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Category Archives: Mental Illness
Paraphrased questions from some comments on this Captain Awkward post about green flags for a good therapist:
“Why do advice columnists (like Captain Awkward) keep recommending therapy? Isn’t there anything I can do for myself?
To find a therapist and keep going to one I think I’d have to be really desperate.
In my country/community, therapy is difficult to access! Maybe there’s only one therapist and he’s Freudian or there’s huge stigma or my insurance doesn’t cover it.
Isn’t there anything I can do on my own?”
There are things you can do on your own, and it can be difficult to audition therapists. I totally get all that. I finally got my therapeutic relationship many years after I would have used it because of those difficulties in finding a good therapist, and, I did a heck of a lot on my own.
Also I wonder what kind of therapist would have been good for me when I was younger; I don’t think I would have clicked with my current wonderful pro, because I came to her after I had a few major epiphanies.
You can do an awful lot on your own. But it can be easier and a whole lot more efficient when your work is guided by someone who knows what they’re doing. Also, and this is a big one for me, having to go to an appointment and talk to someone held me accountable for doing the work I needed to do. Sometimes, my therapist has been a reality check, helping me keep grounded and not get caught up in what I hope from a situation.
A therapeutic relationship is also a tool for growing and improving in deliberate ways, and not just fixing broken things, although it is an expensive hobby.
At times I have found it quite liberating to be paying this person, because when I felt BIG FEELINGS but also felt like I didn’t matter, well damnit, I was this PERSON’S JOB. For an hour a week, this person was professionally obligated to give a damn. That let me be safe to be as petty as I needed to be in that moment.
Paying a professional also means I don’t have to tend to their feelings. Their feelings and reactions are their business and I don’t have to worry about them. If they need help dealing with them, they go get their own therapists! So I don’t have to do the emotional work of managing the relationship. I do some work to maintain a connection, because that’s part of how therapy works, but it’s all for my benefit.
Finally, a quick demonstration of the differences you might see between how different people handle a trying emotional moment, to show how a therapeutic relationship can be awesome.
I am crying hysterically. Everything feels terrible, like the world is imploding. I cannot coherently explain why I feel this way; it’s sheer emotional pain. I can’t breathe, my head is filling with goo, I’m bringing on a migraine.
Here are some scenarios, drawn from life, about what can happen next.
Several hours pass. Eventually, I slow down the hysteria, but I feel scrubbed raw and miserable. Anything can set me off. I go to bed. It happens again tomorrow, and the day after. On the third day, it happens half an hour before I need to leave for a doctor’s appointment. I’m sick of it all, this has been happening on and off for years. With the grand realization of “well I’m not going to be any less miserable at the doctor’s than I am here”, I say FUCK IT and go.
I am depressed and miserable but less hysterical. The process of “well I’ll be just as miserable there as here, so FUCK IT” is a critical healing step out of deep depression, but as a coping mechanism keeps me operating at a level of miserable and FUCK IT.
Me with friend:
Friend brings me tissues for my tears and the goo filling my head. My friend who cares for me is feeling very distressed themselves; they have no idea how this started, and they feel helpless. I’m not able to communicate so my friend has to do whatever they feel is right in this situation. Hug? Tea? There-there? My closest and most empathetic friends feel less at a loss, but also feel more of their own suffering.
I can’t help but notice their distress as well, and because of the way I am, it tends to shut off the hysterical crying. But the emotions behind it are still there, undealt with. My friend is uncomfortable and really wants to help but has no tools for this. We try to talk about it sometimes but it’s hard because I don’t have good words for it and if we get anywhere near the core of my problems, I start getting hysterical again. I feel guilty about laying this burden on my friend and try to keep the worst of it away from them. They feel helpless and frustrated and sad, but they cannot fix me.
I go home and feel more alone.
In the very best of empathetic moments, my best friend made space for me to cry whenever I needed to, and just held me. It was hard for her. During that part of our relationship, she took on almost a maternal role of taking care of me. It was a weird and strange dynamic that most friendships, I think, could not bear.
The best a friend can do is hug you and make reassuring noises, I think, but I found that most friends are really bad at doing so.
Me with therapist:
As I cry, my therapist is paying attention to nothing but me. She has seen it before and is not shocked or distressed, but she is compassionate. She does not come over to me or touch me but she does make sure I have tissues and water.
She has been taking notes and working with me so she has some ideas about my suffering. She has knowledge and experience with people with my particular issues. She says something that validates my current emotional state as real and important. I feel that moment of Somebody Gets It! and react with convulsive nodding and more tears, because it hurts so much and here I am safe to let it out. My therapist says more things that validate and support me, helping me feel connected.
I stop crying in ten or fifteen minutes. I’m drained and tired but in a good way. My therapist watches me to see how I am and where I am going, and asks how I’m feeling now. We talk a little bit about what just happened and where it might have come from.
I leave my appointment a little shaky but hopeful.
These examples are all about hysterical crying but I think the same goes for figuring out emotional stuff, too. You can do a lot on your own, you can learn a lot on your own, but you only have as many resources and as much knowledge as you have. When you are suffering or in need, you’re already straining your resources, and you have less kindness to give yourself.
Your friends have less experience about helping people, you have mutual two-way relationships with them that you must tend and not strain, and in the end they care about you a lot and have something of themselves invested in you. They can’t see you clearly, and they may have something of their own ego invested in your own behavior. The changes you need to make to be healthy may not be changes that they want you to make, or they’d be changes that threaten them. Or the work to make the changes may be just more than they can handle.
Your therapist has no friendship on the line. Hopefully their ego is not bound up in keeping you from changing. They have resources and knowledge and the skill to get more when you’re not in their office (a good therapist will go research things you bring up that they are unfamiliar with. They will also consult with other therapists for ideas about ways to help you).
Your therapist is getting their emotional needs met elsewhere, so your relationship with them can be All About You.
So yeah, you can do a lot on your own and with friends. A lot of people do. But a lot of people also endure unnecessary suffering.
Unfortunately, it can be hard to find a good therapist who fits you well, and a lot of people don’t know about how therapy works. Many people have bad experiences and talk about them LOUDLY.
Got to accept people where they are. Not everyone will benefit from therapy, not least because you won’t change until you’re ready to change. Pushing people into it is expensive and frustrating all around.
It’s helped me, though, once I finally started.