I would agree with this, both as a prior patient myself, and as a psychiatrist and therapist for 45 years. Not only does one size not fit all, many diagnoses are truly hidden even from the most observant therapist.
Since I was both an eclectic therapist and a medication provider, I would work with my patients to discover their diagnoses. Sometimes we would agree to a trial of medication(s); other times I would make a referral to co-workers specializing in trauma, alcohol use disorders, whatever, who were more competent in those areas than I was. Or we would agree to sit there and try to find out what was going on.
The key point was empathy. If a patient said “Doc, I think you may have it wrong” - I would listen. Intently. I had training in CBT as well as psychodynamic therapy, also did groups, marital therapy, saw some kids. But one had always to meet the patient where she was at. I don’t know from what you wrote exactly how your anxiety disorder had been hidden from you (and others), but someone, or something helped you discover that diagnosis. The field is really still new, even after over 100 years.
Hello Ed! I've been meaning to write you back for days, apologies for the delay. I really loved your thoughtful response to my post. THANK YOU. I couldn't agree with you more about the field being very new. The person who helped me discover my diagnosis was actually a very experienced Silicon Valley neurologist who said, "I see people come in every day with this kind of somatic anxiety disorder. You are one of the few people who actually listened to me about it." Which I found super interesting. I think my hardest challenge with therapy was that it tended to start with the question, "So what's wrong?" And I never had the words or clarity to respond...I'm sure my own internal perfectionism didn't help, either.
A very helpful Cranio-Sacral therapist who was working on my hip pain years ago told me the there are 3 ways that we register our memories and feelings. Consciously, subconsciously, and bodily. Unless we can access all three, we cannot process these correctly. So, your anxiety could be present in all 3 areas, or perhaps mostly or only bodily. Ordinary psychotherapy can only deal well with the first 2 categories. But a good therapist would likely feel that there was a missing piece. A good therapist might not give a leading question of "So, what's wrong?", but perhaps more "So, why are you here today?" I know it is semantics, but someone like yourself might tell a story of "something is wrong but I don't know what it is". That would be OK. My female patients with ADHD almost all said something like this initially.
Please clap or leave a comment, if you can. So far only 1 or 2 people have read it.
About 15 or 16 years ago, when this all happened, I wrote a letter to The NY Times about it (it was in reaction to an article they had on ADHD), and they published it. But overall, crickets. I‘ll bet many adults who have covert ADHD are undiagnosed to this day. A shame.
Should probably also say hi! I'm a nonbinary human who was raised and socialized female who didn't realize they (rounded first, skipped second, and stealing third!) had ADHD until much much MUCH much later in their five-and-counting long decades of life.
I would agree with this, both as a prior patient myself, and as a psychiatrist and therapist for 45 years. Not only does one size not fit all, many diagnoses are truly hidden even from the most observant therapist.
My own eye-opening experience was finding adult ADHD in women in the 20s and. 30s that had never been previously diagnosed. https://medium.com/@ed.schwartzreich/previously-undiagnosed-add-in-women-a-small-tale-of-discovery-55691549e4bf
Since I was both an eclectic therapist and a medication provider, I would work with my patients to discover their diagnoses. Sometimes we would agree to a trial of medication(s); other times I would make a referral to co-workers specializing in trauma, alcohol use disorders, whatever, who were more competent in those areas than I was. Or we would agree to sit there and try to find out what was going on.
The key point was empathy. If a patient said “Doc, I think you may have it wrong” - I would listen. Intently. I had training in CBT as well as psychodynamic therapy, also did groups, marital therapy, saw some kids. But one had always to meet the patient where she was at. I don’t know from what you wrote exactly how your anxiety disorder had been hidden from you (and others), but someone, or something helped you discover that diagnosis. The field is really still new, even after over 100 years.
Hello Ed! I've been meaning to write you back for days, apologies for the delay. I really loved your thoughtful response to my post. THANK YOU. I couldn't agree with you more about the field being very new. The person who helped me discover my diagnosis was actually a very experienced Silicon Valley neurologist who said, "I see people come in every day with this kind of somatic anxiety disorder. You are one of the few people who actually listened to me about it." Which I found super interesting. I think my hardest challenge with therapy was that it tended to start with the question, "So what's wrong?" And I never had the words or clarity to respond...I'm sure my own internal perfectionism didn't help, either.
Again, thank you Ed,
Meredith
Hi Meredith,
A very helpful Cranio-Sacral therapist who was working on my hip pain years ago told me the there are 3 ways that we register our memories and feelings. Consciously, subconsciously, and bodily. Unless we can access all three, we cannot process these correctly. So, your anxiety could be present in all 3 areas, or perhaps mostly or only bodily. Ordinary psychotherapy can only deal well with the first 2 categories. But a good therapist would likely feel that there was a missing piece. A good therapist might not give a leading question of "So, what's wrong?", but perhaps more "So, why are you here today?" I know it is semantics, but someone like yourself might tell a story of "something is wrong but I don't know what it is". That would be OK. My female patients with ADHD almost all said something like this initially.
Best wishes,
Ed
Your experience with female patients with ADHD sounds fascinating -- have you ever written about it? Would love to hear more.
Please let me know whether you were able to get the article on Medium. If not I will copy it and send it to you.
Ed
Yes. I have an article in Medium: https://medium.com/@ed.schwartzreich/previously-undiagnosed-add-in-women-a-small-tale-of-discovery-55691549e4bf
Ed
Yes, I can see it!
Please clap or leave a comment, if you can. So far only 1 or 2 people have read it.
About 15 or 16 years ago, when this all happened, I wrote a letter to The NY Times about it (it was in reaction to an article they had on ADHD), and they published it. But overall, crickets. I‘ll bet many adults who have covert ADHD are undiagnosed to this day. A shame.
Should probably also say hi! I'm a nonbinary human who was raised and socialized female who didn't realize they (rounded first, skipped second, and stealing third!) had ADHD until much much MUCH much later in their five-and-counting long decades of life.
Nice to meet you Jayke! Thanks for telling us about yourself!
lowercase j please. :) And my pleasure!
jayke it is!!