My Therapist, Myself

Posted by fxckfeelings on August 3, 2009

Like almost every useful treatment, medical or otherwise, psychotherapy can be dangerous, particularly when you rely on your (say it with me now) feelings to decide whether or not to continue. Ironically, feeling good is one of the worst reasons to stay with therapy, and feeling crappy is one of the worst reasons to end it.
–Dr. Lastname

My therapist is about to depart on vacation for one month, and I’m feeling f*cking nervous and tense about it. I’d like to know what I can do to make the best of this break in therapy and come back refreshed and ready to start work again when my therapist returns, and also how to keep the unpleasant feelings of missing her to a minimum.

Congratulations! While your question seems like a short-and-sweet query (or maybe a chance to cheat on the classic back-to-school essay, “What I did on my therapist’s summer vacation”) it’s actually a perfect example of the dangers of focusing too much on feelings when you’re undergoing psychotherapy. A+

Look, there’s nothing wrong with enjoying therapy, experiencing emotional relief or a feeling of personal growth, or liking or missing your therapist. Just remember—you’re paying for this and should never forget what you’re getting it for. Or you’ll be sorry.

If you rely on your feelings to tell you whether to continue therapy, you may never have reason to stop. You may continue to like your therapist, find the subject interesting, learn something new, and feel the treatment supports you in a way nothing and no one else does.

Here’s the rub though; if the therapist’s vacation forces you to suspend treatment, you may find that you do just as well during his or her absence and that missing treatment (and having a little more time and money) pushes you to do more with your life and relationships.

A better goal than coming back refreshed or minimizing unpleasant feelings about your therapist is to review what you’re getting treatment for, how far you’ve come, and whether it’s likely that you’re going to get more out of it. That’s your real summer assignment.

It may not ease your achy-breaky heart or refresh you, but it will make you stronger in the long run and save money better spent on refreshing vacations with people who don’t say “our time is up.”

And please, don’t wait until your heart tells you you’re ready to go out on your own. Unless you’re Bob, you don’t live with your therapist. Ask yourself what you’ve gotten out of therapy and, if you want more, whether it’s likely to get you there.

If you have insurance, pretend you don’t; pretend therapy is costly and unpleasant. At some point, every therapy stops being therapeutic, not because you don’t continue to need help, or because therapy is bad, but because most treatments are of limited benefit and, at some point, have done all they can, and you’ve got to live with what you’ve got.

Here’s another tough part: you can’t count on your therapist to tell you when further treatment is unlikely to be worthwhile. It’s not that they’re greedy– it’s worse than that. Like you, they can get over-involved in feelings, particularly their hope that eventually their treatment will give you what you want, regardless of evidence to the contrary. And you know how dangerous and evil false hope is.

So enjoy your chance to take a break from therapy and do some evaluation of your own. And if you find yourself missing therapy for all the wrong reasons, it’s probably time to make the vacation permanent.

STATEMENT:
Compose a summer vacation statement to direct your need-for-therapy assessment. “My summer job is to ask myself what I want from therapy, what it’s done for me, and what it’s likely to do, given my recent progress or lack of it. I will use simple, easy to observe measurements that anyone can see. Feelings are a bad measure because they’re too subjective. If I’ve made progress but nothing has changed recently, I need a good reason for thinking more treatment will provide more benefit. If I think treatment is necessary to keep me from stumbling, I should examine my level of function during this treatment-free month to see if that’s true. Otherwise, I need to stop.”

My brother has struggled with severe depression his entire life. Sometimes, he finds a magic potion of pills and can function like a normal person, but most of the time, he’s struggling to hold on. He’s in his 30s now, has had a long run of bad luck this past year (break-up, lost job, even a dead cat), and he’s told me that he doesn’t think he has any fight in him anymore. He doesn’t want to try new pills or continue treatment of any kind. I know if he’s a real threat to himself I can have him committed, but he’s not hysterical, just sort of resigned, but I don’t want to wait until he’s at the edge before getting him help, because at that point, it’s really hard to bring him back. I know I can’t give him a reason to keep trying, but my goal is to find a way to encourage him not to give up.

You’re right– if you were looking for an emotional way to inspire, or guilt, or otherwise move your brother to stay alive and keep thinking positively, you’d be pursuing a faulty goal.

If that were your quest, it would leave you worn out, disappointed, angry and guilty. Plus, he’d be avoiding you at a time when he really needs you. It’s hard not to try to “get through to him,” but it usually backfires.

But if you know, from sad experience, how persistently depression turns negative feelings into negative thoughts about oneself, one’s accomplishments, and one’s future, then you may have a tool for helping him that will not drive him away. He may eventually be able to use this tool for himself, and that’s the tool of positive thinking and reasonable perspective.

You know he’s a good guy who’s down on his luck. He could have a good partner if he were luckier (and maybe a little wiser) in his choices, and you admire his willingness to work, regardless of whether depression or other kinds of uncontrollable shit get in his way and impair his performance. You even know he provided a good home for his late cat.

And if antidepressants or therapy didn’t “work,” that’s not his fault. Antidepressants and psychotherapy may reduce the frequency and severity of relapses some of the time, but their effect is statistical, not absolute, and often those relapses do keep on coming. More bad luck.

So don’t tell him to resume treatment because it will help him, because you’re offering a kind of hope he’s learned is false. He’s got a severe, recurrent, incurable disease that has turned out to be treatment resistant. He’s thinks he’s fucked, and in this way, you agree with him.

From there, however, you have to complete the picture. For a guy with a bad illness, he’s done lots of good things. You don’t see him as a hopeless depressive, but as a courageous guy with a persistent illness that would wear down anyone, and you have nothing but respect for him, regardless of what he decides to do. He’s doing his best, and if you show him this kind of support, you’re doing your best, too.

STATEMENT:
Compose a statement that reflects your support. “I know that your depression is bad, your life sucks, and nothing is going right. But life is like that sometimes, and I think you’re a good guy who manages it very well. I assume you know that depression always makes things seem more negative than they really are. Your depression may tell you that you’ve failed, you’re a loser, you haven’t gotten anywhere, you’re a drag to be around, and the future won’t be any better. I hope you know better. I like being around you because I feel your courage. If you don’t want to try any more treatments, I can understand why you don’t want to be bothered. But don’t stop trying because you think your efforts are meaningless. That will never be true. I see you as a success because of who you are and as long as you try to do what’s important to you, regardless of what depression is doing to your brain, I see it as tremendously meaningful and I admire you for it. See you later.”