Psychotherapy expert: Clinically-depressed spouse

Vol XV: My wife is clinically depressed. She won't get out of bed or leave the house. She won't tolerate visits or being alone for more than an hour at a time. It has come to a point where it is affecting my health. What can I do?

By DR. MIKE GROPPER
dr mike 88 (photo credit: )
dr mike 88
(photo credit: )
Dr. Mike is a licensed clinical social worker (USA and Israel) in private practice in Ra'anana. He recently wrote a column called "Psych-Talk with Dr. Mike" in which the feedback from readers was excellent. He has decided to shift gears and invite readers to submit their questions concerning a wide range of topics: child development, adult problems, addictions, ADHD, adjustment problems, crises and transitions, trauma, phobia, mental disorders such as anxiety, depression, and bi-polar. He also welcomes questions concerning your marital or couple relationship, family issues, parenting, problems at work, self-confidence, shyness and much more. "I take pleasure having the opportunity to answer your questions in what I hope will be an informative and exciting weekly column in the Jerusalem Post-online edition. Look forward to hearing from you soon." Dr. Mike Gropper, DSW (09) 774-1913 Send your questions for Dr. Mike. * * * Psych-Talk with Dr. Mike: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Click here for Volumes I-IV Click here for Volumes V-IX Click here for Volumes X-XIII * * * This column is intended solely to educate and is not a substitute for personal diagnosis or treatment. If you have a difficult problem, please seek advice from your own doctor or mental-health professional. * * * Vol XV Q: Dear Dr. Mike, my wife has been diagnosed by a psychiatrist as suffering from a deep depression. She is unable to sleep more than 3-4 hours and spends almost all of the day in bed. Furthermore, she continuously checks her blood pressure with a home cuff every 15 to 20 minuets and refuses to have any company visit her. Even our four grown-up and married children can only be tolerated at max 1 hour. The only time she puts on clothing is when she has a doctor's appointment, and as soon as that visit is over, she demands to be taken home directly and undresses and wears only nighttime clothing. The psychiatrist we consulted wanted to prescribe medication to help her with her depressed mood. As a measure of precaution, he wanted to first communicate with the family doctor to ascertain if such medicine will be tolerated in the digestive tract. My wife was unsatisfied with his suggestion to take medication and brushed him off as being unuseful. What I have been advised by all medical personnel is to just leave. The problem of taking such drastic action is, one, this person is totally dependent on me, this person does not drive, this person is frightened to be left alone for more than an hour or two, and she is frightened to sleep alone. Living under such conditions I feel as if I am incarcerated, but what is more frightening to me is that since I am also locked up in the house I also am unable to exercise as required to maintain my own health. I am also becoming depressed and I am getting weaker by the day to the point that even climbing a ladder or even getting on a step stool makes my whole body shake. I am hesitant to involve our children more into helping their mother since I fear that they will be unable live a normal life. While I do have a nursing home policy, it first requires a hospital stay after physicians determine that she is in danger of hurting herself, and since she is not suicidal, this option would not work.. I come from a very orthodox family, my history of Bergen Belzen intrudes, I do not find any comfort in Religion or its rituals. I wish I did that may have helped me somewhat, but it would not have changed my reality. Is there any advice or do you have any experience with such a situation? A: Your situation is very painful, but one thing for certain is that something has to change. It sounds to me like your wife was looking for something more humanistic than a psychiatric consultation in the psychiatrist's office and a recommendation to take an anti-depressant. I do agree with the psychiatrist that it sounds like she is clinically depressed. My first suggestion to you is that you need to get empowered and realize that the status quo of this situation has to change or else you risk sinking more into the pit of your wife's helplessness and depression. You must make a conviction to yourself that either something changes and improves or you may in fact have to leave her. But before getting to that point, you may consider consulting with a good clinical social worker who is also trained in cognitive therapy as well as family therapy and someone that knows what community resources exist that may be available to you and your wife. Consult with the local Jewish federation in your area to find such a service and see if they can send a social worker to your home. Several home visits could potentially help to crack the wall of defense and resistance and perhaps get your wife to come on board in making a plan that she would agree to (this is called old-fashioned social work intervention). She sounds like someone who very much wants to maintain control but may be suffering because she feels that she is loosing control, therefore needs to control everything, including yourself. I would have the social work arrange another evaluation with a psychiatrist who hopefully could meet her in the home to evaluate if there is any dementia, bipolar illness, and/or depression. I also think that you are letting your grown children off the hook too easily. You need their support now more than ever. The social work-family therapist could be a significant resource in helping you to get the support you need from your kids. By the