Do I really not need therapy?
August 11, 2018 3:41 PM   Subscribe

I have some stressful stuff going on and I'm feeling stressed out, tired, upset, scared, etc. much of the time. I went to my primary care doc, a therapist, and a psychiatrist/therapist (someone who does both), and they all agree that I'm fine and if I just get regular exercise then I won't feel bad about anything anymore. I'm so frustrated and tired.

All of these folks agree that since my bloodwork is fine and my thyroid medication is keeping my thyroid numbers good and I'm trying to keep a good mental outlook all that's left for me is exercise & controlled breathing. What they're literally telling me with their actual mouths is that therapy & medication won't help me and they won't give them to me for that reason.

Is it typical for someone showing up saying "i'm very sad and tired and anxious all the the time please help" to hear "There is nothing anyone can do to help you if you're not exercising?"

Is this really what people are saying now? It doesn't sound in line with everything I've heard about how you're supposed to reach out if you're having a hard time. But only if you're exercising I guess? Why don't they just put elliptical machines on train tracks instead of signs telling people to get help?

Also the last few therapists I've been to consider "therapy" to be "Tell me what's going on in your life and I'll tell you what I think you should do." Is that what it's supposed to be? It doesn't seem that helpful. I just want someone to listen, I guess.

PS: Whereas before I wasn't exercising because I was tired even though I know it's good for me, now I'm not exercising because I'm tired and stubborn, so please consider that I have already heard about how good exercise is (actually I've been told this every day of my life) and I don't need to hear it anymore. I just want to find out if this is what other people get told.
posted by bleep to Health & Fitness (21 answers total) 7 users marked this as a favorite
I work in the fitness industry and...I think the care you are getting is somewhat typical and I hear it a lot...but it is absolutely horrid and you deserve better. Keep interviewing therapists.
posted by warriorqueen at 4:09 PM on August 11, 2018

It happens. People get brushed off all the time. Doesn't make it right.

I had one doctor hand me a printout on chamomile tea after I described sleeping problems, that later on were proven to be directly related to stress. (I went somewhere else and got a prescription for Zoloft after I started experiencing full-blown panic attacks.) As if I had no access to the Internet and had never tried teas, Benadryl, melatonin, breathing exercises, on my own already. She also waved off my inquiries about allergy shots. They were too much of a bother for her, is what came across to me. (Take a Claritin and a Flonase and off you go now, basically. It's not going to kill you, so don't worry about it. It's just a little sneezing.) Never mind that the sneezing caused my whole body to get inflamed and often as not I would also get hives and feel sick and exhausted for two days following an attack. I ended up getting the shots from an allergy specialist, and they did help to increase my tolerance to grasses, mold, etc.

Get a different doctor and be prepared to fight and insist on getting your condition treated properly.
posted by Armed Only With Hubris at 4:19 PM on August 11, 2018 [1 favorite]

My dang, that's a shocker.

I have never been much of an exerciser; I'm pretty obviously a sedentary sort, plus I report honestly on the forms; and I have never been told that crap. I have gone to multiple professionals multiple times complaining of sadness or lassitude or both, and they've at least tried to be helpful. I would be highly irritated with anybody who told me to go away and try cheering myself up with a brisk walk.
posted by Don Pepino at 4:21 PM on August 11, 2018

I find this a really interesting question, because in my world I am more familiar with doctors assuming everything is depression/anxiety that needs medicating, and prescribing accordingly. I know people working in the mental health field who argue there is currently huge problems with the (over)prescription of antidepressants without considering a) the actual context and severity of people's issues and b) alternative or complementary approaches.

So to answer your question, my opinion may be biased based on the people I know personally and who work in the field, but this experience seems not the norm.

