Therapy. What is it good for?
June 6, 2023 8:06 PM Subscribe
Registered Counseling (talk "therapy") as an adjunct/ add-on to pharmaceutical interventions for major depressive disorder with generalized anxiety. What kinds of things is it good for?
My prescription medications have stabilized; although there persist side-effects, they bring me to a 5-6 (/10). Psychiatrist recommended I pursue therapy (registered counseling).
Went to the initial session. Introductions. Was given a homework assignment of writing down my thoughts 3x/ day, detailing intensity, emotion, and what I did afterwards.
Made an appointment about a month out. Their recommendation was every week or two.
What has this kind of therapy offered you, what kinds of things is this particularly good for? What kinds of things is this for?
Because, it's, you know, expensive.
My prescription medications have stabilized; although there persist side-effects, they bring me to a 5-6 (/10). Psychiatrist recommended I pursue therapy (registered counseling).
Went to the initial session. Introductions. Was given a homework assignment of writing down my thoughts 3x/ day, detailing intensity, emotion, and what I did afterwards.
Made an appointment about a month out. Their recommendation was every week or two.
What has this kind of therapy offered you, what kinds of things is this particularly good for? What kinds of things is this for?
Because, it's, you know, expensive.
Self-knowledge and a lot better understanding about why I react and behave in the ways that I do in the situtations I often find myself in. And the consciousness—having made those steps of self-awareness—that I can change those, somewhat.
posted by Fiasco da Gama at 9:04 PM on June 6, 2023 [6 favorites]
posted by Fiasco da Gama at 9:04 PM on June 6, 2023 [6 favorites]
I've had meaningful, significant help from therapists on a handful of occasions... all were specific crises, when something in my life felt like it had gone sideways and I needed someone objective and experienced to advise me. On a couple of occasions the relief from just two or three sessions has been so great that I think of them years later with gratefulness.
No experience with using them for a chronic condition, sorry.
posted by fingersandtoes at 9:10 PM on June 6, 2023 [3 favorites]
No experience with using them for a chronic condition, sorry.
posted by fingersandtoes at 9:10 PM on June 6, 2023 [3 favorites]
The drugs will likely help with the depression and anxiety, but it’s very unlikely they will banish them from your life. Talk therapy can be about building a personalized set of tools for managing the remainder.
In addition if you’ve been living with anxiety and depression you’ve almost certainly twisted your life to fit those confines. In the short term a therapist can help you recognize the compromises you’ve made so you can take advantage of your new freedom.
For me the problem with trying to mend myself by following written instructions is that I am capable of endlessly bullshitting myself. Having to say something out loud to another human cuts down on that a tremendous amount. And having a dedicated therapist to say them to cuts down on the number of friends who start to avoid me because all I do is talk about myself.
posted by Tell Me No Lies at 9:18 PM on June 6, 2023 [12 favorites]
In addition if you’ve been living with anxiety and depression you’ve almost certainly twisted your life to fit those confines. In the short term a therapist can help you recognize the compromises you’ve made so you can take advantage of your new freedom.
For me the problem with trying to mend myself by following written instructions is that I am capable of endlessly bullshitting myself. Having to say something out loud to another human cuts down on that a tremendous amount. And having a dedicated therapist to say them to cuts down on the number of friends who start to avoid me because all I do is talk about myself.
posted by Tell Me No Lies at 9:18 PM on June 6, 2023 [12 favorites]
Good therapy should help you get to some root issues and patterns to identify where the depression or anxiety etc arises, and ways to address and identify, cope, change perspective.
That said, finding a therapist you click with is essential...studies show it's the most essential factor for effectiveness of the therapy.
posted by bearette at 4:24 AM on June 7, 2023 [7 favorites]
That said, finding a therapist you click with is essential...studies show it's the most essential factor for effectiveness of the therapy.
posted by bearette at 4:24 AM on June 7, 2023 [7 favorites]
Anxiety disorders tend to be self-reinforcing. You experience an anxiety trigger, and the experience of the anxiety itself creates enough of an unpleasant association to reinforce that anxiety trigger. The thing that talk therapy can do that drugs can't is help you identify those triggers and implement strategies to deal with them in ways that aren't debilitating and don't further reinforce them.
This is also an important way that drugs and therapy can be complementary: the drugs turn the volume down on your anxiety just enough that you're capable of analyzing and responding to it in ways other than whatever established patterns that weren't working, clearing space to establish new, less damaging patterns.
posted by firechicago at 4:30 AM on June 7, 2023 [4 favorites]
This is also an important way that drugs and therapy can be complementary: the drugs turn the volume down on your anxiety just enough that you're capable of analyzing and responding to it in ways other than whatever established patterns that weren't working, clearing space to establish new, less damaging patterns.
posted by firechicago at 4:30 AM on June 7, 2023 [4 favorites]
Anxiety is a physiological response to threats - actual and perceived. Generally speaking, an anxiety disorder is when those responses are inappropriate for the level of threat and often when they don't subside when the threat has passed.
I bolded two things in the first sentence - medication is very good at managing the response level - but the real freedom from anxiety in my experience is being able to limit the things that trigger an inappropriate response - i.e., your perception of the world around you (conscious and subconscious.)
This is where therapy can come in - my experience with CBT is that it is very useful to have someone to help you map out cognitive distortions that trigger an emotional response, where they come from, and to help you avoid repeating patterns that aren't helpful to you. Typically, this comes from talk therapy (someone to speak the words that you may not feel comfortable speaking to anyone else - or may not even realize are inside you), the exercises and work between sessions, and in having someone to be accountable to for putting good habits and practice into place.
Nearly all the solutions that I have found effective from therapy - CBT exercises, breathwork, meditation, exercise, diet, etc. - are free and available to me. But what I have found is the secret sauce to getting them to actually help me is to have an impartial but on my side guide to working through them, and someone to report back to in order to make sure I actually do the stuff. Occasionally they also notice things you don't about your patterns which is useful.
posted by openhearted at 5:19 AM on June 7, 2023 [4 favorites]
I bolded two things in the first sentence - medication is very good at managing the response level - but the real freedom from anxiety in my experience is being able to limit the things that trigger an inappropriate response - i.e., your perception of the world around you (conscious and subconscious.)
