Is it worthwhile to enter therapy if you're not in acute distress?

January 18, 2008 10:21 PM

Is it worthwhile to enter therapy if you're not in acute distress?

So, I'm pretty sure I'm not depressed. Or anxious. Or OCD. Or addicted to substances. However, I dislike myself a fair amount of the time. I like the work I do and the things I produce, but I don't really like being around myself. To a certain extent, I have a suspicion that this is just part of the human condition. Why else would people be so obsessed with the idea of complete transformation, of being "born again" or "made over"?

The things I don't like about myself aren't things I feel capable of changing. For instance, there is a certain core unhappiness/loneliness/neediness/self-obsession which is a bit disgusting to me (which is reflected, actually, in this desire for transformation). I can distract myself from this through work, or through various forms of self-indulgence, but in the end I will always wind up coming back to the same dissatisfaction and disgust. Maybe part of my problem is that deep down, I think that if I were a truly rational and/or virtuous person, none of this would matter very much. Not everyone gets to be happy and not everyone gets to be loved. There is nothing fair or unfair about it, or it isn't any more or less fair than any of the other basic facts about being alive. Why do I think I deserve these things in the first place? But at the same time, I do want these things, and sometimes think I would do anything to get them. I wish I could truly be satisfied with what I have, but it seems at this stage in my life that I am unable to do so.

Basically my questions are:
Is therapy useful for people in my type of situation?
Can therapy make you like yourself more?
Can therapy help you become a "better" person, or alternatively, can therapy help you come to terms with your failures to live up to your idea of what a "good" person is?

Also, since I don't think I would qualify for insurance -- I'm basically looking at doing this out of selfishness rather than medical necessity -- how much money should I save up before trying to talk to a therapist? My plan was to set aside around $2000, which I'm hoping would last for 10 to 15 sessions. Is this a realistic plan? Would I get any benefit out of only ten sessions of therapy? I'm not sure I could really afford to spend much more without changing my life around a lot, but I guess after ten sessions, if I feel a lot better, I could think about moving to a cheaper apartment. Should I be looking at some other category of help entirely?

Apologies if this question has been addressed before.

posted by anonymous to health & fitness (32 comments total)

I don't think that the things you're talking about are amenable to a short course of interventional-type supportive psychotherapy. I think what you are looking for is a proper course of psychoanalysis, which is much more rigorous - often daily - and can take years. Unfortunately, a psychoanalysis costs much more than what you have put away, limiting its availability to all but the very rich.

If you're interested in learning more about psychoanalysis, though, I recommend Daniel Menaker's splendid The Treatment, a book which should have received a lot more attention than it did.
posted by ikkyu2 at 10:35 PM on January 18, 2008 [1 favorite has favorites]

Not everyone gets to be happy and not everyone gets to be loved.

Yes, it's worth it and you'll definitely know whether it's doing you any good by the 10th session.
posted by rhizome at 10:41 PM on January 18, 2008

Sure. Therapy can be quite useful for when you feel some sort of rut or need a new direction in your life but aren't sure exactly what path to take, for example. I'd say go for it. You might learn some more about yourself, including possibly why your mind shifts that way, and what might make you happier in the end.
posted by cmgonzalez at 10:55 PM on January 18, 2008

I strongly disagree with ikkyu2. I think 10 sessions could help you a lot, especially if you're willing to risk taking an honest, open, unguarded look at yourself. True, psychoanalysis isn't going to work for you at this time (because, as ikkyu2 mentioned, it's a very time and money intensive), but there are plenty of good therapists out there who practice other methods. Also, I suggest discussing you financial situation with the therapist as many have sliding scales.

By the way, are you familiar with dysthymia?
posted by SampleSize at 11:18 PM on January 18, 2008

My grad school advisor was a clinical psychologist for many years and advocated a bit of therapy for everyone. She used to say "many of us dedicate several hours a week to the betterment of our bodies at the gym, but few ever want to spend one hour a week bettering their mental state with a therapist". I think she has a valid point.

