Latest / Take1.5 Podcast: Stories from the Messy In-between / Not Okay? Here’s What to Do 괞찮은척은 이젠 그만

Transcript

Not Okay? Here’s What to Do 괞찮은척은 이젠 그만 · Take1.5 Podcast: Stories from the Messy In-between

0:00
I don't feel fine. I don't feel well, but I don't
0:04
even know like how to put finger on it.
0:06
When is it that we really have to say, wait, no, it's not fine?
0:11
I really need to seek some sort of help.
0:14
When? When would that be?
0:15
It's a great question. I think in our culture, unless
0:19
you're like bleeding out, you're fine.
0:23
Let's just get right into it. So Doctor Jiang Chou, thank you
0:26
for being here. I really appreciate you making
0:28
the time, even though you're this is your third time on the
0:31
podcast. Yay.
0:34
Would you briefly introduce? Yourself.
0:36
OK, well, thank you Min for inviting me again and again.
0:41
Love it. So my name is Doctor Jiang Chou.
0:45
I'm child and adult psychiatrist.
0:47
I do have my own practice, but also my special interest is in
0:53
working with Asian American families.
0:55
So my practice actually a little less than 1/2 of my patients are
1:00
Asian American families. And I say families because I we
1:03
to tend to treat children with families.
1:06
And so that's been my passion. In addition to that, I've
1:14
written book chapters for child psychiatry, for Asian American
1:18
mental health. I've worked with different
1:19
organizations in work supporting Asian American children.
1:25
You know, as a part of the mental health series that I'm
1:28
doing today, I wanted to go over with you how to maybe breakdown
1:34
the barriers that we have. We always talk about, you know,
1:38
the Asian American API community.
1:40
We don't seek help until something actually happens, like
1:44
a crisis break out, right, right.
1:47
And then we don't even know how to get help or we've never
1:51
talked about our problems, especially mental health issues.
1:56
So I wanted to talk to you about like how, what do we do?
2:00
Like how do we get over this, right?
2:03
I'm sure you see among your patients or even in a social
2:06
circle when you ask somebody, oh, how are you?
2:11
Our automatic answer is, oh, fine, everything's great.
2:16
And I wonder sometimes I don't feel fine.
2:20
I don't feel well. But I don't even know like how
2:24
to put finger on it. When is it that we really have
2:27
to say, wait, no, it's not fine, I really need to seek some sort
2:32
of help. When would that be?
2:36
That's a great question. I I like the fact that you're
2:38
starting with that, right, because I think I'm so in it
2:43
that sometimes I forget that that's where people grapple with
2:47
to answer your question about the, you know, like, well, to
2:50
add to the your comment about like, I'm fine.
2:54
So my go to like start of my sessions usually for each
2:58
patient is like, how are you right?
3:00
And most people will say like, I'm good and I go really, how
3:05
are you today? And then they kind of open up
3:08
obviously in our sessions that they know.
3:10
But so it is right. Need your responses like I'm
3:15
fine, right? But what is fine?
3:18
And I think the definition of what is fine is very broad.
3:21
And I think in our culture, unless you're like bleeding out,
3:26
you're fine, right? Right.
3:31
To get to the point about, well, at what point am I not fine?
3:35
And I need to think about help. I think about the other
3:40
opposite. And you know, a lot of people
3:42
think about, well, if I'm miserable or if I'm thinking
3:45
about like, I don't want to live that those are the extremes,
3:50
right? And it's even then, sometimes
3:52
it's hard for people to, especially for Korean Americans,
3:55
I think is difficult for us to say, well, that's just isn't
3:59
that how most people live? You know, like, you know, like,
4:04
I wish I could be dead. In English, it's a little
4:08
different. But when you say that in Korean,
4:10
it's like very normal saying in some ways.
4:14
Yeah, or something like. That right, right, right, right,
4:16
right. Yeah, right.
4:17
Yeah, yeah, yeah. So it's a different connotation
4:20
in some ways, right And that's very cultural difference.
4:25
So I think that to me, obviously as a psychiatrist, if someone
4:29
says those things or thinks about those things, that's very
4:32
serious and I take it very seriously.
