Adolescence and Mental Health Management with Emily Shaw NP

What got you into the field of psychiatry?

Emily Shaw  0:01

People are just going to respond differently you know what works for one person like isn’t gonna work for another person. So like, I find myself like explaining things different ways I find myself pointing different things out, you know, it’s not one size fits all. people need like very different approaches.

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Daniela Galdi  0:18

adolescence is a time for growth and big changes to the body, social development, and especially mentality. So for this episode today, we cannot wait to dive deeper into mental health. I am Daniella, your co host sitting here with Kira.

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Kira Yakubov  0:36

Hi, everyone. I’m Kira Yakubov, founder and the therapist of Heal Your Roots Wellness. And I’m so excited to invite Emily Treadgold Shaw today she is a nurse practitioner in psychiatry. She’s currently practicing at integrative psychiatry, of Manhattan, and she happens to be a good friend of mine as well. So Emily, thank you so much for being here.

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Emily Shaw  0:57

And thanks so much for having me on,

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Kira Yakubov  0:59

of course. So I first want to ask what got you into therapy and becoming a nurse practitioner and to mental health field.

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Emily Shaw  1:08

So I it’s funny, I knew that I wanted to do this from sort of an abnormally young age, I can remember being 15 and telling one of my friends that I wanted to be a child psychiatrist. And they said, Well, that’s a long way off. But I, I just, it’s funny, other people were really good at other things. And what I was really good at was talking to people about their problems and helping them really sort through it. And I found out like, oh, like people can pay for this, like I didn’t pay any money to just talk to people talk people through their problems and help them. So I studied psychology in college, and then I graduated into the recession. So I went straight to grad school, and I decided to become a nurse practitioner, because I wanted to be able to prescribe medication. But I also really wanted to be able to do psychotherapy, I think it’s really important to be able to do both. And I really wanted to do both. I didn’t want to lose that talk therapy side. And I also really wanted the flexibility of being able to prescribe when needed. So yeah, so that’s sort of how I got into it, I lasered in on it, and at least are done on it at a young age. But I decided, you know, I just kind of like kept going straight through with that I had a really hard time when I was a teenager. And I had a lot of protective factors. So my parents were really great. They loved each other very respectful. They were respectful and honest with me and my brother, it was a lot of warmth and kindness. And I was still like really struggling. So I also really wanted to help kids that might not have come from the same kind of really supportive family of origin. That had, you know, that had more challenges than I had. And I’m really struggling with those.

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Kira Yakubov  2:48

I love that. I did not know I wanted to be a therapist, when I was younger. I mean, I did subconsciously. But from my background, my parents were like, oh, you should go to accounting because for a woman. So I love that you actually always wanted to do that.

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Emily Shaw  3:05

Yeah,

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Kira Yakubov  3:05

Specifically working with kids.

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Emily Shaw  3:07

Yeah.

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Daniela Galdi  3:07

Now let me ask. What were you guys like as a teenager, because I know, for myself, I was very rebellious. I was, well, I was a good student. So in my mind, it was like, because I’m a good student, I should be allowed to come in when I want. in that sense. But I was very hardworking, very, like, very disciplined in terms of like, if my mom asked me to do something, you know, things like that helpful. But when it came to like, wanting my freedom, that was that was like, Oh, I’m owed this because I’m looking at me, I’m doing so. But I understand now as an adult, that it probably drove my parents through the wall with nervousness, you know, so that was me as a teen. And juggling a lot. And I really think I should have been seeing a therapist, for sure. And not just because I was like had that had that rebellious side but because I did struggle a lot with like depression and not understanding it. I had a lot of insecurities. And you know, kind of get pushed aside is like, I’m shy. I’m shy, but it really was like I’m dealing with all these emotions and thoughts in my head that are unhealthy. So yeah, so with that, so that’s kind of that was like me in a nutshell as a teenager, but what about you two?

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Emily Shaw  4:29

So I was the opposite of rebellious. I was also shy, but I was very, like, I really wanted to get good grades, like really wanted to, like Please, everybody, I want to please my teachers and I wanted to please my parents. And my parents were not that strict. They were really honest with us. They grew up in the 70s. Like they were really, really, really honest with us about the stuff that they were doing. I did not do any of those things [muffled] college. I was also struggling with depression and didn’t know it. It was also you know, and it’s it’s so sad to me now. Oh, if I had asked my parents to go to therapy, I’m sure they would have said yes. I just like I didn’t know that I was depressed. I just thought that everybody was sad all the time. And I ended up talking to a lot of my friends. I’m an oldest daughter, and a lot of my friends are also oldest daughters. And we sort of just ended up talking about it amongst ourselves and like trying to support each other, and then being like, well, we can’t tell our parents like, then they would be worried. So sad to me now, because that that didn’t come. Like for me that didn’t come from my parents. And I’m sure if I had ever gone to my parents with a problem, they would have helped me. It was just that, like, I didn’t want them to know, I was struggling. And I wish that someone I wish that there had been like someone that had been able to be like, it’s okay to ask for help. So I that’s like, I think I think that’s why I was really drawn to the field. Like I really even at the time, like, even when I was 15. I was like, with no insight. I was like, I want to be a child psychiatrist. I wonder why. I wonder why I had that thought it was, you know, I like I really, I think, wish that someone could help me but like, didn’t think that there was like the avenue for that just didn’texist in my head. Yeah,

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Kira Yakubov  6:06

yeah. So this is gonna be a sad girl club, because I was also very depressed, and anxious growing up. I mean, there was like, a before and after, like, as a younger kid, I was very outgoing. I wanted to be an actress, I wanted to be like, center of attention, loved it, until it was like approaching adolescence, when I had like facial hair, and my body was changing. And I was like, oh, I want to be hidden from everybody. Because if they can’t see me, they can’t make fun of me. And I’m just gonna be like, the funny kid in the back like the class clown. So that was like, my way of coping through that. But I had very strict parents, like Daniella, who has immigrated here from Azerbaijan, Eastern Europe, and they did not understand sleepovers, they did not understand really like being sad, because we came to America, and there was like, no war currently happening. So that was, I had everything I needed. So I didn’t have a reason, a good enough reason for them to understand why I’m sad or anxious. And I was really shy, too. And I think the way that I dealt with that was okay, like, if my parents aren’t gonna let me do this, how can I problem solve and like finagle a way to still get what I want, which is like in social settings, so like, I would sneak out or I would, this is, I don’t know, for listeners who are around our age, but caller ID in three way calling.

