Self-care and mental health during the pandemic

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Mental health is a major concern as people around the world navigate the COVID-19 pandemic and current events. Psychologist Carly McCord, PhD, and licensed social worker Bradley Bogdan give advice for building resiliency and seeking help for mental health.

Episode Transcript

Lindsey Hendrix: We bring you advice and compelling insight on the latest in health, medicine and scientific discovery. From tips for getting better sleep, to discussions about major issues like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M Podcast Network.

Lindsey Hendrix: Hello, and welcome to Texas A&M Health Talk. I’m your host, Lindsey Hendrix. If you’re an avid Health Talk listener—which I’m sure about two of you tuning in right now are avid Health Talk listeners—you’ll notice this is different for us, and you’re right, because we used to have about five different shows under the Health Talk umbrella. Now we’ve decided to consolidate all of that excellent content into a single show, this awesome podcast called Health Talk, hosted by yours truly. So, this is episode one. Thank you so much for tuning in. This episode is going to be a little bit different than what you’ll experience down the road, because we are still very much in the midst of the COVID-19 pandemic.

I’m recording from my home office and my guests are joining us today via Zoom. But I felt like we really needed to dig into this topic because what we’re going to talk about today is incredibly pertinent for a lot of people, and that is mental health. We’re in unprecedented times right now. I know you’re sick of hearing that term by now, unprecedented times, but it’s true. This is something that we’ve never navigated, at least not in this generation, and definitely not in the way that we’re navigating it right now.

Mental health is something that I think a lot of people are thinking about right now. Many people are having a difficult time, and that’s to be expected. Our lives have changed so drastically, so rapidly. Our world doesn’t look like it did just weeks ago.

I have with us today the lovely and brilliant Dr. Carly McCord. Carly is the director of the Texas A&M Health Telebehavioral Care Program, and she’s also a clinical assistant professor in the Texas A&M College of Medicine. And along with Carly, we’ve got Bradley Bogdan. Brad is a licensed clinical social worker, and he works with the psychiatry and behavioral health program here at Texas A&M Health. Thank you both so much for being here.

Bradley Bogdan: Thank you for having us.

Carly McCord: Thanks for having us.

Lindsey Hendrix: Oh, absolutely. Absolutely. Thank you for coming. Let’s just go ahead and dive right on into this topic. Like I said in the introduction, life has changed so drastically so rapidly. I feel like a lot of people are struggling right now. A lot of us are still working from home. Kids haven’t been in school for a while, and we’re not entirely sure when they’ll go back, and we just don’t seem like we’re quite as socially connected as we were just weeks ago. In general, in your professional opinion, how are Americans doing right now? How are we doing? Are you seeing an increase in stress and anxiety and depression and things like that right now?

Carly McCord: Yeah, I think we are. Having routine and consistency for both adults and kids are some of the things that give us just the constancy in life to know what to predict. When we know what we can predict, then we feel like we can cope. So, having new things thrown our way and being separated socially from many people that we care about definitely is taking a toll on people from what I can experience personally and what we’re seeing in our clinics, and just what we’re hearing from folks around the state and the nation, and the world.

Lindsey Hendrix: Yeah, that’s so true. I think we tend to think about this as Americans, because this is our experience, but this is a worldwide issue and stress, anxiety, and depression, and mental health issues aren’t just unique to Americans or citizens of the United States. If you’re tuning in overseas or from somewhere else around the world, just know that we’re talking to you too. So, have y’all seen an increase in people seeking services? Have you noticed more people coming into the clinics lately?

Bradley Bogdan: Here in our outpatient clinic, we’ve seen about a 50 percent bump in people seeking services. That is probably not entirely due to the pandemic, but I’m sure a giant portion of it is, being it happened at the same time over the last few months. I know, in the first month or two of lockdown, the National Suicide Hotline also saw a giant spike in terms of calls, and fortunately, their assessment of that increase was fortunately not necessarily that amount of people looking to get help for suicidal thoughts, but it was very much reaching out to have some contact to talk to a professional and not really knowing where to start. Fortunately, they do a great job with making sure they’re out there and available as a resource, and they were able to help with that surge of folks looking for help and get them directed to the right places. So, it is definitely real.