4:34
And that's like another extreme. But I think a lot of people
4:38
don't think about the opposite end of it.
4:40
Where am I actually enjoying things in life, Right.
4:47
So it's it's not about like me feeling miserable or feeling
4:52
like, you know, dreadful, but am I actually enjoying parts of my
4:59
life, parts of the days? Like you don't have to be happy
5:05
and joyful all day every day with who does, right?
5:09
Maybe young children. But it's it's about like, you
5:14
know, the saying like, do I stop and smell the flowers once in a
5:18
while? And then when I do and if I do,
5:21
do I feel joy? And I think if you stop and
5:29
think about it, then then then there's your answer.
5:33
Like if the things that used to matter to you, the things that
5:38
made you happy are no longer there, then then that's when you
5:45
think about, well, I need some help.
5:46
When you are losing interest in things that you used to give you
5:50
joy, I think that's very important.
5:54
So for adults, right, If you're losing interest in socializing,
5:59
if you're someone who takes really joy in kind of going out
6:02
with friends or talk on the phone with your friends,
6:04
especially for women, right? Or the hobbies that you used to
6:09
like are no longer fun, like if you're losing bits and pieces of
6:14
your interest. So then, then we start thinking,
6:18
well, something is going on. Something is going on.
6:23
Isn't that every day though? Like.
6:25
Do we really find? Like, you know, I mean it sounds
6:29
like OK, like can we at that .0 do I, am I depressed?
6:34
Am I going through a depression? But I would, if I say that to
6:41
like other folks, I think people would say, well, that's every
6:44
day for me. Yes, yeah.
6:49
So, you know, I think part of it is the culture, right?
6:56
Then you just push through. There's so many things that you
7:01
need to do, a lot of obligations and those things become kind of
7:06
the priority. But if you mentioned kids, but
7:11
if you look at look at children, they're not in hurry, right?
7:16
Like they stop and look at things and little things make
7:20
them laugh out loud. When do we lose that quality?
7:25
And so I think that it's important to well, with or
7:32
without depression, it's important to do that in your
7:35
life, right? The kind of I, I always say I
7:39
collect little bright things in life and then those little,
7:43
bright little things, tiny little things add up to my
7:46
happiness. And that could be like, you
7:49
know, my dog sitting in my deck and just looking at me and I
7:54
think I find it funny or, you know, cherry blossom happening
7:59
up the window or like funny jokes that happen.
8:04
Like for example, this morning my my daughter said I'm in a
8:10
make a joke for you. And she said, do you know why
8:13
psychiatrists don't go to the bathroom?
8:16
And I'm like, I don't, I don't. And I was like, why, why?
8:20
And she goes because pee is silent, right?
8:26
But silly jokes, right? But, but it was funny.
8:29
So those little tiny moments, right?
8:32
But what if you just go through, Oh, that's such a lame joke,
8:38
right? So that's the slight difference.
8:41
And you have to train your brain to actually enjoy those moments,
8:47
right? So that's a that's a kind of a
8:51
lifelong goal for people that are living this modern day where
8:56
everything's really, really busy.
8:58
Really, everything goes fast and you miss out on those things
9:02
because everything else seems so important.
9:05
Yeah, yeah. But there is a point where even
9:10
if you tried, you don't feel anything and maybe that's the
9:16
time where you have to look back and be like something is going
9:19
on. Yeah, yeah.
9:22
So I think what I'm hearing you say is that when we don't notice
9:27
the little stuff, when we forget to find something, some joy in
9:34
anything in life, that's when we have to step and think, am I OK?
9:42
You know, I think you're so right.
9:44
We we are so used to getting things done.
9:50
Busy, busy, busy. And like all the functions and
9:54
responsibilities and the behaviors, we forget that life.
9:58
You're supposed to enjoy life. You're supposed to find joy in
10:02
life. When you said that I'm like,
10:05
what? What joy?
10:08
But yeah, I see what you mean. Isn't that so sad?
10:15
We we think this is so normal. Yeah, things get lost.
