Things to expect from your first counselling or therapy session

A counselling session is meant to help a person with certain mental or emotional problems and giving them advice and suggestions on how to cope up with them. Counselling is done primarily for the purpose of solving issues related to mental health . Major issues that have become common today are depression , anxiety , bipolar disorder and trauma which can even lead to an outcome as drastic as suicide.
Therapy can prove to be a very effective solution for such mental issues . There are many types of therapy such as cognitive behavioral therapy , psychoanalytic therapy , exposure therapy etc. Talking to a psychologist or doing some activities as directed by them can make changes in your overall mental and emotional health. You should choose your therapist according to your needs and convenience , for example if a girl feels more comfortable in sharing her experience with a woman then she can choose a female therapist .

When you sit for your first counselling session , there are some things which you can expect to happen . First of all , you may feel overwhelmed while sharing your experience with the therapist and it is totally normal . If you feel like crying , then you should cry . There is no need to hold back as you are sitting in the therapy to solve your problems . Giving an honest and true account of your feelings and emotions is important.

Your first session is not the only session you are going to sit for , there will be many in the coming future. So dont expect big results from your first experience . A mental issue that has developed over years or months needs time . Change will happen slowly and it will take some time to again start feeling better.

You should try sharing maximum with your therapist . Dont try to hide anything unless and until it is really something that you dont want anyone to know. There is no need to feel ashamed or judged as everyone makes mistakes . Make full use of your space and be comfortable before your start interaction . The therapist is not sitting there to judge you or punish you.

At some stage you may feel that sitting for the session was probably a mistake or you should not have done this . Remember you must have come for counselling only after feeling that there is no other option. If you feel that your therapist is not able to understand you appropriately or you dont feel that you struck a vibe or rythm with them , then you can very well change your therapist. You are not supposed to proceed if you dont feel so.

Your first session may be a little overbearing and can leave you feel light headed at the same time. You may feel guilt , remorse , anger or irritation while interacting and calm , relaxed and peaceful after the session.

Overall , your first counselling session is supposed to set you on a path to recovery from a mental issue. Dont be nervous or afraid as it is not an examination or a test . One thing that you can do to avoid being a little spontaneous during the session is to plan what you want to say and how you to say that. Planning will aid you in sharing your experience in a systematic manner . Take your time to plan and try to stick to your plan. So psych yourself up and All the very best to you for your first session !

Hyperthyroidism Awareness

It is important to remember that hyperthyroidism can occur at any age. While most may present with a rather typical constellation of symptoms, many may present with exacerbation of pre-existing conditions which may make the diagnosis initially elusive. Worsening anxiety, insomnia, fatigue, panic attacks, palpitations, hypertension or diarrhea may not initially signal that the thyroid is involved. Clinicians must have a low threshold to check thyroid function early to rule out a component of hyperthyroidism.

Once a suppressed thyrotropin (TSH) has been detected, further investigation with serum triiodothyronine (T3) and free thyroxine (free T4) can help delineate overt from subclinical disease. A thorough history of past thyroid disease, as well as current medications and supplements, can help detect any pre-existing diagnoses or exogenous sources of thyroid hormone or over supplementation with iodine. More commonly, hyperthyroidism is due to either Graves diseasetoxic multinodular goiter or toxic adenoma. Distinction between these can usually be made with the assistance of a thyroid uptake scan, TSH receptor antibody measurement, and thyroid ultrasound. An additional physical exam finding of exophthalmos can further support the diagnosis of Graves’ disease. Understanding the etiology can help guide patient expectations. A small percentage of patients with Graves’ Disease may undergo spontaneous remission after 1 to 2 years, which may prompt patients to wait before considering a definitive treatment option.

With confirmation of the diagnosis of hyperthyroidism, focus is on hormonal control with an antithyroid medication (ATM, most commonly Methimazole in the United States). This may be augmented with beta-blockade, steroids, cholestyramine or SSKI for those who are difficult to control.

Many patients may need further consideration for definitive management with either radioactive iodine ablation (RAI) or thyroidectomy. Your local resources may also influence these options, but it is critical to understand that all three treatments (ATM, RAI and thyroidectomy) are possible options. Certain patient factors and priorities may alter the preferred definitive treatment. Smaller gland size, easy to control hormones, and lack of eye symptoms are factors that may favor continued ATM management. A large goiter with compressive symptoms, difficult to control hormones requiring high dose medications/ multiple modalities, pregnancy, severe eye disease, multiple nodules within the thyroid with or without thyroid cancer, or desire for rapid and reliable hormone control may favor thyroidectomy. RAI is a good option for patients with a smaller gland size, and a desire to pursue definitive management but avoid surgery.

