"Do I have an underdeveloped sense of self?" ep.195

This week licensed therapist Kati Morton discusses what it means to have an underdeveloped sense of self, why we can't stop crying when we are struggling with suicidal thoughts, and why certain diagnoses can can frequently co occur together. Kati also discusses TBI’s and other head injuries and the effects that can have on our mental health. She then talks about being a mental health professional and having our own issues, and why therapists leave room for silence in sessions.

Audience questions for Ask Kati Anything ep.195

1. I often see “an underdeveloped sense of self” on symptom lists for mental illnesses, but I’ve never really seen a comprehensive description of what a fully developed sense of self looks like. How do you recognize when someone’s sense of self is underdeveloped? Does sense of self always develop in the same way, or are there different facets of it that can be delayed like with executive functioning?

2. I am struggling with constant suicidal ideation and when I talk about it to my therapist or psychiatrist, I don’t cry when I say the hard stuff and I’m afraid it is painting the narrative that I am lying about it. But the truth is that in the past whenever I would cry, I wouldn’t get help. Also with this being constant for over 2 years, my therapist is expressing that she is beginning to feel helpless which makes me feel so bad and like a burden. What are your thoughts?

3. I was wondering if you could explain why certain diagnoses can commonly be coexisting. Like why is having an ED and ocd seen together often? I'm in the trenches right now with both and GAD, and they feed into each-other and are so tightly intertwined, that even the idea of sorting them out is exhausting. At this point it feels like the "what came first, the chicken or the egg?" question and I find myself just going through the cycle of trying to attach the behavior to the correct diagnosis, getting frustrated because there is so much overlap, and then shutting down. And as much as I know life would be so much easier without either of them, these thought cycles are persuading me away from that and make life feel easier with them than to get rid of them. How do you as a therapist pick what needs to be targeted first (contamination ocd vs ED) when it feels like the treatment for one will just cause the other to get worse?

4. I suffered a head injury about 6 months ago and have struggled with feeling depressed adjusting to my new way of life (not ‘smart’ anymore, can’t work full time, not able to participate in hobbies etc). For context I had anxiety before the injury and was apparently struggling a lot with this (I can’t remember the last couple of years). I’m struggling feeling anxious about being ‘stuck’ like this forever. I’m UK based and am receiving basic CBT and am on a long waiting list for high intensity CBT - could you explain a bit what this is please? Can just CBT help process a trauma like this? Should I try and seek a more talk based therapy to process some of the depression/trauma? Thanks for all you do.

5. Right now I'm in my internship of counseling. I feel like I'm a fake and a failure. I personally struggle with anxiety and what I believe is ptsd. But my therapist recently changed it so it's not ptsd. I struggle with my parents divorce and dealing with a lot of emotions and anger towards my dad. Currently all of my clients that I'm getting are all struggling with similar issues and with their fathers. It's getting to be so much. I struggle to be able to talk about it during sessions with my personal counselor and I don't want to turn away all of these clients. What suggestions do you have to help!

6. Hi Kati, I have a new therapist. Been seeing her for almost two months. During our session I talk about something and when I'm done she just sits there in silence looking at me. It drives me crazy. I told her this and she didn't give me an explanation as to why she does this. Is this a therapist tactic? Is she looking for me to do something? Your help on this would be greatly appreciated.

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