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Daniela Galdi  7:35

Oh, yeah,

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Kira Yakubov  7:36

I told this to my parents later on in life. But I would say I’m like sleeping somewhere, I will say I’m sleeping at a friend’s house, we’re really at the sleeping somewhere else. And then I would call my friend and a neighbor call my parents house and the caller Id would show up so it wouldn’t, I found ways around it. And I was also very rebellious. But I just I journaled a lot, or talked to my friends about being sad, or just read a lot of vampire books. And that’s something

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Daniela Galdi  8:06

This is new that I learned about you.

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Kira Yakubov  8:07

Yeah,

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Daniela Galdi  8:08

but it was something that you turned to to help manage it.

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Kira Yakubov  8:11

Yeah,

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Daniela Galdi  8:11

it was your thing, too, was like your personal thing that you love. You brought up something that comes to mind now, because you mentioned about being the oldest. I know, you’re the only daughter. And now while my parents were also immigrants, I do feel like I got a lot of freedom. I’m also the fourth and baby of my family. So what is your perspective? And I’ll ask Emily, first, what’s your perspective with birth order? And what happens to our mental state or emotional side?

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Emily Shaw  8:41

Yeah, there’s definitely, I feel like there’s stereotypes. There’s this stereotype of the oldest child having to feel like they’re really responsible. And I definitely felt like I fit that to a tee. Like other people’s parents, or my friend’s parents, or my parents friends would be like, Oh, you’re so mature, you’re so responsible. And I feel like that’s sort of the stereotype of like, the oldest child like having i It’s not I have one brother. But I felt very, like I had to have everything under control. And not because not because anybody told me that, but I feel like oldest children are sort of just like socialized to be, like, hyper responsible.

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Daniela Galdi  9:23

And then Kira. What did you experience with that?

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How does birth order play into mental health?

Kira Yakubov  9:25

Yeah, I mean, so I’m the youngest of three, and the girl . I have two older brothers, and my oldest brother definitely fit that bill. He was. He was very parentified out of necessity, like we came America. My parents didn’t speak English. He was like seven. So he went everywhere with them to translate to set things up. I mean, like adult things to do. So he definitely took on that role. And then I have a middle brother, and then I’m the youngest, and I was definitely treated like the baby. And I think birth order does make a difference within family dynamics for sure. And even though you grew up in the same family in the same house, everyone has a different experience. And everyone’s treated a little bit differently based on the birth order, your gender, different things that are going on with you, whether it’s like personality or medically, or just like your relationship with each parent is different. So I think all of these factors definitely play into mental health.

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Daniela Galdi  10:23

Absolutely, because with me mentioning, being the youngest of four, I was also born a few years later. So I did get I do feel taken care of a lot. But at the same time, and my you know, my mom worked two jobs at times, my dad worked full time job. So I did find myself being responsible, which, if my mom ever listens to this, she’s going to maybe laugh when I say this, but she feels bad about it. She’s like, I feel like, you know, I wasn’t able to be there. But she totally was, I think in me a little bit was like, I need things a certain way. And and you mentioned earlier, Emily about control. And I wonder if that played into like subconsciously, because I was anxious and had all these other feelings. I needed that sense of control for myself, maybe. But I also had to be very responsible at times, because I was a few years behind my sisters. And so it was almost like I got the attention of I feel like a first child at times. So yeah, so it’s such an interesting aspect. And I asked that, because I know you both talk, you talk to a lot of family members here, and then Emily working a lot with teens.

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Kira Yakubov  11:31

So I’d love to hear what you enjoy the most about working with, whether it’s adolescents or teens, and maybe some of the parts that are the toughest.

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Emily Shaw  11:40

Yeah, I love adolescents, because they’re just discovering everything for the first time, then there’s this sense, a lot of times, like when they’re doing well, there’s a sense of possibility, there’s a sense of like, I could be anything or do anything, and I’m just discovering why, like, there’s also adolescents will keep you on their toes, they will just be like, you really know what you’re doing, you’re gonna really have to be you cannot, you can’t try to finesse, a kid that much like they will see you right through like, you really have to be at least that I find that I have to really be honest. And that like I like that they keep me on my toes like that. If it is it is really challenging. You know, the challenging thing about working with kids is like, you have to you know, you’re also working with parents options, you’re also working with the school counselor. A lot of times you’re also working with the teachers, tutors, there’s just a lot more people that you’re communicating with, which is great, because when you get a really great treat and treatment team coalescing around a kid, that’s really rewarding, but it’s also you know, you’re coordinating all these moving parts isn’t there’s appearance aren’t getting along, and sometimes you’re getting divorced. And sometimes, you know, they’re they have different ideas about what the treatment plan should look like. And it’s also, you know, it’s hard because kids have very limited control over their environment. And a lot of times, if they’re in a really tough spot, that’s very hard. Because, you know, you all and I had to like learn to like put like boundaries up and you know, like, learn not to take work home. But it’s like, you wish that there was so much more that you can do and you just can’t do that much. And as an adult, I feel like sometimes it’s a little bit easier, because like kids, they really can’t change their circumstances a lot of the time. And that’s really challenging.

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Hardest part of working with kids.

Kira Yakubov  13:24

So I worked at a high school as an adolescent counselor. Yeah, well, I, it was not my favorite.

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Emily Shaw  13:33

Fair. Fair.

