massage can do what six years of psychotherapy can’t!

10) Undiagnosed learning disabilities may be affecting your mental health. Some people have difficulties with auditory processing, making it hard for them to interpret day-to-day communication. People with processing difficulties can feel confused, anxious, depressed, frustrated and motivated to avoid social situations. Therapists may assume the problem is social anxiety. Practicing auditory brain exercises using a system like Brain HQ can enhance verbal processing. To boot, strengthening the left brain calms the emotional and potentially over-reactive right brain. If your therapist is unaware of cognitive processing issues and learning disabilities, you may never discover the cognitive aspect of a mental health problem.

11) Cognitive rigidity could be contributing to your obsessive compulsive symptoms. One clinician has discovered that cognitive remediation can help patients with anorexia nervosa. She notes the rigid thinking of this disorder and designed a protocol that encourages these patients towards holistic thinking. Indeed, people who fixate on detail often succumb to OCD. Cognitive exercises can help shape new ways of thinking. Even doing Sudoku puzzles daily may help.

12) Look for lifestyle factors when addressing a sleep disorder. We know that eating too much protein, eating dinner too late, drinking too much caffeine, inadequate water intake, overuse of devices well into the evening, all promote sleep difficulties. On the other hand, if you start relying on melatonin to fall asleep, you potentially worsen the problem; your own body stops manufacturing that necessary hormone.

Another factor to think about: in health, people wake up in the morning with energy, spend that energy over the course of the day, and gear down in the early evening. These days, people program activities for day and night. They push through fatigue or use caffeine to re-energize themselves and otherwise run on adrenaline to maintain a high level of activity. After a full day and night, the person comes home revved up and then can’t sleep. This effect has been called “social jet lag.” The remedy here is a lifestyle change, not sleeping pills.

13) Group forums can be inexpensive and incredibly helpful. Before you start paying for individual psychotherapy, consider less expensive modalities. Group therapy can provide valuable learning. For eating disorders or other addictions consider Overeaters’ Anonymous or 12 step programs which have free meetings in most cities and free telephone meetings which can be accessed from anywhere.

14) Check out available technology for creative ways of addressing your issues. These days there are a myriad of apps or other resources which can help you achieve your therapeutic goals. There are apps which you can use to track your dietary intake and get real-time feedback about your food choices. Other apps allow you to register your weight loss goals and compete with others to attain them. There are apps to use for relaxation training. Some programs are designed to help you change behaviors and thinking patterns such as the one developed by Jane McGonigal, who came up with SuperBetter.com, a free program that helps people recover when dealing with difficult life circumstances.

15) Consider whether you have exhausted DIY approaches before you invest in psychotherapy. Visit YouTube to find hundreds of hours of lectures by noted mental health practitioners to see whether you can get vision and counsel by experts in the field. Popular culture seeds a worldview which can breed discontent, accounting for a trend which has some young people exploring other worldviews. One of the fathers of modern day psychology, Alfred Adler, reflected that “Faulty evaluation is at the root of mental disorder.” Be open to looking at your worldview, reviewing your premises or as a way to figure out whether some of your assumptions are faulty. This sort of self-reflection can help you become wiser, more mature and healthier.

16) If you plan to see a psychotherapist, ask about the assessment process. Are there questionnaires or surveys? Bona fide psychological tests? Projective personality tests? Inventories that track progress before and after the treatment? Adlerian therapists solicit clients’ 10 earliest memories which they can analyze to understand personality and lifestyle. Jungian therapists analyze dreams.

When a therapist has a more elaborate assessment process, he or she is reaching to get the big picture of your situation and may garner a broader perspective, accessing big picture issues: nutritional patterns, cognitive processing issues, potentially undiagnosed medical issues that clients can explore with their primary care practitioner, the stuff everyone else may have missed. Find an approach that looks at your problem from many angles, gauge whether the feedback you get feels right and see if it gives you new ways to move forward.

References

Asaad, G.(1995). Understanding mental disorders due to medical conditions or substance abuse: What every therapist should know. New York: Brunner/Mazel Publishers

Christensen, L. (1996). Diet-Behaviour Relationships: Focus on Depression. American Psychological Association Publishing.

Christensen, L. (1990) The Food Mood Connection: Eating Your Way to Happiness.

Hammer, Leon (2005). Dragon Rises, Red Bird Flies: Psychology and Chinese Medicine. California: Eastland Press.

McGonigal, J (2016). SuperBetter: The Power of Living Gamefully. New York: Penguin.

Peterson, Jordan (2018) 12 Rules for Life: An Antidote to Chaos. Toronto: Random House.

Poizner, Annette (2020). From Chaos to Order: A Guide to Jordan Peterson’s Worldview. Toronto: Lobster University Press.

Rowlands, David (2017) What Your Body is Telling You and What You Can Do about It. Indiana: Balboa Press.

Van Der Kolk, Bessel (2014). The Body Keeps the Score: Brain, Body and Mind in the Healing of Trauma. New York: Viking.

Walker, S. (1996). A Dose of Sanity: Mind, Medicine, and Misdiagnosis. New York: John Wiley & Sons, Inc.

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