You are the person who is most in touch with your own mental health and what you need. I would keep trying therapists until you have found someone whose therapeutic style is a match for you. In the same vein, find a new doctor if they are unwilling to help you find a solution that is appropriate for you. Your mental health is important, and worth the fight. Good luck!
posted by DTMFA at 4:23 PM on August 11, 2018 [4 favorites]

Best answer: This isn't a criticism because I do this kind of paraphrasing, too, but:

Is it typical for someone showing up saying "i'm very sad and tired and anxious all the the time please help" to hear "There is nothing anyone can do to help you if you're not exercising?"

Are those the exact words that came out of your mouth, as best you can remember them? Are those the exact words that came out of theirs? Because I don't think that's normal exactly, but I also think that one of the things that happens to me when I'm trying to explain stuff to doctors, and especially to my psychiatrist, is that I fall into the same habit of being oblique about my brain weasels that I usually do with other strangers, and it doesn't help, and I'm wondering if the trouble here is that there's some level of miscommunication.

Because the one thing I have noted is that if you minimize the extent of your problems and go "I mean I think I'm basically okay and I feel kind of anxious but you know mostly I'm managing that but I'd just like it to improve", for example, they'll avoid putting you into a thing where you're expected to repeatedly take time out of your day and pay money to go talk to someone. If you go "my anxiety is very not okay right now and I need someone to talk to," period, that gets a very different response.

Finding therapists who aren't just "tell me about your day" is super hit and miss, I've had good ones and I've had less good ones, it can help to go in straight out and say "I've heard about this CBT thing and I'd like to find someone who can help me with that" for example. But for them to just say "have you tried exercising" sounds very much like the kind of thing I get when I either am doing mostly okay, or when I'm saying I'm doing mostly okay even though I'm not, where they're trying to save me money and not just put me indefinitely into therapy for the hell of it. (Which I'm glad for, because for example, I do have an anxiety problem but right now I'm working on that on my own and I wouldn't want to have to be putting the time into therapy if I didn't need to.)
posted by Sequence at 4:48 PM on August 11, 2018 [22 favorites]

Oh, and if money is not a big issue with this and you just can't find someone who works for you locally, I tried Better Help awhile back and was pleased with it as a service even though it wound up being a bit more than I wanted to pay for what I was getting out of it, so that kind of thing is an option.
posted by Sequence at 5:08 PM on August 11, 2018

I'm of the opinion that pretty much everyone would benefit from seeing a therapist periodically, so I say go for it. It sounds like your symptoms are probably subclinical, though, so I wouldn't expect a lot in terms of treatment. (Although "tell me what's going on in your life and I'll tell you what to do" is kind of what therapy is; I'm not sure what else you're looking for.)

To be perfectly honest, you come across as somewhat med-seeking, which may be why you're not getting better responses. Maybe you do need medication, but that's for a medical professional to decide, not you. This could be part of a plan to rule out other treatments first before putting you on medication. My advice is to try what has already been suggested and see if it works, and if it doesn't, let your doctors know so that they can determine the next step.
posted by kevinbelt at 5:16 PM on August 11, 2018 [1 favorite]

This is consistent with my experience with talk therapy. Once, I saw a therapist for several months during which I was constantly suicidal, only for his grand conclusion to be “I think you've got what we would call mild dysthymia!” Apparently-directionless meandering chatter has seemed to be the dominant approach and in my case, at least, the therapists usually didn't seem to have a good way to evaluate whether it was getting anywhere and try different things.

I think it's just that figuring out what's going on in someone else's head is a difficult problem and the sort of strategies that will work to get the ball rolling, as it were, in the therapist-client relationship can vary alot. You just need to keep looking until you find someone you click with. Be prepared for it to be a slog—I think I got up to around my sixth therapist before I encountered someone I started to get real traction with—but don't give up. I wish you good hunting!

(One thing to know... for some people, at least, a side effect of SSRI anti-depressants can be to make you more tired. When I first started taking them I was in a very stressful job involving lots of travel and it wasn't until many years later that I finally realized I'd been unable to distinguish between the fatigue caused by the drugs and the fatigue induced by everything else. Not a reason to refrain from that approach, and newer drugs might have milder side effects, but it's something to be aware of.)