Lindsey Hendrix: Yeah, and it’s good that people are reaching out, right? Because I think if you look back just a few years ago, a lot of people either weren’t aware of the signs that maybe you should seek some professional help, but there was also so much stigma surrounding mental illness and mental health issues. So, in your experience, how is that trending these days? Are we seeing more people open to talking about mental health issues?

Carly McCord: I would say yes, because it’s such a shared experience, and it’s really hard for anyone to be going through this pandemic and just the racial and cultural tensions that we’re experiencing here in the U.S., and even that is a global issue as well. It’s hard to not bring attention to mental health issues. Talking about those figures earlier, I think that there is some relation then to an increase in seeking services, and hopefully, that correlates too, to a reduction in stigma or fear of reaching out. I know that across the globe, there’s been a huge increase in telehealth use and breaking down of barriers that clinicians and proponents of telehealth had been fighting for, for years in terms of reimbursement and regulations that may have prevented accessing those services. Many of those kind of broke down overnight, and so it’s made it easier to access care from the comfort of your home.

That, I think, all of that helps break down stigma when more people are using it, experiencing it, then it becomes less of this scary unknown, and now you know somebody who’s tried it, and was like, “Oh, telehealth is great.”

Lindsey Hendrix: Yeah. I would definitely want to try it out if I heard from a friend that I trusted that it’s good. From a professional standpoint, though, are there differences between telehealth and in-person services? Are you going to find differences in the quality or the outcomes between the two?

Bradley Bogdan: I was going to say, Carly’s group has done some fantastic research, the fact that people seem to get the same benefit from in-person therapy as they do via telehealth.

Carly McCord: Yeah, having done telehealth for over a decade, I definitely like it a lot, or I wouldn’t keep doing it. All of our data has shown that outcomes are similar, at least from the behavioral health side of being able to see someone from a distance like this, it’s still … you’re still able to make a connection. The treatments we use, the evidence-based therapies and things, they transfer. It’s talk therapy. I think, in some cases, we even see, in a lot of our trauma clients, we see, being able to do this from the comfort of their home actually provides an additional layer of safety and security. Some people even like it better. I think on the primary care side and other specialty disciplines, it can be harder to get vital signs and things. There’s so much that can be done in preventative care just by asking questions and checking on symptoms and connecting with people, that all of that can be done from a distance.

Lindsey Hendrix: Yeah. I can say, even from just a professional standpoint, I think a lot of us are working from home right now, and it’s kind of nice, because as we’re all getting more savvy with this teleconferencing systems and stuff, like what we’re doing right now, recording this podcast. It’s nice to get to see people in their houses. I see you in your house, I see you in your office, and I feel like seeing people in their own environment kind of adds a level of personability or something. Like, I can get to know you a little better, just seeing you in your own environment. So, do you think that applies to counseling as well?

Bradley Bogdan: Absolutely. In a couple previous jobs I had, I was doing primarily in-home services. Even when somebody says, “Oh, things are going great,” if you notice that all the dishes are stacked up, or if you notice that the laundry hasn’t been done in a couple of weeks, or some of those other signs that you wouldn’t necessarily hear if they were coming into the office, and not necessarily feeling comfortable to talk as openly as you might hope they would. You can totally see when you get a window into where they’re living and where they’re spending all of their time. It can be a big benefit to be able to see into somebody’s home. Like Carly mentioned, it really helps kind of deepen the relationship in a way too, because the relationship is different with somebody that you invite into your home to do something, even digitally, than it is when you go out to a third-party location to just meet and do something. Yeah, it can push that therapeutic relationship another step farther.