10:19
Definitely. Wow.
10:23
So, you know, I'm thinking about moms particularly.
10:32
You know, I remember when I was a younger mom, when my kids were
10:34
younger once someone, someone asked me, oh, what do you like
10:40
to do? What are your hobbies?
10:41
I'm like blank in my mind. I'm like, what?
10:44
What are you talking about? What hobby?
10:47
I don't know, like literally that was I'm not even
10:51
exaggerating. That was like mindset where I
10:55
was, you know, during those times.
10:57
You know, when I say little things and I've been there like
11:02
people, they even be four children.
11:04
People are like, what's your hobby?
11:05
And I really think about it. And I was like eating or like
11:11
everything, right? And, but I, I, you know, it's
11:18
great to have a hobby, but I'm not even talking about hobbies,
11:23
right? It's just the mundane things in
11:26
life that can be fun or little, little fun, right.
11:32
So, you know, like I think it's about also like I can never find
11:39
the right word in English, but yo-yo, you right.
11:44
And so like this morning I made my cup of coffee and all that
11:51
today it was much better than yesterday, that moment.
11:56
That's all I'm asking, right? But you have to cognitively
12:00
train yourself and you know, when you're, when you're dealing
12:06
with a toddler or little babies, like you might just chug it
12:10
right? But even the moment where I'm
12:13
like, well, my kid is 9. So now I have to, I can sit down
12:16
and have a sip of coffee like, wow, that's actually really
12:19
great. So that, so that that cognitive
12:23
change I think is what's helpful.
12:27
And when you don't or when you can't do that, even when you try
12:32
it, I think that's when you're like, I need, I need some help
12:36
to find that back. Yeah, yeah, it is important to
12:40
notice that. I remember that you need to
12:42
fight it back. So it's a practice, it's a
12:45
mindfulness, It's something that doesn't really happen
12:49
automatically, but it's something that we need to work
12:52
on a catch, right? Why do we have such hard time
12:57
getting help emotionally, Mental help especially?
13:03
Well, you know, this is something that I've been
13:04
thinking about too lately, but I think part of it is, well,
13:11
there's multiple things going on, but part of it is like our
13:15
culture where you should be able to do this on your own, right?
13:20
If you're not taught that mental health is something that you can
13:25
get help with. It's like for where you're just
13:29
not, you're, if you do, then you're weak, right?
13:32
Like it's, it's your will should be able to do it.
13:37
And and then there's a stigma about therapy, psychology,
13:42
psychiatry, right? That's only for crazy people,
13:46
right? So that's number two.
13:49
And then I think more and more, especially for Asian Americans
13:55
and Korean Americans in the United States, I think the
13:59
access to care, especially for mental health, the barriers are
14:03
really high. You know, having being more
14:10
knowledgeable about how to get help is really difficult.
14:15
The road to get the help that you need is very tortuous.
14:21
And most people don't know how to navigate that.
14:24
And that's not just for Asian Americans.
14:26
It's from most Americans. And unfortunately at this point,
14:31
But I think with the language barrier too and stigma barrier,
14:34
I think it becomes double and triple layered.
14:38
Yeah, yeah, yeah. It's so true, you know, people
14:43
in the community sometimes as you know, fellow mom or older
14:47
mom, they asked me about therapy and and is there such a big
14:54
block like a barrier for them? One, the stigma and two is like,
15:00
do I really need it at this point?
15:02
Maybe it'll get better. And the third one is I can't
15:06
afford cost of therapy because it's expensive.
15:09
It's mostly out of pocket. So let's first talk about how do
15:14
we, how do we get help? Like where do we go?
15:17
How do we seek for help? If I said, oh, I notice, oh, I'm
15:20
not finding joy. I'm noticing that.
15:23
What do I do? Well, the easiest and the most
15:28
successful is to go to your primary care doctor and or your
15:34
for your kids pediatricians, right?
15:37
And for women sometimes you know, OBGYN is the primary care
15:40
doctor and we as physicians, we are trained to screen you and
15:47
also a lot of the primary care doctors and pediatricians and
15:50
even OBGYN's for postpartum. They do have referral base,
15:55
right. And if there is a need for
15:57
medication, sometimes they are able to start them.