This is where therapy can come in - my experience with CBT is that it is very useful to have someone to help you map out cognitive distortions that trigger an emotional response, where they come from, and to help you avoid repeating patterns that aren't helpful to you. Typically, this comes from talk therapy (someone to speak the words that you may not feel comfortable speaking to anyone else - or may not even realize are inside you), the exercises and work between sessions, and in having someone to be accountable to for putting good habits and practice into place.
Nearly all the solutions that I have found effective from therapy - CBT exercises, breathwork, meditation, exercise, diet, etc. - are free and available to me. But what I have found is the secret sauce to getting them to actually help me is to have an impartial but on my side guide to working through them, and someone to report back to in order to make sure I actually do the stuff. Occasionally they also notice things you don't about your patterns which is useful.
posted by openhearted at 5:19 AM on June 7, 2023 [4 favorites]
I’ve suffered with lifelong severe depression. Talk therapy (which, honestly, encompasses a long list of possible approaches and techniques) has been an essential part of staying above water.
CBT bounces right off me. It’s simply too superficial, in my experience. I need the deeper digging and inner exploration of underlying thoughts/issues/events/repressions/etc. that long-term talk therapy affords. It’s like having a serious and revealing dialogue with someone who knows how to guide you through your inner darkness, help you open locked doors, and deal with what’s there.
The trick, as always, is finding a therapist who has the tools and talent to effectively guide you.
posted by Thorzdad at 5:46 AM on June 7, 2023 [2 favorites]
CBT bounces right off me. It’s simply too superficial, in my experience. I need the deeper digging and inner exploration of underlying thoughts/issues/events/repressions/etc. that long-term talk therapy affords. It’s like having a serious and revealing dialogue with someone who knows how to guide you through your inner darkness, help you open locked doors, and deal with what’s there.
The trick, as always, is finding a therapist who has the tools and talent to effectively guide you.
posted by Thorzdad at 5:46 AM on June 7, 2023 [2 favorites]
I got nothing from it that I couldn’t have gotten from talking to a friend.
Therapy first and foremost gives me a place to say things that I cannot/should not say to friends and family. I suppose some people don't have those thoughts or have friends and family that are able to absorb the negativity/criticism/bleakness, but that wasn't the case for me.
Additionally, over time therapists have been skilled at identifying the narratives I am telling myself to make sense of my world, and either challenging them or helping me rewrite them into something healthier. (This is a bit like CBT working with cognitive distortions even though I never went to a CBT therapist.) As Tell Me No Lies mentioned above, depression and anxiety can warp your behaviors and limit your views; as those symptoms lift your habits and thinking do not automatically change entirely.
posted by We put our faith in Blast Hardcheese at 6:47 AM on June 7, 2023 [8 favorites]
Therapy first and foremost gives me a place to say things that I cannot/should not say to friends and family. I suppose some people don't have those thoughts or have friends and family that are able to absorb the negativity/criticism/bleakness, but that wasn't the case for me.
Additionally, over time therapists have been skilled at identifying the narratives I am telling myself to make sense of my world, and either challenging them or helping me rewrite them into something healthier. (This is a bit like CBT working with cognitive distortions even though I never went to a CBT therapist.) As Tell Me No Lies mentioned above, depression and anxiety can warp your behaviors and limit your views; as those symptoms lift your habits and thinking do not automatically change entirely.
posted by We put our faith in Blast Hardcheese at 6:47 AM on June 7, 2023 [8 favorites]
A lot of talk therapy modalities today are about digging into "stinkin' thinkin'" - the concepts or narrative or talk tracks or straight up misunderstandings that live in our heads and serve as limitations or threats to daily functioning.
There's also an emerging trend in somatic therapies, which tackle the body-mind relationship. As an easy example, anxiety isn't just a bad thought, its a trigger to the body to spit out a bunch of neurochemicals and literally clench in anticipation of the hyena catching us, to prevent immediately bleeding out and other extremely short-term survival advantages. Unfortunately for a lot of people in non-hyena environments, this biological process tends to cause stuff like vomiting, running away, almost or completely fainting, going entirely still to try to fool predators into thinking we disappeared, punching people, and many other destructive behaviors as well as all kinds of wild unproductive behaviors applied to calm ourselves down and to avoid future situations where there's any perceived chance of that bad feeling happening again. While there are some drugs that dull the brain's danger receptors, they're not especially good for your other organs if used a lot or at length. There's a number of emerging modalities that are about yes, re-calibrating your brain to expect a lot less hyenas in any given day, but also to disrupt or de-escalate the body from proceeding with the Hyena Procedure over relatively low-stakes threats. Or even high-stakes ones, where you really need to keep your wits about you instead of throwing up and running away.
If it helps you to understand the mechanisms, there's a bunch of books that just cram all today's common modalities together in a big 101 - this one is pretty comprehensive.
It's good to have people in your life you can process with. It's bad if they have terrible advice like "just drink more" or "have you tried just not being worried/upset/angry/gay/abused?" or "here's a rug you can shove that under" or "church". It's also bad to put an untrained individual in the position of having to carry your secrets, trauma, baggage, and the caretaking of your wellbeing. Not all friends are safe for all things, even if they mean well, and there are things in this world you shouldn't expect amateurs to manage for you.
posted by Lyn Never at 7:18 AM on June 7, 2023 [3 favorites]
There's also an emerging trend in somatic therapies, which tackle the body-mind relationship. As an easy example, anxiety isn't just a bad thought, its a trigger to the body to spit out a bunch of neurochemicals and literally clench in anticipation of the hyena catching us, to prevent immediately bleeding out and other extremely short-term survival advantages. Unfortunately for a lot of people in non-hyena environments, this biological process tends to cause stuff like vomiting, running away, almost or completely fainting, going entirely still to try to fool predators into thinking we disappeared, punching people, and many other destructive behaviors as well as all kinds of wild unproductive behaviors applied to calm ourselves down and to avoid future situations where there's any perceived chance of that bad feeling happening again. While there are some drugs that dull the brain's danger receptors, they're not especially good for your other organs if used a lot or at length. There's a number of emerging modalities that are about yes, re-calibrating your brain to expect a lot less hyenas in any given day, but also to disrupt or de-escalate the body from proceeding with the Hyena Procedure over relatively low-stakes threats. Or even high-stakes ones, where you really need to keep your wits about you instead of throwing up and running away.
