Stop Recommending Therapy Like It's a Magic Bean That'll Grow Me a Beanstalk to Neurotypicaltown

Stop Recommending Therapy Like It’s a Magic Bean That’ll Grow Me a Beanstalk to Neurotypicaltown

May is Mental Health Awareness Month, which makes this an excellent time to talk more about our beautiful broken brains!

(Ahem. Because I am an honest chap, I feel compelled to stress that we did not plan this in advance. We are not nearly organized enough to do that. It was purely coincidental.)

I’m an advice column junkie. My regs right now are Where Should We Begin?, Dear Prudence, Dear Sugars, Savage Love, Care and Feeding, Captain Awkward, Ask a Manager, My Brother My Brother and Me, and the collective wisdom (?) of r/relationships. Yeah… it’s a problem.

When the subject of mental health arises, I’m perennially dismayed to see a very narrow, circumscribed answer appear again and again and again. It goes something like this:

“Go see a therapist; get counseling; find a psychologist; get into therapy; go see your school’s counselor; go to a mental health clinic; you need to be in therapy; find a support group; have you talked to your therapist; have you tried group therapy; talk to your doctor; therapy, therapy, counseling, therapy…” 

And this really bothers me.

It’s not that this advice is bad. It’s not bad! All things being equal, most people would probably benefit from therapy. I have no doubt that the net benefit of professional mental healthcare is incalculably vast.

But it pains me to see therapy described as a one-size-fits-all solution for every person in every situation. I’m someone who experiences intermittent depression. Like half of all mentally ill people in the United States, I’m not currently receiving medical care for it. This doesn’t mean I’m irresponsible or helpless. There are a lot of very understandable reasons why people can’t or won’t seek professional help. Let’s talk about a few of them.

Therapy is hard fucking work

For one, the unanimity of advice suggests that therapy is some kind of magic bullet—a store you can walk into crying “One mental health, please!” This isn’t the case. Therapy cannot be successful if the person getting therapy has the wrong impression about what it consists of, and what it requires of them.

Mental therapy is just like physical therapy. It requires work. No, seriously, like a lot of fucking work. It requires you to challenge yourself and change your behavior. You may be tasked to read books, follow workbooks, keep a journal, document your thoughts and behavior, change habits around exercise, sleep, and diet…

You may even be shocked at what most needs work. Maybe you go in ready to talk about job stress, but therapy leads you to revelations about your family, or your relationship. You might not want to talk about that stuff yet, but a canny therapist is like a fucking truffle pig: they’re gonna root all that delicious stuff up. And surprise: you may feel worse before you feel better.

Your therapist is a facilitator, not a magician. And knowing what your issues are doesn’t immediately, automatically unlock your best, healthiest self.

Therapy requires a sustained commitment

Some people aren’t willing to work on themselves. There are people out there who misuse therapy as a tool to curate their story and validate their current actions. (Incidentally, therapy can make sociopaths and psychopaths more powerful by teaching them better mimicry of emotions! Who knew?)

Some people are unable to work on themselves. Illnesses like depression rob you of the spoons needed to invest in mental health treatments. When I’ve been at my lowest, everyday tasks feel like wading through knee-deep mud. It’s some real Artax in the Swamps of Sadness shit. I have to ration the energy I need to shower. You want me to do a bunch of research on healthcare providers, call them to schedule an introductory visit, wait a few weeks, then leave the house to go talk to a stranger about how weak and pathetic* I am?

(*Depressed people are not weak and pathetic. Rather, I feel weak and pathetic when I am depressed. Important distinction!)

Therapy requires some existing support and stability

Finally, some people are emotionally willing and able to work on themselves, but can’t for logistical reasons.

Students, night workers, and working class people with irregular shifts may find it hard to maintain momentum (and a good relationship with their chosen healthcare provider) through frequent rescheduling and cancellations.

Therapy is of great potential help to stressed, burnt-out caregivers. But caregivers may feel compelled to spend the little time and money they have on counseling for their dependents, rather than themselves.

Women feel this pain in particular. They’re already statistically shouldering a much greater share of childcare, elder care, household chores, and emotional labor. (This cultural norm is so deeply ingrained that even same-sex couples mimic it.) They cannot afford to address their illness because all the spinning plates may come crashing down. As one practitioner puts it:

“When postpartum women say they do not have time to come to therapy or seek treatment or get help, it is more than just an excuse. It is a symptom. Asking for and accepting help is just another way of screaming ‘I’m sick’ and many women do not feel ready or able to accept that. Sometimes, it can be as simple as giving them permission to do so.”