16:00
So that is the number one like easiest access in terms of kind
16:05
of getting the help and you mentioned the finance a
16:09
financial part of it. And so most of those physicians
16:12
do take entrance and so that would be covered.
16:16
So I think that is the easiest start.
16:20
So that's number one #2 is if you're looking for strictly
16:25
first therapy, there are some websites that are very specific
16:32
for therapists. And Psychology Today is going to
16:36
be able to kind of get you to therapists in your area and you
16:41
can kind of filter through kind of, you know, whether they take
16:47
the insurance or not and things like that.
16:49
So that's number two. And post COVID also, this is
16:53
something that was good thing that came out of anti Asian hate
16:59
movement was that there were now there are multiple, but there
17:02
are two really representative like websites that actually have
17:10
names and search engine for Asian American therapists in the
17:15
United States. And you can actually search
17:17
through geographical and language therapists who are in
17:23
your area who speak your own language and things like that.
17:27
And so that's a start as well. So that would be actually really
17:32
helpful looking for therapists. So first talk to your family
17:37
doctor or your primary care primary care for refer and
17:41
they're able to you mean start like on medication immediately
17:45
if you need. It they can assist me for risks
17:48
diagnosis. A lot of times unless it's very
17:51
complicated cases they can. Also, if they feel they feel
17:55
that it's a good fit then they will start medications for you.
17:59
I see. And that's usually covered under
18:01
your care, primary care and all, right.
18:05
And then they would refer you to someone if there's a need.
18:08
Yeah. So they usually a lot of the
18:10
doctors will have a list of therapists that might be on
18:14
their base and you have a list that at least you can start
18:19
with, right. And also, if you, you mentioned
18:26
a lot of the therapists are out of pocket.
18:28
But if one of the ways to do is to actually call up your
18:32
entrance and be like, I need a therapist and this is my zip
18:36
code, then they will pull up a list of therapist under their
18:41
insurance and send that over to you.
18:42
And now it does fall on you to call them right, each of them
18:47
and try to figure out if they are taking your patients.
18:50
But that's a good. Start to yeah, yeah.
18:53
So check out Psychology Today website and you'll, you'll send
18:57
me the list of the two websites where people can go.
19:01
So I put it in the description. Yeah, that's a great resource.
19:07
What are some things that's important to look for when
19:10
you're looking for a? Therapist Done, done, done.
19:16
That's a loaded question. I think it's well.
19:19
So it's like dating, right? It's totally like dating in that
19:27
you have to find the right fit and you might not know what
19:30
what, what fits you yet, right? But so, so I do, I think I do
19:38
too in my practice. But a lot of the therapists will
19:41
offer kind of like a introductory call where you can
19:44
kind of fill them out and see if you like them or not.
19:49
So, you know, and you might have like a criteria, right?
19:52
Like some people really want like a certain gender, certain
19:56
ethnicity. To me, it, it's more what you
20:03
don't want, right? So I do have a lot of people who
20:07
have like some. Specific sexual trauma who might
20:11
not want a therapist of certain gender, right?
20:14
Or some people who have really difficult with English or
20:19
someone who wants to talk in their own language or you know,
20:25
like if someone who's like, well, I really want the virtual
20:27
because available because my schedule is really difficult at
20:31
night. Sometimes I can't make it there,
20:33
things like that. So it's about your own criteria
20:37
first. I think also partially the two
20:41
things that I think about in therapy is, well, number one is
20:46
therapy is not like you get it and then done right.
20:53
It is a long term investment. What it means is you're
20:57
investing not only your effort, emotional effort, but you're
21:01
investing your time and your money.
21:05
And three of them are all equally important.
21:09
So, you know, someone could be very good fit with me.
21:13
She, you know, they like me, they really want to do it with
21:15
me. But financial issues not working
21:17
out, then we're not a good fit because consistency and
21:22
stability is important. If you're going to have to, you
21:26
know, worry about finances every time you meet with me.