If it helps you to understand the mechanisms, there's a bunch of books that just cram all today's common modalities together in a big 101 - this one is pretty comprehensive.
It's good to have people in your life you can process with. It's bad if they have terrible advice like "just drink more" or "have you tried just not being worried/upset/angry/gay/abused?" or "here's a rug you can shove that under" or "church". It's also bad to put an untrained individual in the position of having to carry your secrets, trauma, baggage, and the caretaking of your wellbeing. Not all friends are safe for all things, even if they mean well, and there are things in this world you shouldn't expect amateurs to manage for you.
posted by Lyn Never at 7:18 AM on June 7, 2023 [3 favorites]
Like Blast Hardcheese, I found that while I am pretty good at sharing with friends various hardships and my partner is generally great, there’s just things I have not felt comfortable articulating. And frankly, dropping something heavy on a friend or family member just isn’t always a fair and kind thing to do to them. In the case of my partner, my anxious brain would also be worried about how it would affect our relationship and I’d hold back. Also, your friends and family are not trained therapists and can often have harmful reactions. And they have no duty to keep your words in confidence.
If you don’t have this particular tangle of issues and find that medication is very effective for you right now then maybe you can let that ride. I did more than a year of talk therapy before going on medication and I found them both immensely helpful and for different reasons. Regardless, I hope you are feeling better soon. Just know that even with medication, you’ll have bad days still. When I am having a bad day, the work that I’ve done in therapy is helpful to get through them.
posted by amanda at 7:19 AM on June 7, 2023 [3 favorites]
If you don’t have this particular tangle of issues and find that medication is very effective for you right now then maybe you can let that ride. I did more than a year of talk therapy before going on medication and I found them both immensely helpful and for different reasons. Regardless, I hope you are feeling better soon. Just know that even with medication, you’ll have bad days still. When I am having a bad day, the work that I’ve done in therapy is helpful to get through them.
posted by amanda at 7:19 AM on June 7, 2023 [3 favorites]
The kind of therapy you're describing where the session frequency is once a month and you get worksheets - idk maybe it helps some people but would never have helped me.
I benefitted immensely from longer term weekly therapy which went much deeper than homework and worksheets and coping techniques (not to diss coping techniques - they can be useful - but you can get those out of a book). This type of therapy is when you work with someone over the course of a year or more (in my case 5 years) and you get to do neat things like resolve the underlying issues that are causing your anxiety, and internalize your therapist's voice and attitudes, so that you gain the superpower of helping yourself through a tough episode gently and kindly, and heal some of your attachment wounds, and calm your inner critic down, and so on.
If that sounds good you'd want to look for a psychodynamically oriented therapist, or maybe someone who calls themselves a relational therapist or trauma -focused therapist or emotionally focused therapist etc. There are many possible names and flavors which would give you the above style of therapy. What you should probably avoid is any therapist who focuses on "behavioral" therapies including cognitive behavioral therapy, and (this may be a controversial take but I can back this up) I would also avoid "evidence based therapy", because that is almost always code for insurance-friendly short term manualized therapies (i.e. dispensed from a manual that prescribes what happens on a session by session basis for 12 weeks or whatever). These approaches are kind of impersonal (because they're forcing the treatment to follow a manual instead of being led by your needs) and definitely top-down (as opposed to collaborative), and while they may be useful for some people in some cases, I don't think they are representative of, let alone anywhere close to as powerful as, "plain old therapy."
posted by MiraK at 7:19 AM on June 7, 2023 [7 favorites]
I benefitted immensely from longer term weekly therapy which went much deeper than homework and worksheets and coping techniques (not to diss coping techniques - they can be useful - but you can get those out of a book). This type of therapy is when you work with someone over the course of a year or more (in my case 5 years) and you get to do neat things like resolve the underlying issues that are causing your anxiety, and internalize your therapist's voice and attitudes, so that you gain the superpower of helping yourself through a tough episode gently and kindly, and heal some of your attachment wounds, and calm your inner critic down, and so on.
If that sounds good you'd want to look for a psychodynamically oriented therapist, or maybe someone who calls themselves a relational therapist or trauma -focused therapist or emotionally focused therapist etc. There are many possible names and flavors which would give you the above style of therapy. What you should probably avoid is any therapist who focuses on "behavioral" therapies including cognitive behavioral therapy, and (this may be a controversial take but I can back this up) I would also avoid "evidence based therapy", because that is almost always code for insurance-friendly short term manualized therapies (i.e. dispensed from a manual that prescribes what happens on a session by session basis for 12 weeks or whatever). These approaches are kind of impersonal (because they're forcing the treatment to follow a manual instead of being led by your needs) and definitely top-down (as opposed to collaborative), and while they may be useful for some people in some cases, I don't think they are representative of, let alone anywhere close to as powerful as, "plain old therapy."
posted by MiraK at 7:19 AM on June 7, 2023 [7 favorites]
Medication helps you manage the physiological symptoms of anxiety and hopefully reduce the frequency of panic attacks. Heart racing, sweating, shaking, panic attacks, trouble breathing etc. Medication dampens everything down, so it’s possible to work on what’s actually causing the anxiety in the first place.
We need individual therapy, because the cause of anxiety - indeed the definition of it - depends on each person and their own social context.
To explain. Like all emotions, fear and anxiety are useful. Fear stops us from doing dangerous things. But again, like all emotions, too much or too little is a problem. Too much anxiety, and we become paralyzed. Too little, and we put ourselves in physical or social danger.
