Ask Dr Kim | Archived live chats

[Chris_B]

Good afternoon everyone, Dr Kim is here and we're ready to start.

Welcome Kim, our first question is below:

I am a 23 year old female with contamination-focused OCD. Do you have any advice about how I could deal with anxiety over my boyfriend's health? He is the only person I kiss and share drinks with, which means that if he does get sick, I will be likely to get infected. I really love and care about him, so the anxiety is not just about fear of contracting germs and illness, but also wanting him to be healthy and well.

[Chris_B]

And last question for today:

What would you say the best method is for overcoming lack of motivation?

[Dr_Kim]

Lack of motivation can be really tough to manage and may be a symptom of many different things. For some people it’s because they feel they’ll never get something done, for some they feel they’re not good enough, for some it’s no energy, for some it’s fear of judgment. It’s a broad question.

One helpful tool can be to break down your day into tiny little parcels of time. Don’t think about everything you have to do in a day so you feel overwhelmed and will never get through it, or find the energy. Just simply set a task of eg. First, get out of bed and get breakfast. Then see how you go for the next task. Set the tasks in fifteen or thirty minute blocks, and allow yourself to shorten the time periods if it gets too difficult.

If you break down bigger tasks into smaller pieces, they can feel more manageable as well.

[Chris_B]

Good afternoon everyone, welcome to another week of Ask Dr Kim. Straight into it with a difficult question from a woman with a suicidal partner:

Hi Dr Kim. My partner suffers from depression, a few years ago he tried to commit suicide but his mother called the police and they took him to hospital and hospital sent him to a mental health clinic which didn't make anything better. Since than his sister committed suicide and my partner found her. He isn't coping well and is turning to alcohol which is causing issues between myself and him, I'm not sure how to help him, he doesn't like to talk about his emotions unless he is under the influence of alcohol. He has told me numerous times that he wants to kill himself and ive always been able to talk him out of it, but recently he has taken a turn for the worse, he attempted suicide recently and I needed to call the police. It is affecting me seeing him and hearing what he is saying, i just would like some advice on how to help him or steps i can take to get him to get help. Depression is a hereditary illness in his family, I would greatly appreciate it if you could give me some advice on how to support him, what to say to him, what to do. Thankyou for your time.

[Dr_Kim]

Hi everyone, good to be back for another week.

Hi and well done for reaching out for help. You have an enormous burden and one that is not reasonable to handle alone- you need support. Severe persistent depression and suicidal behaviours are terrifying and exhausting not only for the person experiencing them but for the family and friends around that person. It is very important that you understand the limits of what you can offer and what the steps that you can take in a given scenario to attempt to keep him and yourself safe. He is definitely high risk and I feel it is important that you speak to either your GP, a counsellor, his mental health clinic or somewhere like a Headspace or e- Headspace ( if you are under 25 ) or a local Mental Health Service in your region ( if you are over 25) . You can search these services in your browser. e.g. “ local mental health service Brisbane “ or "local mental health service Bendigo".

I think it is important for YOU to receive the support and help even if your partner will not, as you need help in developing a clear plan with a professional that you trust as to what to do and who to call when. During a crisis it is really hard to make those decisions , but if you have pre thought it all out then it is easier to put the “Action Plan” into place.

Please know that sometimes, despite everybody's, best efforts , people just don’t or can’t find their way out of their illness and sadly people are lost to depression all the time. In the worst case scenario that this happens to you , it may be a comfort to you that you had professional advice and did everything you could to help prevent it. Grief is a terrible thing but it is more awful i think complicated by regret and I would like to spare you that.

I don’t envy your situation . It is really tough and it sound like you are an amazing partner to him. He is lucky to have you but it is really important that you look after yourself too so you can stay strong for him. Get the team around you. No one should do this alone.

[Chris_B]

Our next question is about some distressing experiences on public transport:

Hi, I'm a wheelchair user and I have been harassed and physically assaulted by complete strangers many times on the train and in public, in broad daylight (four assaults in the last 2 months alone). As a result, I now have anxiety and have to take an SSRI just to use public transport. Even with the SSRI, I feel anxious and scared to leave my house or catch the train in case I am assaulted again. Every time I've told myself "that was just one person", but then it happens again and again and again and again. Now I feel too anxious to catch the train or leave my house.