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Kira Yakubov  13:33

It was not my favorite position. And I also had to, like reach out to like their individual therapists and things like that. And one of the things that was tough for me that I think is different than when working with adults is kids, they didn’t always want to see me, but they had to see me or it was part of their treatment plan that their parents and teachers decided for them. And so I would have kids come down like yeah, I don’t want to talk to you like this is super dumb. I don’t know, I don’t care about you, and he would sit there. And sometimes it’d be like, pulling teeth. And they understand why from their perspective. And from my perspective, and like, it’s not always, for me personally, it just didn’t feel rewarding or helpful, because I feel like I’m forcing someone to talk to me. And like as a person, I hate feeling like I am forcing anything. I always want people to come like voluntarily. So that was the toughest part. For me working with kids.

Emily Shaw  14:30

That’s really hard. I have that a lot. And I’ve had it a lot. Also, I’ve worked in all kinds of places, and I’ve worked in an inpatient unit for adolescents also where they definitely don’t want to be there. Yeah, so I that’s really hard. I actually I think that’s one of the things I find more rewarding because sometimes you start out with a really tough kid and they’re like, this is stupid. I’ve been to therapy before and it doesn’t work. You know, I don’t want to be here. I’m only here because my parents are making me and I’m like, okay, great to let’s play Uno. You know, and I always had like, you know, you don’t have to say I my first ever therapy client when I was School was a 13 year old girl that would not talk to me, like not a word. But she was like, look away from me. And we like, would just play games. And eventually, she warmed up a little bit. And I also like, I didn’t think, of course, I’m like, in school and freaking out, and like, I’m not helping this person at all, like, I’m going to get I’m definitely failing at this. Like, this was such a terrible idea. And it actually like that is now what I find like something like really rewarding is when kids don’t want to talk to you. And then eventually, like, if you don’t, if you don’t push, you know, you gotta like, You got to kind of give them enough space. But like, eventually, like when they start confiding in you like, that’s really like, that’s also like, extremely rewarding. Yeah, but it doesn’t always happen like that. Like, sometimes kids are just like, I don’t want to be here. And that’s hard. Yeah. It’s easier for me now. Because now that I’m in private practice, I have like so much longer, that I can work with this game family. That’s actually one of the reasons why I switched from working in. I love working in hospitals. But it’s one of the reasons that I switched to I wanted to see kids longer term, I really wanted to see them like evolve.

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Kira Yakubov  16:11

Aww

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Emily Shaw  16:11

Yeah.

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Daniela Galdi  16:12

Is that what you mean by seeing them longer? Like the duration? Was it different when you’re seeing them from the hospital or counseling?

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Emily Shaw  16:19

Yeah, so when I worked in hospitals, unfortunately, because of the way that insurance is structured. Now, a lot of times if you go to an inpatient hospitalization as a teenager, or even as an adult, you know, it’s like a seven to 10 day hospitalization before the insurance company is like. So. So it’s hard, you know, you somebody can improve a lot in a short amount of time. But what I really like is seeing that long term improvement over like, weeks and months, and like some of my patients now I’ve had for years. So I ended up trying to, you know, and a lot of people transition, like, it’s really good to work at a hospital right out of school, because you just like use the I learned so much, you see a ton of stuff. But I ended up you know, but it’s also really hard. It’s like, it’s really difficult circumstances, and I just after a while just couldn’t do anymore. So it is, you know, it has been really nice to work with kids longer term.

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Kira Yakubov  17:10

And so I’m curious of I know, with kids, especially younger, it’s like being able to play and do games and stuff. How do you feel like that has changed with COVID and having to do it completely remote.

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Emily Shaw  17:21

So I actually was in person, the whole pand-, not the whole pandemic, when the pandemic hit, I was working at a public hospital in the city and we went to all phone and that was really hard. And then my, the job that I had after that I was actually in person. And then now I’m in person I was in person two days a week before I got pregnant. If you’re just listening and not watching the video, I am seven months pregnant and enormous

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Kira Yakubov  17:47

and grogeous

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Emily Shaw  17:50

before I got pregnant, I was going two days a week home three days a week. now I’m going in one day a week. But I usually like reserved my in person slots for like younger kids. I have a couple of like 11 12 13 year old. So I try it’s just harder, you know, it’s harder. Some kids, some kids are great with technology. Some kids like transitioned, like right away, they were like, you know, is totally fine. We like play, we’ll like play drawing games and stuff like that. But it was really hard to transition especially like at the beginning to transition from like seeing kids in my office being able to play with them to like doing all like all over the phone. That was that was really challenging. Being like the flexibility of being able to work from home, but I also like when I see kids, I really like being able to work with them. Yeah.

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Social media’s effect on teens and mental health.

Daniela Galdi  18:35

The phone sounds so challenging just to keep something adult’s focus, I would imagine.

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Emily Shaw  18:39

Yeah.

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Daniela Galdi  18:41

Or teenager, an adolescent in that sense. But yeah, that I commend you for that. Because that sounds like that was a lot of extra, possibly in your approaches. For you.

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Emily Shaw  18:51

Yeah, it was just it’s just harder to keep people engaged.

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Kira Yakubov  18:54

Yeah.

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Emily Shaw  18:54

Like, there’s no way you know, if you can’t see them, like there’s no way to be like you’re watching TV right now. Yeah, so that was that was challenging. Oh, kids, the kids adapted to it really Well. I was really impressed with I mean, the pandemic has precipitated, like a huge, like, adolescent mental health crisis that was there totally there before, but just like sort of like laid bare that adolescent mental health crisis that we were already having. But I was actually really impressed with how resilient the kids that I worked with, were and how like, well, they adapted.

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Daniela Galdi  19:27

So you’re mentioning that the phone and you mentioned about technology? My question to you is how do you see or what is your perspective on the fact that social media now plays a part with teens? In my opinion, I like the fact that people can learn about mental health I feel like the awareness is heavy. It could just be who I follow, but I’m hoping that it comes across to teens as well. But I also see a downside to it. So what’s your both of you that will start with Emily but what your perspective?