Lindsey Hendrix: That brings up another point, which is, what are some of the warning signs that maybe you don’t have it all together mentally or emotionally, and maybe you should seek some professional help. You mentioned dishes stacked in the sink, or laundry not being done. There could be a variety of ways that it could manifest. Can you list some of those warning signs that you might see?

Bradley Bogdan: Sure. The things that tell me most is not necessarily specifically somebody getting behind on laundry, getting behind on the dishes, because obviously that happens to all of us, but big changes in routine. If somebody is typically really on top of those things, and then isn’t, that should be a sign that something is off and you need to ask. Big changes in sleep. If somebody is used to getting a full night of sleep and they’re not able to get to bed, or they’re not able to stay asleep once they’re asleep can be a really important indicator of something being off or some kind of stress or anxiety or depression building up. Then, differences in how they’re interacting with other people. If somebody is typically really bright and cheery, or typically maybe not very talkative, and you see their behavior change or the way they interact with other people change, that also can be a really important sign that, hey, you should ask and see if something’s going on, or if they’re connected with people they need to be connected with and feel supported.

Lindsey Hendrix: Right. Yeah. How would you advise broaching that subject with somebody? You’re noticing a family member or a friend who seems to be having a hard time, how do you open up that conversation and get them to talk about it?

Carly McCord: That’s a good question. I would say there’s probably no one right way to do that. Often, I think, when we are just caring and concerning selves, that we often know our friends and our family pretty well, that you can trust your gut in trying to think about a way to broach that subject. I think just the most important part is that you do broach the subject, if you’re worried about somebody. Being able to ask them, “Hey, I’m really worried about you, all of this,” affirm, “all of this is really hard and there’s a lot of challenges, and I’ve noticed, it seems like you’re not sleeping very well. Do you want to talk about that, or have you thought about talking to somebody else about that?” I think that’s really important. It makes me think of the suicide question, that there’s a myth out there that if you ask someone, “Are you thinking about taking your life or killing yourself?” that you’re going to put that idea in someone’s head.

I guess, I want to take this opportunity to dispel that myth specifically, that it’s okay to ask, “How’s your sleep, are you eating? Hey, you have seemed really down. You just seem really blue. Have you thought about hurting yourself or taking your life?” You don’t have to be a mental health professional to know what to do next. If someone says yes, your next thing is, “Can I get you some help? Can I help you get connected?” That can be your role, is just to help make phone calls, google providers, talk to insurance companies, whatever kind of those barriers, whatever’s getting in that person’s way. Are there barriers that you can kind of help break down for that person?

Lindsey Hendrix: Yeah. So, when you are ready to make that next step, what do you google? What do you look for? Who do you call? What kinds of professionals are qualified to provide that kind of care and help for mental health?

Bradley Bogdan: I was going to say, wherever folks are listening to this from, there is, at least in the U.S., there is a couple of different national helplines for mental health and suicide. Also, every locality in the U.S., as part of the funding they get through Medicaid, has a more local helpline for mental health emergencies. We have one here in the Brazos Valley that’s run out of our local public mental health provider. If there is an emergency and you call that number, there will be somebody there within a half an hour, and usually a lot sooner, to be able to respond to that crisis. If somebody is not in an emergency, there are a lot of different places that you can go to seek services. Through your insurer, if somebody has health insurance, they will always provide you a list of local individuals who can provide those mental health services under your insurance plan.

Every county in the U.S., again, through that same national funding, has a public mental health provider. Sometimes they’re an overburdened resource, but they exist every place. Carly does a great job of reaching out to a lot of underserved communities through telehealth. Are there more clinics like our own, Carly, that reach out to those underserved areas to treat people?

Carly McCord: Yeah. Often, training clinics, whether that be for social workers or master’s level licensed professional counselors, marriage and family therapists, psychology doctoral programs, often we’ll have training clinics associated with them, or trainees that operate on sliding fee scales or provide free services. One of our former graduates and postdoctoral fellows created a website called Low Cost Help. It is a resource where they’ve compiled, across all of the states, different low-cost mental health resources. Yeah, I think different licensures and credentials have some built-in security and established standards for training and previous experiences that give you some kind of stamp or guarantee on some of this shared set of experiences and trainings that they’ve had, that you can rest assured, often in those licenses and credentials.

