I’m a big proponent of taking care of your mental health, which means that I have suggested therapy to a number of friends who have come to me with problems (only after listening to them and determining that their problems were way too big for me and I could not handle them). Oftentimes I hear the response “I tried that once and I didn’t like it. I don’t think it would help. I felt worse afterwards”.
Now of course everyone has the right to decide how to deal with their own health and well being, but I have to call bullshit on that response. Many people who have never done therapy seem to have an odd conception of what therapy is like. They think that it’s a way to feel better, as if it’s some sort of medicine that will turn off the bad feelings. Maybe they imagine it will be cathartic, or their therapist will solve their problems for them. Others imagine a Freudian style therapist asking “why do you feel that way?” or other probing questions to illuminate your true self.
Because therapy can be an extremely effective way of dealing with mental health problems, or even just a good support for those who are going through a tough time, I think it’s important that people have a realistic idea of what it is and what it’s there for. If you’re going to make informed decisions about whether something is a good idea for you, you need to know what the potential downsides are. I’m in a fairly good position to talk about what therapy is like. I’ve had many different therapists in individual and group settings, in college, in eating disorder clinics, in general clinics, and participated in therapist like DBT, CBT, EMDR, some psychoanalysis, and intensive talk therapy/exposure therapy. I have been in therapy for about 5 years continuously. I’ve got a good handle on this guys, I promise.
The first myth that I want to clear up is the idea that therapy exists to make you feel happy/good/better. In reality, therapy exists to help you become mentally healthier. This means reducing symptoms of mental illness, providing coping mechanisms for difficult situations, making sense of the patterns that exist in your thoughts, and helping you live more effectively. Different therapies have different specific goals, but generally they fall under the realm of helping be more effective at living the life you would like to live.
As examples, DBT asks you to set “life worth living goals” (things that will make your life worthwhile in your mind), and the whole purpose of the therapy is to be able to allow you to reach those goals. In contrast, something like exposure therapy might have as its goal the ability to function in the presence of something that was previously triggering. Oftentimes in order to reach these goals you have to do some incredibly difficult things.
Therapy is not enjoyable. It does not make you feel better. Oftentimes you feel a whole lot worse after you start therapy because you are asked to dismantle some of your old coping mechanisms, seriously look at your problems, and then build up real and good coping mechanisms. No one particularly likes to look at their problems, so this process hurts. It’s like rebreaking a bone that was never properly set. Oftentimes you will come out of a therapy session feeling raw, weak and vulnerable. Oftentimes you will feel as if you’re going crazy because your therapist has asked you to give up an unhealthy coping mechanism and hasn’t replaced it yet.
A therapist is not there to tell you how to fix all your problems. In fact if a therapist tells you straight out what to do, they’re likely not doing their job very well (with the exception of some clear symptom like, self-destructive behaviors like drinking or restricting food). What a therapist does do is help provide you with a set of tools to manage your mental health, your relationships, and your life. You still have to do all the managing yourself though, and that’s a lot of work, particularly when you’re first starting. Changing behaviors and thought patterns takes a lot of time and effort which no one but you can do.
In addition, depending on what problems you’re struggling with, it may take a very long time before things start to look up. A simple phobia is probably the quickest, and that still can take a couple of months. Something like an eating disorder, a personality disorder, or PTSD may take years of work before you feel you can manage your symptoms or call yourself “recovered”. Making it even more difficult is the fact that oftentimes you don’t notice progress because for many things progress is a lack of negative symptoms rather than a presence of feeling totally awesome.
Another difficult element of therapy is the fact that you and your therapist won’t click from day one. It takes work to find a therapist that you’re comfortable with, and once you’ve done that you have to spend time building a relationship with that person, just like you would with anyone else who you ask to help you and mentor you. This again takes time and means that often your sessions will not feel easy or smooth.
Now despite all of these difficulties, the fact that therapy really is not any fun at all, the fact that it takes lots of time to work, and requires a great deal of energy on the patient’s part, there are wonderful things you can get out of therapy. If nothing else, therapy should give you someone who is on your side, someone who will listen and provide feedback. When it works really well, therapy can give you a great deal of insight into why you do the things you do, how you can change the things that are hurting you, how to determine what you truly want out of life and what your values are, how to live in accordance with those values, and a wonderful relationship with someone who cares about you and will do their utmost to show you how to live the best possible life. It can make your life a whole lot easier when you have the tools to manage your emotions in a healthy way.
So next time you hear someone say “Oh I tried therapy once and it didn’t work for me” you can give them a big ol’ side eye because that is not how therapy works.
I am a therapist. Another point to go along with this article is there are over 400 types of mental health therapies out there, and what I have found is that often people will go to four or less therapy appointments and not get much out of them, because that is basically less than a therapeutic “dose” of therapy. I have had to use the phrase “I am here to help you not to make you feel better”, but that happened more when I worked in a detox. I am primarily a CBT therapist and most people don’t feel worse before they feel better from my experience with CBT as it deals primarily with the present, but CBT is not for everyone. I would think that CBTs focus on empirically controlled research and emphasis on logic based reasoning would appeal to most skeptics. DBT is in a family with CBT, but tends toward more complicated mental health problems. If anyone is interested in an overview of CBT, I would recommend any appropriate books by David Burns, MD., but applying the concepts with a therapist in person is necessary for moderate or worse symptoms. Also, Reconcilable Differences is a good therapy book for couples.