What counts as too much fear or anxiety? What constitutes paralyzing rather than helpful? Well that depends on where you live and who you are. If I’m too afraid to leave the house because I’m afraid of being eaten by a tiger, that would be paralyzing. If I lived in a jungle, it might be helpful.
Therapy helps you figure out your personal line between fear that is helpful and fear that is holding you back, and then help you decide what you’d like to try to do about it.
If the fear has its roots in an interpersonal memory or experience, the therapist is trained to help you untangle the complicated memories, feelings, and thoughts you have about it. Sometimes we develop short-cuts in our thinking and never go back to reexamine them. A therapist is trained to notice those shortcuts and draw your attention to them, and ask questions that can prompt you to stop and notice what you’re doing.
An example. The therapist might say “Just now you said you were sad you missed your friend’s birthday lunch, but you couldn’t go because your boyfriend was working. Why couldn’t you go alone?” Here, the person has got to a point where it's unimaginable that she would leave the house on her own. The therapist's question makes her go back and reexamine that belief. Is it really too dangerous for her to go to lunch with her friend, without her boyfriend there to keep her safe?
Anxiety is weird though, because when you’re experiencing it, it seems completely rational! And in many ways it is, because there is always a degree of real risk. The kicker is the proportionality and the degree to which it helps you or hinders you in daily life.
For instance. Climate change really is a risk to our lives. But if you spend every waking moment of your day worried about climate change, you can become paralyzed by fear and get to the point you can't get out of bed or feel unable to do normal life things like have kids or plan for the future. We need to be anxious enough to be good citizens and protest, vote, etc. But not so anxious we have panic attacks each morning. It becomes really hard, however, for friends or loved ones to talk to the person who is “disproportionately” anxious about climate change, because they probably care about this issue too!
Similarly for a person who is anxious about, for instance, covid precautions or their newborn baby. It’s really really difficult to recognize where the line is. And ultimately the person themselves has to be the one who recognizes, you know what, this is exhausting. I don’t want to feel this afraid or scared anymore. I need help managing this fear. And that’s why you need a therapist who is trained to help you talk through this without ANY judgement, so you can speak without fear of consequences in your wider social circle, or it coming up later in conversations. Because anxiety disorder in particular can come with a ton of judgement and shame.
Anyway. My rough (pinch of salt) guide to types of therapy so you can get a vague idea of what to look for:
“I’m a rational person and kinda prefer having clear instructions to work through. I want to focus on now, not the past.” = CBT
“What the FUCK everything is CHAOS AGHHH HELP my emotions are VERY CONFUSING!!” = DBT
“Everything (had a shitty childhood so what some trauma sure don’t really want to think about it) is fine! What’s (I sometimes feel like I’m not connected to my body) the problem?!” = Trauma informed therapy, Somatic therapy, Internal Family Systems, EMDR.
“I’m not sure what I’m doing with my life anymore and it scares me.” = Narrative therapy, Existential therapy.
“My family is pretty fucked up, I can see I’m headed in the same direction, and I’d like to work on that not happening.” = Person-centered therapy, Rogerian therapy, existential therapy, narrative therapy, humanistic therapy, trauma informed would probably help.
posted by EllaEm at 7:35 AM on June 7, 2023 [6 favorites]
We need individual therapy, because the cause of anxiety - indeed the definition of it - depends on each person and their own social context.
To explain. Like all emotions, fear and anxiety are useful. Fear stops us from doing dangerous things. But again, like all emotions, too much or too little is a problem. Too much anxiety, and we become paralyzed. Too little, and we put ourselves in physical or social danger.
What counts as too much fear or anxiety? What constitutes paralyzing rather than helpful? Well that depends on where you live and who you are. If I’m too afraid to leave the house because I’m afraid of being eaten by a tiger, that would be paralyzing. If I lived in a jungle, it might be helpful.
Therapy helps you figure out your personal line between fear that is helpful and fear that is holding you back, and then help you decide what you’d like to try to do about it.
If the fear has its roots in an interpersonal memory or experience, the therapist is trained to help you untangle the complicated memories, feelings, and thoughts you have about it. Sometimes we develop short-cuts in our thinking and never go back to reexamine them. A therapist is trained to notice those shortcuts and draw your attention to them, and ask questions that can prompt you to stop and notice what you’re doing.
An example. The therapist might say “Just now you said you were sad you missed your friend’s birthday lunch, but you couldn’t go because your boyfriend was working. Why couldn’t you go alone?” Here, the person has got to a point where it's unimaginable that she would leave the house on her own. The therapist's question makes her go back and reexamine that belief. Is it really too dangerous for her to go to lunch with her friend, without her boyfriend there to keep her safe?
Anxiety is weird though, because when you’re experiencing it, it seems completely rational! And in many ways it is, because there is always a degree of real risk. The kicker is the proportionality and the degree to which it helps you or hinders you in daily life.
For instance. Climate change really is a risk to our lives. But if you spend every waking moment of your day worried about climate change, you can become paralyzed by fear and get to the point you can't get out of bed or feel unable to do normal life things like have kids or plan for the future. We need to be anxious enough to be good citizens and protest, vote, etc. But not so anxious we have panic attacks each morning. It becomes really hard, however, for friends or loved ones to talk to the person who is “disproportionately” anxious about climate change, because they probably care about this issue too!
Similarly for a person who is anxious about, for instance, covid precautions or their newborn baby. It’s really really difficult to recognize where the line is. And ultimately the person themselves has to be the one who recognizes, you know what, this is exhausting. I don’t want to feel this afraid or scared anymore. I need help managing this fear. And that’s why you need a therapist who is trained to help you talk through this without ANY judgement, so you can speak without fear of consequences in your wider social circle, or it coming up later in conversations. Because anxiety disorder in particular can come with a ton of judgement and shame.
Anyway. My rough (pinch of salt) guide to types of therapy so you can get a vague idea of what to look for:
“I’m a rational person and kinda prefer having clear instructions to work through. I want to focus on now, not the past.” = CBT
“What the FUCK everything is CHAOS AGHHH HELP my emotions are VERY CONFUSING!!” = DBT
“Everything (had a shitty childhood so what some trauma sure don’t really want to think about it) is fine! What’s (I sometimes feel like I’m not connected to my body) the problem?!” = Trauma informed therapy, Somatic therapy, Internal Family Systems, EMDR.
