What should I expect from DH's GP visit to talk about stress?

[Mydelilah]

Hi all

Not sure if I should post here or MH. My DH has been struggling to cope with stress and getting more and more depressed for some time (about 2 years i think, much worse in the last 6 months). He's not sleeping, has become very withdrawn from me and DC, and just is not able to engage/ enjoy anything at all in life. Root issues we think are partly a horrible, pressurised and stressful job with management that is unreasonable to say the least, bordering on bullying; and we also have financial difficulties which are weighing him down. Generally life can be difficult to manage with 2 DC and both of us working FT.

DH now agrees he's not really coping, small issues become huge in his mind and he cant reliativise/ work out how to manage simple issues. He agreed he needs some help, he asked me to make him an appointment with GP which I have done. He's going Monday.

Can anyone offer any advice, what should he expect from the GP? He's petrified of being signed off work as he feels his credibility at work will be damaged/career over (not necessarily rational but he works in a very competitive industry so I understand his concern). How can I help him prepare for the appointment/what he needs to communicate to the Dr?

Sorry, long, thank you for reading.

He needs to try and be as honest and open as he can; not down-play things, not try and justify or diagnose anything: some people do. They come in saying 'I am depressed' which the might be, but it is much more helpful if they describe what they feel, for instance low in mood, not sleeping, trouble concentrating, being unable to enjoy things they used to enjoy, poor memory, heart racing, 'churning' stomach, dreading work, feeling tearful, overeating/not eating etc etc (in no particular order).

A GP should sign him off if he is not fit for work or if, after discussion, time off work might be beneficial. It is common practice to write something vague on a medical certificate in order to be discrete ie 'debility' which does not really mean anything.
He might benefit from time off work to get a chance to reflect and regroup. It can be helpful to issue a certificate that states 'Stress At Work' which will help to make an employer take note of the problems.
If he works for a large employer, good occupational health structures may be in place which could actually be helpful to him.

What is he hoping the doctor can do for him, what are his expectations? Medication is very rarely helpful for stress, and is only for very short-term relief of symptoms. If stress is the underlying problem, then the situation causing the stress needs to be addressed. If, OTOH, he is actually depressend, then treating depression can help with that. In principal and summarised very generally, options are medication or talking therapy of some kind or both.

It may help if he writes down what he wants to say, if for no other reason that it forces him to clarify to himself what he needs/wants to say. The key thing IMO and IME (I am a GP btw) is that he is honest and able to articulate what is ailing him.
I don't think that there is much you can actively do for him to prepare for his appointment (other than asking the Wisdom of MN of course!), but being supportive of him is great and will helpful.

Ultimately, he has to tackle this himself and possibly make changes if that is what it comes down to.

Good luck.

It is so good that he is going. It is great that you are being supportive. Are you going with him into the appointment? Don't have advice about whether or not to, just something to consider.

I would recommend that he at least consider asking for (or be ready for a suggestion of) CBT. My husband had it and I think it suited him as a man. It doesn't involve going into childhood issues, necessarily, which might put him off, and it isn't about talking endlessly about how you feel. It is about recognising thought patterns like 'If I say no to my boss I will get sacked and then my children will starve' and finding better ways to frame issues.

Medication can help too, of course, although I don't know much about it.

Do suggest he write things down beforehand, as suggested.

Really hope the GP is a good one.

Thank you to both of you for your responses - really helpful indeed and much appreciated. I very much take on board Pacific's comment about not delivering a self-diagnosis but focussing on communicating his problems/ ailments. DH and I just talked through and he is pulling together in his mind a clear view on what he needs to communicate at the appointment.

Following your responses we are clear - he is not looking for a sick note, he seeking help to cope with work, not to avoid it, and I hope if he can get on a more even keel, he may have the confidence to look for a better job...

Building - I'm not sure what CBT is - counselling by telephone? I've heard this can be offered as the NHS solution. He can go privately on company health insurance, and DH thinks talking through things with someone other than me (I definitely have my limitations!) would be helpful. I'm so impressed with how engaged he is with all the options to make things better for himself and our family, it feels he has turned a corner just agreeing to look for help.

