Therapy, You and Me

Posted by fxckfeelings on August 29, 2013

Whether you believe in a particular psychotherapy or find the very prospect of head-shrinkery scary, don’t let the emotions that draw you towards or away from the therapist’s couch drive your treatment decisions. Develop your own fact-based procedures for deciding whether you’re fucked-up enough to need therapy and, if so, whether there’s a treatment that isn’t too risky and has a good enough track record. Maybe we’d all like the experts to figure that out and make such decisions for us, but we’re better off picking the brains of experts and then making treatment decisions, pro or con, for ourselves.
–Dr. Lastname

Please note: We’re taking next week off for a long-deserved summer vacation, but look forward to hearing about your back-to-school/work misery when we return.

How long is too long to be in therapy? I have been in therapy for four years now, and it has helped enormously. I went into therapy initially because of a trauma situation, but I don’t want to stop, even though I’ve long worked through that trauma, because I still think I can benefit. Still, now that I reached the four-year mark, I’m wondering, how long is too long?

If you’ve read this blog, you’re probably aware of our belief that the most important goal of mental health treatment is seldom to relieve all your pain; that’s usually an impossible pursuit, or one that just shifts the pain from your head to your wallet and your friends, who are sick of hearing about what you learned in therapy.

The better goal of therapy is to use it to figure out how to prevent that pain from interfering with the way you think about, and lead, your life, and lucky for you (and us), your question reflects this healthy priority.

You know you may continue to have symptoms indefinitely and that further mental health treatment may help, but you’re now questioning how much additional benefit you’re likely to get and whether it’s worth it. Asking such questions is, almost always, an excellent therapeutic exercise.

After four years, you should know what this particular psychotherapy does for you and, apart from its ability to make you feel more confident or better understood for a week or two after a good talk with a nice, familiar shrink, it’s probably not going to make additional changes to your personality, life, or ability to cope. As we always say, breakthrough moments only happen to people in movies or inventors in the 1800s.

What you’re asking yourself at this stage, then, is whether stopping is going to remove an essential support and send your life down the crapper, or whether you desperately need something that this treatment hasn’t yet given you and therefore should be doing research or getting a consultation to decide whether to look for it somewhere else, including a different psychotherapy. If neither is true, then it’s OK to stop the therapy, save time and money, and prove to yourself that there’s a take-away you can apply to future problems. If you find you actually need it, you can always return.

In any case, don’t wait until you feel healed, confident, and ready to move on before you stop treatment. Instead, use a realistic, business-like method for deciding the value that treatment has for you now. Weigh the benefits and costs and make a decision that reflects the relative value you give these facts, and not just your feelings. Remember, if, after stopping, you discover you need treatment more than you thought, or discover it’s less costly than expected, you can revise your decision.

Some therapists don’t agree with this notion and will want to see you confident and symptom-free before they recommend stopping treatment. I encourage you to follow through on your own question, however, and find an answer from your values and realistic observations.

If you elect to suspend treatment because you’re ready to accept pain and uncertainty, and ready to re-start it if you find it necessary, then you’ve achieved one of psychotherapy’s most important goals. Life will always involve pain; don’t let fretting over the decision whether or not to stop therapy add to it.

STATEMENT:
“I don’t feel strong and healthy, and I’d like to feel better, but I’m not functioning badly, treatment hasn’t made a huge difference over the past year, and I don’t seem to slip back when I miss a session or two. I will hold off on treatment for a while, save my resources, see what happens, and thus objectively determine whether I continue to need it.”

My wife says I’ve seemed depressed and distracted since my mother died two years ago, but I think I can get through it without therapy. She says our sex life isn’t the same, I’m not into my work in the same way, and I’ve developed a temper I never used to have, but I don’t feel that bad, and life goes on. I’m basically the same guy and I don’t like to spill my guts out, so therapy isn’t for me. I know I’m not going nuts, so tell me why I need treatment.

The question is never whether you need mental health treatment, but whether you’re using a reasonable method to make that decision for yourself; whether you dislike treatment or have a bad experience with a particular therapist is irrelevant. That’s like avoiding medical treatment because a particular drug once gave you hives years ago or because needles give you the willies. Your job is to manage your mental health in the same way as your medical health, by getting help whenever you think it’s necessary and worthwhile, not because you’re influenced by fears, bad feelings, and all the things covered by therapy that you think you hate.

Here you’re saying that your mood since your mother’s death hasn’t gotten better in two years, and is affecting both your work and your most important relationship, all while turning you into a jerk when you lose your temper. Your values are the ones that count here, not mine, but it sounds like its impact on your life has been major. Sure, you’re not suicidal and lying in bed all day and you can toilet and feed yourself, so things could be worse. Honestly, however, if you were rating a friend’s disability and he was as disabled as you in the ways that matter—again, your values—I think you would rate it as moderate to severe.

If so, you owe it to yourself to consider your treatment options. Obviously, treatment isn’t worthwhile if there’s a high risk of dangerous side effects, but if there isn’t, it’s your responsibility to pursue them while evaluating for yourself whether they’re working.

If you’re good at self-help, there’s nothing wrong with beginning by reading up on methods for fighting the negative thinking of depression and getting yourself to exercise and think more positively. It’s like getting a good book on workouts and seeing whether it’s enough to get you going.

If you haven’t been able to share your grief with anyone, read up on grieving, see if you can share more with your wife or close friends, and, if you can’t, look for a therapist you can talk to. Otherwise, shop around for good therapists as you would for a good trainer, looking for someone who has good ideas, a positive attitude, and a personality you can relate to.

If these non-medical methods aren’t working fast enough or you’re in a jam and need faster help, try medication the same way you’d explore other treatments. Read up on them and discover the risk (low, but not zero) and effectiveness (do some good two times out of three). Then, if you think you need medication trials, find a psychiatrist.

Whether or not your mood improves, you’ll always feel better when you know you’re getting good, responsible, rational care—from yourself. Life does indeed go on, but you don’t have to stand idly by if it’s going downhill.

STATEMENT:
“I feel like I’d like to be left alone to do what I usually do and not have people bother me about my mood, but I can see what’s happening to me and I will get help if I think I need it and if it has something to offer.”