P.S. I notice in your profile that you're a lady, whereas I'm a dude, so you probably want to add on an additional sexism-level difficulty on top of what I say above.
posted by Sockpuppet Liberation Front at 5:24 PM on August 11, 2018 [1 favorite]

Also the last few therapists I've been to consider "therapy" to be "Tell me what's going on in your life and I'll tell you what I think you should do." Is that what it's supposed to be? It doesn't seem that helpful. I just want someone to listen, I guess.

It might be that when these recent professionals took your history, they thought you were saying you've already tried therapy and didn't get much out of it so please can they suggest something else. there's also a possibility they thought you wanted to be told you didn't need therapy, and so they told you you were fine in hopes that having your problems 'normalized' would make you feel better -- I think this is really irresponsible but some doctors do it.

I have heard of therapists refusing prospective new patients for reasons other than a full schedule, but it's very unusual and I think in that case they'd be saying they personally couldn't help you, not that you didn't need help. it really doesn't matter how bad your problems are, since therapy spans the full spectrum from essential health care to luxury consumer good: it's a thing you can buy, and you don't have to bring in a diagnosis to legally access it. just like a massage therapist is not going to turn you away because your back doesn't hurt enough, you know? A particular psychiatrist might not want to be your therapist if he's not also prescribing medication, maybe, but it's not normal for therapists across the board to turn you away because you aren't in enough need. they would have no idea of the extent of your issues until they'd talked to you for several sessions, anyway, and they know that.

bottom line is if you already know you want a therapist, don't say you need help and trust them to figure out what that should be; say explicitly that you're looking for a therapist. If you do that (or if you already have done that), at the very least they should refer you to someone if not offer their own services. if they won't, something is not right. maybe just in the communication between you, maybe something more.
posted by queenofbithynia at 5:49 PM on August 11, 2018 [3 favorites]

HAHAHAHA this is my life as a chronically ill woman and it's bullshit. (Well, technically they said it was all anxiety but didn't even recommend therapy so I went on my own.) *My assumption is you are feminine presenting?

1)Find a GP that believes you. I've written about this before. I can dig it up if you DM me. Doctors on the whole don't believe women* and "normal" ranges can be total bullshit when it comes to your individual body. You could also have additional health or mental health issues.

2)Find a therapist that will listen. My experience when I was in therapy was talking about stressors and coming up with steps to manage them and grounding exercises and clearing out my thought processes. There were definitely parts of homework for therapy. It's supposed to be a process to get to a better or more stable or less stressful area. But no, just ranting about sadness or problems isn't quite therapy in my experience. It will be some work on your part.

3) FUCK anyone who says you should exercise first. Seriously. Burn that advice with fire. Sure, exercise can help things but you've got to make sure major health issues (including mental health) aren't at play first. Jesus, diet and exercise are ways for medical professionals to ignore patients. Also exercise isn't technically good for everyone depending on their health.
posted by Crystalinne at 5:58 PM on August 11, 2018 [15 favorites]

Nobody's commented on the thyroid angle yet, so I will: Primary care docs are almost always complete and utter shit at treating hypothyroid. Do not accept the "your numbers are good" brush-off if you feel terrible; fatigue and depression can absolutely be symptoms of under-treated hypothyroid.

Get a GOOD endocrinologist. Find someone who will do thorough testing, not just tsh but also T4, free T4, reverse T3, and antibodies, and who uses the presence of symptoms to adjust dosage of thyroid meds, not just lab test results.

As for tsh results: The American Endocrinological Society set the cut-off for normal function at 3.5 years ago, but many labs still use 4.5 or even 5. Even in the tradition of caring only about lab results, that is just wrong. Many people think that 3.5 is far too high. Take a look at your actual tsh number.

