intake, EllisTangents

The Most Important Question – The Scrubbing Bubbles Story

Sometimes, therapy is REALLY easy and short.

But first, let me tell you a story.

So, I was cleaning the kitchen tile grout when I moved into my new house. (Yes, those are my actual kitchen tiles, in progress. ACK! And it is beige grout, not white, just so you don’t get all judgey on me! Haha! ) This is how that went: Squat, Spray, Wait, Scrub, Spray, Wait, Scrub, Rinse, Heave-off-of-creaking-knees-to-move-two-feet, Squat, Spray, Wait… for FIVE HOURS. And then, something happened that I thought was a complete disaster. … Halfway through my kitchen, I ran out of spray.

“Oh no!” I thought to myself. “Now I’m going to have to change sprays and use the crappy spray under my sink that is not the special spray I bought for cleaning tile grout and it’s going to be so much more work and so much more time… WAAAAAAAH!” But I decided to do that (rather than, I realize now, going to the store and buying more, which possibly could have saved me a bunch of time, but I was messy and sweaty and cranky and didn’t want to.) So, I huffed out a breath and got the other spray out from under my sink.

It was a miracle spray. WHAT?! NO squatting – the spray stream was awesomely direct and I could spray every grout line standing up. NO waiting – by the time I got back to my initially-spray tile, it had already done its work. Almost no scrubbing – this spray was amazing effective! I finished the rest of the kitchen in under an hour.

So much pain and effort and time saved, by just trying something different that was already at my disposal, even though I thought it wouldn’t work.

Some of the ways this has shown up in therapy:

How’s your sleeping?

Have you recently changed medications?

Are you sure that’s necessary?

Did you tell them that out loud?

I probably could have titled this “The Most Important Question – What have they tried so far?” But then, that would have been too easy and short, right?

Comment below: What have been some of the wildly easy “fixes” that have made a big impact for your clients?

Post Concussion Syndrome

Diagnostics is always more complicated then it seems – more like a DND roll than a simple symptom checklist or binary “has it” or “doesn’t have it” question. Here’s a great example:

Post concussion syndrome (PCS, or postconcussional syndrome) is a relatively vague set of symptoms that can continue to occur well after someone has had a head injury. The symptoms are wide and many of them are mental health symptoms, which is why it’s especially important for us to know about it. A headache is usually accompanied by symptoms like:

sleep problems
depressed mood
irritability
anxiety
trouble concentrating
difficulty with memory

Sound familiar?! YIKES!

In fact, it’s so closely associated with other mental health conditions that 10-20% of student athletes meet criteria for it… even if they haven’t had a head injury – just because they’re stressed and somewhat sleep deprived! So, it’s important to consider all facets of this diagnostic mess!

PCS codes in ICD-10 as F07.81. Now, we probably wouldn’t want to diagnose Postconcussional Syndrome…. but we very well might want to put it in as a Rule Out or make a referral for additional testing/diagnosis with a physician or neuro specialist.

We definitely want to have a question on our intakes that helps us keep this possibility in mind. For example, on my regular intake I have this question:

Have you experienced:
– chronic headache, migraine, vision changes, loss of consciousness, or dizziness?
– changes in your vision, hearing, other senses, or movement? (e.g., blurry vision, ringing in your ears, difficulty swallowing, trouble speaking, weakness or paralysis)
– difficulties with your memory, planning ability, or thinking clearly?

If so, when did you experience these symptoms and for how long?

That allows me to consider PCS, along with some other potential issues such as mild neurocognitive disorder and functional neurological symptom disorder (formerly conversion disorder). These answers can also “flesh out” other conditions, such as chronic headache associated with generalized anxiety disorder or difficulty concentrating as part of a depressive disorder. Loss of consciousness sometimes maps onto a substance use disorder. It’s a big question, but it gives lots of data and paths to follow-up on during the actual intake.

Comment below: What are some of the diagnostically oriented questions you have on your intake?