Not all partners (or employers, or parents, or friends, or even medical professionals) validate the existence of invisible mental illnesses and the importance of their treatment.

You need the right provider with the right approach

The success of therapy often depends on finding a skilled healthcare provider with whom you click. But finding a great therapist can feel like trying to find a mate. They have to be affordable, close by, take your insurance, work with your schedule, understand your situation, have at least some overlapping values, and be scrupulously ethical. Opening up to someone is fucking draining. And it’s really easy to become discouraged if the first (or second, or third) person you try isn’t for you.

And there are lots of different kinds of therapy! Cognitive Behavioral Therapy, Cognitive Analytical Therapy, psychoanalysis, mindfulness, relationship counseling, family counseling, music therapy, art therapy, equine therapy… one or more may work for you, but it’s expensive and access can make it difficult to explore them all.

Therapy can make things worse

Anything that can heal you can also damage you. The wrong kind of therapy with the wrong kind of therapist can fuck. you. up.

The first mental healthcare provider I ever went to betrayed me in basically the worst way a mental healthcare provider can betray a patient. I was a child, and I disclosed sexual abuse. She was a mandatory reporter, and she did not report. The result was that I spent a few more months living in the same house as my rapist, and suffered a pretttttttty respectable mental breakdown in complete isolation before striking out on my own at seventeen.

Therapists are people. They have training and knowledge, but they also have weaknesses, biases, lapses, and gaps in experience. I didn’t know mine was a bad apple until she poisoned my ass. Your mileage may vary.

Access is a problem

Counseling and therapy can be really freaking hard to access in rural areas. There may only be one person or one clinic that honors your insurance—or you may have to set aside half a day to drive to the closest urban center. And if you don’t like the local option, or they don’t specialize in the kind of care you need? Tough shit.

See my wretched anecdote above. This woman was a Christian family counselor because that’s what the area had. She believed that forgiveness was the highest form of healing. I disagreed; instead, I was really jonesing for that physical and psychological safety stuff. Even though I was a kid, I knew this lady was not going to be the right person to help me. But when you live in the cornfields, you may not have any other choice.

People who aren’t white have problems finding mental healthcare providers who understand their cultural experience. The Atlantic did an amazing deep dive into this topic, read it here.

This isn’t just anecdotal, or specific to one demographic or region. There is a serious shortage of mental healthcare professionals across the United States. 89.3 million Americans live in an area designated as a mental health professional shortage area by the Health Resources and Services Administration. Fewer and fewer people are interested in pursuing the field of mental healthcare.

One of the main reasons? Check the blog, kid, it’s money! Insurance reimbursements are slow, burdensome, and incomplete, leading many therapists to only accept new clients on a cash-only basis.

That cost tho

And here we go, kids. This is the real shit right here.

If you think houses are money pits, try having a fucked-up childhood!

Healthcare is expensive. That includes mental healthcare. And it’s never a one-time expense. (Related: Bad With Money just had a great episode on medical crowdfunding. Turns out that nobody likes to chip in towards chronic conditions because they’re fucking bummers. Cool!)

If you have great insurance, you might have a copay as low as $25 per session—but if you’re seeing a counselor once a week, that’s still $1,300 for just one year.

If you want to see someone outside of your insurance, or you don’t have insurance at all, expect to pay at least $100 per session. That’s $5,200 for a year. I don’t know many people who have that kind of money jangling around in their pockets. And if you’re seeking treatment from a specialist, or an intensive therapy, or live in a high cost of living area, you could pay double. This doesn’t include the cost of medications you may be prescribed on top of therapy.

This is not to say that mental healthcare is some kind of optional or frivolous expense. For all my handwringing, there is no way to quantify the number of lives improved or outright saved by counseling, therapy, psychology, and psychiatry. It is an invaluable tool.

But if that tool isn’t universally available, affordable, and achievable, it can’t be the only tool in the box. Speaking of which…

Stressed? Overworked? Burned out? Cooked through?! Experience the Bitches Get Riches Burnout Workshop: a comprehensive, actionable, dirt cheap video course and workbook filled with practical solutions and exercises to stop the burn and help you catch your breath. Also… it’s funny as hell! Our moms said so!

Cheap therapy might not be good or realistic therapy

Try Googling “I can’t afford therapy” and see what comes up. Or don’t, because I already did it and I’m about to tell you what’s out there.

  1. Here are ways to get shady discount therapy that are extremely situationally specific, geographically exclusionary, and wildly optimistic!
  2. Here is a list of 2,500 $10 mindfulness apps???