If you've been taking synthroid, you might need a dose increase, or you might need to try an option that includes T3 as well, such as Armour's or Naturethroid. Don't let idiot physicians tell you those are dangerous. They are stringently manufactured and have been for decades, and they help a lot of people more than synthroid. is a helpful web site (I'm not affiliated in any way).
posted by nirblegee at 6:32 PM on August 11, 2018 [9 favorites]

I might suggest that you look specifically for therapists who describe themselves as Rogerian, humanistic, client- or person-centered as keywords. I think broadly, that style of therapy is less likely to blow you off as "just" needing this or that and saying - if you feel like therapy is necessary or useful for you, then you should be here.
posted by nakedmolerats at 6:50 PM on August 11, 2018 [4 favorites]

One additional consideration - if you are in the US and paying for your therapy using your health insurance, the insurance company wants to make sure that you are "sick" enough and that the point of therapy is to "cure" your "illness". So if you minimize your symptoms, the therapist may have a hard time justifying why (according to the insurance company's rules) you need therapy. Not say you wouldn't benefit from it, but if you minimize say you mostly fine when you really aren't, it would be hard for the therapist to justify the kind of diagnosis that would be covered by insurance.
posted by metahawk at 7:53 PM on August 11, 2018 [5 favorites]

No you do not come across as med-seeking so please ignore that "advice."

It is taking me forever to find a good therapist. It took me getting a recommendation from someone else's therapist to get me a call back, and I've had a few visits and feel like this one might be ok so far. By forever I mean three years of looking and trying off and on (it is difficult to keep trying therapy when it keeps not working) until it basically hit a boiling point. I told my friend's therapist that I was in desperate need of getting a grip on my mental health and would drive up to an hour each way to get it. That, I think, helped too.

There's some kind of barrier to getting therapy for some of us that I can't quite articulate. So be persistent until you find someone who takes you seriously. That is the best advice I can give; that is some bullshit, and I'm sorry. This is a real and unfortunate thing and it's absolutely gendered. I'm sorry you're experiencing it. You deserve better. Take care.
posted by sockermom at 7:53 PM on August 11, 2018 [11 favorites]

Oh also I recommend ruling out therapists who only list cognitive behavioral therapy and/or dialetical behavior therapy. My current therapist uses Gestalt. I've heard good things about integrative therapy. For whatever reason CBT and DBT don't work well for me and it seems like many or most therapists only practice those. I feel like that may also be the case with you? So that could be something to look for.
posted by sockermom at 8:04 PM on August 11, 2018 [1 favorite]

Are you trying to use insurance for therapy? What they might be saying is, "you do not have something severe enough to require insurance to cover it." Depending on your insurance, that bar could be very high. Just spitballing here though...

In any case, I'd say keep looking for therapists who can help you. I'm sorry, this sounds really frustrating.
posted by Toddles at 8:41 PM on August 11, 2018 [2 favorites]

Seconding everything Crystalline said above. I've told this story on the green before, too: I spent years being told by medical professionals that I needed to get more exercise, lose some weight, practice better sleep hygiene, etc., before I finally presented with a condition "serious" enough for one of them to do a more thorough investigation and led to my first diagnosis of chronic physical illness. My mental health actually improved after my "I don't care what the doctors say; something is wrong sense was acknowledged at last.

On therapists -- I think a good therapist will discuss what you're looking for from them and check in periodically as to whether you feel like you're getting what you want out of therapy. I understand that therapist shopping can be difficult if you're limited by a list of who takes your insurance, but agree with the poster above who said CBT/DBT are probably not what you're looking for. Psychology Today's therapist finder listings can be useful to narrow down an insurance list -- the therapist profiles list their therapy styles and the issues they help clients with.
posted by camyram at 9:20 PM on August 11, 2018 [1 favorite]

To be perfectly honest, you come across as somewhat med-seeking, which may be why you're not getting better responses. Maybe you do need medication, but that's for a medical professional to decide, not you.