21:30
That's not about it, right? Like we have to get those things
21:33
out of the way first. So it's about also where, where
21:37
that works and what your, what your financial status is and
21:40
what you cannot award. So that's really important.
21:45
Number 2 is you do have to feel comfortable, right?
21:49
Someone some people like, I work with a lot of teens.
21:53
So some, some teens, teens like my sketch style.
21:57
I'm very casual. But also some, some teens don't
22:03
like that. They want, they want someone
22:06
who's more authoritative or someone who's more right, like
22:11
something like that. And that's something that you
22:14
have to think about for yourself.
22:17
I also have some people who are like, I want someone older,
22:21
right? Some older people feel very
22:25
undermined, even if that's not the case, right?
22:27
So all of these like dating fits very important.
22:32
And I always say shop around. The second thing that I were
22:37
warn people about looking for therapist is that do not despair
22:41
if the first one does not work right, right.
22:45
They say that the average is about 3 until you actually make
22:51
the right choice. And so even if you feel like
22:55
it's a good fit and you try them and then you're like after a
22:58
couple times you're like don't be discouraged.
23:03
I think it you don't just go to like one day.
23:06
I mean, yes, some people would look out, but you don't just go
23:09
to one day and then make them marry them.
23:11
Right, right, right. So, so think of it as like, you
23:15
know, it is an investment because I do want to have
23:17
someone who's going to be long term with me and I can fall back
23:20
on them. And so you know it's going to
23:23
take them. Take courage and time.
23:28
It sounds like you really have to be committed in getting this
23:31
help, right. Yeah.
23:34
Yeah. Because, I mean, otherwise, why
23:37
would you spend that energy and time?
23:39
Why would you even go on the one date?
23:42
Yeah, good point. Good point.
23:45
So I was wondering, Doctor Cho, there are so many different
23:48
types of mental health help it seems like out there.
23:52
But as a patient or a client I wouldn't know.
23:56
Like who do I call? Who do I call a counselor?
23:59
Do I call a therapist? Do I call it LPCLMFT,
24:03
psychiatrist, psychologist. Like does it matter?
24:08
So yes and no, in general sense it does not matter because so
24:14
yes, there are multiple degrees within the umbrella of therapy,
24:19
right? Therapist.
24:21
And they have all different kinds of training.
24:26
And even with the same degree, sometimes the modality of the
24:30
therapy that they use is different, right?
24:34
But what is to me, what is the role of therapist or
24:40
psychiatrist or psychologist or you know, even primary care
24:44
doctor? But you come to me and it's my
24:49
job to figure out what you need and then figure out, am I able
24:53
to give that or do I give you other resources?
24:58
So it's not on, it shouldn't fall on the patient to like
25:02
figure out like exactly what do I need?
25:05
Of course, if you can, that's great, but that's an out of
25:08
norm. Like nobody knows, right?
25:11
Like I've had like, you know, I joke that I went to like grade
25:15
33. So I've had a lot of training in
25:18
this. And, and so it is my role to
25:23
figure out what you need or what your child needs.
25:26
You can go to the therapist and meet with them and then the
25:30
therapist can figure out, well, does this kid or person need a
25:34
therapy? What kind of person, what kind
25:37
of therapy does he need? Do they need meds?
25:40
Maybe, maybe not. They don't decide on that, but
25:42
if they feel that there's something that needed to be
25:44
assessed, they'll refer. If you think that you have to
25:48
find the right right to read therapist or whatever from the
25:52
gecko, that really heightens the barrier and it's overwhelming.
25:58
It is overwhelming. Yeah, just just get, just get to
26:02
the one. And if they're trained well
26:06
enough as a qualified person, they should be able to let you.
26:10
Do I mean, I guess we don't decide as patients, but isn't it
26:13
true if you need medication, let's say the the therapist,
26:17
LMFTS and LPCS cannot prescribe? Medicines, so, so traditionally
26:24
the medications can be done, medication assessment and
26:28
prescription are done by psychiatrists, which are MD
26:34
ordeal physicians. And also these days in certain
26:39
states, you can have psychiatric nurse practitioners that will do
26:44
that. And so it's very, it is
26:49
confusing. So basically therapists will not
26:53
be able to do the medication, but they'll do the therapy.