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Emily Shaw  20:00

Yeah, so I, there’s so much good and bad. I see so many teens using it in such a creative way to express themselves. And also, honestly, a couple of my young adult patients have seen things on social media either like about ADHD or about like, complex PTSD. Or they’re like, oh, wow, I really relate to the symptoms, and then we talk about it. And that’s like, why they came to therapy. That’s awesome. I have also had a lot of like, early adolescent girls be like, I have borderline personality disorder. And me being like, No, you definitely don’t. Like, I know that you saw a list of symptoms. But that doesn’t mean,

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Kira Yakubov  20:37

this is just regular.

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Daniela Galdi  20:41

Because as an adult, I’ve also done that to my therapist. I was reading about schizophrenia, and I think I am schizophrenic. And she was like, no.

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Emily Shaw  20:52

So I think that like, as long as you have a person that you can talk to about it, that that’s great, but that I can, it’s very easy for me to see how you could like read a list of symptoms that you relate to, because you were not the developmental, like age target of the symptoms. And you could think that you have like, you could sort of like label yourself with this thing where you’re like, Oh, my God, and it turns out to not really be accurate for you. So there’s, like, I’m glad that there’s so much more like awareness and information, I think that kids do feel so empowered to talk about their own mental health struggles in a way now that like they never did, even when we were kids, which I think is amazing. But I, I also, you know, what’s funny is I’ve been thinking about this for a while, because I’m about to become a mom. So my husband, I were laughing, that, you know, when we talk about the baby, I’m going to be like, no screens til you’re 40. So, I know, I’m so glad that I didn’t have social media as a child. So like, I got Facebook for the first time I was 16. But it didn’t even have the newsfeed back then it was like super, like, it was like a really, really early version, there was no infinite scroll, there was no there was none of the things now that sort of whatever they’ve engineered to make it, like hit the dopamine part of your brain that makes me want to do it more. And then Instagram didn’t come out until I was in grad school, I think, and I’m so glad. Like, that’s like, I sort of like think all the time about how, like, grateful I am that I didn’t have Instagram or Tiktok when I was in high school. And that makes me really sad. Because I definitely see a lot of the, you know, girls that I work with, but also boys like, also like, even like adult men, like really strong with their body image. And I you know, I really struggled my body image in high school and college without any of those things. So like, I’ve seen girls really struggle I see boys really struggle there’s like this pressure to you know, there’s all these like bodybuilder Instagrams, and like, even just, you know, it’s a, you have to keep in mind that you’re just seeing like a very, like curated, like very, like, you know, nobody is posting their bad angles or their bad days, and you’re just I feel like it, people feel really inadequate. And then it also with the, you know, with things like infinite scroll, like, it’s so hard to to and even, like, I find it really hard to tear myself away from my phone. And like, I don’t use social media at all, like, I’m really, that was like a boundary that I had to set for myself, because I was like, oh, like I am like having trouble, like putting this down to like, as an adult, I had to be like this, like I can’t, like, I can’t, I don’t want, I don’t need this to be part of my life. And like, it’s fine, because I it’s not the primary way that my close friends communicate with each other. But if you’re a teenager, you know, I could never say to one of my adolescent patients like okay, well, why don’t you just not use you TikTok? It’s not realistic, you know, so I have to talk to them about like, meeting, you know, I just sort of meet them where they are. And, you know, parents are freaking out and have to be like, you know, especially like, also, like video games during the pandemic, a lot of the boys and girls that I worked with, were playing a lot of online games with their friends and parents would be really upset because, you know, I had to be like, look like they’re not in school, like they can’t see their friends. Like, this is like the time that they have to like, relax and like, chat with them, like the way that you talk to your friends. And I don’t think they should be doing it 12 hours a day, you know, we can still keep limits on it. But I think that it would be really hard for them to go without any social communication, like that is also not good. So it’s about striking a balance. But striking a balance with these things is so difficult. And even it’s difficult for adults. So it’s like kids have no you know, your prefrontal cortex doesn’t finish developing until you’re 26. So it’s like it’s really hard to like self regulate, like social media and video game used when you were an adolescent. So it’s difficult and also a lot of the tools that parents use to limit their kids social media use the kids that I work with, they’re very like tech savvy. Just get around me like when we were kids even there are some of that yeah, like I remember like Going through VPN at the school by like playing nerdy word games. But this is like how much rebelling I was doing. It was like playing text quiz in the library. But I yeah, I mean, that’s the thing is like parents are like, Oh, we have parental controls on the TV, and I’m, like, it doesn’t matter, sorry, sorry, but your kid knows how to get around them, and has been getting around them for two years.

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The difference between a psychiatrist and a nurse practitioner.

Kira Yakubov  25:26

So I dont work with kids now at all. But when I did it, I mean, it’s exactly what you’re saying. Like the if there’s a will, there’s a way and like, they, I learned so many different apps they would use to communicate with each other to figure things out, parents would never have a clue. And like you wouldn’t know unless you’re a kid, or you’re like figuring that stuff out. I can definitely see how parents might think that they have certain controls, or they know what’s what their kids are watching or doing. And, unfortunately, they may not or may be under estimating their ability to do what they want to do and be able to communicate with their friends. And I’m also very glad that I did not grow up with social media. I mean, we had MySpace when I was in high school. And texting was like a hot mess, like you have to hit the same button like three times to get it. So it wasn’t really a lot of texting, there was the AOL and AIM

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Daniela Galdi  26:25

I was thinking, AOL,

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Kira Yakubov  26:26

yep

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Daniela Galdi  26:27

we used to think, like, we used to crack codes for people’s passwords. That’s how we spend our time trying to try to hack

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Emily Shaw  26:37

AIM is how I learned to type a 100 words a minute , I definitely wouldn’t have achieved that without.