“I’m not sure what I’m doing with my life anymore and it scares me.” = Narrative therapy, Existential therapy.
“My family is pretty fucked up, I can see I’m headed in the same direction, and I’d like to work on that not happening.” = Person-centered therapy, Rogerian therapy, existential therapy, narrative therapy, humanistic therapy, trauma informed would probably help.
posted by EllaEm at 7:35 AM on June 7, 2023 [6 favorites]
I meant to add: not only are friends not trained (and trained friends, according to most professional codes of ethics, shouldn't formally treat you though they may well be great listeners informally), but there is usefulness to the formalized Patient-Therapist dynamic that is rolled into the technique. Even the exchange of money for service (even if subsidized or covered by someone else's funds) plays a role in the therapeutic process.
There is a little bit of an arm's length there, and you get to have the expectation that the person you're interacting with is not and has never been a part of - for example - your actual family and its dynamics, and has no stake in the success or failure of your relationships or career aside from you being able to obtain their services. They are also trained and obligated to leave their own shit for their own time - this doesn't always happen, but I have certainly known quite good therapists whose personal lives were (as everyone's is, now and then) a shitshow but only off the clock. Your time is about you, in a way that most of us don't really get anywhere else. This is a lot harder with friends, who by definition ought to be some kind of two-way street.
posted by Lyn Never at 8:44 AM on June 7, 2023 [1 favorite]
There is a little bit of an arm's length there, and you get to have the expectation that the person you're interacting with is not and has never been a part of - for example - your actual family and its dynamics, and has no stake in the success or failure of your relationships or career aside from you being able to obtain their services. They are also trained and obligated to leave their own shit for their own time - this doesn't always happen, but I have certainly known quite good therapists whose personal lives were (as everyone's is, now and then) a shitshow but only off the clock. Your time is about you, in a way that most of us don't really get anywhere else. This is a lot harder with friends, who by definition ought to be some kind of two-way street.
posted by Lyn Never at 8:44 AM on June 7, 2023 [1 favorite]
Having a connection with another human being, to whom you can reveal thoughts or emotions that seem silly or irresponsible or dangerous or impolite, and have them reflect back acceptance can be immensely healing in itself. Through that connection, you learn how to accept yourself and how to navigate change from a baseline of that self-acceptance.
In an ideal world, we wouldn't need therapists because our friends and family and community would provide that. Interestingly, a lot of my training in becoming a therapist has been un-learning conventional patterns of responding to other people's emotions ("It'll be ok!" "You're strong, you'll be fine!" "What you should really be upset about it..." "What you should do is..." "Have you tried..." etc.) and learning how to just sit with people in pain and distress and be a non-anxious presence.
Yes, there are techniques and insights and such that therapists learn and can share (and should learn and share!), but I keep going back to the core of the healing process being much more about leaning into connection, with others and with self, and really feeling that in the presence of another human being. It's a healing relationship where you can practice your other relationships, and practice your self, in an accepting place so that you grow the skills, confidence, and knowing for how to do that in other places and relationships.
posted by lapis at 8:47 AM on June 7, 2023
In an ideal world, we wouldn't need therapists because our friends and family and community would provide that. Interestingly, a lot of my training in becoming a therapist has been un-learning conventional patterns of responding to other people's emotions ("It'll be ok!" "You're strong, you'll be fine!" "What you should really be upset about it..." "What you should do is..." "Have you tried..." etc.) and learning how to just sit with people in pain and distress and be a non-anxious presence.
Yes, there are techniques and insights and such that therapists learn and can share (and should learn and share!), but I keep going back to the core of the healing process being much more about leaning into connection, with others and with self, and really feeling that in the presence of another human being. It's a healing relationship where you can practice your other relationships, and practice your self, in an accepting place so that you grow the skills, confidence, and knowing for how to do that in other places and relationships.
posted by lapis at 8:47 AM on June 7, 2023
Sometimes a good chunk of my therapy time is me going, "Am I the crazy one? Is this normal?" and my therapist saying, "No, that is definitely not normal." Or walking me through how to do something I'm anxious about. Stuff that frankly, you can't keep demanding of your friends before they get fed up and quit you. Some therapists will give advice, some won't.
I admit some days it is me just whining, a lot, though. But that's on me, and sparing my friends who are tired of hearing that shit yet again.
posted by jenfullmoon at 9:34 AM on June 7, 2023 [2 favorites]
I admit some days it is me just whining, a lot, though. But that's on me, and sparing my friends who are tired of hearing that shit yet again.
posted by jenfullmoon at 9:34 AM on June 7, 2023 [2 favorites]
For a moment, let's imagine that your health concern is not mental health. Let's say for the sake of the example that you have an injury that causes significant pain. You go to your primary care doctor and she gives you pain medication, and her guidance is that you'll take this for the rest of your life, probably a high dose now but then a lower dose for pain management as time goes on. Now, you have two options.
Option 1 is self management. Your doctor sends you home with a pamphlet on exercises to do at home. You try to do the exercises every day. Maybe this works really well for you, and you follow them diligently and over time your pain gets more and more manageable. But maybe you find the exercises difficult, confusing, and painful, and you get frustrated when you don't see change.
Option 2 is physical therapy. Your doctor refers you to a PT. You go in for a weekly appointment with her and she teaches you the exercises herself, walking you through them step-by-step and making adjustments if they aren't quite working. She also does some pain relief for you right there in her office, like deep tissue massage or electrical stimulation. Then, you practice the exercises at home, and if some of them are difficult and confusing, you bring them back to your PT and she recommends some adjustments, gives you different exercises to try, or even just helps you set expectations about how soon your pain will start to improve.
That's what therapy is.