way, I suspect there are many issues here, some of which may stem back to the Holocaust. It is not uncommon for survivors to suffer from depression or psychosomatic pain and illness, having been exposed to so many traumas, and the loss of loved ones. The condition that I am referring to is called a somatoform disorder in which difficult emotional and life experiences are experienced as physical symptoms. Patients who somatize present with persistent physical complaints for which a physiologic explanation cannot be found. Failure to recognize this condition and manage appropriately may lead to frustrating, costly, and potentially ineffective interventions that fail to recognize the true underlying cause of the individual's suffering. Once again, these issues need to be evaluated if done in the home, this may be less threatening and safer for your wife. Finally, you should also seek counseling from the social worker for yourself, and by all means do not compromise your own health or else you will not be able to help either your wife or yourself. Get out there and start walking to get some fresh air and basic exercise. I do wish you success and I hope that things will get better in the very near future. * * * Vol XIV Q: Dear Dr. Mike, I am a 28-year-old male seeing a female psychotherapist for a few weeks. In the beginning she acted quite distant, maybe because I was a new patient. Now that I've been there a few times I notice that the atmosphere is significantly better and that she expresses certain body language. Sometimes, I also catch her glancing at my body, mirroring my posture and some other signals that seem to be very flirtatious. I recently discovered on the Internet that you can tell a lot by reading it and although I think it's very exciting, especially because she is quite attractive, I remain a bit confused because I don't know if she is doing this on purpose to provoke something in me or if it's  happening unconsciously. Thanks for your answer. A: It is not uncommon for clients seeing a therapist of the opposite sex to become attracted to the therapist. Now you state that you catch her "checking you out" by her flirtatious actions in the sessions. You also note that you just recently began your treatment with this therapist. There are a few possibilities that come to mind. It may be that you are in fact picking up on some attraction that your therapist has towards you. Therapists are in fact human beings and we do react to many different aspects of our clients, but in doing so, we are also trained to understand these reactions (known as counter transference) and to use these feelings professionally for the purpose of diagnosis and treatment. Your therapist, depending on her level of training and self-awareness, may or may not be aware of her reactions to you, if this in fact is what is going on. The other side of the coin is that you may be bringing into the therapy an emotional and subconscious need to see your therapist admiring you (called transference). Sometimes, clients will deal with their resistance to therapy or working on their emotional problems and needs by transforming the therapy session into a scene of "seduction". This can serve the purpose of keeping your emotional issues under wrap and basically avoiding them. My suggestion in either case is that you should bring this issue up with your therapist and see if she can help you to get past the initial thoughts you have that she is flirting with you. If you don't work this out with her, and sexual tension continues to be a problem for you, try another therapist. Good luck. Q: Hi Dr. Mike, G-d willing, I would love to make Aliyah in the future, after obtaining a graduate degree in psychology first. I was wondering whether Israel's Ministry of Education will recognize a degree in health psychology, forensic psychology or neuropsychology? Also, will having a PsyD degree limit potential job opportunities there or is it regarded pretty equally with a PhD? Lastly, would you advise obtaining an American degree and then applying for a license once in Israel, or will I be at a professional disadvantage for not having received the degree from an Israeli program? My parents insist that I get my degree from America for fear that I won't be able to cope financially while abroad and will need to come back to America to support myself. I appreciate all the help and advice you can give me- thank you. A: Dear Samantha, First of all, I hope that you will succeed in your dream to come live in Israel. As for your questions, the old boy scout motto, "Be prepared" is the name of the game in Israel. Your question is the first step in fulfilling this rule preparedness. PsyD degrees are recognized in Israel, but this doesn't guarantee that your PsyD will be automatically accepted. All higher learning degrees need to be independently evaluated by the Ministry of Education. Their requirements are spelled out at their website at www.education.gov.il The following information taken from the NefeshbNefesh website summarizes the steps: Degree Recognition  Dissertation: You must submit a printed copy of your dissertation. The offices will not accept it on CD. If your dissertation was not written in English, Hebrew or Arabic, officially, it must be translated into one of these languages and submitted with a legal declaration from a lawyer stating that the translation is accurate and does not include any additions. Note: Before you translate the dissertation, check with Misrad Hachinuch (Ministry of Education) if this is really necessary. If an expert on the review committee happens to speak the language of your dissertation, you won't need it translated.  Original version of the Ph.D (Psy.D) diploma or a notarized copy provided by an Israeli notary. It is worthwhile to bring a photocopy as well. Note: If you have a doctorate in psychology, you will need 2 notarized copies for Misrad HaBriut (Ministry of Health) plus one notarized copy for Misrad HaChinuch Ministry of Education).  