Needing a little vocabulary help to take some practical steps.

[Mme.Marie]

Ok , I need some help guys. I am not a complete idiot , but I am having a hard time figuring out the technicalities of the mental health industry.

I am 19 , a freshman in college who works full time and doesnt live at home. I have been doing my best to work out some issues from high school , and live a healthy life. However , I recently started having nightmares again and horrible thoughts that just pop in my head. I never act on them , but I want to try to work things out and move on with my life.So I am looking for a therapist type person , because this is really starting to affect my sleep and therefore my school work and my job , which few can afford in the current economic climate.

SO my question is... do I need to see a psychologist or a psychiatrist ? And do they specialize in certain things like other doctors do , so would I be looking for a specific type of psychologist/psychiatrist ? Are there specific types or therapy I should consider ? I know that the specifics will really be down to what doctor I go to , but a nudge in a direction would be helpful.

I must admit I really dont know much about this , and google is only so helpful. Anyone who knows about this or can throw some advice my way , this would be greatly appriecated.

[WildChild]

Hi.
A psychiatrist has both a degree in medicine and a degree in pyschology. They can and far too often do, prescribe drugs. There are differents types of therapy, you need to ask what they do, how they procede. Be clear what you want. I've had some who were really helpful in just a couple of sessions and others who were virtually useless after several. Some people enjoy the attention and can afford to let it drag on for years, others want some insight, some specific steps they can take and to get on with it! You will have to interview them, maybe try a couple sessions and decide for yourself. Remember you are employing them to help you, they aren't gods and you can fire them if you don't think you are getting what you need.

[CHANDLERS WISH]

I just wanted to say good for you, as you understand that the nightmares stem from what ever is happening at school and therefore, you want assistance in dealing with those issues.

WC gives good advice there.

CW

[Little]

Your school should have a free "counselor," which I found was a good place to start. It varies on whether they're ologists or iatrists, but giving it a try for free can't hurt. Good luck.

[jss2000]

Hi there,
Here are a few additional suggestions for working through post-traumatic stress, which seems to be what you are describing (i.e., based on your reference to unfinished business from high school and the nightmares)

Psychiatrists prescribe medicine but in most cases do not have much training in cognitive/behavioral therapies (e.g., cognitive-behavioral therapy, stress innoculation training, behavioral/exposure therapy, and eye movement desensitization and reprocessing).
Psychologists (PhD, PsyD, or MS/MA), clinical social workers (LCSW, CSW), and licensed professional counselors (LPC) are more likely to be trained in these treatment approaches, though individuals vary. WC's advice is solid--ask the counselor about their approach, and expect to make some progress within the first 4 or so sessions. Ask the therapist for a ballpark guess on how many sessions will be needed for a good treatment response. You can and should discuss with your therapist if you don't seem to be making progress. Adjustments to the therapy or a referral to another therapist are options. Most therapists should be plenty flexible about making treatment work for you, though.

I can't say I know the medication research for PTSD. However, medications have been shown to have some benefit for a wide range of emotional and anxiety disorders. They often have side effects, though. Also, problems tend to come back when you stop taking the drug, whereas receiving legitimate counseling treatments tend to maintain their gains.

PTSD counseling will likely have an early focus on behavioral and thought exposure. This means the therapist will help you (gradually) encounter the everyday anxiety triggers that you may currently be avoiding or feeling stressed about--certain types of people, situations (including going to sleep, b/c of the nightmares), bodily sensations, or or other things that remind you of the traumatic event(s). PTSD is a tough thing to deal with because those anxiety triggers start to pop up everywhere in your life, and you either start avoiding everything associated with them or enduring them with extreme discomfort. So the first step in therapy is to approach those anxiety triggers so that they become less anxiety provoking.

For example, a war vet may have a trigger where loud, sudden noises remind him/her of gunshots. Or, even more difficult, he/she may have images of comrades dying that likewise trigger intense feelings of anxiety. Avoiding situations where loud noises may occur would be extremely disabling. In the second case, trying to monitor one's thoughts is extremely stressful, and usually has the unintended effect of making those thoughts come up more frequently.

The second phase usually deals with any core issues related to the trauma that you still need to work through. After that, your therapist should help you develop a long-term plan for managing anxiety if it ever resurfaces.

Think about getting a good patient educational book on PTSD to supplement what you are learning in therapy. A recently published example is "The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth" by Glen Schiraldi.

[jss2000]

Sorry, forgot a couple of the professional groups. Some marriage and family therapists (LMFT) are also trained in PTSD talk therapy.
Also, APRN's are the master's level equivalent of psychiatrists, and they may charge less and/or be easier to schedule appointments with. Like psychiatrists, they prescribe medications and are less likely to do psychotherapy.

[Mme.Marie]

I wanted to thank everyone for replying first . I am not sure medication is a route I would prefer , except as a last resort. I have seen all too well how a mis-diagnosis and incorrect medicine can cause issues , for both of my bestfriends . Although , I dare say their issues are very different from my own. I dont know that it is PTSD , however. My nightmares arent always about the same thing. And most of the time , I dont appear to be triggered by anything in particular. I was thinking it could be stress , because I have a lot of dreams about work and I generally feel worse when I have been juggling work and school. That is not likely to change anytime soon however , so making it better or learning how to handle this is really the key for me.

I am trying to avoid school counselors because I am an honors student and work on campus , I would rather avoid tying any of this to my school. Although I am thinking I may ask the school counselor about local psychologists to get an idea of who to consider. Unfortunately my insurance will be the ultimate decision maker there. I would ask my mom , but I daresay I have caused her enough grief when the whole mess came to light , then it was decided I was lying ( apparently the word "inappropriate" is too big for a high school student to use and not be lying ).

Anyways , once again , thank you. I think a psychologist is what I am looking for in this case. I would really like to straighten this all out , I think it will make life easier for me.