Therapy for trauma: more trouble than it's worth?

August 2, 2013 6:04 PM

I need to decide whether it's worth the trouble for me to go to therapy. I am fortunate to be able to afford it financially, but in terms of time and emotional energy, I am not so sure. Details inside.

I am a first-year medical student who just moved halfway across the country. I grew up in a somewhat dysfunctional and occasionally abusive but loving family. I was also fairly recently manipulated and sexually assaulted by a man who was in a position of trust to me. So, I definitely have a lot of things I would like to talk about.

However, I've been finding that after attending therapy, I'm completely debilitated for the next 8 to 24 hours-- all I do is sleep and cry. I feel so sad that I can barely breathe. Just yesterday, I excused myself from class even though we were working in a small group project and cried for half an hour in a secluded spot. I don't think I could go to therapy and still do well in school. My medical school is technically pass-fail, but with therapy, I might not even pass my classes, given how significantly I am affected by going to therapy each time, and the fact that I am still adjusting to medical school in general (we just started classes!). On top of that, I haven't found a therapist in my new town who I am completely enthusiastic about, and shopping around for therapists involves retelling the story each time, which is draining in itself.

In the past, counseling (concerning the same issue) went smoothly for me and I did not have the debilitating emotions following each session; I'm not completely sure why I'm suddenly experiencing these strong negative emotions now. When I don't think/talk about it, I am high-functioning. I might be mildly unhappy and withdrawn, but I'm still functional, responsible, amicable, and so on. I would be able to do well in my classes.

Is it possible that therapy is more trouble than it's worth for some people like me? So many people have told me to get myself to therapy for months. And yes, there are still things I want to process, but I simply don't know how to deal with the emotions in the hours following the therapy session. Part of me thinks that if I kept myself busy enough, eventually it would just fade away on its own-- I'm certainly better than I was a few months ago. If it makes a difference, for the most part I have healthy habits (eat healthy foods, don't smoke or drink, exercise daily), friends, and enriching hobbies like art, music, and journaling. That said, I also know that medical school can be stressful, that I'm in a new place far away from my friends and family. I am wary of the emotional issues coming back to haunt me once I get a bit more stressed in other areas of my life with classes and whatnot.

Thanks for your insight!

posted by gemutlichkeit to Health & Fitness (14 answers total)

"Therapy" is a big big big big big bunch of different things. You're kind of saying the same thing as "I just don't know if I can deal with doctors right now; every time I try I seem to get ridiculously sick."

It would help a ton if you could say which kind of therapy has affected you like this. There are a bunch of different types.

If you haven't already done it, I think you should consider doing a more solutions or cognitive or validation or acceptance kind of therapy, as opposed to one where you talk a lot about the past, etc.

Some would say that DBT (2) is especially suited to this kind of "emotional regulation" and "distress tolerance" type of stuff (the extreme reaction, feeling like you can't control or handle your emotions, etc.) I pretty much hated DBT more than anything I've ever tried, but it works wonders for people who aren't me, so.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:19 PM on August 2, 2013 [1 favorite]

I think of therapy as seeing a neutral professional who gives me the tools to be able to deal with issues when I can't deal with them on my own.

So for instance, after a bad abusive relationship, I wasn't functioning very well. My therapist was able to give me validation, because I wasn't thinking straight. Then she gave me some simple things to do, hobby, exercise, etc., as well as some insights.

There is the old school of thought that you need to dredge up every emotion and past event to get through it, and there are newer schools of thought that short-term therapy is fine and dandy.

It's up to you to decide whether or not to continue: if it's not serving you right now, and you are able to function, why put yourself through it? You can always go back if you feel like you need a therapy shot in the arm.

Maybe what you need is to tell the other well meaning people in your life that you're fine, thanks for asking.
posted by Marie Mon Dieu at 6:20 PM on August 2, 2013 [2 favorites]

Oh, and totally feel free to just skip the therapy for now or forever. It's 1000% your absolute right not to participate in any kind of therapy or a specific kind or a bunch of specific kinds - it doesn't mean you're hiding from your problems or in denial or resisting change or whatever. Not everyone wants it, not everyone needs it, and not everyone benefits from it (most sufficiently-professional therapists understand this.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:23 PM on August 2, 2013 [4 favorites]

Have you talked to your therapist about this? What do they say?
posted by rtha at 6:28 PM on August 2, 2013 [2 favorites]

Best answer: Med school is only going to get more stressful. Do you have a support system where you are now? I'm guessing no, since you just moved a significant distance. That's going to wear on you more in the next few months. If multiple people are telling you to "get therapy" your trauma must be affecting you severely enough to be obvious to people around you. I know the emotional investment is a lot, but it will be easier now than as a second- or third-year medical student. Just a little advice from someone who had to take time off in med school to get her head straight.