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The difference between a psychiatrist, nurse practitioner, and therapist

Kira Yakubov  26:42

A little bit like shifting gears, so you’re a nurse practitioner in psychiatry. So not a lot of people know the difference between a nurse practitioner and a psychiatrist, a therapist. someone could do all the things. So if you’d be able to kind of share a little bit about the differences, that would be great

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Emily Shaw  27:05

yeah, okay, I have this conversation with people all the time. So a psychiatrist is a medical doctor that can prescribe medication. And then sometimes they also do psychotherapy, they’re licensed to do both. A lot of psychiatrists only prescribe because of the way that insurance is structured, but some do psychotherapy. So I’m a nurse practitioner in psychiatry, which means I got a nursing degree after my two bachelor’s degrees, because it took a little longer. So I have a bachelor’s in psychology, which you don’t need if you want to be a nurse practitioner, but I happen to have two bachelor’s degrees. So I went back and I got a second bachelor’s in nursing. And then I got a master’s in psychiatric nursing. So I’m licensed to prescribe and do psychotherapy as well. The privileges for nurse practitioners are different state to state, where I’m licensed in New York, I basically can do almost everything that a psychiatrist can do. So you have to have a supervising physician for two years of full time work the equivalent of two years and full time, full time work in New York. And then you can practice independently, which is what I do now. But I used to work in Louisiana, and then I had to have a I would have to still have a collaborative position if I were still living there. So it’s a little bit different state to state, like how much supervision you need and what you’re allowed to do. But in New York, the laws the parity is pretty good. So I really like a practice, pretty much like the full extent of my licenses, which is great. And then sometimes, you know, a psychologist is usually someone that has a PhD in either clinical psychology or there are different kinds. But in most states that people can’t prescribe, but in some some states have prescribing psychologists where you finish your psychology degree, and then you do like a shorter pharmacology degree. That’s like, that’s new. And it is like, I think gaining momentum in some places. There’s a huge shortage of psychiatric providers, and especially for kids. So I was sort of, like whatever we can do to improve access is really good as long as like the, you know, as long as the training is adequate, and like very into like improving access. And then there are therapists that are trained as licensed, licensed clinical social workers. You know, they’re like a lot of different ways of becoming therapists. But psychiatrist and nurse practitioners, usually and right, some psychologists can prescribe.

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Medication Management versus Therapy

Kira Yakubov  28:20

Yeah, so licensed therapists, like myself, cannot prescribe medication. And so it’s really great for us to have great connections with nurse practitioners or psychiatrist so we can work together to help clients. And I’m also wondering, so in the moment, or do you see clients only for med management and not therapy, or do you normally do both?

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Emily Shaw  29:49

I try to do both. I have. I have a couple clients now they’re only therapy. And then I have, I have a lot of clients where I do both and some clients I only do medication management, but usually if they already have an individual therapist. Um, so usually sometimes people will see a therapist for a while. And then their therapist will say, you know, I feel like maybe you should talk to a psychiatrist or a prescribing practitioner. So most of my patients that just do medicine, a digestive medication management with already have a therapist, and then patients that don’t, I will usually do some amount of therapy with them. And then especially a lot of my child, adolescent patients, a lot of them are not on medication, some are, but some are not. Some of them. I’m just doing psychotherapy. Yeah,

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Daniela Galdi  30:32

it’s just so fascinating. What’s the range of that diagnoses? I guess it will be called,What is that range that you see?

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Emily Shaw  30:43

So it to a lot of stuff right now. in the practice that I work in, I’m seeing a lot, it’s a lot of ADHD, a lot of anxiety, a lot of depression. A lot of I, you know, some like obsessive compulsive like PTSD. Some, you know, I have some patients that some patients that have psychotic disorders, not as many as when I was working in hospitals, just because like the population is a little bit different. But there’s Yeah, I mean, I also would really enjoy working with patients that are working on like trying to heal from substance abuse. So that’s mostly my mostly my adult patients. But I see a lot of that as well. Yeah.

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Kira Yakubov  31:25

And so I’m curious for for listeners out there for parents, because I know some parents might feel nervous to have their kids around medication, other parents are all for it. What has been your experience with working with parents, especially when they’re under 18 who are bringing their kids in?

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Emily Shaw  31:41

Yeah, a lot of parents are really hesitant. And I totally understand that, like, you just want to do what’s best for your kid. A lot of parents are like, what if they become addicted to drugs? Because of this, a lot of parents are like, what if they can’t stop taking the medication, I think there’s a lot of nervousness about like setting them on a path that they’re free, they’re not going to be able to control kind of like where that goes next. Also, I mean, unless somebody in these medications have risks, like it’s not something that I would do lightly, like a lot of my child, adolescent patients are not on medication. I certainly like want to always try everything else. First. There are a couple of things are like, for instance, like, with Attention Deficit Hyperactivity Disorder, there’s not a lot you can do with just psychotherapy, like the medications for that are really helpful. And they have the potential to really improve like a lot of kids lives. But I totally understand like parents hesitancy, and you hear a lot of horror stories on the Internet, about ADHD medication, and some of that is, you know, there are like real risks. So I, you know, from a personal perspective, like, I wish that I had had medication, I take medication for depression now. And I wish that I had been able to take it earlier, I got diagnosed when I was 27. I feel like I could have avoided some of the things that happened to me before that, if I had been diagnosed earlier, I mean, obviously, like everything, I’m glad, you know, I am happy with the way that everything turned out in my life. But from sort of, from a personal perspective, a lot of times I think you can alleviate a lot of harm. You know, if you were in pain, like physical pain, like if you work your arm or your leg. The analogy that I use a lot with parents is, especially like parents, especially parents that have kids that have ADHD and don’t want to start medication. You know, I say it’s a little bit like if your child needed glasses, and you were saying that they just needed to try harder to see better. Like, it’s not possible, you know, and they’re not lazy. They’re not bad kids, like they’re trying as hard as they can. They just, you know, their neuro chemistry is like different than other kids. And without medication, it’s going to be really hard for them to perform up to their potential. And a lot of times, like kids are losing self esteem. They’re like, I’m dumb, like, I can’t get this Why is everybody else getting this or getting in trouble. They’re like, I’m a bad kid. So like, that’s really when I’m like look like we could really prevent like, a not so great outcome in the future by starting medication now. Also. Also, if you’re unmedicated for ADHD, your risk factors go up for other like for car accidents for like substance abuse for depression and anxiety. So I really like this is something that I really try to emphasize to parents when I talk to them that like, I know it seems really intimidating and scary and frightening to start medication for your child. But a lot of times it’s like, if it’s preventing them from like repeating a grade or preventing them from dropping out of high school or preventing him from being like unemployed or underemployed. Like really like the benefits outweigh the risks in so many situations.