I ran this by former roommate Goosey, who’s no stranger to mental health issues.

KITTY: If you google “what to do if I can’t afford therapy” it’s like “go to a local school and let inexperienced people practice on you lol!”

GOOSEY: Okay wait this is relevant because I sent this to my therapist who LAUGHED FOR DAYS AND SAID PLZ DONT GO TO A SCHOOL…

Yeah, Goosey once looked for low-cost help after a major traumatic event. Her reward was being locked in an evaluation room against her will, One Flew Over the Cuckoo’s Nest style, by a provider who was (she found out later) actively under investigation for violation of human rights.

These kinds of lists come with the best intentions, and aspects of them are totally worth trying. But I think it’s too simplistic of a view of mental healthcare. People who are cash-strapped are almost always time- and energy-strapped as well. Are you seriously telling me to cold-calling counselors and asking for free healthcare until someone says “yes?”

You want me to run a marathon, too? If you stick a broom up my ass, I’ll sweep the streets while I’m at it!

Help is hard

For people who have mental health issues that manifest through low energy (like depression!) or low self worth (like depression!) saying “I can’t afford it” is often shorthand for “I cannot fucking fathom it.” The energy isn’t there. I don’t want to look at myself, think about myself, talk about myself, or spend money on myself. My hygiene isn’t good enough to leave the house. I don’t have the strength to try. I am too afraid to fail. It feels good to put it off because it helps me feel like I’m not at rock bottom yet.

I’ll speak from my own personal experience here: when I am depressed, I feel like I’m failing myself. (I intellectually understand that this isn’t true and that this is just my brain chemistry being off—it’s just how I feel.) And when I feel like I’m failing myself, I’m most fragile to the idea of being failed by others.

Now pay me five cents.

Knowing I could call someone to ask for help feels like having a safety net. I would never intentionally leap into that safety net to test it. Because what would I do if it failed? How could I survive if I thought that I knew, for certain, that no one could help me? How would I cope if a suicide hotline hung up on me?

That’s my attempt to explain the odd logic of my personal depression, and why it’s actually a comfort to hide my symptoms and not seek help. Don’t take this as an endorsement to not ask for help when you need it. I am as my life experiences have made me. But if what I’m saying sounds familiar to someone, I hope it’s a comfort. Everyone’s brain is different, so again, your mileage may vary!

Is there more?

I am thrilled to report the vacuum of practical alternative advice is slowly being recognized and filled. I’ve seen it most in the fair land of Tumblr, home of good-good children who are dedicated to validating each other’s mental health experiences.

I believe that peer support might be the greatest untapped mental health tool on the planet. And next week, I’m going to aggregate some of the best of it into a collection of mental health advice that isn’t therapy. If you don’t find therapy helpful, or you can’t access or afford it, or you just don’t have the energy to take that step yet, it should offer some practical small steps that might help you feel better.

A caveat, which I will repeat next week: if you are thinking about hurting yourself or someone else, that is where the armchair Internet advice sidewalk ends, bruh! I’m extremely lucky that my depression has never manifested serious thoughts of violence to myself or others. I don’t know what that exact experience is like, and I am utterly afraid that someone would read my well-intended words and use them as permission to give up on themselves.

If that’s your situation, you need to tell someone—anyone—and ask them to help you. It doesn’t have to be a stranger or a doctor. It just has to be someone who will listen and take you seriously and help you find the right next steps.

And all you mentally healthy, trauma-free, fifty-five-spoon-having motherfuckers readers can just fuck right off JKJKJKJK we love you too! Please read this stuff anyway! One in five Americans suffers from some kind of mental illness. You can make yourself a good ally by soaking up some of this information. You’ll need it some day, even if it’s not for yourself.

Phew… That’s the most personally uncomfortable article I’ve written yet! My ENTJ ass would rather have one (1) nail pulled out than expose my soft underbelly to the world for public consumption. And I’m probably gonna get dragged by a bunch of people who don’t read the article and want to call me irresponsible. OH BOY I CAN’T WAIT.

35 thoughts to “Stop Recommending Therapy Like It’s a Magic Bean That’ll Grow Me a Beanstalk to Neurotypicaltown”

  1. [slow clap mixed with tears of recognition]

    I was in therapy three times. The third time was, in fact, the charm. Still face anxiety, generally daily, but now I have the tools with which to (mostly) deal with it.

    Anyone who thinks “therapy” means “talk to a nice person a few times and then skip, (HEALED!) out the door, surrounded by butterflies and puppies, in the direction of the rainbow that arches over Neurotypicaltown” is, well….pretty representative of citizens of our culture.