Original diplomas & transcripts for your undergraduate degree and Master's degree. It is worthwhile to bring a photocopy of each. If you studied in a direct Ph.D (Psy.D) program, you are required to provide a letter that you received before beginning your Ph.D (Psy.D) studies, indicating that you were accepted into a direct Ph.D (Psy.D) program, and that this is an option in the institution where you studied.  Official letter indicating that you fulfilled all of the requirements for your Ph.D (Psy.D) . This letter might include information about the requirements for receiving a Ph.D (Psy.D), entrance exams (if relevant), necessary coursework, number of credits completed, the scope of your doctoral work, etc.  Official letter indicating the language of instruction in the institution where you studied. If your dissertation is in a language that differs from the language of the university, you must submit a letter indicating that this was approved by the university before you began your dissertation.  Official letter indicating the title and position of your mentor and your Ph.D (Psy.D) members of your doctoral committee.  Official letter indicating that your dissertation was approved by two dissertation committee members. One member of the committee must be on staff at the institution that granted your degree. The second member of the committee should not be a staff member; but rather should be from outside the institution.  If you completed your dissertation in less than 3 years, and did not work during your studies, you must submit documentation providing that you did not work during this time, such as income tax returns, social security documents, etc.  Official letter describing the extent of your interaction with your mentor, including the number of meetings, number of email or phone interactions, etc.  Letter from an Israeli lawyer indicating that all of the above is accurate and that to the best of your knowledge, you are submitting all of the documents requested by Misrad HaChinuch (Ministry of education). Even though your degree may be recognized, to be licensed to practice in Israel, you will still need to meet licensing regulations set by the State's licensing bureau for psychologist. Licensing Procedure Psychologists must be registered in the Pinkas HaPsychologim at Misrad HaBriut (the Ministry of Health) in order to work in their field. To obtain a license, you must personally submit your request at the branch of Misrad HaBriut closest to your home (according to the address written in your Israeli Identification Card.) See Misrad Habriut Offices for a listing of local offices. The following is a list of the documents necessary for processing this request. For additional information, contact the Vaadat Harishum B'Pinkas Hapsychologim by phone at 02-670-5866 or fax 02-679-0846. The office is located at 2 Ben Tabai St., Jerusalem. You can also fax the Tel Aviv branch at 03-515-1180 or call 03-515-1166, Sunday through Thursday between 8 am and 4 pm. ·Questionnaire, in 2 copies. You will receive this and complete it at the health office or you can download it here . ·Israeli identification card + 2 photocopies. The Sefach (attachment) of your Teudat Zehut (Identity Card) must state that you are an Israeli citizen. Sometimes new Olim do not have this written on the Sefach. You need to check what it says. If it does not state that you are an Israeli citizen, you must request from Misrad Hapnim to issue a new Sefach that says on it "Ezrach Yisrael". You must be an Israeli citizen for a minimum of 3 months before Misrad Hapnim will issue the new Sefach (attachment). You should send in your documents to Pinkas HaPsychologim before the Teudat Zehut is corrected in order to get the process started, and bring in your corrected Teudat Zehut (original, not a copy) when you receive the updated Sefach. ·If the name on your Teudat Zehut differs from the name on your diplomas, you must provide either a marriage license or document from the Ministry of Interior confirming a change of name + 2 photocopies. ·3 passport photos. ·Diplomas: BA, MA or Ph.D + 2 photocopies. Your university must be recognized by one of the following: International Handbook of Universities (see www.palgrave.com), the American Psychological Association (APA) or Malag (Israeli Council for Higher Education (see www.che.org.il). ·Detailed university transcripts noting the courses for all degrees. For each course, you must list the number of course hours or the number of academic credits. ·Letter from the police indicating that you have never committed a felony. You can bring this letter from your own city in the U.S. or you can bring a letter from the police in Israel. To obtain the letter in Israel, first go to the local post office and buy stamps. or "Bulim", for a "Tofes Le'Iyun B'Mirsham Haplili". Take these stamps to the local police station and you should receive the necessary document on the spot. Unlike other medical professions, transcripts, syllabus and any others documents that are in English do NOT need to be translated or notarized. Note: If you have a degree in counseling (and not psychology), you will not be recognized as a psychologist. Finally, it probably would be better for you to finish your degree in the States before making aliyah since this would be in your native language. If you fulfill the educational requirements mentioned above and licensing rules, then you can work in Israel in your profession. Good luck, Dr. Mike * * * Send your comments >> Cafe Oleh experts have been chosen for their knowledge and reputation. Cafe Oleh does not take responsibility for any advice they offer.
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