If you have the money socked away and can find a therapist you trust to help you with specific aspects of your unhappiness/loneliness/neediness/self-obsession it may help you a great deal. Just don't be afraid to switch therapists after a session or two. You are not just going in to talk at a person, it is a two-way dialog and openness and trust between you both are key.
posted by prefrontal at 11:56 PM on January 18, 2008

There are basically two kinds of therapy. Traditional psychoanalysis takes a very long time as others have said, and attempts to find the root causes of the problem such as childhood trauma.

Cognitive therapy takes only a few sessions, and basically attempts to address the problems by encouraging the patient to think rationally about things.

About ten sessions should be fine for cognitive therapy, but is not enough for psychoanalysis.
posted by TheophileEscargot at 12:15 AM on January 19, 2008

Ditto Theophile. Go for cognitive. And definitely go.
posted by futility closet at 12:44 AM on January 19, 2008

I was in the exact situation you were, and derived much benefit from therapy. It's a structured time for you to untangle skeins of thought out loud, in the presence of a sympathetic and observant person, who can gently steer you toward perspectives you would otherwise miss. Really, it's all the other junk we spend our money on that we should think twice about, and not therapy.
posted by limon at 1:23 AM on January 19, 2008 [1 favorite has favorites]

Is it worthwhile to enter therapy ?

your answering to this question is part of the therapy. The outcome is what you cannot know before you've entered therapy. Therapy is a place where you are the one in charge of the choices. But beginning doesn't mean that you've sold your soul to the devil... You can try a kind of therapy, then change for another one. You can meet a therapist then meet another one if things do not click. You can stop for a while, then resume... Different therapies work differently for different people. Therapy is supposed to make you more responsible of your choices. Actually, you're the only one who knows what he's after. Therapy definitely induces changes in the short or long term, but you have to know that you may use some strength to resist to these changes.
posted by nicolin at 2:21 AM on January 19, 2008

There are basically two kinds of therapy

There really aren't. It's in no way a binary split between 10-sessions-and-that's-it CBT and multi-year psychoanalysis. A huge number of therapists are 'eclectic' in their approach. There are lots of reasons why I would give ultra-traditional psychoanalysis a miss, but in general almost all the studies (and personal and anecdotal experience) show that the 'school' of therapy is much, much less important than the personal relationship with the therapist. Shop around a little, see how you get along with people. Distrust anyone who claims you'll be "cured" of all your issues in 10 weeks, and also anyone who claims that you have to sign up for years for it to be worth it.
posted by game warden to the events rhino at 2:21 AM on January 19, 2008 [1 favorite has favorites]

And Nicolin is so right. For more in that vein, read If You Meet The Buddha On The Road, Kill Him!
posted by game warden to the events rhino at 2:24 AM on January 19, 2008

You don't say how old you are, but the condition you describe is to one degree or another universal. I'd venture to say that no one feels entirely adequate. What to choose to do with that realization?

Therapy is certainly an answer. But you may be unsatisfied with therapy for a variety of reasons. It's expensive. It's hard to find a good therapist. It's often difficult to know whether therapy is "helping." You can spend a long time with a therapist only to recognize months (years?) later that it didn't make any difference. If you can find someone good, it's great. Like having a good friend to lean on.

Medication is certainly another answer, if the feelings of "dissatisfaction and disgust" become more profound.

In the end though, your inquiry has to be with yourself. Mindfulness meditation is a good way to start. It costs little, is highly rational in its approach, and if approached correctly is a loving and reassuring process that can provide a lifetime of wisdom - your own wisdom - to guide you through life's difficulties.

Therapy may not get to the root of the "problem," since the problem may never completely go away. What therapy can do, what meditation and other mindfulness practices can do, is help you learn to live with self-doubt. To learn how not to react to it. We all have feelings of self-loathing (though I think it's more a problem in wealthier societies) - it's our negative reaction to those feelings that leads to a cascade of despair.