26:56
And it could be all, you know, LMFTS, social workers,
26:59
psychologists, right? Psychologists also have sides
27:04
and PhDs, but they're all doing therapy and then nurse
27:10
practitioners and psychiatrists are the medication management
27:16
piece. And then not all psychiatrists
27:20
in nurse practitioner will do the therapy component.
27:23
Some people do. We get trained in it, but some
27:26
people do the medication only and some people do that.
27:29
So your advice is just to go for one and see yes?
27:34
Just sketches that one person who who is gonna be your point
27:40
person in the beginning. Yeah.
27:42
And you know, if for the children, it could just be a
27:46
school counselor even, Right. And then there even the schools
27:51
will have some names and they'll be able to direct you as well.
27:55
Right, right. What about this is on the side
27:59
note, but what about like ADHD assessment?
28:02
And you know, because a lot of a lot of people talk about ADHD
28:06
these days. Who do we who do you?
28:08
Where do you start with ADH ADHD?
28:11
You don't just get medicine, right?
28:12
You have to go through no assessment.
28:14
So yes, you do go through the assessment.
28:16
There are multiple ways to do assessment, so 1 is through
28:22
school. If they're actually having
28:24
specific very significant difficulties, then in public
28:29
schools, American public school system, you can request to see
28:33
if the kiddo needs an individualized educational plan
28:38
assessment and if they the school deems that it is needed
28:43
and they'll do a part of that as well.
28:46
A lot of the districts will have psychologists that will come and
28:49
do the assessment if need to and that is the long way but also
28:58
cheapest way. Right, right.
29:00
Yeah. But also ADHD is a clinical
29:06
diagnosis in that like the pediatricians sometimes will be
29:11
able to do the diagnosis and medication management.
29:16
If not, then if you're very specifically wanting to know if
29:20
there is an ADHD component or not in the pediatrician says
29:23
it's a difficult case, then you do need a child psychiatrist or
29:31
neuropsychologist. So neuropsychologists are
29:35
different because they are psychologists and they do
29:39
testing and the neuropsyche testing is not just for ADHD,
29:44
but it could be autism, any learning disability, mood
29:48
disorders, but it is very comprehensive.
29:51
So I always say it takes like days actually that you go in
29:54
multiple times. They'll do an extensive
29:58
interview with the parents as well.
30:00
They do a lot of specific exams and tests and then you come out
30:05
with like 5 to 10 page report. And that's not for everyone, but
30:11
I think it is something that is very helpful for someone who's
30:14
like really struggling or and then I am able to diagnose,
30:21
assess and diagnose ADHD and all child psychiatrists are trained
30:25
for that as well. Is that something that as a
30:29
parent that could decide I want an assessment of my child?
30:33
I think he has AHD something that has, yeah.
30:37
Of course, yes. So I get phone calls and it
30:41
would be so for me, for any kiddo, ADHD or not, or
30:46
depression, anxiety, whatever, I would meet with the parents for
30:50
about an hour, get all a very detailed history, and then I
30:55
would talk to the kiddo and then we talk about.
30:58
So the whole process for me takes about two hours and then
31:03
the neuro psych testing is much more comprehensive and more
31:07
testing based. OK.
31:10
Do you only see patients like locally or are you able to
31:15
assess? Yes.
31:16
So my practice is a little bit unique in that I am, my practice
31:25
is virtual. So everything's virtual and I
31:28
spend about 6 states, so I see patients that are living in,
31:38
write them down everyone, New York, NY, DC, Maryland,
31:43
Virginia, State of Washington and California.
31:47
Nice, nice. We'll we'll list them in the.
31:50
Description. Make sure to check it out.
31:53
That's right. Oh, nice.
31:56
OK, that's, that's helpful. You know, I've been interviewing
32:01
a lot of Korean Americans in mental health profession or
32:06
industry, right? And I was so happy because I
32:10
have a list of names where I could, you know, refer people
32:13
to. But one question that people
32:17
have is what about the confidentiality?
