Just before the holidays hit me like a Mack truck, I quit therapy. For the third time over the course of about 2 years (I started during the Great Freakout of Aught-Nine, partially documented here*). Although this time I had different reasons: the first time I quit primarily because I couldn’t afford it, the second time I had signed up for a finite number of sessions and had to stop; this last time, I just fucking hated how fucking miserable it made me, and I dreaded going. Therapy, in this last case, was making me feel and do worse, not better. (And yeah, I know that might be “part of the process,” but feeling consistently shitty 2x a week for nearly 5 months? Fuck. That.)
Anyway, I quit, and it instantly felt better. Maybe I’ll try again at some point, when I feel like it might help, but looking back on my experiences, I still don’t really know if any of it helped. Most of the time I think not. So, rather than turning this entire thing into PhDork Haz Problemz, so I asked my sister Harpies to discuss their experiences with therapy in seminar format.
PhDork: So what is therapy *for*? How do you know if it’s working; if it’s worth the time and money you’re spending?
annajcook: I have a couple of immediate responses to this.
One is that (speaking as a”willing-to-share-everything with intimate family and friends” sort of person) there are times when, no matter how close and discussion-happy your pool of people are, it helps to have 1) an outsider, 2) who has a professionally-acquired perspective on your issue-du-jour, and 3) who is bound by professional ethics and law to patient-client confidentiality. This is particularly true, for me, when the issues may involve discussing intimate details not just about myself but also about those close to me — say my partner. Am I happy to discuss some details of my sexuality with close friends and family? You bet! But my partner is not always ready to be open about the same things or with the same people. So it helps to have a place where I can talk freely and not worry about compromising her privacy.
The second thought is that an outsider person can really offer mediation for difficult discussions in families (couples or more extended groupings) which would be hard to get from anyone who may have interests in the outcome. The therapist can be neutral, they can be invested in helping relationships stay intact or in helping all parties reach a satisfactory compromise. In a way that a family member or friend can’t really be.
PhDork: Yeah, the Dude’s therapist works for him for those reasons, anna. I’ve gone to sit in with him and her a couple of time, and she seems really kind and likable, and since he needs time to work through his thoughts and feelings, he thinks she’s of help, so, good!
Maybe traditional talk therapy–when I don’t really have a problem talking about things with friends or family, and I have a pretty good handle on myself and my emotions (I mean why I act/feel certain ways)–just isn’t for me. My experience was basically “go sit in this room with a near-stranger and cry and fume (what I came to call “therapuking,” hence today’s title) about things you used to cry and fume about at home for free, and then come back in a few days or a week or two, and cry and fume about them some more.”
SarahMC: I have very limited experience with therapy but I did go for a little while the year after I graduated from college. It was a depressing year for me, and eventually I began having suicidal thoughts and I was breaking down all the time.
I attended some therapy sessions but it wasn’t getting me anywhere. I would cry and complain about not having a car and feeling dependent on my boyfriend and missing college and how a sink full of dishes would send me into a pit of despair and every molehill felt like a mountain. And then I would go home and continue feeling bad. I got on Cymbalta, which helped me so much, and stopped going to therapy. I don’t know if therapy is more beneficial to people with deep seeded issues they are trying to work out or what, but it did not feel beneficial to me. I’m sure it just depends on the individual situation.
BeckySharper: I’m super goal- and solution-oriented, so my approach to therapy is very pragmatic. I was in therapy in college years to deal with some PTSD issues that were causing me anxiety and panic attacks. Therapy helped me process my emotions, learns ways to integrate the bad experiences into my life and heal myself. It took a couple months and I haven’t had therapy since. I’m extremely fortunate to have a lot of wise, caring friends and family, and good mental health, so I’ve been able to bounce back from all the other shit life has thrown at me without professional help.