Also, sometimes you get a therapist who doesn't work for you and that's fine. That's also true for PT: maybe the first PT you go to pushes you too hard, or explains things in a way that confuses you, or electrical stimulation doesn't give you any pain relief (happened to me!), or you have another disability that makes the exercises hard and she has no experience with it and doesn't understand your needs. So you move on and get a second opinion.
posted by capricorn at 9:46 AM on June 7, 2023 [1 favorite]
Option 1 is self management. Your doctor sends you home with a pamphlet on exercises to do at home. You try to do the exercises every day. Maybe this works really well for you, and you follow them diligently and over time your pain gets more and more manageable. But maybe you find the exercises difficult, confusing, and painful, and you get frustrated when you don't see change.
Option 2 is physical therapy. Your doctor refers you to a PT. You go in for a weekly appointment with her and she teaches you the exercises herself, walking you through them step-by-step and making adjustments if they aren't quite working. She also does some pain relief for you right there in her office, like deep tissue massage or electrical stimulation. Then, you practice the exercises at home, and if some of them are difficult and confusing, you bring them back to your PT and she recommends some adjustments, gives you different exercises to try, or even just helps you set expectations about how soon your pain will start to improve.
That's what therapy is.
Also, sometimes you get a therapist who doesn't work for you and that's fine. That's also true for PT: maybe the first PT you go to pushes you too hard, or explains things in a way that confuses you, or electrical stimulation doesn't give you any pain relief (happened to me!), or you have another disability that makes the exercises hard and she has no experience with it and doesn't understand your needs. So you move on and get a second opinion.
posted by capricorn at 9:46 AM on June 7, 2023 [1 favorite]
I haven't seen this above ... a key part of therapy is to monitor the effects of the drugs you are on. Most psychiatric DXs have numerous potential drug RXs to treat them - choice of drugs, choice of dosages. They will work better or worse depending upon the person, and often a change in drug or dosage will be indicated. All psychiatric drugs have side effects, and they are often different from patient to patient, and some are so severe as to merit a change of drug or dosage. And efficacy / side effects can change over time!
posted by MattD at 9:59 AM on June 7, 2023 [1 favorite]
posted by MattD at 9:59 AM on June 7, 2023 [1 favorite]
Sometimes anxiety is a subconscious fear that is constantly being stimulated, like fear of exposure, being disliked, lack of safety etc. But this fear is buried. Why is this alarm always ringing? It’s coming from inside the building.
Therapy can help uncover these things. We are real strangers to ourselves sometimes.
posted by St. Peepsburg at 12:36 PM on June 7, 2023 [1 favorite]
Therapy can help uncover these things. We are real strangers to ourselves sometimes.
posted by St. Peepsburg at 12:36 PM on June 7, 2023 [1 favorite]
I'm biased because 1) I am a therapist, and 2) I've gotten a lot out of my own talk therapy for anxiety. Here's how I think about it: At it's core, good talk therapy allows me to be in relationship with another human* who accepts me as I am**, holds space for me to experience whatever emotions arise and process whatever experiences I need to***, observes things about me**** that I might not be aware of, and offers questions/challenges/reframes/insights that I can try on without pressure. There's a lot of good in the mutual relationships we share with loved ones, and there are limits to what those relationships can hold in terms of unflinching presence with and acceptance of our deep personal stuff.
*Relationships are where we do a lot of our learning, growing, getting hurt, and healing.
**The therapist's job is to accept and meet with me as I am right now, not to be invested in some different or better version I could be, not to miss the version of myself I was a year ago, etc.
***I don't need to worry about scaring, hurting, or upsetting my therapist with my emotions or stories, so I can be really honest and unfiltered and trust they'll face it with me, whereas I might need to hold back from telling a loved one, "I feel so ashamed about X" because they'd rush to reassure me I don't need to feel ashamed or they'd get really sad and then I'd just feel bad about making them sad.
****Patterns in my communication, emotions, relationships; little shifts in body language, tone, energy; conflicts between values and behaviors. Things a friend might overlook or would have difficulty pointing out nonjudgmentally.
posted by theotherdurassister at 1:51 PM on June 7, 2023 [2 favorites]
*Relationships are where we do a lot of our learning, growing, getting hurt, and healing.
**The therapist's job is to accept and meet with me as I am right now, not to be invested in some different or better version I could be, not to miss the version of myself I was a year ago, etc.
***I don't need to worry about scaring, hurting, or upsetting my therapist with my emotions or stories, so I can be really honest and unfiltered and trust they'll face it with me, whereas I might need to hold back from telling a loved one, "I feel so ashamed about X" because they'd rush to reassure me I don't need to feel ashamed or they'd get really sad and then I'd just feel bad about making them sad.
****Patterns in my communication, emotions, relationships; little shifts in body language, tone, energy; conflicts between values and behaviors. Things a friend might overlook or would have difficulty pointing out nonjudgmentally.
posted by theotherdurassister at 1:51 PM on June 7, 2023 [2 favorites]
The big difference between my therapist and my friends is that I could say "My husband has been getting more and more bossy and critical and I'm not sure I can handle it." My friends will tell me I need to just tell him off or leave him. My therapist asks if there's a way I can tell him the criticism is unwelcome and unhelpful and then walks me through scenarios and then finally explains the differences between a boundary that you set and an ultimatum.
My friends are there to love me and support me. My therapist is there to give me the tools to navigate my emotions, thoughts, and methods of coping and sometimes she tells me I'm a nice person and sometimes she tells me the things I think are helpful are really hurting me. My friends tell me that too but they are required to because they love me.
posted by teleri025 at 2:02 PM on June 7, 2023 [2 favorites]
My friends are there to love me and support me. My therapist is there to give me the tools to navigate my emotions, thoughts, and methods of coping and sometimes she tells me I'm a nice person and sometimes she tells me the things I think are helpful are really hurting me. My friends tell me that too but they are required to because they love me.
posted by teleri025 at 2:02 PM on June 7, 2023 [2 favorites]
Therapy did absolutely nothing for me and I consider CBT abuse. Therapy only helps about 50% of people. It’s just not that effective.