this is very likely representative of some doctors' mindsets and as such it is grade-A pure power-tripping with absolutely no grounding in concern for your safety. it is also not very accurate because much of the time you can walk into a doctor's office and request a particular drug by name and walk out with a prescription and free samples too if you're lucky. this isn't good, but it's true. a medical professional who will pause to cross-check side effects with your other conditions and medications first is a rare gem.

personally I don't think antidepressants should be prescribed in the cavalier manner they usually are, and just because they will virtually never kill you if taken as directed doesn't mean their effects can't be extremely unpleasant and debilitating and fuck you up. but doctors as a body do not tend to worry about this; intolerable side effects are a preoccupation of patients, not doctors. it is patients with depression and anxiety who must make the genuinely difficult decisions here, and cater to Medical Professionals' egos while they're doing it. It is not, actually, for doctors to decide whether people "need" psychiatric medication; it is only for them to decide whether people may be permitted to purchase it. Short of involuntary commitment, the ultimate responsibility for taking or refusing a drug always remains with the patient. just as ignorance of the law is no excuse when it comes to crime, lack of a medical degree is no excuse when it comes to harming yourself through trusting what a doctor tells you.

"med-seeking" is a sneer almost exclusively applied to patients who want painkillers, presumably because alleviating pain is a base preoccupation of the lower orders. so if this is not the class of drug you're after, do not let this make you paranoid. you can march in and say in so many words that you're seeking a medication such as a beta blocker or an SSRI or hormonal birth control or etc. without worrying about the "med-seeking" label, even though that is exactly what you're doing. every time a person goes to the oncologist for their chemo infusion or goes to the pharmacist to pick up their antibiotics, they are seeking medication. and they find it, too.

in other words, "med-seeking" when doctors say it doesn't mean med-seeking at all. it's code for "I don't respect you." If you are seeking medication and therapy, you may have a long struggle to get it and you may be mistaken about what will do the most good, but you do not have to be ashamed of yourself for trying and you do not have to put on a show of pretending you're not trying.
posted by queenofbithynia at 11:15 PM on August 11, 2018 [12 favorites]

Yeah, from personal experience--med-seeking is a thing they worry about with scheduled medications. If you didn't bring up benzos specifically, then it is incredibly unlikely that it even crossed their minds, and it's kind of ridiculous to suggest it as the problem in this context. Not only should you not feel ashamed of asking for help, which you shouldn't, but like--there is no reason here to think your doctor even thought that. People ask for medication for anxiety all the time. Even if you walk in and ask for Xanax, if you have successfully communicated to the doctor that you have anxiety symptoms of any variety, they just give you different pills instead of the Xanax.
posted by Sequence at 8:08 AM on August 12, 2018 [3 favorites]

I thought of something: have these three all been since the "sitting is the new smoking" fad broke? Because my data all predate that. It's entirely possible I would have a different experience these days if everybody is starting with "exercise is the new not-smoking," now. It's still absolute bullshit, of course. And you don't come off as "med-seeking;" wtf even is that? I wonder if that dude that just stole a plane and crashed it asked for help but got told to go pound sand because he seemed all gross and medseeky. Hey, docs! If somebody is sad enough to say they're sad, WHY NOT ASSUME THEY ARE FEELING PRETTY SAD.
posted by Don Pepino at 9:41 AM on August 12, 2018 [3 favorites]

That’s not been my experience (getting told to exercise for sadness instead of getting therapy and/or medication). It is very annoying that you have been having this experience.

For the medication part you might try the Maven app — it’s telemedicine designed for women, with mostly female practitioners. They have nurses and MDs and therapists and you can get short cheap visits (like $20) with the medics and if you get someone in your state they can prescribe. You can usually find a same- hour appointment and I’ve had good experiences with them (using a nurse, a pediatrician, a physical therapist and a nutritionist).

I hope you feel better soon.
posted by hungrytiger at 1:24 AM on August 13, 2018 [1 favorite]

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