32:20
These are people in the Korean American community, You know, we
32:24
know each other from, you know what, what did they say?
32:28
Like Hyundai Condimentata, right?
32:30
We know each other. It's a tight knit community.
32:34
What about the confidentiality? What would you say to that?
32:38
Well, I would say do not worry because we are legally bound.
32:45
So confidentiality is basically a grained in all therapists and
32:51
all physicians in general, right?
32:54
It is very federal law basically.
32:57
So whenever I talk to the patients, I so about #1 in adult
33:04
patients in general, I have obligation as a moral
33:10
obligations and legal obligation to keep the confidentiality.
33:14
And what goes into confidentiality is everything
33:18
that we talk about in my recession, unless you say that I
33:23
can divulge those things, right? And, and so this is a talk that
33:29
I have with teens a lot because they are like, well, you, you
33:33
know my parents, you talk to my parents and, you know, what are
33:35
you going to do? And So what I tell them is my
33:38
patient is you and my confidentiality obligation is
33:43
towards you. So a parents are not my patient.
33:48
So for example, everything that we talked about is confidential
33:53
unless you tell me that I'm OK to talk to them about, I can't.
33:57
There are two there. And these topics include sexual
34:03
orientation, gender identity, substance use, pregnancy.
34:10
All of these things I cannot divulge at all.
34:14
There are two things as a psychiatrist, I am obligated to
34:18
divulge. If something, if you tell me,
34:22
one is if you tell me that you're going to go kill yourself
34:26
today, societality, right then I am obligated to say do something
34:31
and say something. The other one is homicidality.
34:36
So if you're telling me that you're going to either go kill
34:38
someone or hurt somebody today, then I am obligated.
34:43
But I have side of those two, you know, I am unable to now.
34:51
I just want to put a addition to that, that with teens, then I
34:56
add, but if you are having any of those problems and you tell
35:01
me that I can't talk to the parents, then we can talk for a
35:05
long time and talk about why that is and why we should talk
35:09
to the parents about it, right. And so I unless you say yes, I
35:14
can't. But we will be talking about why
35:16
that isn't things like that now in adult system, you know, even
35:21
even if I end up meeting you at H Mart, what we talk about is
35:28
I'm not gonna, I'm not gonna say hi to you unless you say hi to
35:32
me. I'm not going to introduce
35:34
myself to anybody unless you come in like you want to do
35:37
that. And that's I'm more than willing
35:39
to do it. But I am I'm unless you initiate
35:43
it. I'm a silent person, right?
35:48
Yeah. So it should be the least of the
35:50
worries. Confidentiality.
35:52
Yes. And it does not, you know, all
35:55
the medical records. I have a lot of parents who are
35:58
like, well, is it going to be in the school?
36:00
Like what if they are applying for school, for college, for
36:03
work? No.
36:07
Yeah, that's something that needs to be clearly understood
36:10
because a lot of people wonder what that seriously.
36:12
Really. But yeah, I guess I don't know
36:15
how that works in the Korean society, but I it seems like a
36:18
lot of people are worried about, oh, it's going to go on my
36:21
record, but it's going to interfere with my job search and
36:24
getting to schools. No, no, Yeah.
36:27
OK, Well, that's good to know. You mentioned a little bit about
36:30
it, but I think the cost of therapy really is one of the
36:36
biggest barriers. You know, I feel like maybe the
36:40
the perspective has to change how we look at therapy as
36:44
something extra. I don't know what, what can we
36:48
do? How can we look at this?
36:50
Yeah. So unfortunately, I think, you
36:52
know, the structure of American Medical insurance is in certain
36:59
way, especially for mental health that it is really
37:03
difficult. So some therapists and
37:07
psychiatrists do take insurance. And so if that's important, then
37:12
then I think that's when you go to your entrance, say can you
37:15
give me the list of the names? And they'll give you names of
37:19
people who are in network and then then you pay copay and
37:23
that's it. And so that's number one in
37:27
terms of if you do have the funds, but also it is quite a
37:30
lump sum, then a lot of times, yes, you do have to think about
37:35
your investment and what you want to get out of it, but also
37:41
people who are out of network per SE who don't take insurance.