As far as therapy styles go, I’m leery to generalize too much, because results may vary, but I’m a big believer in Cognitive Behavioral Therapy because it tends to be problem-specific and suits my personal philosophy of “if it’s broke, fix it.” I am somewhat more suspicious of psychoanalysis and some forms of talk therapy which just seem…well…emotionally masturbatory. Living in New York, I know many, many people who have been in treatment for years with talk therapy and whose lives have not noticeably improved (e.g. they’re still angry, self-loathing, stuck in a rut or in a bad marriage, etc) Their descriptions of the therapy sound kind of like yours, Dorky. They get an (expensive) hour to vent and rage at the world, but if you don’t actually use that time/energy to change your behavior (or get medicated if that’s what you need)…as you’ve said, you’ve just spent a lot of money doing something you can do for free. Good therapy is supposed to be effective. It’s not necessarily a speedy process, especially if you have a ton of dysfunction in your life, but if you’re working away at it for a long time and you are not healthier and more functional, it’s time to try a different therapist or a different approach.
PhDork: I’ve been thinking about CBT as a possible alternative, since my major issue seems to be my bone-deep certainty that I will never be financially/professionally successful, that all my education, training, and work has been a huge fucking waste, and I’m a giant simp for ever thinking otherwise. Whether or not I’m “right,” it has a way of making me hate life.
I’m like Becky, I guess, in that I want to solve the problem, not stew in the feelings, and that is very much what talk therapy was for me, all three times. I came to dread it; worrying about “what on earth could I talk about today,” trying to come up with something, and always always leaving and feeling like “well now what?” It didn’t feel connected to anything real in my life. It was after asking, repeatedly, what I was supposed to be getting out of our sessions and not getting any kind of real answer from the therapist that I knew it was time (past time) to quit.
annajcook: I think sometimes our culture over-emphasizes (at the same time it stigmatizes; three cheers for mixed-messages!) talk therapy as a solution for every sadness or source of distress in or lives. Mary Pipher talks about this in her book The Middle of Everywhere where she talks about working with refugee families who come from cultures where talk therapy is not the norm. They often have other ways of dealing with trauma. Not always better ways across-the-board, but sometimes for particular people they are more effective. Like, if your problem is that your life is limited because you don’t have a car and can’t drive and you live in a city where you need a car to make social connections … then the solution is to provide the person with a car and a driver’s license, not sit them down in talk therapy!
For what it’s worth, I think that “talk” vs. “solve the problem” is a false dichotomy. Communication and clarification of thought can often facilitate problem-solving. Dicussion does not always signal lack of progress. Even if it feels like you aren’t progressing. Human beings work in complicated ways. (And, as you say, PhDork, sometimes they work in ways that therapy doesn’t facilitate so much!)
foureleven: I’ve been to therapy three times in my life: twice in high school and once in college. My mom took me and my dad to family therapy when I was a freshman or sophomore. The experience was a disaster because no one wanted to talk about anything. It made me wonder what therapy really is for. At the time I had no idea. I thought it was “for” people with problems and as a teenager I thought that I didn’t have a problem, my dad did. Looking back, I realize this wasn’t a good fit. My therapist in college was funded by Temple University (read: free) and she was a perfect fit for me. I told her everyone about my life and she was not judgmental at all. I think non-judgmental is first on my list of must-have qualities in a therapy. I saw her for a year until she finished her PhD in psychology and received a job offer elsewhere. We were both sad.
Sometimes I feel as if therapy has a intense stigma, but when I was living in NYC, I feel as if everyone I knew (bosses, co-workers, friends) was in therapy for something or another. I realize that this is probably an NYC anomaly. I think therapy is for yourself, to have an objective person talk to you about anything; not just your life, but your likes and dislikes. I’ve only been to traditional talk therapy so this is where all of my experiences are coming from.
PhDork: S tigma, hell yeah. I grew up in small towns in the midwest, where nobody went to therapy, or deeply hid the fact if they did. I didn’t know anyone who went to therapy, or even was a therapist. Therapy was for Broken People. It was a Woody Allen joke to me (and actually, looking at WA’s film depictions of talk therapy might have conditioned me to think it was all crap, anyway: overprivileged whiners, whining to overprivileged, variously avuncular or materteral eggheads).