Self-acceptance is what you're aiming for, no matter the method (therapy, medication, meditation), not necessarily becoming a "good" person. In Buddhist terms, by seeking to become a "good" person you are missing the point and in fact likely getting in your own way.

Also, I should mention what worked for me more than anything. Service. Caring for people in more pain than me.

Also, exercise. It just changes the way you think about yourself and everything else.

So, to answer your question. Therapy can help, but. Best wishes.
posted by pammo at 3:44 AM on January 19, 2008

I gotta say that the kind of intensive psychoanalysis Ikkyu2 mentions is not only extremely expensive, and thus limited to the rich, but it is that way for a reason: there is not much in the way of conclusive evidence that it provides any significant mental health benefit even close to commensurate with its costs. That's why insurance won't cover it.

But it is just the thing for people with nothing seriously "wrong" with their mood or thought processes, a lot of time on their hands, a huge bank account, and a need to talk about themselves every day.
posted by fourcheesemac at 5:04 AM on January 19, 2008 [2 favorites has favorites]

You just need someone insightful with whom you can discuss these issues. If there is no friend in your life who fits the bill, no priest or other person who might, then a therapist can help. The advantage of someone who knows you - they don't need to learn all your history, your personality etc. Frankly, that can be a lot of sessions right there. The advantage of the therapist - they are trained to hone in quickly on the likely issues and dig out the root causes. They have seen it before. Also, they keep their mouths shut later. Further, if it turns out that you have complicated mental issues they have the knowledge to help that some regular schmo probably does not. It can be helpful but you need to find someone you click with. If you don't feel you are making progress with the first one, try someone new. Good luck.
posted by caddis at 5:53 AM on January 19, 2008

A lot of people turn to spirituality for these types of problems. If you're not against it on principal, participation in and exploring the theology of an established religion may give you some of the tools to help deal with these feelings.
posted by fermezporte at 7:07 AM on January 19, 2008

I think you are understating your problem, and that you could benefit from therapy. Sometimes it's hard to realize that there is something better, if we are so used to just feeling bad. But you can feel better. Nobody has to feel the way you do all the time. You could look into low-cost clinics for the uninsured. Most cities in the US have them I think. They usually have sliding rates, that are in a similar ballpark to what your copay might be if you were insured. Alternatively, you could look into getting a new job that does offer insurance (or better insurance. Maybe yours does, but doesn't cover mental health). There are some companies that offer medical benefits for part time employees even. Ikea and Starbucks come to mind. There are more I'm sure.

Also, as others have mentioned, there are alternatives to therapy. You could try finding a friend you feel comfortable talking about these issues with. Religion. Meditation. Also, any therapist will tell you to do a few things if you aren't already: eat healthy, and excercise. Exercising will raise your endorphins, hopefully raising your mood for the rest of the day. Eating healthy will ensure that your body has all the nutrients you need for healthy body chemistry.
posted by gauchodaspampas at 7:32 AM on January 19, 2008

Intensive psychoanalysis - or psychoanalysis - is maybe also for people really focused on the way their unconscious is expressing itself through their conscious everyday life, and maybe focused on trying to make things move and change at an unconscious level. Some people believe there is such thing as the unconscious. Some people don't.
posted by nicolin at 7:34 AM on January 19, 2008

Nthing the suggestion of cognitive behavioral therapy and mindfulness meditation (or just mindfulness). CBT helps you uncover and challenge the deep, irrational beliefs that influence how you view the world.

