Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a “symptom” of underlying depression in men or a co occurring condition that more commonly develops in men. Nevertheless, substance use can mask depression, making it harder to recognize depression as a separate illness that needs treatment.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, angry, irritable, and, sometimes, violently abusive. Some men deal with depression by throwing themselves compulsively into their work, attempting to hide their depression from themselves, family, and friends. Other men may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm’s way.

More than four times as many men as women die by suicide in the United States, even though women make more suicide attempts during their lives. In addition to the fact that men attempt suicide using methods that are generally more lethal than those used by women, there may be other factors that protect women against suicide death. In light of research indicating that suicide is often associated with depression, the alarming suicide rate among men may reflect the fact that men are less likely to seek treatment for depression. Many men with depression do not obtain adequate diagnosis and treatment that may be life saving.

More research is needed to understand all aspects of depression in men, including how men respond to stress and feelings associated with depression, how to make men more comfortable acknowledging these feelings and getting the help they need, and how to train physicians to better recognize and treat depression in men. Family members, friends, and employee assistance professionals in the workplace also can play important roles in recognizing depressive symptoms in men and helping them get treatment.

(Adapted from NIMH.)

In focus groups conducted by the National Institute of Mental Health (NIMH) to assess depression awareness, men described their own symptoms of depression without realizing that they were depressed. Notably, many were unaware that “physical” symptoms, such as headaches, digestive disorders, and chronic pain, can be associated with depression. In addition, men were concerned that seeing a mental health professional or going to a mental health clinic would have a negative impact at work if their employer or colleagues found out. They feared that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends, or their standing in the community.

Over the past 20 years, biomedical research, including genetics and neuroimaging, has helped to shed light on depression and other mental disorders ­increasing our understanding of the brain, how its biochemistry can go awry, and how to alleviate the suffering caused by mental illness. Brain imaging technologies are now allowing scientists to see how effective treatment with medication or psychotherapy is reflected in changes in brain activity. As research continues to reveal that depressive disorders are real and treatable, and no greater a sign of weakness than cancer or any other serious illness, more and more men with depression may feel empowered to seek treatment and find improved quality of life.

(Adapted from NIMH.)

If the mental health professional believes you may have an anxiety disorder, the next person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.

Remember that once you start on medication, it is important not to stop taking it abruptly. Certain drugs must be tapered off under the supervision of a doctor or bad reactions can occur. Make sure you talk to the doctor who prescribed your medication before you stop taking it. If you are having trouble with side effects, it’s possible that they can be eliminated by adjusting how much medication you take and when you take it.

Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out. If you don’t have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.

(Adapted from NIMH.)

People with anxiety disorders who have already received treatment should tell their current doctor about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful.

Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.

(Adapted from the National Institute of Mental Health.)

The second step in making referrals is to know the professionals and other resources available in our community. It is important to get to know professional Christian counselors, hospital personnel, and a variety of physician specialties such as family physicians, pediatricians, obstetricians and gynecologists, and psychiatrists. As we get to know these professionals and how they work, we can feel more confident that those we refer will be in good hands.

A third step in making effective referrals is to be able to convince clients that the referral is necessary. It is important that we be honest with our clients and that we let them know when there is a more professionally skilled person who is best to treat them, or that we may have conflicts in dealing with a particular client or their problems. It is also important that we have enough self confidence and integrity to be able to be honest about the limits of our professional competence. We each have an area of specialty. No professional can be all things to all people.

A fourth step in making effective referrals is to be able to educate the client about what the professional we are referring them to will be able to do for them that we are not able to do. It is also helpful if we can assist the client in becoming more comfortable with the person we are referring to by informing them that we know the person personally, and that in our experience with them they can be trusted and are helpful.

A fifth step in making effective referrals is the ability to allow clients to express themselves and their feelings about referral. Some clients may be angry, some clients may feel depressed or betrayed, and other clients may be afraid. It is important to allow the client to discuss these feelings. It may be necessary for us to offer reassurance and clarification of any misunderstandings. It is also important that we allow clients to know that we do care for them and that we intend no malice or harm by making the referral. Redefining what your relationship will be like after the referral is completed is strongly recommended.

The sixth step is getting the client to make a commitment to follow through with a referral. If we simply say to a client, “I suggest you call a counselor,” and we are not specific about who we are referring to, the chance of follow through is extremely small. If we ask the client if they will commit to making the phone call, and when they will make the phone call to make to appointment, then there is a significantly increased chance of follow through.