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Kira Yakubov  34:54

I wish that you existed. Well you did exist, but when I was a kid with my parents and like, as immigrants, especially from where we come  from mental health is like not a thing that you really are concerned with or understand. And so I was diagnosed ADHD inattentive type as an adult. And like, as a kid, I, it wasn’t detected because I wasn’t hyperactive, I wasn’t bad in class, I wasn’t disruptive, I would just daydream, my head would be out the window, I wouldn’t know what the teacher is saying, I would, I would like I would hear, I would forget, and then it would make me feel like I’m dumb, or lazy. And then I did develop depression and anxiety. And I can’t imagine if I would have told my parents back then they would have done much not because they don’t care. I don’t think that they even recognize that there was like resources like that for me. And they definitely would not have put me on medication. Like even now, as an adult, I was like, concerned like to take it, do I not? What is it going to do to me, like, all the same stuff. And I can see the benefits of taking it and the huge difference. And if I was in school, when I was younger, taking medication, I mean, I don’t know how they would have turned out, I’m happy with my life now. But I think it would have decreased a lot of the struggling that I went through, and a lot of like, the insecurities that I experienced.

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Daniela Galdi  36:20

Absolutely, and hearing, hearing when you say like, as someone who wants to be a future parent, but also recognizes a few things, right. So I recognize that for myself, I love the all natural approach, right. And I also take medicine for my depression. So I also recognize the benefit of medicine, because I had to be explained that this had to be explained to me several times by my doctor, by my therapist of well, you know, I always got the diabetes, you know, the diabetes example, if you had diabetes, you would have to take medicine, right? So you want to just not take it and suffer, right? And while you’re taking it, you can also do things in your lifestyle to help it right. So there’s also the dependency doesn’t have to be there either. Eventually, there’s ways to work past it. But right now, you know, right. In those moments, it was it was really helpful to recognize that effect. And so all these things considered, for me myself, one day, when I want to become a parent, hearing, you say, Emily that like, you don’t take it lightly. And then hearing both accounts. And I feel I feel similar in the sense of like, as a child, I do recognize that, like, there could have been a lot of help seeking a therapist, possibly the medicine to so hearing all this and then hearing on top of that, like you don’t take this lightly, to diagnose the medicine gives me so much comfort. And I just want to put that out there for people because in case we do have listeners who are parents, or you know, there are teens, and they want their teens to listen, because maybe the teen is not comfortable with it. Right? They can know that. It’s not just something that’s like we are dismissing you, we don’t care about you pure pop, pop this pill or whatever you have to do to feel better, like it’s not a dismissal is actually a very well thought out process.

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Kira Yakubov  38:23

And I also want to say I hear this a lot with adults, because I work with adults is I can even like go through this and explain this and they intellectually understand. And there’s like this narrative or belief like, well, then it means I’m weak. Or it means that I can’t just do this on my own, like, there’s something wrong with me, I should be able to just figure it out, suck it up, do better. And it’s like, it’s not about motivation. I mean, like part of it, right? But like you said, it’s like the brain chemistry, we can’t will our way out of brain chemistry. That’s just the physiological part of our brain. And I think part of it is the acceptance and working through that shame that like, it’s okay, if you rely on this thing. Like that’s, I mean, think about like, what do we do every day, like the glasses things was a great example to or if someone like there’s a disability, or they need a cane, or if there’s not like if it improves your life. It’s not a negative thing. And it’s not a sign of weakness, it means that actually, I think it means you’re pretty courageous to accept all the resources available to you so you can be your best self.

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Emily Shaw  39:29

Yeah, I didn’t have that much insight about it. inmyself, even when I. I became a nurse practitioner in 2014. And it wasn’t until 2017 that I started medication. So even though I knew I remember really vividly, I was in graduate school and I was reading a questionnaire for depression that I was giving to adolescents as I was doing an intake for one of my clinicals and I think it was the back. i But I remember that I was reading these questions like, I feel like it failed. You’re I feel like I’m being punished. I feel like I don’t look as good as I used to. And I was like, oh no. Because I was, you know, I was really burnt out. And I was really struggling. And it was, literally years later, I was seeing this amazing therapist in New Orleans, when I was living down there, and she eventually, you know, she brought it up to me a couple of times, she tried to be really gentle. She was like, Have you ever thought of it this. I was like, No. And even though it was in the fields, and even though I should have theoretically been able to recognize all the signs, like it was she, she finally had to be like, go to a psychiatrist, do not pass, go, do not collect $200 I don’t want to see you again until you talk to someone who can prescribe medication. And then once I started, I was like, oh, like is how other people function. And like, have been, like, managing to do things. Like, they’re, like, my entire, like, my entire life. I could have had this. Like, people, sometimes people, you know, there’s that saying that doctors make the worst patients. And it’s like, sometimes, like, even in the like, even though you’re in the field, even though you know, everything, theoretically, should be able to know everything. Like, I couldn’t like make the connection. And it’s like, you just have this huge blind spot when it’s yourself. That’s why also a lot of my friends and people I know were really hesitant to get into therapy, because they were like, well, I’ve read a lot about this, like, I don’t think there’s anything that like, I couldn’t already, like found out find out for myself. And I’m like, No, look, you can’t see yourself, clearly, you need someone else, to talk to, to be able sometimes to sort it out for you, and to switch your perspective on it. And that, you know, I’m still I’m so grateful that that happened. And I’m so grateful that I finally accepted help. But it’s funny, like I Yeah, it was, it was hard for me to ask for it, even as an adult,