37:45
So yes, we do personally, I do keep credit cards on file and
37:50
charge them. But what we what we do is we
37:54
provide what's called super Bill.
37:56
And so super bill is kind of like a receipt.
37:59
It will have certain informations the insurance
38:02
companies are looking at and then you can submit that to your
38:05
insurance and a lot of the insurances will reimburse a
38:10
portion of that. The way to figure out how to do
38:14
that is you call it up by your insurance and it's very
38:18
important. The keywords are what are my
38:21
mental health out of network benefit?
38:26
So that's a really keyword because mental health is carved
38:29
out of the medical and medical health.
38:31
So you have to say what are my mental health out of network
38:34
benefit? And they're able to say like,
38:37
well, will you reimburse 70% or or how much ever.
38:41
So that's the keyword that you're looking for, to ask them
38:44
what your specific plan is giving you.
38:48
And so I have a lot of patients who will before starting
38:52
treatment and we'll go back, go to them and ask about it and
38:55
then see what their financial status is, right?
38:58
So that's important. And then a lot of the therapists
39:03
and psychiatrists will have what's called sliding scale.
39:07
So if you just tell them, you know, like this is a little bit
39:11
hefty out of my range, but I really want to work with you.
39:15
Is there a way to the word the cost and that we can workout a
39:20
sliding scale. Some people, actually, some
39:23
therapists, colleagues will take the income based a sliding scale
39:27
for their patients. If it's something that's really
39:31
difficult like, you know, some students or someone who is not
39:35
opening job, a lot of the mental health clinics in the cities
39:40
will have kind of a training program where they, you know,
39:45
like I was in a program where I paid $10 a session to go for
39:50
therapy while I was in residency and things like that.
39:53
So there are definitely ways to to it, even if you don't feel
39:58
it, You know, I don't want people to feel like this is only
40:01
for the wealthy. I'm so glad that a lot of people
40:05
are I, I see this in my everyday that a lot of people are open
40:10
about getting therapy and the need.
40:14
So that's a good thing. That's a good thing.
40:16
But I do see also see a lot of people stopping maybe in the
40:20
third or fourth session because of, I don't know, the time and
40:25
the, the money issue and everything else.
40:27
I guess they don't feel like I see the difference right away.
40:32
But it's a journey. It's a long process.
40:35
You know it's not good. Yeah.
40:37
So in therapy, I mean, depends on the modality, but I would, I
40:41
would have to say the shortest would be like, you know, the
40:44
modality that the cognitive behavioral therapy, like CBT
40:48
even it's like at least, you know, 16 weeks, 12 weeks
40:54
program, right? And so it is a long term in, in,
40:58
in terms of the therapy. I always tell my patients, we
41:01
look at, you know, how like you have report cards.
41:04
We look at it as like every six months, not Even so maybe a
41:08
year, right? And a lot of times people don't
41:11
notice what's happening or what's getting better.
41:14
And then we do like a session in six months and like, what are
41:17
the things that let's go back to my notes from six months ago.
41:20
Are these things happening or this is better?
41:23
And people are like, oh, yeah. So it's not like a drastic, like
41:27
transformation. It's very subtle, but also very,
41:32
if you think background breaking.
41:35
Yeah, yeah. Take away today is if you don't
41:38
find joy or not stop noticing things, maybe it's time to say
41:43
is there something that I need to do and start small.
41:47
Maybe your family doctor or your primary care start there and see
41:52
what works out. And it's like dating you don't,
41:55
you don't have to find the one, but with the first try.
41:59
And also there are ways to get help financially and and it is
42:04
important, very important and essential part of our Wellness
42:09
these days. Yes.
42:11
So thanks, Doctor Jiang Chou, for your time and such
42:17
insightful wisdom. And yeah, I'm so excited for
42:21
this series. Hopefully many people will find
42:24
it helpful. And click that subscribe button
42:28
for me. Music.