Thanks again - love the wisdom of MN!

I think it's Cognitive Behavioural Therapy. Not sure what it is though

When I went to my GP I wrote it all down so, when I became upset, I just handed it over.

I hope it goes well for him

Thanks addicted. I would never have guessed cognitive behavioural therapy (shows how little I know!). Off to google

Take a spare piece of paper to jot things down as well - I never remember otherwise all that was said.

Mind has a reasonable description of the different types of therapy including CBT here
Another possibly helpful site about therapy if you're new to the world and the lingo! http://www.itsgoodtotalk.org.uk
If he can go privately on company health insurance that is really great news, as it means skipping potentially long waiting lists. If I were you I'd have a leaf through the company health insurance policy to find out exactly what's covered, how referrals work, what choice he gets of provider etc.- maybe you have done this already.
I hope it goes well for you.

CBT is very much a practical approach to help with mental wellbeing, so NOT psychotherapy, does not involved looking at childhood trauma or what relationship somebody might have had with their parents or whatever.
Very much challenging negative thinking "Oh this task is hard, I am hopeless, I'll cock it up, I'll get fired, we'll all end up destitue and my teenaged DD will end up prostituing herself for the family's sake when it is MY job to provide for us" rather than "Oh this taks is hard, let's see how to tackle it, I know how to organise this/break it in smaller tasks/ask for help and I have done difficult things before. It'll be hard but fine" (I am exaggerating, but you catch my drift).
It means that he'll just approach things differently rather than doing it dfferently necessarily (although learning to say 'no' and how to delegate and good time management all help too of course).

Absolutely take advantage of anything the company can provide to help him though this. He is more valuable to his employer when firing off all cylinders rather than when at the brink of collapse with stress, so it is in his employer's interest to support him.

This may give him an idea
This is a site that links to lots of other sites

Online self-help does not replace speaking to a person face-to-face (much as our health care managers would like us to believe ) but it's a start.

Not wanting to go off topic here but it's a bit of a myth that CBT doesn't involve talking about childhood trauma and attachment-actually it can be very much about doing that if necessary -dependent on the problem. A full CBT treatment will involve that including a formulation of the development of the problem-beliefs about self and world developed in childhood etc. A guided self help treatment using CBT techniques will not go into early life experiences but is also not suitable for chronic or complex problems.

Fair points, away, I should have said childhood etc is not necessarily the focus of CBT like it can be for some other forms of therapy.

Thanks for the links. This looks really good - DH self esteem is at an all time low and this kind of 'break the negative thinking' approach looks really good. (Also understand the 'as a man' comment from Building now!)

Health insurance is a company benefit where he pays a bit each month from salary and company pays the rest and he has some level of private cover for referrals from GP to specialists etc. We've paid it for years but never actually used it - no doubt it is capped/caveated but on my to do list tomorrow to give them a call and check.

Just showed DH your links Pacific and Domestic, and he thinks it looks good. All positive.

Thanks!

About 10 years ago I was in a similar situation to your dh. I was burned out with stress from work.

When I went to see the GP, we talked about how I felt and how stress and depression are two sides of the same coin. We talked about me getting counselling through work (which I did), about ways of finding good coping strategies (eg exercise, relaxation, making time for myself), also about anti-depressants (which I absolutely refused, something I regret in hindsight)

DH came with me, which I found helpful (although I can see it might not be for others, there might be things your dh wants to say that he will find hard to say in front of you - this is no reflection on you btw) If you do go, don't be surprised if the GP asks to speak to your dh alone as well (this is routine)

My GP was lovely and saw me every couple of weeks until I felt better.
The counselling was really good at helping me reframe things.
I did need some time off work though. Your dh can self-certify for up to a week, would that be more palatable to him?

To save time in the appointment he could fill in a form called a PHQ9 (I think its on Patient.co.uk) which is a depression scoring tool the NHS use for diagnosis. He may not be depressed of course but its something the GP will want to rule out.

I just want to thank all of you for taking time to respond - feel much more prepared to make sure DH gets help he needs now.