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Daniela Galdi  41:48

I can totally relate to that. And in so many ways. And it was actually that moment of, for me, as you mentioned how people are like, well, I can fix it myself, I can fix myself, I’ve been fixing things my whole life, you know, very independent. And what would happen is I would turn to my friends and family. And I started because guilt plays actually helped me in this sense, because I started to feel like they didn’t, they were no longer able to know how to help me like they would multiple times I had people say to me, at my worst moments when things were just I could not cope. And I was turning to them, they would say I don’t know how to help you anymore. Right. And so then it was like, you know, like, I couldn’t help myself, I was putting this, you know, I say burden, we’re not a burden on our support system. But I was I felt like a burden on my friends and family to the point where they’re like, We don’t know how to help you like we can, I will sit with you. I don’t know what I don’t know how to help you anywhere. And that was like, my guilt kind of kicked in for putting that on them. But also, it was a, it was a good little kick in the tush of like the there are professionals for everything, including what I’m going through. And I’m, you know, I got I gotta just be brave and do it again. And this was like an again situation, right? Because I have started therapy when I was 24. And just like the year or two after college, and which I feel is like that, if that had to pick an area to like really dive into is like that transition period. I just feel like there’s so much there. But I felt that confusion at that time. And so I had been in therapy for a long time. And then I stopped because I felt good. But then years. I let myself go years before starting again. And it had to be all these things. But you know, as you mentioned, I can fix myself, I can do it. I can do it. I can I can apply this which we can. But now with all that, oh, I know with mental health and the work that I do talking with therapists and things like that, I know that that comes into play for management, right? And so yes, we have the capability to cope, to manage to improve, but it’s going to be so much deeper to work with somebody to really heal and really get that process going of changing your mind changing the patterns and all that.

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The importance of having a support system.

Kira Yakubov  44:09

And I appreciate both of you being so vulnerable and honest about this. Because it’s true. I mean, even as a practitioner therapist, we in air quotes should know or should be able to diagnose but we’re still human beings, right? Like that’s why we need an objective third party or you know someone outside of us in our relationship to point to things that ask us questions to look at things in a different way. And we don’t have any stake in their decision besides wanting them to do well and having their best interests in mind. And so like yes, having a support system is extremely important and like having community and recognizing that your family and friends are going to be biased and like that’s okay. And they’re going to see things from their perspective through their lived experiences and what they think you should be doing based on what they think would make you happy, and it may not actually be, what would make you happy. So I mean, I started seeing a therapist once I went to college because of the University Counseling Center. I never went in high school, I never even thought about asking my parents but as soon as I went to college I was like wow, it’s free, well, not free. You pay that tuition, and I’m still paying for it, but it’s included. And so I would utilize that. And I saw a therapist throughout my entire, basically my entire time at Drexel. And then when I went to grad school, I saw a therapist there too. So it is extremely helpful for anyone. And for therapists too. like, we are not above having our emotions, process and analyze and have a new perspective.

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Emily Shaw  45:47

Yeah, when I was in graduate school, they actually were like, we can’t make you be in therapy. They were they were very, like it is really important. You know, because especially in child and adolescent mental health is like you’re absorbing all this stuff.  lot of it was really heavy. So I’m really I started going in grad school. But again, it was there 10 free sessions as part of like the student like health insurance plan. So after that, and I graduated, and I didn’t go again, until I would I think I was like 20 21 then and I think I didn’t go again until I was 24. And I yeah, I sort of like could have used it that whole time. But I yeah, that actually honestly I’m grateful for that too. Because that sort of gave me this like plausible deniability where I can be like, Well, my school really recommended this. So but I wish I had known that it was okay, just to go. Yes.

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Daniela Galdi  46:46

Do you have a favorite approach that you use?

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Emily Shaw  46:49

Like a therapy like a favorite therapeutic approach?

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Daniela Galdi  46:52

Yeah,

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Emily Shaw  46:52

yeah. So that was my training was very like psychodynamic psychotherapy oriented, which is a little bit like old school now. But that’s I trained in New York City and New York City is very like psychoanalytic psychotherapy. So I tried now I fold in other I fold in a lot of cognitive behavioral therapy, I fold some Dialectical Behavioral Therapy, which I really love, actually, some of it is just more supportive. But I would Yeah, I would say that sort of, like my training is psychodynamic, but I am it’s astuted to my personality, I tend to be a little more reactive. And like, I like to give a lot of direct feedback. So a lot of my patients have said that they’ve been in therapy before, but the therapist just asked them questions or like, didn’t say anything. And I also I have like a negative experience with the psychodynamic psychotherapist, when I was in when I was younger, I had a couple, I’ve had therapists that trained in all different modalities. But I, and I think that like, anybody can be good in any modality , anybody can bad in any modality. And you should say, it doesn’t really sort of depends on the individual. But I will I just, I’m just [muffled] reactive. AndI like to give a lot of direct feedback. And I, you know, I’m, I’m really direct with my patients in a way that I think a lot of them really appreciate. And maybe some of don’t appreciate . But I think I tend to be a lot more direct than a lot of other psychodynamic psychotherapist, so I wouldn’t say I, you know, I’m hesitant to call myself that because I do tend to be a little more hands on.

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Kira Yakubov  48:34

That’s actually hilarious, because I was also trained in psychodynamic and I also give a lot of direction.

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Emily Shaw  48:40

Yeah,

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How do modern therapists differ from old-school therapists?

Kira Yakubov  48:41

I wonder if it’s, I think our generation of therapists might be different from the old school ones, where we learned psychodynamic, we might have learned all these different modalities. And we kind of choose to pick and take what we think is helpful to incorporate and not stick solely to one only and do it exactly the way we were taught. Because psychodynamic, I love it. And for people listening that aren’t a therapist or the mental health field know the jargon. It’s really like processing and being analytical of what’s going on underneath what you’re presenting with or what you’re experiencing to get to like the root cause. And like observing and being reflected like your coping mechanisms, and how different family members and different dynamics in your life impact you and how you view the world. And so there is a lot of therapists that tell me more, and that’s it and the other person’s like, okay, so like, what do I do with this information? Now? You know, I love that you give the direct feedback, too, because I think it’s, I think it’s important just how we’re having a conversation. Like I think it’s intimidating to just walk into a room and then the therapist is sitting in silence and like you just have to start the session. Like what is happening, right now.

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Emily Shaw  49:55

Yeah, and I think that’s sometimes again, like I’ve definitely given direct feedback that people were not ready to hear.