For example, it's apparently common for people to believe, deep down, that there is something fundamentally wrong with them and that they are therefore unlovable, undeserving, etc. CBT can help you challenge the logic of that belief, and mindfulness practice helps you keep your thoughts on a healthy track all day long. Changing your thoughts can really change how you feel. So can exuberant exercise.
posted by PatoPata at 8:05 AM on January 19, 2008

if i may suggest an alternative: if you're looking for some sort of transformative, introspective experience, may i recommend travel? $2000 will go a long way if you want to backpack through latin america or asia for a couple of months. even better, find a volunteer project. i think volunteerabroad.com has a bunch of 3-week projects you can sign up for.

there's something about linguistic isolation that makes you interact with the world in a different way. it's very eye-opening. you'll introspect without realizing it. you'll get a different perspective on what happiness is and what being loved means. when you interact with people in a completely different way, you uncover parts of yourself that you never knew existed.

so, that's just a thought.
posted by thinkingwoman at 8:15 AM on January 19, 2008 [1 favorite has favorites]

In my experience, yes. It is worthwhile to see a therapist when one is not in the midst of a crisis situation.

I saw a therapist several years ago, when I was particularly unwell with chronic, deep depression. Then I stopped (lost health insurance), got to a much better place in life, and felt better than I had ever remembered feeling.

I recently resumed therapy, however (yay health insurance!). I'd still been having some problems with depression, largely linked to those same sorts of feelings of self-loathing which you mention. We've been doing weekly sessions for about two and a half months (some psychoanalysis, but mostly just talk therapy), and I've noticed a definite improvement in my mood, behavior, and feelings of self-worth.
posted by weatherworn at 8:20 AM on January 19, 2008

If you've a medical school or university near you, their psychology and/or psychiatry departments may offer therapy sessions for much less money (or on a sliding scale according to your income) than you'd pay a practitioner in private practice. The therapists/psychiatry residents are almost done with their training and are under close supervision of professors.
posted by Salthound at 9:02 AM on January 19, 2008

The answer to all four of your question, IMHO, is yes.

There are many kinds of therapy, not just CBT or psychoanalysis. I go once a week, sometimes twice a week, and my therapist just calls it "psychotherapy". It is helpful and...

I know for sure now that it is when I am not really depressed I make the best headway.

This is because I am trying to dismantle the many, many things that I wrongly believe to be true; things which are not true because the premise lying deep beneath them is that I am a bad person, which is false. It's hard to identify all those logically unsound things when I am deeply committed to that false underlying premise. When I am more psychologically grounded, i.e. not in the midst of a giant-ass depression, I can see the illogic.
posted by girlpublisher at 9:13 AM on January 19, 2008 [3 favorites has favorites]

I've seen a therapist for 12+ years, once a week. Because I have an underlying diagnosis, insurance covers part of the cost. Also, you can use a health savings account (your pre-tax dollars) for any therapy or counseling, regardless of insurance coverage or diagnosis. With therapy and meds and lifestyle changes and age (getting older), I am much much much happier with myself and my world. I can only remember the feelings you describe as a distant memory. I used to feel that negativity toward myself was just "me" but now that is not at all me. (YMMV.)

My therapist is eclectic, as someone wrote above -- she uses a bit of everything. Cognitive behavioral tricks, psychoanalysis, dream analysis, talk therapy, a little woo woo, a little Ann Landers, etc., etc. I went through a marriage and divorce with her, now parenting. Only in the past few months have I begun to think for the first time that I don't "need" to go anymore.
posted by ClaudiaCenter at 9:35 AM on January 19, 2008

You can do a full course of CBT in 10 sessions and I think it would really help you. People like you (and me) think you're just being rational and realistic when you say these things, but you're actually being deeply negative, and that kind of thinking is very effectively balanced by the practical techniques you'd learn in CBT.
posted by loiseau at 9:51 AM on January 19, 2008

Oh, and I mean to say, it sounds like you're like me that you're not the kind of person who's into a bunch of mysticism or wants to lay back and talk about how you felt when your father spanked you. CBT was the hidden approach I'd wanted with a tonne of therapists I'd seen before that, who were into talking about my childhood and never getting to any actual SOLUTIONS. It was a real revelation for me that you could actually learn techniques to counter negative thinking instead of hashing, re-hashing, and re-re-hashing stuff for years with no end in sight.
posted by loiseau at 9:54 AM on January 19, 2008

Don't forget to tell the therapist what your expectations and budget are.
posted by gjc at 10:39 AM on January 19, 2008

Don't make assumptions about what insurance will cover.