    Therapy is completely gutting at times, and if you’ve got too much else going on in your life then taking on the hard, necessary work of facing your demons just isn’t gonna happen. If you can afford it in the first place, that is.

    Allies: Please listen a LOT more than you talk.

    Fellow survivors: Thanks for reaching out.

    Kitty and Piggy: Thanks for doing you.

    1. Thank you so much, my dear! Yours are words to live by. There was a good quote I found but lost while researching. It went something like “therapy can be as painful
      as talking about food on an empty stomach.” And that’s so true. Even when it’s healing, it freaking hurts. I’m so glad you got the tools you needed!

  2. Haha, I reference the Swamp of Sadness in my book (Frugality for Depressives #shamelessplug) too. Clearly depressive minds think alike!

    Seriously, though, beautifully put. I’m a big advocate of therapy, but like you said, it’s hard and exhausting and can get pretty expensive — and it won’t magically cure you instantly. Not to mention those of us whose brain chemistry is just permanently differe — Bipolar II here thankyouvermuch — and who will always need meds to keep us sane(ish).

    1. UGH I was such a horse lover as a kid, that scene fucked me UP! Also I still love horses. Horses still rock.

      Please say you are on tumblr? Their bipolar community is huge and wise and freaking hilarious.

  3. As a therapist, “one mental health, please!” is now going to be my new catchphrase

    I’ve been working on a very related post for mental health month that hits a lot on the topic of finding the right provider, and you really hit home when talking about how discouraging, draining, (and expensive!) it can be trying to find the right one.

    I audibly gasped reading about how your childhood therapist did not report your sexual abuse. That is unthinkable to me. You’re absolutely right about the importance of being scrupulously ethical.

    I currently “live in the cornfields,” and work at the biggest (and one of the only) mental health providers in the area (though I won’t be able to say that much longer; tomorrow is my last day). When there is only one option and you don’t like it, or worse – they provide substandard care – access is a HUGE problem.

    You mentioned peer support being the greatest untapped mental health tool and I COMPLETELY agree!!! Especially in the US where we are more and more individualistic, I think the power of personal relationships has diminished and people are relying more on therapy for support they would be getting from family/friends/the community in more co-dependent, relationship-focused societies.

    This is such a complex topic and you touched so many important points here. I’m going to have to stop this comment before it becomes an entire post in and of itself, but thank you for writing this!

    1. You have NO IDEA how much this comment means to me. Thank you. I poured a lot into this one. I wanted to be honest about my experiences, and I was extremely nervous that it would come across as unhelpful (or actively harmful). Writing something nuanced about mental health is freaking HARD! I can’t wait to read what you have brewing!! We’ll definitely blast it out!

  4. I *wish* it were easy.

    Man, you’ve been having a lot of really great posts lately. I’m glad you’re on solitarydiner’s blogroll!

    I did get reduced cost CBT in graduate school from a student who was getting trained and it worked really well for me and my specific anxiety. It helped that it was one of the best places in the world for training CBT, and that my university had a link up to it (my crappy free university therapist gave me the info for it). It took me several months to get off the waitlist for it (it was supposed to be a 6mo wait, but they were able to get me in over January recess) and it was still $50/session on the sliding scale– this was ~15 years ago, so $50 was worth more (my income was 18K/year for comparison). So, I guess #notalltherapistsintraining, but also if it’s any good it will still take a while to get and it won’t be that cheap, and, as you point out, you have to be near a university that trains exactly the kind of therapy you need. And it was so much work and I’m glad I was able to start during a school break, or I don’t think it would have worked as well, having therapy to go to (and a really lengthy multiple subway ride to get there) on top of everything that was stressing me out. So basically, I totally agree.

    1. CBT rocks. I’m so glad you were able to get good help from a student! I didn’t mean to slam all students, I’m sure many are capable and closely advised. And they do need to learn! But whenever I think about the quality of the discount-rate videography services I provided as a film school student, I shudder, bahahaha… I’m sure many pros feel that way, regardless of the field.

      1. I think it was more like the student haircuts I would get at Vidal Sassoon—there was a professional doing backup who talked with her after each lesson who also reviewed anything I produced on paper. (At VS, it took longer but I was not allowed to walk out with a bad haircut—the teacher would stop in and show her how to fix/improve for later haircuts and stood there observing for the earlier ones).

  5. Thank you for pulling this together! I’m looking forward to next week’s post. I have not struggled with depression but have a couple of close friends who do, and I am aware that I need more empathy and information. I’m hopeful some of your next post will be useful to allies, as Donna kindly termed it above.