We certainly don’t necessarily have a corner market on change though, with a credential, that there are, culturally, there can be healers in different cultures that may seem more appropriate. At the end of the day, I would rather someone reach out for help than not get any help at all. I would lean towards recommending someone that is licensed and credentialed in your state.

Lindsey Hendrix: Say you’re not quite ready to seek professional help yet. You feel like you’re struggling a little bit, but maybe there are some things that you can just change yourself to help build that resiliency during this health crisis and other crises that you may encounter in your life down the road. What are some things that you can do yourself?

Carly McCord: I just had a flood of things come to my mind. Number one, I just think that, in my opinion, hurt and pain thrive in the darkness and in secrecy. Anytime you can reach out and tell someone what you’re struggling with that, that is a major win, in and of itself, aside from setting lofty goals for, maybe things that we know are really helpful, like journaling, gratitude journals. Trying to focus on the positive things that are going on in your life, and the basics of, that you cannot underestimate the positive impact of getting seven to nine hours of sleep a night, and putting healthy foods into your body, and getting up and moving in between your Zoom meetings, or at some point, in the day where you put your body in motion. All of those, even just setting small goals, it’s got to be attainable to let it come true.

You don’t have to set this, “I’m going to work out an hour every day for the next month.” “I’m going to walk in between one Zoom meeting a day,” and try and do something that you can do is going to improve your mental health.

Lindsey Hendrix: Yeah, that reminds me of something I heard the other day. Somebody who had just recovered from alcoholism was saying, you don’t have to not drink alcohol every day for the rest of your life. You just have to not drink that day. I found that so helpful, because it really breaks it down into what you can do that day. You just do what you can do that day, and don’t worry about working out every day for the rest of your life or something like that. Do you think some advice like that would be helpful?

Bradley Bogdan: Absolutely. I know, just like Carly was mentioning, the things that I’ve been working with my own therapy clients on have been those small things that they do on a daily basis. So, have you picked up the phone to call somebody that you care about today and have that connection that you might otherwise be missing out on? Have you gone outside today? Did you take a shower and throw on a new set of clothes? They sound silly and basic, but when you have some sort of established routine of those good things, even when they’re little, that provides so much benefit, in terms of resilience, that it’s tough to overstate.

Lindsey Hendrix: Yeah. Routine reminds me so much of how routine helps young children. Like I’ve said before, I’m a parent of two littles. So, how can we help our kids during this time? How can we help, from small children who are used to going to daycare every day, to teenagers who aren’t seeing their friends, they’re not going out and going to parties and things like that? How can we help support their mental and emotional well-being during this time?

Bradley Bogdan: I found that the first thing that seems to have helped the families that I’m working with is being able to share your own feelings and thoughts with your kids in age appropriate language. One of my favorite folks that works with kids is not somebody who’s licensed, but it was Mr. Rogers. He, very famously, developed an entire way of speaking through the scripts in his shows that was very concrete and directed at the age group he was looking to work with. Because until we’re reasonably old, kids don’t have a great handle on language that isn’t concrete and very firm in what it means. So, being able to say, “Hey Cindy or Bobby, I’m sad too, because I haven’t been able to go out and see my friends today,” is a great way of sharing some of the fact that you’re struggling with this too, and then figuring out a way to do some of those restorative things that’ll help both of you, parent and child, get through it together.

Carly McCord: Yeah. I think scheduling is hard to come by, is a bit of a luxury, sometimes, these days. When you can schedule and creating a routine, a bedtime routine and sticking to those, where if you got off kilter, what’s something that you can, again, break it down into smaller pieces. It doesn’t have to be every night, it’s going to be this particular time with these seven different bedtime steps. What’s one thing that you can reinstate a routine into some of the chaos?

