Medical Mimics in Counseling

Camille McDaniel (00:01.644)
Welcome back to another episode It is wonderful to have you whether you’ve been here for the journey or whether you are new to the podcast It is great to have you here. So, you know last week we were talking about Ethics in podcasting ethics surrounding video podcasting so just a lot of good information for clinicians who might be in that field already not field as in Korea necessarily, but I mean

you know, doing that already. And for those who want to, and I think this week’s topic is also going to be important as well, and give some things for us to think about and how we might want to implement such things because we’re going to be talking about medical mimics. And so you might be thinking, okay, what is a medical mimic? And I’m pretty sure that there are

Many of you who are familiar with what a medical mimic is, even if that’s not the term that you would use for it, but simply put, it’s when a physiological issue shows up in the counseling space and presents itself as though it’s a psychological issue. And that can cause people to obviously be misdiagnosed and mistreated.

for something that really has a biological root. I actually was kind of just looking into like, is there research on that? And I was on the NIH website, just kind of combing through some of their articles. And they do have some articles that are just talking about basically medical mimics and researchers and I guess different individuals in the mental health spaces have taken a look at just based on the number of people. I was thinking about a particular article.

based on the number of people who had been admitted to the psychiatric hospital, how many of those individuals had a biological or physiological, same thing, issue that was really going on that was at the root of the psychological symptoms that were popping up. I will link in the notes on the website, I will link that NIH article.

Camille McDaniel (02:28.234)
but they were they were saying 12 % of those admitted actually had a physiological issue at the root of the symptoms that we’re presenting. And I’m thinking like you know 12 % sounds small but 12 % of hundred thousand is actually a lot of people. mean 12,000 people is is no small thing and we know that there are more than just a hundred thousand people who are admitted.

to a psychiatric hospital in the span of one year. So it’s something for us to really think about. And I know for myself, when I think about my graduate studies, I didn’t get this. So I know in our graduate studies, we did talk about the body and there were certain parts of our experience, I guess, in graduate school that discussed like,

the biological aspects of psychological disorders, but I did not get training on the biological aspects of different illnesses, diseases that then present themselves as psychological disorders, such that if you recognize these symptoms and you are able to kind of catch the red flags,

then you could possibly be able to recommend that your client speak to their medical provider for a check-in and further checking into those symptoms. That’s not something that I got. That is not something I got. And I don’t know why, when I think about it now, I don’t know why we don’t get that. And how many people may we be treating that we just thought

I guess, know, it’s just resistant to this particular treatment model. It’s just resistant to, you know, what I’m doing. so therefore there might be something going along where their body is just not allowing them to move forward from these physiological issues. When really it actually could be something different altogether that’s showing up in our counseling room.

Camille McDaniel (04:53.356)
So I don’t think this is something that we should be skipping over as far as our trainings and as far as our graduate studies, but here we are. So this episode, let’s talk a little bit about this. We’re going to kind of talk a little bit more about medical mimics and how it might show up in our counseling practice.

The majority of us do not have medical backgrounds. I know some might, like when we did the summit just a week or so ago, there were some attendees who actually were registered nurses, but the majority of mental health professionals usually don’t also have medical training in that way. The majority of us aren’t also, you know, nurses and doctors.

but usually we are just like, you know, trained as it relates to mental health, mind, emotions, and that’s the training that we continue to get moving forward. So this is going to be something that’s not about, it’s not about turning us into doctors. I mean, there’s no way one, you know, one training, one episode, that’s obviously not gonna do it, but.

we are going to be able to recognize it. We should be able to just recognize when things don’t add up. And as Christian counselors, we are already bringing together two of the things that the Lord has created. We are bringing together mind and spirit into our practices. And we’re kind of leaving body over there in the corner by its lonesome.

And so we want to kind of talk about bringing body on over into the picture and what it looks like to really incorporate an understanding of how the body might be reacting and therefore giving us some false positives when it comes to our mental state and our emotions. So.

Camille McDaniel (07:14.082)
you know, we’re gonna kind of dive in a little bit more today, right? Because we’ve heard about a lot of things like what might look like depression or what might look like anxiety or, you know, when we talk about like depression, like everybody has probably heard, you know, low iron levels, low vitamin D and, you know, too much caffeine can, you know, give you symptoms that look like anxiety.

but let’s go a little further, just a little further in the time that we have today. And then I want to just share with you that there is a training available should you feel like, I think I probably need to maybe kind of dive in a little bit more and get a better foundation or get a complete framework for what’s going on. So.