And, FWIW, feeling like crap after therapy means it's working.
posted by arrmatie at 6:48 PM on August 2, 2013 [1 favorite]

Can you change your schedule in such a way that your "flip out" time (what I call the 2 hrs immediately following my therapy sessions where I'm Captain Cries-A-Lot) doesn't overlap with your "working" time?
posted by spunweb at 7:35 PM on August 2, 2013

This may be stating the blazingly obvious, but can you schedule your sessions for a time when you know you won't have anything pressing for the next day? Late Friday afternoon, maybe?

I realize you're in med school and the prospect of "down time" seems nonexistent, but you can build this in. Set aside Friday nights and Saturday mornings as critical time for self-care and healing. Which yes, may hurt like a sonofabitch some of the time.

If you keep yourself busy enough it will fade away--but that doesn't mean *go away*. What that means is that the effects of the trauma that you have not worked through will continue to shape you and will manifest, probably in some troublesome ways, further on down the line. Not worth it. Not worth it.

It was absolutely, unequivocally wrong and completely unfair for that person you should have been able to trust to sexually assault you, and it is absolutely and completely unfair that you should have to bear the burden of healing from it as well. But an even worse situation yet would be to let it lie and have that and other abusive experiences from your past continue to influence your life, and probably not for the better.

I wonder how much of your increased emotionality is from the stress of starting med school? Like your defenses (which are probably really freaking strong, if you grew up in chaos and still have your act together enough to get into med school) are unusually low.

You may need to hear this too, from someone else who learned to be super freaking tough from a chaotic upbringing: it is OK to be weak. It is OK to need help. It is OK to be in a situation where you can't do it all yourself and you need someone else to be strong and help you. You don't have to shoulder the entire load alone. You deserve help, and down time, and nurturing and care. You are human and it is OK, necessary even, to have limits to how strong and capable you are. If you need to wade through the trauma and heal, do it. It's OK. It's OK.
posted by Sublimity at 7:39 PM on August 2, 2013 [4 favorites]

Therapy appears to be a bit of an American, "thing". Prior to joining this community, I'd absorbed enough American television to have made the connection, but I assumed it a bit of stereotype; now I realise it's legitimate - your obsession with therapy is virtually cultural. It's my perspective negative experiences occur within most peoples' lives - why immerse oneself in them for months or years on end, particularly if the experience is painful and results in tumultuous emotions and hindered functioning?
posted by Nibiru at 11:51 PM on August 2, 2013

So many people have told me to get myself to therapy for months.

This suggests to me that you haven't been doing as well as you think you are.

I have the same reaction to therapy as you - if you want to look through my history, you'll see that I've talked/asked about this in the past. Here's the thing. If just talking about yourself and your feelings makes you feel this way, you're probably not fine. I also think I got the most out of the therapy sessions that left me the most shredded. What I do think is important is to give yourself the opportunity to process this stuff properly. Therapy got MUCH MUCH better for me once I switched my session to the end of the day and didn't attempt to do work afterwards. If that means talking to your school's disability office about changing your class schedule or finding a therapist who works at the weekend or whatever, it's probably worth it. I assumed it would no way be possible for me to change my therapy session, and then I talked to my therapist about it and she was shocked I hadn't brought it up before. Thinking you've got to just cope with things and can't change them to suit your needs is as much a symptom as anything, I think.

I come from a culture where therapy and talking about your feelings are not as standard a thing as they are in the US, and what I worked out during therapy is that my culture's ways of dealing with strong feeling are shite and dont work for me. I do think that different cultures predispose people to different ways of experiencing trauma, but I don't think that a culture's own ways of treating emotional distress are always the best ways. I say this as someone who is a lot more OK with certain kinds of cultural relativism than most people.

I'd also say this: if you're going to be a doctor, there are a lot of side benefits you'll get from therapy - a more forgiving attitude, a gentler approach to weakness, less shame and more honesty - that will make you a better doctor. Even if you end up having to take time out or do your studying more slowly, I would rather have an emotionally healthy, open doctor than one who was hard and tough and went through life with an attitude where people had to just push on with things.