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Kira Yakubov  49:59

Sure.

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Emily Shaw  50:00

So I like it’s a learning curve. I mean, I like I wish I could be like, I’m perfect and every session I did the perfect thing for the patient. I have definitely been gotten, I’ve definitely, like, stepped in it before too. So I it’s a balance between, you know, you don’t want to, like just put a bunch of stuff on the patient that they’re ready to hear. But also it’s, you know, when they like it has to be their decision, they have to like, you know, rather than, like cutting to the chase, like it’s important for them to like come to the realization. But I think that it’s also important that you know, if it’s going to take them like two years, and it’s really messing up their life, like sometimes I am a little more direct.

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Kira Yakubov  50:38

Yeah.

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Daniela Galdi  50:39

As the person who is not the therapist, and on the receiving end, I feel I would say that I appreciate that so much. Because I know I like to talk, right? I don’t mind.

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Kira Yakubov  50:54

You do?

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Daniela Galdi  50:55

I do. Funny, when I was younger, I didn’t. Right? So this is like a whole as an adult, it’s like a whole would be coming for me. But I do I like to talk at the same time. If I went into a session, like, where’s your mentioning Kira, that the person is just waiting for you, I would be intimidated off the bat. And I can’t even imagine for someone who already isn’t comfortable about talking about their mental state, like I will tell you that, you know, I’m happy to share if I’m having a crappy day, you will hear more about it then you want to know, but you know, so on this one, just you both know, at least from my own opinion, I appreciate that so much. And what was actually funny is with with my therapist, I started to recognize her facial expressions. So it was like she I would say there was a directness. And then I miss her expression at times. And I’d be like, go ahead. Just go ahead. You can tell me.

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Emily Shaw  51:56

Well thats why really old school Psychodynamic Pscyhotherapist would make you lie on the couch, so you can’t see them react. Yeah,

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Kira Yakubov  52:02

Blank slate

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Emily Shaw  52:03

Yeah. And I did have a therapist like that once that did make me lie on the couch, probably cuz I was trying to make him laugh. And he knew and he was like, no, like, you’d be like, you can’t like you got to not be able to see me. Yeah, because I think I sort of I tend to use a lot of humor like to cope with stress. And in a way, you know, and it’s that like healthy in some ways and unhealthy in other ways. That I think that he Yeah, we started out face to face. And eventually he made me lie on the couch. Because that’s like traditionally why. Like that’s, you know, it’s like an old school in sort of like New Yorker cartoons of the therapists office, or you’re lying lying on the couch and the therapist is behind you. That’s originally why it’s so that you weren’t trying to gauge the reaction

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Daniela Galdi  52:43

I did not know that.

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Emily Shaw  52:44

Yeah,

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Daniela Galdi  52:45

I just thought it was to make comfortable setting.

You know, this reminds me of two. And this is maybe a little bit of a digression. But I’m learning a lot about EQ and leadership with someone else actually, I’m working with on a podcast. And so they’re talking a lot about leadership in it and reminded me a lot of like situational leadership where you can adjust your, your approach to things within the moment of what happens. So with this idea of like situational leadership and adjusting to this scenario, I know you have the skills, right? You’re both professionals, you’re both trained, but have you experienced this moment where you have to really adjust to the situation and lean on maybe experiential skills or any type of other skills outside of what you’ve learned professionally.

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Kira Yakubov  53:44

I would say my whole job.

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Emily Shaw  53:47

There’s like, never a dull moment. Yeah,

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Emotional intelligence and body language.

Kira Yakubov  53:49

I mean, I think it’s. so for the EQ is emotional intelligence. I mean, that’s really what we’re doing the whole time is, a lot of it is reading body language, which was kind of tough during the pandemic, when we went all remote because all you see from a person or a client is basically their neck or shoulders up, and you’re missing so much other information that you’d be receiving. So yes, we have all this training all these different methods and theories and techniques. And you really have to be able like to be in touch with your intuition and read body language and be able to feel what someone is experiencing or going through, and how that may not be congruent to what they’re saying. So like someone might be telling a horrible traumatic story in their life, and they’re smiling and laughing. And so I take a moment to pause like did you notice that this is what your body’s doing as you’re sharing this? And so it is like every I feel like all of this issue with all the sessions are situational for us to be able to like shift gears, because yes, we have a treatment plan and there’s techniques and there’s things that we want to do but you can’t prioritize I don’t know, for me at least I can’t prioritize this structure over what’s happening right now in this moment with this person in front of me. What do you think Emily?

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Emily Shaw  55:09

Yeah, exactly. It’s, I would say, at this point I rely more on, like, rely a lot on my experience in terms of like, what patients are going to respond to, from my sense of what they’re like. So I find like learning about the world. And like, when you’re seeing something like that through a child’s eyes, it’s like you’re getting to see it again, for the first time. That’s like, that’s something that I’m really excited about. There’s so many cool things about our roles. And as an adult, even especially, like, I’ve had periods of time where I’ve worked a lot and gotten really, like, you know, forgetting to stop and smell the roses. So I feel like having a kid makes you be so present in the moment. It just forces you to be like, no, like, this is what’s around us right now. And this is what we’re going to talk about and notice and engage with. So I’m excited to [muffled]

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Kira Yakubov  55:57

Aww

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Emily Shaw  55:58

yeah,

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Kira Yakubov  55:59

I love that

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Daniela Galdi  55:59

me too. that was beautiful. Like, can I come. hang out together?

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Emily Shaw  56:04

go camping with us

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Daniela Galdi  56:04

Yeah. [muffled]

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Kira Yakubov  56:10

I think we can kind of start to wrap it up. Emily thank you so much for being on today. It was a blast. I’m glad you were able to join us and I hope you can come on to future episodes. Yeah, anytime. It’s just so great. Thank you so much for having me.

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Daniela Galdi  56:23

And we’re going to make sure that you can connect with Emily in our show notes. There will be a link to to get in touch with her but we will see you in two weeks. Thanks everyone for listening.

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Kira Yakubov  56:39

Bye

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