Okay, imagine with me and none of these are real people. These are all examples, although I have definitely a mind full of real incidents that have occurred over the years. And some of it has been trial by error, you know, that I have found that there was this physiological component. And sometimes I wonder how many people did I not see?

their red flags and I didn’t necessarily bring in the physiological as much because I am psychologically trained and I was on the psychological train and may have left body in the corner. So picture this with me. All right, so you’re working with someone, let’s just say, who is coming to see you. They seem to be extremely

depressed and you determine this because they’re you know, they’re experiencing increased fatigue They’re maybe even gaining weight all of a sudden and they can’t seem to focus and you know therapy just doesn’t seem to be helping them and so you might imagine that maybe they just have resistant treatment resistant depression Maybe you even switched modalities to try to help them and still nothing is getting better

Camille McDaniel (09:36.768)
And so you think, my goodness, we just have to work a little harder. Maybe we need to give a referral for some psychotropic medication. And then we can continue to work on this and try to help improve. But had you thought about talking to them about a medical referral, not necessarily psychiatry right away, but a medical referral for their primary care or

a different type of physician for them to actually get checked out. Okay. And if you had not, do you have anyone in mind now that you think, hmm, I might need to maybe have a discussion after maybe hearing more about this episode, you know? It’s like, hmm, then I might not, I might need to do that, right? Okay, so imagine then, again, like we said, it’s starting to look like treatment resistant depression.

because you all have really been working on this over time. You really have been even trying different modalities to see if like, you know, maybe another one might assist that you are well aware is usually quite helpful and successful in the treatment of depression and nothing’s working and even medication is really not working that well.

Now, when you actually do bring in the body, let’s imagine that you give a referral and find out all along it was a thyroid issue. Because did you know that a thyroid issue can actually mimic depression? Yeah, it can for those who didn’t know that. And it would be called hypothyroidism. And that’s when

your thyroid is not working well. It’s under active. It’s going too slow, which that thyroid, my goodness, the thyroid does so many things, but the thyroid being under active can then cause your body functions to slow way down. Metabolism slow way down. Messages to the brain slow way down.

Camille McDaniel (11:54.786)
And so you might actually notice that when you refer out and refer them to their medical professional, testing could show that. Now I’m not saying that everybody who shows up with treatment resistant depression, it definitely has this. I’m just giving an example because obviously when we talk to our clients, we can’t tell them, it might be this or it might be that. We can’t do that. Now that’s…

going outside of our scope of practice. But what we can do is we can say, you know, this might be medically related, and I would like for us to at least rule this out and then kind of, you know, go from there. Same thing with, again, let’s pretend you have a client in your room and they are coming to you and they are experiencing extreme panic attacks, right?

And they themselves are convinced that this is just anxiety. I am coming to you. I only want to talk about my symptoms with anxiety. I want to get rid of this panic. I need you to help me. But you continue to work together. And again, nothing seems to be helping. They’re still struggling. They’re like that. I don’t know what it is, but that didn’t work. And again.

let’s say after having tried everything that you could try, you say, okay, let’s pause here. Let’s just rule out any kind of medical challenge going on. And they come back and let’s say their physicians did find something. What could it be? Well, you know what? It could have been, and obviously we’re not.

hoping this for anybody. We’re not really actually hoping to find necessarily that there is a medical issue, but in us just doing our proper due diligence with our treatment planning, we just want to keep aware that this could be an issue. And let’s say they come back and they actually had like a heart issue that was then causing some irregular beat that was then impacting some internal

Camille McDaniel (14:13.938)
biological functions that was then giving off symptoms of anxiety. And so this can still be very helpful for us in the mental health field because we can still be working to support our clients, providing some psychoeducation about what they are experiencing and how it might show up in their day to day, helping them to recognize red flags and what to do as they move forward.