Well done, Olivia! As a therapist of 20+ years, I very much appreciate your words. From my perspective, I think you’re right on target! :-D
I really glad you mentioned DBT because aside from DBT and CBT (Cognitive Behavioral therapy) there is little scientific research that indicates other forms of talk therapy are nearly as effective at achieving specific goals. Another very promising modality for family issues is FFT (Functional Family Therapy) which has some similarities to DBT. I refer clients to therapy many times a week and part of my discussion with clients is about how to choose a therapist. Many therapists specialize, so when looking for a therapist at a clinic or when shopping around on the internet please please please call and ask if they have the experience and education to meet your needs and treat your problems. If you’re an educated professional dealing with OCD and depression a therapist who spends most of their time working with domestic violence and child abuse victims may not be the best choice. Also the therapist whose career has primarily dealt with relationship and life event problems and struggles is not likely a competent provider when there are more serious issues like significant depression, psychosis, or Bi-Polar disorder. Finally competent therapists who are in over their head should refer you on to a more suitable provider or refer you to a qualified psychologist or psychiatrist for further evaluations if necessary.
“I really”. Really Jacob?
I made an account just to comment on this. I started going to therapy about 9 months ago after years of resisting it. I’d just assumed that it couldn’t help me, and also that I deserved what I was doing to myself.
I’d been suicidal for more than twelve years, hated myself, constantly engaged in self-destructive behavior, and was in an abusive relationship. I’d suffered from anxiety disorders, OCD, and horrific nightmares every night from before I was 9 years old. At first, my therapist didn’t engage in any particular kind of therapy. Just sitting down and trying to talk through the mess in my head took forever. But within a few months, I felt strong enough to end the abusive relationship I’d been in for 10 years. After that, she recommended EMDR for a number of traumatic incidents I’d dealt with; she was careful to spend a lot of time working up to it.
In the last few months, my social anxiety has decreased tremendously. I can deal with children, when I always thought it was just something I personally couldn’t handle. I’m able to make mistakes without rocketing into a downward spiral of self-loathing. Most significantly, the violent nightmares I suffered every single night for the last 19 years have stopped, and so have the constant thoughts of suicide and self-harm.
And this is why I think it’s important to emphasize that therapy isn’t about “feeling good,” at least right away. I feel better now than I ever have in my whole life, but that wasn’t the purpose of everything I’ve worked on, and it took nine months of constant difficult work to see those results. It’s not because I worked on feeling better; it’s because I worked on sorting through all the stuff I’d built up over the years, figuring out what I needed to keep, what I needed to let go, and what I needed to learn.
It has not been a pleasant or easy process. But I never thought that I could or would ever see the results I have. I sincerely thought that I would be miserable and despondent until the day I eventually worked up the courage to kill myself. Now, that doesn’t seem even likely, let alone inevitable. I recommend therapy all the time now, especially to people who are skeptical about it.
What zugasaurus says above is my experience, too–therapy doesn’t start feeling good until AFTER it feels really bad. It’s not a magic wand that will solve your problems, it is a lot of hard work.
“Oftentimes you feel a whole lot worse after you start therapy because you are asked to dismantle some of your old coping mechanisms, seriously look at your problems, and then build up real and good coping mechanisms.”
This, so very much. My therapy first got me to a level at which I was stable enough to really face my actual problems, and the it got me to the point where I really broke down. Then it got better.
I’m a Registered Psychiatric Nurse, trained in Canada and living/working in Australia. I really clicked with this article; I’ve been saying similar things for a long time. Thanks for that.
Great post, as a professional in the field, I can agree with most of what you said. Unfortunately as psychologists, we don’t always do a good job of getting this type of information out there and certainly not about efficacious interventions. I’d suggest for those interested to check out the website http://www.abct.org/home/ which is primarily for CBT users (which includes ACT & DBT approaches) but provides a guide for what is evidence based and where to find good certified trainers.
With that said, I just had one small issue with the mention of EMDR and just want to mention at the very least that informed consumers should be aware that it’s status is perhaps not up to par with other CBTs. Here is a great summary of the issue of EMDR and how it may very well be a pseudoscience.
http://phtherapies.wordpress.com/2011/09/15/emdr-empirically-supported-treatment-or-pseudoscience/
I think part of it’s how we think of medicine. Yes, ideally, medicine shouldn’t be harmful, but it can be. And psychotherapy tends to involve exploring past trauma; practically by definition, this is triggering.
It doesn’t help much that when people think of psychotherapy they think of pop psych like the self-esteem movement and psychoanalysis.
This actually speaks to an aspect of therapy that’s always sort of bothered me. Some of the people who would benefit from, or need therapy may not get it, because they quit their therapy on account of the things they’re getting therapy for. That’s not saying therapy doesn’t have a lot of value to it, or that all (or even most) of the people who drop out of therapy do so because they’re not psychologically able to continue. But for those who really can’t do it because of the very issues they need help with… that’s kind of a problem. And it seems to me that people (not necessarily professionals, but at least a few of my old psych teachers) throw a rug over it, by passing moral judgement on those people.