Chronic or recurrent distress, but no obvious diagnosis
A client came into my office, in acute distress, complaining about a work situation. Their manager made unreasonable demands. Their colleagues were struggling. At home, the family needs were all-consuming and the client had difficulty keeping up. They felt exhausted, agitated. Angry with the world.
Another: quiet, subdued, tearful. Sweet smiles and polite conversation. Sleepless nights. A concerned partner. Anxiety.
Or a young boy, promising school reports, a cohesive family; friends. Spends his days in bed. Struggles to fulfill his own goals. Complains that he wants to achieve, but simply does not ‘feel like’ putting in the work. Plays games on his phone all night.
‘Sub-clinical’ psychological disorders
Much of what I see in private practice consists of symptoms that do not add up to diagnoses. You may be referred, or self-refer, stating that you have ‘depression & anxiety’, but your symptoms do not meet the disorder-level criteria for either. No protocols exist. No clear evidence to guide my practice.
We can debate the reasons. Maybe you are slipping towards a diagnosis. Perhaps you see yourself as less resilient than you should be at this stage in your life (or than people in similar situations in ‘my’ culture). Maybe you’ve been told that ‘the diagnostic system is useless’ and does not adequately explain what people struggle with –versus the opposite: ‘no diagnosis means you’re not really ill’
It does not answer the question: how do we help you when you who feel stuck like this?
I approach it like I would a jig-saw puzzle: Collaboratively, we gather the pieces (the wrongs and the rights, strengths & weaknesses) and lay them out on the table. We consider overlaps and distinctions. Edges that pair up as well as border walls
You don’t sleep well some nights, but much better on other days. What can we learn from the research on insomnia that may help you be more comfortable during those hours in the dark? You feel down when you are tired, but much better again the next morning, or after a good lunch. I draw from the literature on Behavioural Activation for Depression to help understand and ameliorate that. You worry so much about that deadline that you cannot think straight. What does the treatment of Generalized Anxiety offer to help you manage the task optimally?
A clear formulation is like a puzzle
Formulating symptoms, highlighting connections and clarifying associations: informing a road map
that can guide an intervention. Each individual’s life has its own topography, with smooth pathways, rough roads, mountains to climb and rivers to follow. Therapy, based on best evidence, simply aims to provide the skills required to walk the path. Come, join us.
About the Author:
Kirstine Postma CPsych
Kirstine Postma is a clinical psychologist practising in Ottawa. She is trained in CBT and EMDR,
Interpersonal Therapy and Mindfulness-Based Stress Reduction. She also works as a trainer and supervisor in CBT.
Kirstine specialises in the treatment of PTSD, using multiple evidence-based models.
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