Sometimes it is a good idea to allow the client to make the phone call from your office. Particularly, when the client has made a commitment to follow through with a referral, but we sense that if the client hesitates the resolve will weaken, it is a good idea to have the client make the phone call from our office. Sometimes it is effective to ask the client if you can make the phone call for them. Making the initial phone call sometimes makes it easier for the client to follow through.

Most professional offices will ultimately require that the client make a call themselves directly before appointments will be established. If a client is unwilling to talk with a counselor or with an intake counselor over the phone they are often likely to cancel or not show up for their first appointment. Also, many professionals give instructions to help prepare the client for their first appointment and obtain information that will reduce some of the initial paperwork.

A seventh step in making effective referrals is agreeing on what information will be shared with a new professional. If we have previously provided counseling, testing, or any other service, it is important to discuss with the client whether they wish those results be forwarded to the professional we are referring to.

Professionals require a signed release in order to disclose information. Counselors are bound by a code of ethics and laws that require guarding client information and client confidentiality. In the case of pastors and physicians making referrals to professional counselors, it will be necessary to sign a two way release of information in order for information to legally be exchanged as we serve as teammates in helping our clients. It is important that we explain to our clients that working together is in their best interest. As we are able to communicate we are able to work as a team which often speeds the process and increases the chance of successful outcome.

The final step in making effective referrals is follow up. It is important for us to check with clients to make sure that they made the telephone call and established an appointment. It is also important for us to follow up with our clients following their first appointment with their counselor. When people come for counseling they are often confused, anxious, and sometimes disoriented. Sometimes clients will come away from sessions with mistaken impressions or misunderstandings of something that was said in the counseling process. Counseling is a painful process and sometimes raises resistance.

(Adapted from our corporate web site: www.cfitulsa.com.)

GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.

When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.

GAD affects about 6.8 million American adults,1 including twice as many women as men. The disorder develops gradually and can begin at any point in the life cycle, although the years of highest risk are between childhood and middle age. There is evidence that genes play a modest role in GAD.

Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions must also be treated using the appropriate therapies.

(Adapted from the National Institute of Mental Health.)

Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.

(Adapted from the National Institute of Mental Health.)

Specific phobias affect an estimated 19.2 million adult Americans and are twice as common in women as men. They usually appear in childhood or adolescence and tend to persist into adulthood. The causes of specific phobias are not well understood, but there is some evidence that the tendency to develop them may run in families.

If the feared situation or feared object is easy to avoid, people with specific phobias may not seek help; but if avoidance interferes with their careers or their personal lives, it can become disabling and treatment is usually pursued.

Specific phobias respond very well to carefully targeted psychotherapy.

(Adapted for the National Institute of Mental Health.)

Referral is a skill. Making a referral is like any intervention in a professional’s toolbox. If the helping professional is skilled in making referrals, clients often follow through and seek the services of the one to whom they are being referred. As with any skill, referral may be ineffective if we are not confident and competent in making referrals.

Helping professionals are sometimes reluctant to make referrals because they feel guilty that they are not able to help, or they may feel that referral casts doubts about our competence. We may be fearful that the client will perceive the referral as rejection. When a client expresses resistance to seeing a professional therapist, we may be tempted to attempt to provide the counseling ourselves, even though it may be against our better judgment.

Referral is particularly advisable when we recognize that we do not have the competence, training, or experience in dealing with the unique problems that are being presented to us. To practice beyond one’s training is considered unethical for professionals and is frequently a factor in malpractice lawsuits. Helping professionals must not allow their own feelings of guilt or fear of a client feeling rejected to keep us from doing the professional and competent thing which is sometimes to refer.

It is best not to work with some clients. It is advisable to refer when we find ourselves sexually attracted to a client, when we find ourselves angry, when we dislike our client, or in cases where there is a potential conflict of interest due to our other relationships with a client. Dual relationships increase the possibility of our objectivity and judgment being hindered when making diagnosis or treatment decisions.

Referral is appropriate whenever we have provided counseling services to a person who is not showing signs of improvement. After a reasonable period of receiving counseling, clients should show signs of improvement. If they do not, it is our ethical responsibility to not continue counseling when it is not producing progress. We also have an obligation not to abandon a client in distress, but we are responsible to facilitate a referral to another helping professional.

(Adapted from our corporate site: cfitulsa.com.)

Fatherhood is pretending the present you love most is soap-on-a-rope.
-Bill Cosby

Your modern teenager is not about to listen to advice from an old person, defined as a person who remembers when there was no Velcro.
-Dave Barry

People who say they sleep like a baby usually don’t have one.
-Leo Burke