Lindsey Hendrix: Yeah, and I think it’s funny. We think we’re all locked down inside our houses, I think a lot of times, but we can still go outside. Right? You can still do physical activity. You can still get out there and ride your bike and do things like that. I would imagine that would help kids, at least get the wiggles out or get their energy out if they’re little, and then older children as well. I’ve got a next door neighbor who’s got three teenage boys. You can imagine what their house is like right now. They have kind of a home gym in their garage, and all three of those boys are in and out of that gym all day long, and then sprinting down the street. I don’t know how they’re doing it in this Texas heat, but I know she’s a therapist, so I’m sure she’s kind of recommending or prescribing that for them right now, if you will.

Carly McCord: Yeah. We do have … sorry. Internet lag. We have the heat in Texas, but we also have the space. I think, yeah, in most places you can probably go outside, unless maybe you live in inner city, New York. I don’t know. I don’t know if it’s safe to go outside everywhere, but that doesn’t mean you can’t move your body or you can’t do something active, or you can’t do something playful, taking a break from work or from the distress and finding something to laugh about and to just play. I think you can probably find that just about anywhere.

Lindsey Hendrix: We just dove right into the topic and started talking about some of these mental health issues that some people may be facing, but what are some of the differences in signs? There’s anxiety, there’s stress, there’s depression, and there are some more severe illnesses. What is the difference between stress and anxiety, first of all?

Bradley Bogdan: The best way I’ve heard it explained is that stress is just the human response to change, be it good or bad change, something really exciting can be happening, and it’s still kind of stressful. You think about every wedding you’ve ever been to, people are really stressed, even though they’re all happy to be there and happy that it’s happening. Anxiety is when that stress or just natural response turns into something that is not helpful, it isn’t well suited to the situation. You can get to anxiety through a lot of negative stress, or just too much stress at a given point, but anxiety can also build from some very organic places, and that’s part of the reason why, when medication management can help with that and other coping mechanisms can help with that, it’s not strictly a behavioral way to address it.

Lindsey Hendrix: Then, how about depression? What are some of the signs of depression?

Carly McCord: Depression is more low mood, feeling blue, feeling sad, sometimes the sadness feels a lot more, or is expressed more as anger, but kind of that low mood, problems sleeping, problems eating, thoughts, maybe, that you’d be better off dead, or hurting yourself in some way. I think the thread that flows through all of the, when is it time to seek help, and when does it meet criteria for a diagnosis. And our diagnostic and statistical manual, they all have this criteria of functioning. Is there a significant impairment in functioning in more than one area of your life? That yeah, either it’s this worry and concern and fear or anxiety, or perhaps kind of sadness and overwhelm, that once it reaches a certain level, may then more a diagnosis. That doesn’t mean you have to wait until that level to seek help. Help can be available before you reach that kind of criteria though.

Lindsey Hendrix: That’s helpful. That’s really helpful, because I think we are all sad at points, and we all experience stress, but that’s normal to an extent, until it interferes with your everyday life. Right?

Bradley Bogdan: Exactly. Exactly.

Carly McCord: Yeah. Emotions are normal. They’re good. They’re data, they give you information about what you need, and if you’re not listening to them and not allowing them and just pushing them away, then you’re never going to know what it is that you need, and then it’ll build up over time until your body and your mind tell you and demand attention for whatever it is that you’re going through.

Lindsey Hendrix: Yeah. I think, especially as parents, I’m a parent of two littles, I tend to put myself on the back burner and concentrate more on the well-being of my kids and my spouse. We’re thinking a lot about our older adult parents at this time. What’s some advice that you would give for kind of stopping and checking your pulse, so to speak, or checking back in with yourself to kind of see how you’re doing?