  6. There is no one answer to every person’s mental health problems just like there’s no one answer to every person’s financial situation. Therapy is a great tool, so are medications, so are lifestyle adjustments, so is meditation, so is peer support, heck, kale, IDK, depends on the person! I’ve dealt with major clinical depression all my life & have tried everything (I hate kale tho), & meds + therapy are the only things that come close to helping for me right now. And I have to adjust both every so often. And neither are cheap, which sucks, so I don’t always have access — and *that* is a huge problem for many people. Folks need access to all the tools so they can find out what works for them.

    Not-so-fun fact: mental health providers are often not reimbursed by insurance companies at the same rates as other healthcare professionals, even tho they are legally required to be. This is why many therapists don’t accept insurance; they deserve to be paid for their time too! NPR has some info on this problem —

  7. I think this article makes a lot of good points. Some people don’t take into account that receiving therapy is not always easy or feasible. And I’m so sorry and sickened to hear about your experience with therapy as a child. That should not happen to anyone.

    However, I take issue with describing going to a trainee for therapy as “playing mind games with you.” As a current psychologist who went through a doctoral program myself, I have seen first-hand how highly supervised and scrutinized the trainees are. Many already have a master’s degree before even entering a doctoral program. Students, just like licensed psychologists and psychiatrists, and people making recommendations on Tumblr, vary in both skill and innate ability. I’ve worked with early graduate students who conceptualize cases and build rapport better then far more experienced clinicians. I believe it does a disservice to people who might only be able to receive quality help this way to make a blanket recommendation against it. To be frank, it’s downright irresponsible to equate it to mind games. Your words have power.

    1. You’re totally right, and thank you for saying so. The tone of my texts with Goosey are very shouty/manic/self-deprecating, it’s not a literal characterization. But there’s no context for the reader to really understand that, so I’ve taken that phrase out.

      I have a personal bias against being trained on. My high school was a laboratory school. Our regular teachers were mostly great, but about half the time they would become observers while student teachers from the local college took over. The quality was so frustratingly uneven. Without fail, there was one every quarter who broke down crying or yelling in class about how they didn’t want to teach our age group/this subject anyway. That experience really soured me on the concept of being trained-upon. For every awesome, dedicated student teacher I really connected with, there was really unprofessional behavior born of inexperience, observation, and the pressures of pursuing a higher degree. Thinking about that kind of behavior popping up in a therapy session makes gives me douche chills, which made me want to caution against it. But there’s a whole lot of bias-based-on-anecdotal-experience going on in there, so I’m thankful for more voices adding other perspectives.

      I think the comments have provided a much richer set of examples of student-lead mental health care. It can get great results at a reasonable cost; it can be alienating and slow/tedious; and a spectrum of results in-between. Those comments do a much better job of rounding out the discussion than the original article.

      Thank you for commenting and improving the ~*experience*~ for everyone!

      1. Aaah, I think I did take it too literally, so thank you for clarifying. That must have been an interesting experience going to a laboratory school. While there’s a high risk for quality of services being uneven even among licensed professionals, it would certainly be much higher among students. One good thing for potential clients to take into account is whether these are masters-level trainees where you might literally be the first client the student ever sees, or whether it is a doctoral level trainee. Regarding the former- it still might be worth trying because there are truly some people who are naturally quite good even without firsthand experience (they would have had a year of classes first, at least), but I would be more wary. By the time someone is, say, a fourth year doctoral student, they will have typically had 4-6 years of total experience (either 4 years doctoral or 2 years of masters + 4 of doctoral program), and be much more similar to a professional.

        On another note, I find it very refreshing that you are able to respond to commenters with different thoughts or opinions not only without getting defensive, but actually putting thought into examining your original statements and considering if they might need to be revised. The way you handle them seems very sincere and not just a superficial statement to pacify or appease. That shows a lot of character to me, so I just became an even bigger fan of your blog (-:

        1. That is all great additional information about how students progress through their training!

          Oh, of course we want to engage in a positive way with critical comments! Our readers are wicked smaht and we want them to make us smahtah and bettah too!

          Sadly, 90% of our critical comments are the incoherent ramblings of MRAs who read only the headline before stumbling onto the site looking to destroy some misguided feminists with a powerful ki blast of their amazing mansplaining powers. We shudder with delight when we hit the “trash” button on those comments. We get super excited by any critical comment that ISN’T that!