“More than half of the patients receiving therapy had little or no benefit and that only a third entered “remission” (meaning their symptoms lessened enough that they no longer met the study’s criteria for depression). Given that the patients were assessed just one to three months after treatment started, Cuijpers said he considered those results “a good success rate,” but he also noted that “more effective treatments are clearly needed” because so many patients did not meaningfully benefit.”
posted by Violet Hour at 4:19 PM on June 7, 2023 [1 favorite]
“More than half of the patients receiving therapy had little or no benefit and that only a third entered “remission” (meaning their symptoms lessened enough that they no longer met the study’s criteria for depression). Given that the patients were assessed just one to three months after treatment started, Cuijpers said he considered those results “a good success rate,” but he also noted that “more effective treatments are clearly needed” because so many patients did not meaningfully benefit.”
posted by Violet Hour at 4:19 PM on June 7, 2023 [1 favorite]
Speaking as someone who had a loved one in therapy, a major benefit was to ME as it immediately, greatly reduced the number of times my loved one would vomit out a heavy load of anxious doom and worst case scenarios onto me (or anyone else who was somewhat receptive) followed by a lot of self loathing for burdening me with the doom-vomit, which I then had to soothe and reassure away as best I could.
I love this person! but it was leaving me wrung out, worried, and struggling to maintain positivity in other areas of my life. The relief to me once they had a designated professional for this purpose was noticeable and significant. They also began making slow but real improvements, like implementing a regular exercise routine and catching themselves when they were engaging in catastrophic thinking. So therapy not only benefited their own life, but that of the people around them as well.
posted by castlebravo at 6:31 PM on June 7, 2023 [5 favorites]
I love this person! but it was leaving me wrung out, worried, and struggling to maintain positivity in other areas of my life. The relief to me once they had a designated professional for this purpose was noticeable and significant. They also began making slow but real improvements, like implementing a regular exercise routine and catching themselves when they were engaging in catastrophic thinking. So therapy not only benefited their own life, but that of the people around them as well.
posted by castlebravo at 6:31 PM on June 7, 2023 [5 favorites]
There's something very simple--but incredibly useful--therapy can do, with the caveat that milage varies, depending on the individual quirks of the client and therapist. It can help you see and through a specific kind of blind spot.
The form of therapy I like best is called Internal Family Systems (IFS), in which what we commonly call "defense mechanisms" are conceptualized as sub-personalities. For instance, I may have an inner critic who tells me to never to make a fuss. In IFS, you work with these sub-personalities, or "parts" as they're called, as if they were individual people. My point here isn't to sell you on IFS (though if you want to learn more, read this) but rather to talk about blind spots via the form of therapy I know best.
One more IFS concept: blending. Sometimes a particular defense mechanism (or "part") takes over our consciousness to the point that we totally identify with it. We don't say "I have a frustrated part" (or talk about the frustration as a defense mechanism); we say "I'm frustrated." We can't stand to the side and look at the frustration. We're wearing it, like a suit. This is the blind spot. When we're "blended" with a part (when we've totally identified with a defense mechanism), examining it would be like trying to look at ourselves with binoculars.
One tool for dealing with this is mindfulness mediation. It teaches you how to observe your consciousness from a neutral standpoint, not identifying with anything that passes through it. ("I'm frustrated" is a form of identifying. It's almost like saying "I'm Mr. Frustrated.") I'm a big proponent of mindfulness. I meditate every day. But for many of us, it's a slow journey. I've been meditating for years. It's been very helpful, but I'm far from "enlightened." And when I get to a certain level of defensiveness, no amount of mindfulness will help me out.
Another tool is therapy. Since the therapist isn't you, he or she can look at you with binoculars. A therapist can see that you've become defensive and point that out to you. Of course, the goal isn't just to point it out. It's to help you gain a a better understanding of your defensive parts and help solve any problems they may be causing. But you can't even get to step one if you're totally blended with the part of you that's defensive. Defensive parts are ... defensive. They don't want to be examined. Try to examine them by yourself and you're likely to fail.
(Defense mechanisms aren't necessarily bad, which is why I prefer the more-neutral term parts. They often help us at crucial parts of our lives. But like anything, they can cause problems. And if we're unaware of them, we can't easily solve those problems.)
There's an IFS Facebook group I'm part of in which people try to do self-therapy, relying on the group to help them out when they're stuck. Here's something I've seen happen hundreds of times in that group, practically every day:
Person A: This part I have is driving me crazy! He keeps making me fight with my mother.
Person B: Sounds like you have a part that's exasperated with that fighting part. Can you ask the exasperated part to take a few steps back so you can get to know the fighting part better and understand why it wants to fight so much?
Person A: Oh! I hadn't thought of the exasperated part as a part.
---
Person A: I have this part that's really scared of public speaking. I don't know what to do for her. I'd like to help her, but nothing I've tried seems to work.
Person B: I'm hearing that you have a frightened part and another part that feels lost and helpless. Can we hear some more about that second part?
Person A: Wow! I hadn't realized I was blended with her!
It's nearly impossible to see through these blind spots--to the fact that we're being defensive--on our own, without help from an outside perspective. And, sure, a friend could do this. But a friend could also maybe fix my roof, so why bother calling a roofing expert? Friends can absolutely be good helpers, but often--not always--trained professionals are better. A good therapist is, amongst other things, trained at being a really good, neutral observer.
Keep in mind that someone who has been your friend for years must necessarily have adapted to your defense mechanisms. There's a good chance he doesn't question them. "That's just the way you are." Or, they may feed into some of the things he likes about you, which may give him an incentive not to try to see past them. He also may be (consciously or unconsciously) scared to prod them, knowing how you react when he does.
Here's something else a therapist can be for you: a very special kind of relationship--one that you probably can't get anywhere else. A big part of therapy is about your relationship with your therapist. Here's an example from my life: I have some challenges when it comes to close relationships with other men. This is due to some baggage from early childhood. For me, being vulnerable around men is hard. My current therapist is a woman, and she's very helpful, so I'm planning on staying with her for now. But at some point, it will be really useful for me to work with a man.
Let's say a male friend tells me he cares about me. That's going to start some warning bells clanging in my head. But there's only so much I'd feel comfortable saying to a friend about that. I wouldn't want to hurt his feelings.
