What we’ve said about Psychoeducation

“So much of what actually makes a patient better is the therapeutic alliance. And that's specifically, most of it is a understanding of what the problem is, what the goals are, and how to get to that goal and how to treat that problem”

“when it's accurately recognized and you actually tell people what's happening to them and how to solve that, people get better a lot faster and a lot better”

“There's no use giving a diagnosis to a patient that they don't understand. OK, or that they can't explain in their own words based on what's happened in their lives”

“worry less about what you call something in terms of a single label worry more about your overall understanding of yourself and how your clinician understands you and whether you guys agree on that and whether you agree on the treatment plan”

“A lot of people come in with a very, very strong, almost culturally embedded idea of what they have. And sometimes that's wrong”

“I think denigrating your formulation is not helpful to the patient. What you can do is say, and I've done this a million times with patients on intakes, as I say, maybe not intakes, because you need to build some rapport and gauge whether you think the patient will accept it”

“I think we can and should give direct education advice on matters that are beyond the normal awareness of a layperson. So anything that is specific to the practice of mental health sciences”

“Your personality is the way that you are used to dealing with yourself and other people and how you think and feel about yourself and other people. And where does that come from? It comes from the things that you went through growing up and who you are as a person”

“it's persistent problems in thinking and feeling about yourself and other people in relationships that comes from a combination of inadequate parenting for any reason combined with very strong tendency towards internal negative emotions”

“The heritability of borderline is 40 to 60 percent. Just for comparison, major depressive disorder is in like the 35 to 40 percent range. Generalized anxiety disorder is 30 percent. Schizophrenia, which I think of as one of the more biological conditions, is 75 to 80 percent”

“once you have the assessment that you feel like it's more of a borderline personality disorder than, say, ADHD or depression, And framing those symptoms in the context that they are secondary to interpersonal dysfunction is crucial”

“BPD, it's not a binary thing. It's not like patients are, there's a category of people that have it and a category of people who absolutely don't have it. There's a spectrum of different clusters of symptoms”

“It makes them feel understood. It makes them feel less alone. It's nice to know that I don't have some treatment-resistant depression that no one can find out, figure out, that there's an identifiable thing that's going on”

“I found that patients really appreciate this psychoeducation in that like, uh it goes really really well and they actually appreciate that they have a psychiatrist that is considering underlying problems um and considering the whole picture rather than being told okay let's try the next one”

“this is not a life of solitude in the forest by life. It means a life with other people, trustworthy people, good people, stable people, some environment, a system that offers more support, trust and the opportunity for growth than what came before”

“if they don't understand why we're doing the exposures and why would they... willingly subject themselves to that pain, right? It doesn't make sense. So we got to give them some kind of understanding of the disease and a hope”

“there is a minimum level of anxiety, panic, and distress that everyone has to have. Okay. Life is hard. Life has a lot of scary and bad things about it. There's a minimum level of suffering”

“I use my hands to show feedback loops because I think something visual is helpful. And I shake my one hand and I say, what happens is you experience a little bit of anxiety and then you start having thoughts of, oh God, I'm having a panic attack”

“I try to make it fairly clear that this is something that has happened to them both because of the traumas that they've had and also because of the response. That it's a rational but also perpetuating response to keep avoiding danger”

“a lot of people are also afraid that they're completely out of control. or can't do anything at all, or are almost unconscious during dissociation, which is not generally true”

“the medication is not the treatment. It's part of the treatment. And how do these work? You're not just going to start feeling happier. This is not a happy pill. What this medication probably does is that it makes it easier for you to change”

“if you don't tell people that, then it's very normal for them to say, wow, I'm taking this mood stabilizer. I feel tired and depressed. I should stop it”

“The mood stabilizers decrease the number of episodes. Yes, it helps with depression but it's very slow. Yes, it helps with mania but it's pretty slow. The reason why I find treating bipolar so fun is because you say we're playing the long game”

“we know medically that these medications are going to help with things like fear stress level sleep and thinking process okay the thinking process will be more organized and less disrupted and therefore you'll be able to concentrate better and live your life better”

“I don't assume that the patient remembers the side effects and the problems and all those things. So for medications, what do you start with? Start with an SSRI. I prefer Zoloft or Lexapro. More recently, I usually pick Zoloft first”

“It's always a balance of giving patients information about the medications and then causing a potential nocebo effect where if you say, oh, the nausea is going to be awful, then the nausea will be awful”

“the patient is seeing that there's more neuro connections after treatment. And then I'll talk about how lifestyle interventions, which I let them choose from, I give them a menu and I don't want to overwhelm them. So I have them really just do one intervention”

“We don't plan on feelings. They really come and go. There's not a lot of really control you have over the flow of your feelings. If someone says, just get up, feel better, let's go to a movie, you can't just make yourself feel something differently”

“I'll just move on up. This is the midbrain. This is where affect comes from. These are where your ancestral inheritance, these are where your emotional experiences, this is where this information comes up. And as we move up, there's a primacy on the influence of information”

“Extinction really is growing new inhibitory connections. So it's all about growth. We don't delete old memories. We don't delete things. You just grow new ones”

“people should get a general idea of what it is, hear about the perils and pitfalls, hear about why it's going to be helpful and what ways it might not be helpful and what the goals are”

“when I was anxious, I would feel pulled to explain what I was thinking or what I was doing rather than let the process unfold naturally because of the discomfort of sitting in silence”

“a therapy does not work by giving the answers. You give answers to a patient. Right. diagnostically, formulation-wise, even if you're 100% accurate, it might as well look like black magic to the patient”