Carly McCord: I think that has to be an intentional slowing down. Again, unless you’re going to wait for those alarm bells, which could be suicidal thoughts or just frequent breakdowns. If you will give yourself two minutes, even five minutes would be great, of just time away and just checking in. What do I notice in my body? Is there a particular part of my body that I’m feeling a lot of tension? If you just give that some attention, oh, there may be some … maybe there’s feelings or worries or thoughts underneath that, that if you just will provide some quiet and some stillness, there’s a lot to be discovered. I think that also can happen in the context of relationships.

If you’re isolating yourself and you’re not talking to anyone, then it’s hard for those things to come up spontaneously. But if you’re allowing yourself connection, even if it’s at a distance, and then allowing yourself to be vulnerable with people that care about you, then that might also be a place where kind of recognize what you’re feeling and needing.

Bradley Bogdan: Carly, you hinted at sometimes those feelings can be physical too, the tightness in the shoulders, or the fact that you’ve got that cramp in your neck or your hip or something that is not usually there, and you didn’t put there through yoga or something else can clue you in that maybe something is building up, and yeah, you need to take some time to address it.

Lindsey Hendrix: Yeah. It’s really interesting how much tension and emotions we can store inside our bodies. But I want to kind of switch gears a little bit and ask you guys about something that’s trending right now, and that’s text-based counseling, or counseling done over text messaging. What is your professional opinion on that? Do you think that is a good option for seeking counseling services, or is it more of like an entry point to counseling?

Carly McCord: I think we know a lot less about text-based therapy, from an evidence standpoint and a research standpoint. It’s kind of the same as the conversation about credentials in my mind, that someone with credentials has gone to an accredited program and has a license, and has just gone through a number of similar steps to say that, what I’m going to give you is quality. Again, I think who’s the person on the other side of the text can make a big difference. There’s certainly a lot of data missing and tone and pacing. Yeah, that it’s certainly different. Again, I don’t want to say that there’s one right way to do therapy. So, if it’s something that you’ve tried and found helpful, then great. I certainly think, again, some of the evidence-based ideas, cognitive behavioral therapy, which is about identifying your thoughts and whether they’re rational, being able to replace those with rational thoughts. I think those are things that you could do asynchronously with these breaks. So, it might also depend on the presenting concern.

Bradley Bogdan: I know that, at least the major platforms that I’m familiar with, I’m at least uncomfortable with the idea of interacting with somebody without being able to interact with them on a live basis, either over the phone or over televideo or in-person. Just because, exactly like you said, Carly, there are certain things that work in therapy with some space to breathe and try out and practice or whatnot in between kind of check-ins, but there are also a lot of safety assessments and ability to respond in the moment and keep somebody’s attention and get them to set aside some time to take care of themselves and take some time out to address whatever is going on, that is really valuable, that I would be really concerned would be lost if you’re trying to break up most of your clinical work into 160 characters or whatnot, at a time.

Lindsey Hendrix: Yeah. So, how do you go about finding a counselor for yourself? Is it like online dating where you pick somebody online, you kind of read about them, you go and visit with them for a little bit, and then you try somebody else, or how does that work?

Bradley Bogdan: I think dating is actually a pretty good analogy for it. No good clinician will be offended if, after a session or two you come back and tell them, “Hey, I appreciate what you’ve done, but I don’t think we’re the best fit for each other for this. You’re not really able to provide what I’m looking for.” Anybody with some of that standardized training and a license behind them is definitely professional enough to realize that they are not the right person for everybody. A lot of people come to, at least our clinic, through word of mouth referrals, even if it’s for other services. People are generally much more comfortable to go to somebody that they know recommends. So, asking some folks that have been to counseling before, “Hey, who did you use, or can you make a recommendation?”

Your primary care doctor also likely has some folks that they work with all the time, that they’re comfortable referring people to. Like I said, it’s a little more of a shot in the dark, but if you do have insurance, your insurance provider keeps a list of local professionals as well. That is a little more like looking up somebody in the phone book, or Googling, but it is definitely possible to find somebody good through there too.