Stick with it. It gets better. I personally found that after a year and a bit (I know, I know, ages, right?) I found some therapy sessions bearable and could have, say, a normal conversation with a person after I'd had them. Some were still hard. But I got a lot out of the process. I like to think I got more out of it than people who breezed through and found it easy, because really those people weren't challenging themselves, and I think therapy has to be about challenging yourself. But maybe that's my old 'no pain no gain' attitude coming through, I don't know.
posted by Acheman at 2:20 AM on August 3, 2013 [6 favorites]

When going to therapy, I have found that it really only works if it is difficult. The post-session rollercoaster is your brain repairing itself, just like when you are sore the day(s) after going to the gym.

I would even say that if the therapy sessions are difficult like that, that it's a sign that you really do need the help. You are unbottling things that have been bottled up, or debugging your brain software and fixing the damage that you've routed around. One of the things that I found to be absolutely true and rarely discussed is that healing from past trauma is all about reliving the bad feelings in a different context and integrating those memories into your conscious self-history. Our natural tendency is to smash down the bad memories and try to forget that they happened. But that doesn't work long term. The memories ARE there, and every time you remember them, they remain powerful. The way to heal is to remember them in a controlled manner and remove their power.

But yes, you do need to schedule your sessions so that you have the quiet time you need to recover.
posted by gjc at 4:14 AM on August 3, 2013 [4 favorites]

Mod note: A couple of comments deleted. Reminder: please address the OP and try to answer the question; if you have a question for another commenter, you can Mefi mail or email them.
posted by taz (staff) at 4:31 AM on August 3, 2013

Therapy is great in situations such as yours: your closest support system is dysfunctional and occasionally abusive, you've been assaulted by another person you trusted, and you're halfway across the country, which I assume means you've also separated from other support networks (perhaps not entirely, thanks to the internet, but there's a big difference between physically present support and remote friends).

Indeed, as gjc mentions, for many schools of therapy (psychoanalysis for one), it's not just about "dredging up the past". For one, that's not what you're doing, not concretely, anyhow. The past was the past. The present, when in therapy, is in a context where you have chosen to entrust your past difficulties that are affecting your present, with someone you hope (eventually grow to know) is able to assist you in "digesting" them, so to speak, as an increasingly-aware adult. You are no longer a child subject to whims of parents you couldn't entirely understand at the time, and you are not in the relationship with the manipulative dipweed who sexually assaulted you. You are safe in the therapeutic context, and that safety, and the therapeutic relationship, are what make all the difference. Research bears out the same. Many therapists, I would say the good ones, are aware of all of this; it has its own term: the therapeutic frame (a great read at that link).

It would be nice if it were better known to patients, because it helps you better grasp just why it's important and totally normal (the therapist is prepared for this... unless they're not that good of a therapist, in which case you can change) to bring up the effect of the therapy, with your therapist. You can indeed ask your therapist the very same thing you've asked us here. They won't take it the wrong way, it's their job to see it in the context of your life, growth; your therapy.

As for your personal experiences, I've been there; I was raped while in university and could not function the first semester afterwards. I didn't have therapy, couldn't trust my family (tried to and they called me a whore for seducing the man and then blaming him... nice...), but, thankfully, was able to trust one of my professors, who helped me as she could, and a close friend. Still, I ended up needing to work through it in therapy several years later, which made a huge difference. I no longer have repetitive nightmares about it, for instance, or even anything related to that experience. I've "digested it", with great thanks to my therapist. So, I too would say that your very emotional reactions, show that this therapy is something that's actually helping you. It's much better to work it out now. It will help you have more energy and stability in the long run. If it is too overwhelming, really, bring it up with your therapist! You can work something out for a balance.
posted by fraula at 4:45 AM on August 3, 2013 [3 favorites]

I don't think you have to go to therapy. I don't think there's anything wrong with just keeping yourself too busy to think too much about your trauma. As long as you are not ignoring clearly dysfunctional consequences, there is nothing wrong with coping in a way that works for you.
posted by elizeh at 7:21 AM on August 3, 2013 [1 favorite]

Don't underestimate how rough starting med school can be, especially with the added stress of moving such a long distance. I did it, and I think it's taken a year and a half to settle (feel free to memail me).
I chose my therapist based on cost: $20-a-visit student therapists at the same university; I had about a dozen visits over the first year. I found it very helpful, mainly with dealing with dysfunctional family issues. I did feel fragile afterwards and so I had a routine of getting myself chocolate and having a quiet space to sit in for an hour or so.
Look up pass rates for your school: at mine, it's unlikely you'll fail if you're showing up to 90% of the scheduled sessions, and it's very easy to stress about how much work you should be doing. I take it you haven't had any assessment yet - this should give you a feel for how much you need to study.
posted by quercus23 at 10:35 PM on August 3, 2013