          1. I would also say as a psychologist who has gone through training in a university clinic that they are very good and give generally high quality services. Yes, the psychologists are new and that often means that their presentation of therapy is more awkward, but what you can be sure of is:

            a) they have only a few clients that they see, so are spending 10x as much time and effort thinking and planning for the clients that they have, compared to a psychologist elsewhere, who often will pick up the notes 10 minutes before your session and give therapy off the cuff.
            b) the therapies they deliver are evidence based and up to date. This is far, far more likely in a training clinic than anywhere else. This means that you won’t be getting any treatment that the literature doesn’t support and that isn’t as effective as what you could be getting.
            c) They are getting individual and group supervision, and their clinical supervisors are responsible for all of their work so are keeping a close eye, so as not to let things go wrong.

            I’m Australian so I know that my experience may not exactly echo that of everyone else’s, but all those points have structural reasons why they would be true across most, if not all universities. They are also not structured for profit so the services offered are just very cheap. In Australia, Medicare provides 10 sessions free for everyone each year but if you have used those, to be able to pay $25 or less and get the service is a bargain, especially where the comparison is not getting any at all. And as the above commenter pointed out, unlike student teaching where its 19 year olds in the classroom, to see clients as a psychologist, you have at least 4 years behind you and these are competitive places so only the best get in, so you aren’t seeing just anybody who hasn’t proved themselves competent.

  8. I hope this isn’t irrelevant but also what I realised in therapy is that your therapist might be great in one area but clueless in another. (no shame – people specialise and no-one knows everything.) the first time i was able to go to therapy in my late twenties I lucked out and my therapist was good and omg it was so hard but progress was being made, and i though ooh i want to talk about body image, at which point my therapist blinks at me and told me to keep a food diary and work out what food i didn’t need to eat so I could be the size I felt comfortable in. Which was NOT what I was asking for at all. And lo i realised that one therapist can not help you solve everything, even if various things that are fucking up your life feel inter connected to you.

    1. That is a really, really good point, I’m so glad you brought that up! I feel like that’s especially true for topics like body acceptance, trans/queer identities, nonmonogamous/poly relationships, etc… The stuff that’s seen explosive, radical shift from disgust/shame-based nonsense to increasing acceptance in a very short amount of time.

      Also whenever the topic of body acceptance comes up, I am required by law to recommend Lindy West’s Shrill to every single human being.

  9. Story time! The university where I got my bachelor’s offered free counseling for students. Great! Most of the counselors were actually final-year grad students getting practice. Which could’ve been fine.

    Except for the bit where ALL the counselors-in-training had their sessions videotaped. As in, patients had to sign a release form at the first session. I got a couple of spiels about how only a few minutes of the tapes ever got watched, how the focus was on the counselor, how the tapes were securely stored and erased at the end of the semester… but the whole thing made me super uncomfortable. I thought it was the price of entry, though. It took me until junior year to get brave or desperate enough to refuse to sign the form, wait ANOTHER couple of weeks, and get in with one of the fully-licensed counselors.

    “Do you record sessions” has been one of my go-to new therapist questions ever since, and pretty much every counselor I’ve talked to since undergrad has been like “what? no!!!” Turns out videotaping is NOT normal and most people seem appalled by the idea. But at eighteen, I didn’t know any of that.

    (On a side note, I also didn’t get much out of therapy until AFTER I got on antidepressants.)

    1. Woah! That’s nuts! I can’t imagine they do that anymore, given how much more sharply privacy concerns have come into focus. I can’t imagine many people found that particularly relaxing or heart-opening.

      Oh, I didn’t even think to add this, but your comment actually made me think about birth control too! Two-thirds of adult women are on birth control! And different methods/formulas can have very different effects that vary from person to person. A lot of the symptoms of clinical depression overlap with symptoms of a pill your body just doesn’t like. (Mood swings, headaches and migraines, low libido, weight change, change in appetite…) It’s probably wise to rule that out as a contributing factor. I’m definitely adding that to our non-therapy survival techniques list.

  10. Oh my god therapy is SO FUCKING HARD. I’ve been in it for a bit over a year, and feel sometimes like I’m not making any progress. I spent half of my last goddamn therapy session crying out of nowhere about all of the MANY MANY things I’m scared of…shouldn’t I be done with this by now??!