Carly McCord: Yeah. I always say therapists are just people. You’re not going to like everyone you meet, and if you don’t … As a therapist, I really appreciate when people tell me, “Give me some feedback of, hey, this isn’t working,” and then I can say, “Oh, I can adapt in that way. Or can we get one more session?” or, “I can’t, you’re right. That’s actually not the way that I do therapy. Maybe I can help you find a referral.” I don’t think there’s anything wrong with that. There are some good … Psychology Today is one of the big listing organizations, it’s not just for psychologists, but where you can read about what are people’s approach to therapy. There’s lots of different theories that drive the work that we do, or looking at the presenting concerns that they’ve worked with, if you have a specific concern. Have they worked with that before? But yeah, I think the word of mouth is a great route to go.

Lindsey Hendrix: Yeah. I know word of mouth is how I choose where I’m going to eat dinner, if I’m going out to a restaurant. I think taking some advice from friends that I trust would be my compass for picking a counselor, especially when you’re talking about somebody who’s going to be working on your mind. Say you’ve chosen somebody, you’ve booked your first session, and you’ve never been to therapy before, what can you usually expect from that first session with your therapist?

Bradley Bogdan: I know, when folks come to see me for the first time, I break it down into three parts for them, because that is a super common question. Folks know that they want to get help and they don’t know what’s going to come, and they’re super apprehensive when they sit down in a chair and have all sorts of preconceived notions based on what they’ve seen in TV shows or movies, or they’re wondering where are the Chaise Lounges. I tell them, I’m going to ask them questions about, what is going on now, what’s brought them in, because obviously if you’re coming to see somebody, you have some level of concern, right? Then I tell them I’m going to ask a little bit about the way it was before. What did you notice has changed to make it like it is now?

Usually, that involves some history about how it was before and how it got to be where it is now, as best as they know. Then, the third part of the conversation is what they want going forward. Is the goal to make whatever feelings that are coming up go away, is the goal to be able to go out and do something that they aren’t able to go out and do anymore? What is the goal? What are we working for? If you’ve got at least the faintest idea of those things, it’ll be a conversation from there to figure out where we’re going to go and how we’re going to get there.

Carly McCord: Yeah. I think the only thing I would piggyback is what’s usually different from an intake, from that very first session, than maybe subsequent sessions is often, the intake is very therapist guided, where they’re going to have more questions. They’re going to have set of questions when you walk in, perhaps, and forms that you have to fill out. Brad kind of gave you this broad overview of, that he’s going to ask you questions along the way to get this past, present and future, and each therapist is going to do that a little bit differently. Then perhaps, in some modes of therapy, subsequent sessions may be more, where you do more talking, and there’s less direction. But I think that’s something that varies therapist to therapist, is how directive they are, how much talking they do and guiding they do, versus wanting you to turn inward and discover and come up with material.

Bradley Bogdan: Yeah, and going back to that idea that there are a million different people under the sun, and there are just as many different people that are therapists under the sun to match them to. It is okay to come in with some suggestions on how you feel most comfortable talking, or how directive you want somebody to be. There are folks that come in to tell me that they really just want a place to talk and almost word vomit everything out. They’re not really looking for a lot of direction or forward movement or shooting for a specific goal. They just want some space, and that’s fine. We can do that. Then there are people that want the exact opposite. They want to present a problem. They want concrete steps. They want physical things to practice in between sessions. They want a lot of input and guidance on what they should be doing to change this or approach that differently. That’s great too. Then there’s shades of everything in between.

So, if somebody has a comfort level with one end or the other, or someplace in the middle, it’s totally okay to tell your therapist before you show up on day one, or on day one, “Hey, this is how I feel the most comfortable. Can you work with this?” And odds are they can.

Lindsey Hendrix: Yeah. I know this is going to vary from person to person, but I got to ask the question, how long can you expect to go to therapy before you notice improvement?

Bradley Bogdan: You’ve got data on this, Carly.

