Have you ever had an Aha moment? One in which you gained a long-awaited insight or figured out the answer to a question that had been long evading you? Just like other medical practitioners, mental health therapists sometimes get stumped in figuring out how exactly to help a client, and we too have our aha moments! Often we are challenged when a client presents with various “symptoms” i.e. behaviors that are visible on the surface, but doesn’t respond well to what we think of as evidence-based treatment. In our last blog, we highlighted the importance of accurate diagnosis in mental health and the factors that get in the way. One thing many people don’t know is the high cost of an inaccurate diagnosis resulting in unsuccessful treatment. Many hours are lost and people many become hopeless if treatment doesn’t provide relief. Our path to helping our clients has often been to take a deeper dive into the presenting concerns, using psychological diagnostic tools that we have come to rely on to get to the real root of the struggle or challenge.
A client, referred to here as Mr. Smith, began attending therapy. He had been labeled with various diagnoses that fit his symptom pattern e.g. severe generalized anxiety, mild social anxiety, and depression. His primary concerns were marital distress and low social support. He shared that had anxiety and depression for years and was on an antidepressant and an anxiety medication. However, he was continuing to have difficulty with sleep, anxious thoughts, and physical anxious arousal including panic attacks. His therapist recommended he pursue further evaluation in order to explore his current symptoms and assess for other underlying conditions that may affect his improvement.
Mr. Smith was given a full comprehensive testing including: intelligence testing, personality assessment, mood and anxiety inventories, neurocognitive batteries assessing executive functions and attention, and client ratings of his own abilities. He also allowed his spouse and parents to provide some current and childhood observations. Results did indicate high anxiety and depression, but also notably (Aha!), another explanation presented itself! Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) were elevated across multiple scales, including self, parent, and spouse reports and neurocognitive tests.
Our conclusion; Mr. Smith was surprised at first, but upon speaking more with his parents, was told he had actually had some testing that was positive for ADHD in his childhood and they had just chosen not to treat him or inform him about it. He reflected on his lifelong challenges and realized that ADHD accounted for a lot of his problems, before anxiety and depression developed. He met with a medical doctor and began taking medication for ADHD. Within a week he reported a decrease in anxiety and physical discomfort, improvement in sleep, and improvement in overall mood, confidence, and focus on work. Within a month, he was taken off his anxiety medication and reported feeling calm and happy. He is continuing behavioral therapy to help himself learn how to best work around his weaker areas and play to his strengths.
On a personal note, we find this work so challenging, yet so fulfilling! This is an example of a person who spent their life not necessarily with the “wrong” diagnosis, but an incomplete one. Had this been addressed at a younger age, the anxiety and depression may not have developed to the severity they did (e.g. panic attacks). Despite being in his 40s, Mr. Smith was able to get a fresh start, uncovering information about himself that helped him understand his past and current situation. His marriage also improved as he and his wife re-examined their marital issues in light of the above information. That’s reason to cheer!
P.S. This is just one of many clients we’ve seen where carefully identifying a root cause of symptoms led to a significantly improved lifestyle for the client. We are thrilled when we see such transformation happen!