    So it’s good, but fuck, it’s hard. And there are so many barriers to entry. Even if you happen to live in a large metro area like I do with a number of people who will take your insurance, finding a counselor with appointments that fit your schedule sometimes seems impossible. Sorry, but daytime appointments don’t work for me because I’ve gotta be at my job in order to keep my health insurance in order to pay for therapy ¯\_(ツ)_/¯ Plus it took me YEARS to finally accept that I should go see someone. When I’m in the middle of it, my depression tells me that I shouldn’t get help because who do I think I am to think I deserve it? And then it took weeks to find someone when I did finally decide to go. My therapist is about a 45 minute commute away from home. That absolutely sucks when it’s Friday evening, I’m tired from the week, I’m hungry, and I’ve just spent a while crying my eyes out. But my therapist was one of the few who had appointments available right after work, so I suck it up in order to go.

    I’m so sorry (and angry) to hear about your experience with therapy as a kid. No one should have to go through that on top of being sexually abused.

  11. You forgot to mention the third issue with going to therapy: in a lot of places in the world, there is a huge stigma attached to it. And a lot of places in the world do not have the same type of confidentiality/privacy/doctor-patient protections like the US. Which means that if you go seek out therapy, people will assume that you are crazy (yes. They will find out) and you will lose your job, might loose your family, it will be used against you in court if you get into any sort of lawsuit, etc… For a lot of people seeking out mental health help is also not an option for this reason as well. And advising them to seek out therapy might be a bad idea if a person lives in that type of place.

  12. That link about how psychopaths and sociopaths misuse therapy just sent chills down my spine – and very much not the good kind.

    I’ve had one good therapist in my life, and after I finally found her (to see if I was autistic) I had to move just a few months later to continue my education. My next one was… less than stellar, and I haven’t seen one since.

    I still have the words of that good therapist etched into my mind though. After I had been laying out my sickly obsession with “being useful” (Or as my teenage self put it; “If I’m not useful, I might as well stop wasting resources”) due to my own, fucked up past, she leaned forward, made eye contact, and said “You are allowed to be happy too.”. I was in my early twenties, and up until that point, no one had said that to me before. You wouldn’t believe such simple words could have such an impact, but it shook me to my core.

    Your posts are amazing.

    1. I had one good therapist, and she once said to me “the next [choice you make] doesn’t have to be the perfect one”, and that perspective freed me from so much then, amd other the years.

  13. All points well said! The access to care and practicalities of providers choosing to work only business hours are giant hurdles. My mother used to only get her antidepressants managed and prescribed through a group of 12 people sitting in a room, sharing a group 50 minute appointment with one psychiatrist. A complete lack of privacy and anyone who needed acute attention had no way to get it because HMOs say this is good enough. I thought it barbaric at the time and think it barbaric now.

    Re advice columnists: whenever they recommend therapy (I’m looking at you Dear Prudence!) I think they are lazy. Not all problems require intense work, energy, and financial commitment. Sometimes people just want the permission of a stranger to get a new roommate.

  14. GAH – thank you for this. We are doing some workshops on mental health at work right now, and while I respect the need for destigmitization, i really don’t need Brenda from Accounting to say “need to talk?”.

    The other thing that really chaps my hide (and thank you for the opportunity to get this off my chest!) Is the idea that therapy is the cure. What jf you (or someone you love), goes to therapy and doesn’t get better? What a loser ammirite? (Sarcasm, obvs). What if i listen and listen and listen to a depressed loved one and they don’t get better? What did I do wrong? (Nothing obviously, but that’s a dangerous message to receive).

    Thank you thank you

  15. At first, I was like hmm but now I am completely digging this article and I’ll tell you why.

    I am one of those assholes who preaches therapy. I am also one of those assholes who does therapy and then doesn’t practice or do what my therapist says. Hey, I can totally admit now. Self-growth.

    It wasn’t until I found A) A therapist who actually had balls to tell me what was wrong with me after two others shoved it under the rug and B) A doctor who didn’t believe I was too high functioning for meds. Yes, I seriously had numerous doctors refuse to diagnosis and treat me properly because I was a college graduate, held down a full-time job and had friends. Oh, sorry you didn’t see that one time I ate cereal for dinner for a month and didn’t shower for a week and slept 14 hours. My bad. My BPD, BiPOlar 1, ADHD, PTSD, Codependent self is finally functioning now, THANK YOU VERY MUCH PAST SHITTY DOCTORS.

    So yes, therapy isn’t a band-aid. Sometimes people don’t want to do the work, sometimes people just don’t like it because it makes them feel worse about themselves and sometimes people don’t have access. And sometimes people can’t do anything because they need to be medicated properly first. It took six months but for the first time in my life I can actually put into place and practice what my therapist says because I am properly medicated. I’m not spending days in psychosis and I’m not trying to go out of my way to fight people. I have also now come fully to terms that online therapy is best for me. If I do therapy in person I’ll just sit and cry and I can do that at home for free.