Okay, last example. Let’s imagine that we are working with a teenager and we’re working with this teenager. This teenager appears to be super irritable and they can’t focus on their schoolwork and they’re having some challenges with, you know, forgetting and it’s really causing a lot of problems at home because their parents’ expectations of what they are going to do

during the school day and how they’re going to produce as it becomes or as it comes relates to, can I get that word out? No. As it relates to their grades is totally different than what their teenager is producing. And that’s causing a lot of challenges, right? So you’re working with them, you’re working with them and everyone is like, hey, this probably is ADHD, this looks like ADHD. Then as you are moving forward with your referrals,

You give your proper referral so that they can get an assessment to see if it is in fact ADHD, or if you yourself are a provider who provides those types of evaluations, then you can do that yourself. And also recommend that they rule out any possible physiological route and ask them if they could speak to their physician just to rule out with proper blood work to see if anything is going on.

because it could show something is in fact going on that might impact attention, focus, memory, and that could be giving off symptoms that then are looking like ADHD. So we wanna just kind of stay on top of this. Like for example, let’s say what it is is an iron deficiency. An iron deficiency in some cases can produce results

Camille McDaniel (16:40.066)
that look like forgetfulness and fuzzy mindedness and not trying, not being able to focus and pay attention. Sometimes it can also result in seeming like your mood is fluctuating really low and unmotivated. But you know what? Iron is responsible for bringing oxygen all over the body and to the brain and all of that good stuff. so,

When you have a deficiency in iron or your body has an inability to hold on to it, then it is going to give off symptoms that may look like mental health challenges. And if we are able to at least get them to be open to talking to their medical provider, then maybe we might be able to just see if there is some physiological aspect going on. And if it’s not,

Wonderful, we will continue to do the work that we’re doing in session with them But if it is now we can incorporate that understanding into the work that we are doing with them and we can continue to give them strategies and tools as They are working with their medical provider in order to take care of the issue That has shown up and while they’re taking care of the issue that’s shown up

we can on the other hand be able to work with them so that they can have some tools in order to continue to move forward in positive ways. But you see now, like with these examples, how it could be beneficial to take the extra step at identifying certain things that seem to still be present no matter what form of treatment we are providing our clients. So it matters a lot, right? It’s important.

There are a few reasons and kind of let’s even talk about this. Like why, again, why is this important? Yes, I understand these medical mimics, but, you know, and I already have a lot of things I’m doing with my clients. Do I really want to be, do I really have capacity to expand myself in this way? And I think you do. Yeah, I absolutely think that you do.

Camille McDaniel (19:01.334)
And I know that some might be like, well, you’re putting a whole lot of trust in what I can do. But I think that you can because it really is actually not a big extra step to just identify that there are certain symptoms, excuse me, certain symptoms that your client is showing up with, that they’re talking about, or that you are actually witnessing yourself. And it cannot be explained all the way.

by the treatment modalities you’re using or the psychological referrals that you’re giving. All of this can help us as clinicians in the field to build trust with our client, its ethical practice. Starting with the trust building, mean, our clients, they’re coming to us for help. They don’t know always what could possibly be contributing to it, but they know for sure

They don’t want to experience it anymore. And if we don’t recognize when there could be something that is a medical component that’s at play here and what we’re doing, we might unintentionally just keep our clients stuck in the symptoms that they’re experiencing. And I think it’s also when we take a look at different codes of ethics, it is ethically clear that

We want to stay within our scope of practice. So if there is something that’s going on and we feel like, this seems to be going outside of just mental health care, then we want to be able to acknowledge it, communicate it to our clients. We want to be able to then give them proper referrals so that they can get all of the care that they need. So what we are really bringing into, I think, as we’re

you know, conversing about all of this, we’re really talking about a much more integrated approach instead of every different discipline operating on its own. So that mental health operates on its own, on its own road, and medical operates on its own and on its own road, and the two never wave or have conversations or any of that.

Camille McDaniel (21:26.978)
And I just, that’s just not going to be the best approach overall. It’s just not holistic. And when people come into your office, they’re coming as one human being, or when they’re showing up on the telehealth session, they’re showing up one human being. They’re not just showing up mind and body and spirit, or excuse me, they’re not just showing up mind and spirit. You know, they’re showing up mind, body and spirit. And we want to be able to find ways to address all of it.

