How to steer your own mental health journey?

April 7, 2021 1:00 PM

After nearly two years of pretty intense instability, I finally feel stable and can look for new / better support. But without much in the way of diagnosis or explanation, how do I figure out what I'm looking for from therapy next and what modalities to use?

You all have even pointed out how unsupportive my therapist is in previous questions -- that has been true throughout, but now I finally feel recovered / spoon-abundant enough to actually take on the project of getting a new one.

I got medicated finally last summer on a low dose of an SSRI and these days am feeling pretty good, most of the time, even during stressful or difficult circumstances. It also gave me enough space in between panics to work on stuff to make my life better. I also noticed I probably used to have some social anxiety, since that's pretty much melted away now. However I suspect what I was dealing with during this period was a mixture of a lot of things - past work & sexual trauma, potentially something non-neurotypical going on (OCD or ADHD? not clear to me but a lot of both of these symptoms resonate), plus general life dissatisfaction / pandemic stress, and maybe a bit of addiction / substance issues.

So one angle to try would be to focus on the emotional dysregulation piece and join a DBT group or therapist (current therapist has suggested this would be helpful for me, some of the techniques I've taught myself have already been useful when dealing with / fending off anxiety attacks.)

Or, I could prioritize the trauma side and try something like EMDR as many people close to me / with similar issues have experienced a lot of relief from this.

Or, prioritize body focused repetitive behaviors (this seems like it could be something relatively easy to solve) since it's concrete and would be an obvious quality of life improvement.

There's also psychedelic therapy which I am generally pro – but since my medication seems in a decent place right now that feels less compatible at the moment. It's coming up in my therapist search already though, so not sure how to think about that.

I know it doesn't have to be only one topic at the expense of the others and imo the therapist should be able to work out what's most important, however I'm feeling like I'm not really going anywhere without driving the direction, and therapists all have their own angles. I also don't feel any huge need to pathologize / name my condition, but perhaps it would help sort out what is causing other issues?

So my question is, if you were me / have been in similar shoes, how would you sort out what you're looking for in a therapist next and where to direct your treatment?

posted by internet of pillows to Health & Fitness (4 answers total)

One thing to think about is whether you're blocked on some techniques by other problems.

For instance: some people are just too fucking anxious to meditate. They find it destabilizing instead of helpful. Getting their anxiety under control unlocks meditation as an option.

For instance: some people can't even really start working on trauma until they're in a life situation where it's safe to fall apart a little. Getting their practical routine and their practical support system nailed down unlocks trauma work as an option.

I'm not saying either of those applies to you. But if there are some techniques where you're like "Fuck, this is so hard for me, I'm just too X," or even "Oh god, this is no use to me at all, I'm just too X," then looking into the causes of X first makes more sense than Just Trying Harder at the technique.
posted by nebulawindphone at 1:13 PM on April 7, 2021

I've been thinking through similar things because I'm probably about to switch therapists (current one is fine but it's been almost 10 years with the same one). I'm also indecisive about this kind of thing. My strategy is to focus on practical realities because there's good chance if I get really excited about one therapy type... I won't actually be able to find a therapist practicing that type that is taking new patients (less of a problem if you're in NYC or LA I hear). Now that you know the kind of things you're interested in, it's probably a good time to start emailing therapists in the directory until you find one that's taking patients and works for your schedule. There's a really good chance that any of those approaches could significantly help you, so the key thing is just to start making progress. Good luck!
posted by JZig at 7:22 PM on April 7, 2021

Some of what you talk about is contingent on other things. For instance, in my area I would struggle to find a therapist who advertises the use of illegal psychedelics for therapy, other than a very tightly controlled clinic offering ketamine therapy that very few people qualify for.

A lot of the rest of what you write about is, frankly, something that is best discussed with a good therapist, not because they would be driving the decision making, but because they have the experience and wherewithal to ask the kinds of questions and thought that an Askme post is unlikely to fully accomplish.

How to get the most out of therapy.
posted by OmieWise at 2:40 AM on April 8, 2021

The way I think of it is a sort of trauma/triage model like in the ER. Like if you have cancer, that's bad, but if you're bleeding from a wound, probably treat that first. In my case, I have some trauma from my childhood I am just now working on addressing, but the past 5 years or so have been scaffolding together some mental support and bandwidth to get to the point where I can deal with that, including getting to the point with my meds where my psychiatrist was like "Look if you want to change anything we can talk about that, but you seem like you're doing pretty well and most of the rest of your stuff you need to do with a talk therapist." So I check in with her when I get a new diagnosis or figure something else out or hey, my non-psych meds have changed, do we need to consider any interactions, etc., but most of the lifting on the medical side is done. (But that took some getting there and was A Journey on its own).

Just reading your post, what I would say is, roughly in this order:

If you're already finding DBT useful, explore it more. Heck, the hard part for a lot of this work is finding a technique that works! You've already done that! And that might give you space to tackle the harder stuff.

If you think you have ADHD/OCD and meds would help, I'd talk to a psychiatrist or see if your therapist could refer you, just because that can be a whole Process on its own. That's a bigger project because finding a provider, finding the right med, and getting that dialed in can be a whole thing, but if you have ADHD, there's a lot that keys off of that. (Maybe you have rejection-sensitive dysophoria, maybe you're anxious because your brain is running to overheating all the time, maybe you're melting down because of that, etc.).

EMDR tends to work fairly quickly (it can be just a handful of sessions and tends to not be something like psychodynamic that runs for years) and would likely help with the trauma as well as anxiety and OCD if they are trauma-based behaviors rather than ADHD based.

I wouldn't mess with psychedelics if your meds seem to be working for you right now. To me that's something to mess with later.
posted by Ghostride The Whip at 10:31 AM on April 8, 2021