[Dr_Kim]

Good on you for trying hard to overcome this to be using very rational techniques to not overgeneralise these events to “ everybody” is out to get me.

Maybe the tack might be to develop a sense of empowerment and strength around this. I wonder if a trip to the police station to ask about the whether or not there are cameras on various platforms and how to go about reporting these events ,what info they need etc.

Is it possible that you may want to contact Disability Advocacy groups that can support you to give you some of their ideas of strategies to deal with this ? Maybe by having recording devices or some other deterrent so that perpetrators are less likely to approach you. Maybe you could have a “buddy” system for your travels until you get your confidence back up? I’m not an expert in this field but I think you should make contact with people who have had similar experiences and ask what they have done and develop a network so you can develop a strategy to manage these incidents.

You have right to safely travel on our trains. I think many people in our community would be outraged to think you feel you can’t . Remember the social media blitz after the Muslim woman felt unsafe riding trains and people started the “I’ll ride with you “ campaign? Maybe we need one for people with disability ? Hey ! I'll ride with you!!!

[Chris_B]

Our next question is about self-blame in the aftermath of a sexual assault:

Welcome back Dr Kim;. I'd like to add to my questions relating to the Scientology issue. Your response was very helpful, thankyou. Deprogramming from negative and destructive schemers has been something I've been trying to achieve. I've had good success, but self blame has been difficult. A comment my mum made to me after being violently raped (age 22) by my then de-facto has caused major problems; "What did you do to make him do that to you?" I know rationally this is ignorant and hurtful, but it's still causing issues with identifying when I'm not at fault. Posts on this forum suggest a lot of people self blame as a matter of course also. My relationships and employment have had negative affects due to this. Is self blame a schemer or something else?

[Dr_Kim]

Thank you for your openness and honesty. It’s really important to validate that sexual assault is never understood to be the fault of the victim, and it’s good that you’ve been working hard to accept that in the rational part of your brain. There is no schema that I know of that should allow you to accept that in any way as being true.

Self blame can come from lots of different places, none of which are pleasant. It can come from lack of self-esteem, which we need in order to help rationalise and balance the negative thoughts that occur to all of us. Self-esteem is nurtured and encouraged usually by primary care givers in our youth. For many of us, we have not had the luxury of the availability to this nurturing, and so can’t immediately draw on these positive internal voices from our childhood.

For others, self blame can be part of an anxiety or obsessive thinking pattern, almost like an internal bullying system. And in that situation, I tend to treat it more like I do with any other obsessive thought: distraction, acceptance, cognitive challenging.

It might be important to think about contacting support services to access that validation to counteract the negativity that you are hearing inside your head via online, individual or group counselling. Have a look at www.sass.org.au for a directory of agencies in your state that provide information and support around sexual assault.

[Chris_B]

Our next question is about being stuck in therapy:

can I ask how a psychologist/psychiatrist feel when the person they are treating with depression just drags on and on and nothing seems to be improving? what do you do when you offer this person alternative options on how to get better and they don't want to do any of them?

[Dr_Kim]

As a therapist, there have been times where I have been honest with people about how things seem to not be improving for them, and wonder how that feels for both of us. In that situation, I tend to shift the focus of therapy from “getting better” to “coping with the situation”.

I think, as a treating doctor, this seems to take the pressure off both of us to keep searching for the way that someone gets better every week, and feeling disappointed if they don’t. It makes us feel that we are hanging in together in a collaborative way, sitting with wherever the person is at the time, and I’m just on that journey with them.

We lose the expectation of weekly change for a time. Sometimes it’s better just to put the obvious facts of not getting better on the table, and take the pressure off the patient to deliver good news of getting better when that’s clearly not happening.

In my experience, you can’t make people get better, but people feel reassured if you acknowledge that you will stay with them on the journey whatever that might be.