There are also relative contraindications for treatment options. ATMs may have serious side effects, like agranulocytosis or liver failure, which prevent further use, or may cause skin eruptions making long term use intolerable. Additionally, high dose requirements or fluctuating doses may make long term use of ATMs not reliable. Women who are pregnant, wanting to become pregnant in the next 6 months to 1 year, breast feeding or have small children in the home will want to avoid RAI. Patients with severe eye involvement, have a large goiter with compressive symptoms, or are smokers should also avoid RAI. Thyroidectomy will be a poor option for patients with multiple previous neck operations on or around the thyroid due to internal scarring, or who are high risk for general anesthesia. Additionally, if they have a history of previous gastric bypass surgery, they are higher risk for major complications from hypocalcemia/hypoparathyroidism after thyroidectomy.

To help the patient navigate these decisions, it is important to allow them the opportunity to discuss each treatment option with respective physician experts – medical management with endocrinology, RAI with endocrinology and potentially nuclear medicine as well, and thyroidectomy with the thyroid surgeon.

In summary, patients with hyperthyroidism require medical control, as well as a clear understanding of the etiology of their hyperthyroidism. Patients with Graves disease, toxic multinodular goiter and toxic adenoma have more than one treatment option, and it is important for patients to be educated and engaged in treatment decisions.

For Further Reference:
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis| by the American Thyroid Association

‘The Sleep’ by Elizabeth Barrett Browning.

Have you ever appreciated your ability to sleep? Now, you will wonder if being able to sleep is something to be praised. Yes, give yourself an applause for you have been given the best gift ever and you will have to cherish this gift. The poem ‘The Sleep’ by Elizabeth Barrett Browning brings out the importance of sleep and why it is to be cherished.

Of everything we have known about God from psalms and hymns, the poet asks if there is any gift which surpasses His gift – the sleep. As humans, what can we give to our loved ones? We can give the hero’s courage and determined heart to confront all the troubles; we can give them a poet’s lyrical verse to move them to ecstasy; we can give them a patriot’s voice to guide them through hurdles and motivate them; we can give them a ruler’s consolation to ease their burdens. But of everything we can give them, there is nothing that will surpass God’s gift to His beloved – the Sleep. 

“He giveth His beloved, sleep”

Sometimes we give our beloved words of consolation and sometimes we add to their difficulties, making their whole world burdened. But God’s gift – Sleep – puts an end to all such sufferings. No matter what words of consolation we say, we can’t solve the problems of our beloved. When things get hard and we have no words of consolation, all we can say to our beloved is to sleep.

“ ‘Sleep soft, beloved!’ we sometimes say,”

We say so, hoping that no bitter memories of hardships shall disturb their ‘happy slumber’. When we sleep, we forget our bad experiences and experience eternal peace. So, this peace gives us hope and when we wake up the next morning, we are prepared for the day. Now is there any gift which surpasses sleep?

Our earth is full of dreary noises and wailing voices of despair. We chase after money, wealth and other material prospects which might leave us anytime. So, God silences these wailings by putting everyone to sleep. God has created this earth and all natural elements and we humans sow and reap. Thus, Sleep is more delicate than the dew drops and clouds. It makes us feel as if we are on a delightful journey and makes us feel lighter.

We go on living, thinking, and feeling without even realizing what keeps us going everyday. It is the sleep which keeps us going everyday. When we sleep, we forget the hardships of today, and hope for a better tomorrow.

“Aye, men may wonder while they scan  

A living, thinking, feeling man  

Confirmed in such a rest to keep;”

Our world is a stage and we are like a tired child watching the performance of the mummers on the stage. So when our eyelids droop, we rest like a child on God’s lap. So, no matter how exhausted we are, it is the sleep which rejuvenates us at the end of the day.

The last stanza ends with the poet asking her friends not to mourn or weep when she dies, for she is just going to an eternal sleep and a state of peace after all. 

“Let One, most loving of you all,  

Say, ‘Not a tear must o’er her fall;  

He giveth His beloved, sleep.’“

The poem makes us understand how blessed we are to be able to sleep. We should no longer take our sleep for granted. Sleep improves both our mental and physical health. So, sleeping is the best thing ever. Finally, think if there is a greater gift than sleep.

“He giveth His beloved, sleep.”

Read the poem at https://poets.org/poem/sleep