I saw a therapist (licensed with a PhD in psychology, not an MD) one hour weekly for issues that sounded pretty similar to yours - i.e. a lot of unhappiness/discontent with self, and my thoughts on it mainly that it was just a combination of the reality of life and personal deficiency. Nothing acute, I never considered suicide for example, but I do have a family history of depression, anxiety and substance abuse.

I feel it helped a lot. The therapist provided a relatively objective alternate perspective, forced me to better examine and justify my internal dialog about things, encouraged me to question whether I had anything to lose being more compassionate towards myself. I'm raising a child now and I feel very strongly that my course of therapy is helping me to be a better father than I would have been otherwise.

Insurance did cover a fair amount of it. It ended up costing around $1000 out of pocket a year. It did last a lot longer than I expected to go - about five years.
posted by nanojath at 12:55 PM on January 19, 2008

The answer is yes. But, actually I believe you can help yourself, if you have the right tools.

First, I'm biased: I don't recommend therapy. I'm a person with a very long history of anxiety, depression, and terrible self-image. I had done the whole therapy and drug thing, and now believe it was a total waste of my time and money. As I learned the hard way, therapists are only Human, and as Humans they have a lot of biases, prejudices, and baggage themselves. There are probably millions of therapists out there, and half are below average. You need a very talented and skilled therapist to achieve results, and people like that are expensive and hard to find or schedule time with.

I think, unless you're suicidal or self-destructive, in which case you should get immediate attention, or you're not functioning enough to attempt things on your own, you can skip the therapy path.

Instead, as others have mentioned, you need a good understanding of cognitive behavior therapy. You need to dedicate at least an hour a day to behavioral modification. You need someone in your life to support you in your desire to change. Finally you need good texts on CBT with real world exercises. I recommend David Burns' book first, but there are others out there.

It's a long journey, but it will work. It took me a couple of years of constant work, and support from a great partner, but I have never felt as good about myself as I do now.

Good Luck!
posted by brandnew at 4:36 PM on January 19, 2008

Yes. Dysthymia is treatable.
posted by callmejay at 8:36 AM on January 20, 2008

Seconding CBT-- either through reading about it or going for it. What you describe are exactly the kinds of thoughts/beliefs about self that cognitive behavioral therapy addresses.

It's true that therapist empathy/patient-therapist connection are more important than school of thought-- but why not have *both*? Ie, find a therapist you connect with who practices an evidence-based treatment like CBT.

Also, if you do via reading, be sure that you are actually practicing what is suggested, not just reading and saying "Yeah, that makes sense." It doesn't work if you don't actual do the exercises.
posted by Maias at 7:43 PM on January 20, 2008

Having gone into therapy only after a crisis, I really wish I had gone in sooner. I strongly recommend going in now. I can't promise that you will like yourself or that you will come out a better person, but I feel that you will definitely get to know yourself better. This may make you hate yourself more at first, but I think that it will teach you compassion for yourself by giving you greater clarity about your actions and feelings.

I would also recommend CBT. I have found that it keeps me moving, thinking and progressing, not dwelling on mother issues and stewing in stuff like other therapies. I feel much more capable of healing myself because of CBT, which, I feel, is an important goal of any therapy.
posted by kenzi23 at 9:27 AM on January 21, 2008

My experience is that I didn't really start to benefit from therapy until after the acute distress passed. When in acute distress I find it difficult to absorb what the therapist is trying to tell me. After I've calmed down a bit that is when the real progress seems to start.
posted by Carbolic at 11:20 AM on January 21, 2008