So I move out here and even though I’m a grown up and have lived in other cities, the ease with which people talked about therapy was shocking to me. It certainly served to explode my “broken people” idea.
foureleven: Yep, overprivileged whiny people talking to overprivileged people with doctorates. I grew up in Jersey, but that’s how most people I know felt. It was as if therapy was for people with issues or problems that aren’t, you know, real, because they have the money to pay people to fix these problems. I also feel as if therapy also has a stigma in the black community. No one really talks about it and no one knows if anyone goes. I don’t know if this means anything because I feel as if everything has a stigma in the black community (like the whole culture of being on the down low) even though it’s so common.
BeckySharper: I’ve noticed that women are much more willing to get therapy and be open about it than men. I think there’s still a greater stigma surrounding men and therapy–that it’s a sign they weren’t able to “man up” and deal with their problems and had to go crying to the doctor. I wish that would change, because I know from my own life experience that men who need therapy but don’t get it can wind up with behaviors that adversely affect everyone in their family (this is true of women, too, but the women in my family who needed therapy tended to get it, while the men chose denial instead.) It’s one of the ways that the Patriarchy hurts men too.
foureleven: I completely agree, Becky. I often feel as if men choose denial or silence as opposed to actually talking about their problems.
annajcook: All that having been said, therapy is frickin’ expensive and most insurance doesn’t cover the cost. And a good therapist-client match is often difficult and time-consuming to find. I don’t think talk therapy is a magic bullet for healing, and sometimes the effort simply isn’t worth the possible benefit.
foureleven: I haven’t been to therapy since Temple, mainly because it’s not free. Also, I worry that I won’t find a therapist that is as good of a fit for me.
annajcook: Another thought that occurred to me on the commute home vis a vis therapy and “overprivileged whiny people” … talk therapy is, in a sense, part of the trend away from an industrial economy to a services economy: with professional talk therapy (of whatever philosophy), we are paying for a service that in other times and in other places was handled in other venues and possibly not a for-profit enterprise. For example, clergy have often served the purpose of confidants for folks who are desperate. Likewise medical doctors (who have been around longer than mental health professionals). Family elders.
Not that any of these alternative systems were perfect or better than paid-for talk therapy. But they were available to a different demographic. Financial resources to pay for therapy wasn’t the barrier — having access to the right religious figure, or having a relative close enough and understanding enough to confide in was what determined whether or not you had mental health support.
I don’t necessarily hear any of the therapy skeptics here making the argument that talk therapy is completely useless. But I do want to speak up for the value of talking about personal struggles with people. And I want to speak up for it as something that, regardless of class, race, gender, etc., some types of people benefit from. I am extremely verbal and one of the ways I organize my thoughts and make sense of my place in the world is through discussing ideas with thoughtful people. I don’t think that’s necessarily a mark of my gender or class standing (though it was likely cultivated and augmented by both) … and there have been times in my life when I have had no other space to do that type of processing than in a therapist’s office. And at those points in my life, I was incredibly thankful that I had access to a therapist (often through community assistance programs or by making use of graduate interns who offered therapy for free or reduced cost).
PhDork: Talking can definitely = doing something. CR groups still have their purpose for feminism, after all. But talking can also be a way of deferring action, and I do wonder, since talk therapy has roots in Freud and his misogyny (Woman is a puzzle to be figured out! By me, Siggy the Wunder Mensch!), to what degree it is useful for real change.
…Readers? What have been your experiences on the couch?
*Just to follow up on that post: I’ve been off BCP since April with no serious problems. My periods are still a bit irregular, but I haven’t fallen down another wormhole into Depressionland. And I thank the fucking stars for that. (And I thank all you who commented on that post and were so kind.)