So, you know, giving just the ability for us to incorporate all parts that the Lord has made and not just a couple for the best interest of our profession and the way we do things in our profession and for the best interest of the clients that we serve. So, you know, we don’t want to only work with certain parts and not others.

So, you know, a couple of things that I’ve mentioned today, I think are things for us to kind of think about because it goes way farther than that. Like I said, there’s some that we know of, we’ve heard of a lot, know, caffeine can, an increase or an overuse, I should say, of caffeine can cause anxiety-like symptoms. I have definitely had those discussions in my practice.

with those who I serve just to find out how much caffeine they are intaking. So this kind of helps with conversations around some of the symptoms that they might be having. Another thing that, you know, I have conversations, I’ve had conversations around just asking, you know, when they have actually last seen their medical professional and.

And if they had any blood work done and if they remember the results of the test just to see if anything has come up. And again, because it is a mental health session, I understand clients aren’t coming just to only talk about medical unless you are working with those who are chronically ill. Those conversations may actually come up much more than someone who is not struggling in that way. But you wanna be thinking about this.

Camille McDaniel (23:51.99)
Other examples might be those clients who are coming who might be postpartum. You know, after just delivering a baby, what do we have going on? A lot of hormonal changes. How long might those hormonal changes and those biological changes like just literally within your organs and things, how long might that last? It could be like a year. You know, I mean, we want to keep this in mind because these things are going to be running concurrent to what we are doing in our counseling practice.

And so we’re having to hold space for definitely what we’re doing as far as mental health. And then we’re having a whole space to just watch out for anything that might be popping up that could be related to a medical issue like hormonal imbalance. You know, I know in my practice, I’ve seen hormonal imbalances that have not gone noticed. And once noticed,

the amount of relief that the client experienced, the amount of change it did to their overall mental health, it’s just like amazing. you know, so we wanna just keep that in the back of our mind. Another one that I think is amazing also is what sleep apnea or even, you know, other types of.

sleep deprivation because it doesn’t always have to be sleep apnea. It could be insomnia. You know, there could be some things related to chronic pain and illness, but whatever it is, it’s depriving the body of sleep. And it’s just wild to see how that can actually give off symptoms of psychosis sometimes. If you’ve ever looked at research to see like what the results were when someone was deprived of sleep for long periods of time, even days and

you know, how long essentially the human body can go without sleep and then start to look at some of the results that they recorded from different human beings that were in the study. And it does look like psychosis. People were losing it because their bodies were literally breaking down. Sleep is a major component of what we need in order to survive. So you can actually go off of lack of sleep for a little bit.

Camille McDaniel (26:11.8)
but then it’s gonna start impacting your reaction time. It’s gonna start impacting your memory retention, your ability to focus. It’s gonna like impact your mood, like irritability and crankiness and all of that. I mean, it just actually does a lot. And then it pulls on systems within your body that are biological, like it pulls on your heart to have to do more work. And there’s a lot that goes into just not getting proper rest.

that can bleed all over into mental health spaces, medical spaces. And so again, these are just things we just wanna watch out. And that’s why I just wanna talk to you about that today because I’m like, wait a minute, we could definitely add this to what we are doing regularly and we can serve our profession and our clients even better than we are now. Yeah. So.

And that’s why I want you to kind of think about, you know, just for yourself, could, how could this apply to the clients that you serve? Like, do you now see in your mind a client that maybe this would apply to? Do you have a client where you’re like, you know what? I think I’m gonna go back and just double check with this client. I oftentimes talk with my clients about the three basics.

Sometimes when I get stuck I go right back to the three basics and I say okay Let me just really quick check in with you and make sure I understand where these are and then we’ll go ahead and move forward and the three basics are sleep nutrition and hydration we already talked about why why sleep why we need to know where they’re at with their sleep habits and And then nutrition. Hey, how’s that going? You know

I’ve had experiences where you had adults whose appetite for whatever reason, for a multitude of reasons, had like dropped down to like that of maybe a two year old. And well, obviously that’s not gonna sustain an adult body. I mean, it can take like 600 calories just to breathe. Yeah, look that up. Okay, so, you know, there are gonna be then significant issues.