Carly McCord: Sorry. I muted myself. I thought I was already muted. Our research would show that by four sessions, most people achieve some clinically significant change. We use a measure called the PHQ. Majority of people come in with some kind of depressive symptoms, and so going from a severe category to a moderately severe, that change usually happens in four sessions. What that looks like functionally, from severe to moderately severe, didn’t mean that the depression went away. It meant that maybe your sleep’s a little bit better, or that, perhaps … One of the ones that we usually see change the fastest, honestly, for a lot of people is the alarm bell, is the, “Oh my gosh, I’m having thoughts that I’d be better off dead. I can’t handle what’s going on right now. I don’t think I even want to be here anymore.” That, once you’ve reached out and connected, instilling hope can often happen pretty quickly, and so that can show some significant gains early on.

Therapy’s not a linear process though. Sometimes you go to one session. A lot of people will come for one session, and whether they didn’t like therapy or they really got something from it that they didn’t have before, I think both of those things happen. Then I think sometimes weeks of therapy get really hard. If you’re doing good work, sometimes you feel crummy, crummier than you did when you walked in the door, but I would really encourage you, that’s the time to stick with it. Do not drop out if you get to one of those spots where it gets really hard. That means it’s about to get really good. Yeah, it’s not linear.

Bradley Bogdan: I very much look at it like, and tell people to approach it like they would working with a personal trainer and going to the gym, whereas people don’t go to the gym and get what they need in a week or two. Every once in a while, I suppose you can end up with a wild card and they figure it out. But for the most part, you have to come back to it and you need to work on it on a regular basis. Then, measuring it over time, you can see the progress. Again, just like physical training or going to a gym, there might be weeks where it’s really tough or it’s really hard, or you feel crummier than you did to begin with. But just like Carly was saying, those are often the times, where if you stick with it, you’ll see a really big gain on the other side and get a lot closer to where you want to go.

Lindsey Hendrix: Any parting thoughts or words of wisdom you’d like to share with our listeners today as they’re navigating this uncertain time?

Bradley Bogdan: That, this is not an original thought to me, but I had a client say it to me from her pastor a few weeks ago, and it stuck with me ever since and I’ve shared it a bunch. Quite often, during times of really big change or national or international issues, we think about how we’re not responding to it well. We need to be better, we need to change this, we need to be able to do that, even with some added stress or concern or routine change. Quite often, those are times when we wouldn’t expect the same out of somebody else. If our neighbor was that way or our mom was that way, or our kid was that way, or some other relative, or aunt, or uncle, or the person down the street, we wouldn’t expect them to handle it without a bead of sweat or any effort involved. Be good to yourself, and extend that same kind of grace to yourself in a time like this. Don’t have expectations that you would be able to handle this when you wouldn’t expect anybody else would be able to handle it without any stress or worry.

Carly McCord: Yeah, definitely. I think, acknowledging the reality of the challenge that we’re all living in, that if you haven’t infected someone today, you’ve done a great job. You’ve achieved a lot. Being kind and compassionate to yourself during this time, to pace the fun, to survive, and stick to the basics of trying to eat, sleep and connect are a good place to start, and just encourage you to … If I could challenge every listener to do one thing, it would be to give themselves the two minutes today to stop, to turn off all inputs and check in, and just see if you hear something from yourself that you could respond to and be kind enough to act on that for yourself.

Lindsey Hendrix: Awesome. Well, thank you, Carly. Thank you, Brad, for being on the show today. Y’all are amazing guests. Y’all have such great wisdom in this area, and I’m sure this won’t be the last time we’ll have you on. So, until next time.

Bradley Bogdan: Absolutely. Thanks for having us.

Carly McCord: Thank you.

Lindsey Hendrix: Bye, y’all.

Carly McCord: Bye.

Lindsey Hendrix: Thank you, guys, our listeners, for tuning in. We really appreciate it. We do this for you, so we hope you like what you hear. If you do, please subscribe, follow us, like us, share us with your friends, pass it back, y’all. All right, until next time, stay healthy.

Timothy Schnettler: Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at, where you’ll find answers to all of your health questions. Until next time, stay healthy.