Whereas therapist is very specifically someone I can say *anything* to. On a basic level, I'm are paying him to listen to whatever it is I have to say. If a male therapist told me he cared about me, I could (and would, hopefully) say, "That makes me really uncomfortable." And we'd explore that. It would just go into the big closet where I keep all the shit I never deal with--all the shit the festers inside me.
Of course, a lot of "You can say anything to your therapist" depends on you. It can be hard to open up. But specifically when it comes to my relationship with my therapist, I work hard to say whatever is on my mind. Many times, in therapy, I've said things like "I think you're full of shit!," "The last thing I want to do today is talk to you," or even "I'm feeling physically attracted to you." All the things I can't say in normal relationships.
And what happens is that these relationship issues transcend therapy. Any issues I have in my relationship with my therapist will almost certainly be issues I have with other people. Working through them with my therapist helps me handle similar dynamics outside of therapy.
posted by grumblebee at 10:48 AM on June 8, 2023
The form of therapy I like best is called Internal Family Systems (IFS), in which what we commonly call "defense mechanisms" are conceptualized as sub-personalities. For instance, I may have an inner critic who tells me to never to make a fuss. In IFS, you work with these sub-personalities, or "parts" as they're called, as if they were individual people. My point here isn't to sell you on IFS (though if you want to learn more, read this) but rather to talk about blind spots via the form of therapy I know best.
One more IFS concept: blending. Sometimes a particular defense mechanism (or "part") takes over our consciousness to the point that we totally identify with it. We don't say "I have a frustrated part" (or talk about the frustration as a defense mechanism); we say "I'm frustrated." We can't stand to the side and look at the frustration. We're wearing it, like a suit. This is the blind spot. When we're "blended" with a part (when we've totally identified with a defense mechanism), examining it would be like trying to look at ourselves with binoculars.
One tool for dealing with this is mindfulness mediation. It teaches you how to observe your consciousness from a neutral standpoint, not identifying with anything that passes through it. ("I'm frustrated" is a form of identifying. It's almost like saying "I'm Mr. Frustrated.") I'm a big proponent of mindfulness. I meditate every day. But for many of us, it's a slow journey. I've been meditating for years. It's been very helpful, but I'm far from "enlightened." And when I get to a certain level of defensiveness, no amount of mindfulness will help me out.
Another tool is therapy. Since the therapist isn't you, he or she can look at you with binoculars. A therapist can see that you've become defensive and point that out to you. Of course, the goal isn't just to point it out. It's to help you gain a a better understanding of your defensive parts and help solve any problems they may be causing. But you can't even get to step one if you're totally blended with the part of you that's defensive. Defensive parts are ... defensive. They don't want to be examined. Try to examine them by yourself and you're likely to fail.
(Defense mechanisms aren't necessarily bad, which is why I prefer the more-neutral term parts. They often help us at crucial parts of our lives. But like anything, they can cause problems. And if we're unaware of them, we can't easily solve those problems.)
There's an IFS Facebook group I'm part of in which people try to do self-therapy, relying on the group to help them out when they're stuck. Here's something I've seen happen hundreds of times in that group, practically every day:
Person A: This part I have is driving me crazy! He keeps making me fight with my mother.
Person B: Sounds like you have a part that's exasperated with that fighting part. Can you ask the exasperated part to take a few steps back so you can get to know the fighting part better and understand why it wants to fight so much?
Person A: Oh! I hadn't thought of the exasperated part as a part.
---
Person A: I have this part that's really scared of public speaking. I don't know what to do for her. I'd like to help her, but nothing I've tried seems to work.
Person B: I'm hearing that you have a frightened part and another part that feels lost and helpless. Can we hear some more about that second part?
Person A: Wow! I hadn't realized I was blended with her!
It's nearly impossible to see through these blind spots--to the fact that we're being defensive--on our own, without help from an outside perspective. And, sure, a friend could do this. But a friend could also maybe fix my roof, so why bother calling a roofing expert? Friends can absolutely be good helpers, but often--not always--trained professionals are better. A good therapist is, amongst other things, trained at being a really good, neutral observer.
Keep in mind that someone who has been your friend for years must necessarily have adapted to your defense mechanisms. There's a good chance he doesn't question them. "That's just the way you are." Or, they may feed into some of the things he likes about you, which may give him an incentive not to try to see past them. He also may be (consciously or unconsciously) scared to prod them, knowing how you react when he does.
Here's something else a therapist can be for you: a very special kind of relationship--one that you probably can't get anywhere else. A big part of therapy is about your relationship with your therapist. Here's an example from my life: I have some challenges when it comes to close relationships with other men. This is due to some baggage from early childhood. For me, being vulnerable around men is hard. My current therapist is a woman, and she's very helpful, so I'm planning on staying with her for now. But at some point, it will be really useful for me to work with a man.
Let's say a male friend tells me he cares about me. That's going to start some warning bells clanging in my head. But there's only so much I'd feel comfortable saying to a friend about that. I wouldn't want to hurt his feelings.
Whereas therapist is very specifically someone I can say *anything* to. On a basic level, I'm are paying him to listen to whatever it is I have to say. If a male therapist told me he cared about me, I could (and would, hopefully) say, "That makes me really uncomfortable." And we'd explore that. It would just go into the big closet where I keep all the shit I never deal with--all the shit the festers inside me.
Of course, a lot of "You can say anything to your therapist" depends on you. It can be hard to open up. But specifically when it comes to my relationship with my therapist, I work hard to say whatever is on my mind. Many times, in therapy, I've said things like "I think you're full of shit!," "The last thing I want to do today is talk to you," or even "I'm feeling physically attracted to you." All the things I can't say in normal relationships.
And what happens is that these relationship issues transcend therapy. Any issues I have in my relationship with my therapist will almost certainly be issues I have with other people. Working through them with my therapist helps me handle similar dynamics outside of therapy.
posted by grumblebee at 10:48 AM on June 8, 2023
You are not logged in, either login or create an account to post comments
posted by vanitas at 8:39 PM on June 6, 2023 [3 favorites]