Camille McDaniel (28:27.958)
that can result from just having a very low caloric intake. And so just making the client aware that, while we are dealing with extreme fatigue and while we are dealing with lack of motivation and just not knowing what’s going on because you’ve been this way for a while, I do want to just help you understand how lack of calories then

can impact and look like mental health challenges, and they’re now overlapping. So you may actually find that you genuinely do also struggle with depressed mood, but you also struggle with poor nutrition. And sometimes it can be that because of a depressed mood, the person loses their appetite. But it can also be that the person is struggling with something

that is taking their appetite away that is biological in nature and then that is causing their systems to be depressed because their body doesn’t have enough calories to actually function properly. So again, see how all of this is like intertwined? See why I’m like, man, I wish I had some training on this a long time ago. This would definitely have caused me to go into the session.

maybe asking some different questions. I absolutely cover that on my intake. I mean, I’ve always asked about any medical issues during the intake. I think along the way though, I added asking how well the person was eating and what that looked like and what their diet was like. And that actually gave me a lot of insight over the years into some things that could be kind of bleeding over into the…

mental health space in the mental health room. And then hydration. mean, we’re mostly, we have a good portion of our body that is made up of water. Can you imagine if you then are depleting your water stores because you’re just not getting any? And what that might do that, you know, again, so we want to just know the basics and then there’s additional things that might pop up that we can get clarity on. So as you, as we’re talking about this,

Camille McDaniel (30:48.846)
Be thinking about like your own clients as you go on through your day. And if you happen to be a graduate student and you are, you know, about to enter into internship, then this is a perfect time to be thinking about this actually and starting to just incorporate this because this is really an integrated approach. I know that for some people when they think holistic care, they…

They think like, that’s all woo woo and everything. And it’s like, no, this is just saying that I am acknowledging that you are mine body and spirit. And I am going to be aware, even though I am trained for the mind and emotions, I am going to have some awareness of how the body actually might play a part in what I’m seeing with regards to your mind. I remember even talking to

there’s a doctor’s office next to my practice now. And I remember going in when I did talk to the nurse practitioner who was really nice and kind of like one day explained several tests that they run in order to help determine certain symptoms that we might see that seem psychological in nature. And I was saying to them, I said, know, for example, I said, you know, hyperthyroidism.

could look like anxiety, hypothyroidism could look like depression. And they were like, really? okay. And so they didn’t, that particular medical professional didn’t even know. know, they don’t also, they don’t get a lot of cross-training or anything like that. So, you know, even for them, that could be helpful if they have somebody who has hyperthyroidism and they’re aware.

they might even be able to give just a little small education on how it might show up and impact their mood or impact how they’re feeling, just so that clients don’t go into the dark just wondering what the heck is happening to me. So that’s why we start these discussions. That’s why we talk about it. So you don’t have to necessarily move forward and jump right in to say, OK.

Camille McDaniel (32:58.668)
I need to have this medical professional training. It’s like, well, you don’t have to try to seek to be a medical professional, but you can absolutely get training that will give you a good foundation. And I want to wrap up and just share that with you. So this training that I am going to offer is going to be through my counseling practice. So it’s going to be on the counseling practice website.

which I will definitely be sharing the information on the website in the newsletter. Like you’ll be able to get it. It’s going to be over there on healingpsychotherapyga.com. That’s healingpsychotherapyga.com. And you will see like wellness programs on the website and you just click and you will see where you can actually.

sign up for the training. So there are two trainings available. There’s the the essentials and essential foundations and then there’s going to be the complete framework. So that way if somebody wants like the one hour training which is going to be online they can get that. When I did a survey just to see what people wanted, some people were fine with just an online program that they could do at any time at their own pace.

And then some people actually wanted it live. So the complete framework I will make available for that to be a live training. And then like the recording people can also get if they just want a recording. And I’ll have more information about that when you sign up. You’ll get more information about it and what’s to come. The Essential Foundation is going to be released like today, I believe, as you are listening to this.

And then the complete framework will be made available in October. So yeah, absolutely going to be necessary and needed for us to just start incorporating a more integrated framework in what we are offering our clients and how we are just kind of upping our game as professionals. I hope this got you thinking.

Camille McDaniel (35:11.23)
And hopefully this is something you can then even start looking for, just looking and listening a little differently in your sessions as you move forward. Until next time, I hope that your day is prosperous and God bless.