    Therapy can be a beautiful wonderful thing but sometimes it can go horribly wrong. Bravo for pointing that out.

  16. I’ve just gone through six, count ’em, SIX different therapists in the past three years, trying to find a decent one, and this ain’t my first rodeo, either. I’ve decided that, at least for the time being, I am stinking done with therapy. It seems like where I live, which is a major metro area in California, it is practically impossible to find a competent therapist unless you’re willing to shell out at least $200 an hour, and even that’s no guarantee they’ll be competent, and even if they say they have a sliding scale, good luck getting them to apply it to you.

  17. “It feels good to put it off because it helps me feel like I’m not at rock bottom yet.” I feel that. It took me a while to admit I was at rock bottom, and when I did I was able to reach out to a social worker at school. He helped me a lot and told me to go see my doctor. Antidepressants helped me get better, and ONLY THEN I was able to reach out to a therapist, a year after rock bottom. And it does help me now, although I’m pretty sure it wouldn’t have a year ago.

  18. This may be a petty complaint not all that related to this article, but I don’t love the little side comment of “therapy can make sociopaths and psychopaths more powerful”, like people with antisocial personality disorder (psychopath and sociopath being outdated words no longer accurate to medical diagnosis) are some kind of video game boss whose powers of evil grow with being given help. Most people with antisocial personality disorder do actually need to be able to mimic normal emotional functioning to not suffer social isolation and shunning, which may already a big issue for them considering ASPD is often/usually caused by abuse trauma, usually in childhood.

    One point I would have raised here is that *abusers*, be they people with a personality disorder or just assholes, can and do in fact take advantage of the kind of jargon they learn in therapy to excuse and explain away their abusive behavior, and in fact, couples therapy is often devastating in the case of abusive relationships where the couple goes to therapy because abusers are really good at manipulating outside people to get them on their side and are usually capable of acting calm, composed and subdued in front of a therapist while their abused partner ends up looking overly emotional/angry/aggressive, which ends with the therapist ‘siding’ with the abuser. This is a really relevant thing as far as the failings of therapy goes, which is that therapists are just people who can be manipulated with the same techniques as anyone else.

    But I wouldn’t go around treating people with a mental illness as some kind of inherent force of evil.

  19. I stumbled on this article purely coincidentally. I had no idea why I clicked on it, because the title of the article invoked pictures of a plate full of cow manure served with a side of sarcastic narcissism. I could almost hear Van Halen’s “Jump” playing in the background. (Understand that I’ve never read any of your articles before and bear with me a little while.) Then I started to read what you wrote. Bravo. Your article practically moved me to tears, and if you’ll spare me a few minutes, I’d like to explain why…
    I like to delve into the minds of those that appear to think completely different than me because I feel that you can’t enlightenly discuss a point with someone if you truly have no idea why they feel the way they feel.
    I am a classic middle-aged, white male that believes this world is going to hell in a handbasket. We are probably not the type that would strike up a friendly conversation with each other on the street, so would never get to know each other any deeper than the clothes we are wearing or the hair style we have that day. Well, I’m bald so it never really changes much, but whatever…you get my meaning. I’m an eternal optimist. I’m one of those squeaky-clean brained people you joked about in your article. But God blessed my life 25 years ago with a redhead that came from a trainwreck of a childhood. She had times of anger, depression, and worthlessness that scared me because I couldn’t understand them, much less help her with them. We were polar opposites in many regards; but it worked. She was actually going to school for her license in Christian Counseling, with a focus on children (she strongly believed in reaching people while they were still young.), when she was diagnosed with breast cancer. Oh, she was amazing. She had a gift of understanding people and getting them to understand themselves. I’ve never seen anything like it. It truly was a superpower.
    I helped her study, and thereby learned a lot myself (and about myself). I opened my mind, and found that this world was a lot more broken than I thought.
    That gives you a very generalized background of myself, but any longer would need chapters, so… I tell you this to accent why your article moved me so much. I have watched my wife battle her own self for a number of years. I attended counseling myself numerous times, and completely agree with your assessment of counselors. They’re like diets. They all promise a new you, but each one only works for certain causes of a broad problem. I’m glad you didn’t give up, and I’m ecstatic that you shared you experiences with the world. I can only imagine how hard it must have been to give us a glimpse of your inner garden like that. I will be reading more of your articles; and even though the wording sometimes burns my old-fashioned eyes, I know you are reaching people that would probably never listen to a word I say in person. So please keep up the brave work you’re doing, and I can say in all honesty… thank you. It was truly a pleasure to make your virtual acquaintance.

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