People often ask me about what treatments I have received for my mental illness. Good question. First and foremost, I have received many treatments – most have been ineffective, some downright disasters, and some have been life-changing. PLEASE NOTE: I am speaking from my own experiences. While I unpack my own experiences in this (and the next couple of) posts with the good, the bad, and the ugly of the treatments I have received, I try to explain what the therapies I received were intended to do, and what benefits/detriments people commonly experience while (or upon conclusion) of the therapy is being conducted.
Let’s try therapy and medications first, as these are the first interventions most people receive for mental illness. Take me, for example. I was in my last year of law school when I first sought professional help. (Welllll, that’s a bit of an overstatement – I was in my last year of law school when my roommates sat me down and insisted I get help. It is no understatement that I owe my life to them.)
Truth be told, no one wants to go to therapy, and no one wants to take medication they don’t believe they need. People just want to be able to will mental illness away, as if it’s a character weakness (spoiler alert: it’s not), or to be able to “fix it” on their own – rarely, if ever, does this work. The very first thing I tried was therapy. I had a lovely therapist who got me through my last year in law school relatively unscathed. I don’t remember what we talked about, but I do remember feeling heard and validated. I remember him sending me to a psychiatrist from very early on in our work together.
I also remember that psychiatrist asking me point blank one day how, exactly, I was going to study for the bar exam when I had admitted to taking a blow-off last semester in law school. Hell, I took legal philosophy and wrote a paper on Snoopy and Dogbert. (I did earn an “A” in that class!) That doctor, whose name is lost to history rendered me speechless: I didn’t have an answer, but I was suddenly filled with terror that I would fail the bar exam (by some act of God, I passed on the first try).
Up until that point, I had just attended my monthly sessions with my psychiatrist as a “favor” to my psychologist. (Here’s the difference between a social worker, a psychologist, and a psychiatrist: social workers – either BSWs or MSWs or both – and psychologists (PhD therapists) are both highly qualified to provide talk therapy. Psychiatrists are MDs who can prescribe medications as well as conduct therapy (though they rarely offer therapy). My therapist pushed but did not shove, realizing, I think, that just getting me to go to see a psychiatrist was a win all on its own. And I think that this psychiatrist recognized early on that gently leading me worked a whole lot better than pushing or shoving.
Medications can be worth their weight in gold. I urge anyone prescribed psychotropic medications to keep a log with the name of the medication, who prescribed it (and when), and whether it was at all helpful. This can be very important information – and this way, you won’t have to reinvent the wheel every time your provider suggests you try medication
Probably the most well-known type of therapy is “talk therapy."
Talk therapy is what most people think of when they imagine a therapist and a patient – a sort of free exchange of ideas, and they’re not wrong. They’re also not right either. Talk therapy only works when the patient is honest and open to change and the therapist has the ability to be fully present as an active listener.
My experience with therapists has been all over the map. The one that I discuss above, my very first therapist, told me when I called to inquire about an appointment, that he really dealt with men’s issues. I think he heard how desperately I needed to see someone – anyone – and he told me he had an opening in his schedule the next day. Did the fact he didn’t usually treat women make him any less effective? In my case, no, it didn’t, but that was owed to his talent as a therapist. Therapists are like anybody in any profession: good, bad, and in the worst cases, harmful. I’ve dealt with all three. If any therapist seems hurtful or arrogant, run.
Therapists need to be on your side and collaborative. Although you might really want a therapist to tell you what to do, they should never tell you what to do. (Exceptions to be made are in situations where you are potentially in danger.)
Why don't you want your therapist to tell you what to do? Well, for starters, YOU are the architect of your life, and only YOU should make decisions about your life. Not to mention that your therapist, in all likelihood, has a different set of values, expectations, and beliefs than you. So, the decision(s) your therapist might make for you may not be the best decision(s) for YOU. Having someone else make decisions for you might seem ideal in the short term but could be catastrophic in the long term. In other words, making your mistakes is better than making someone else’s.
So, I said that the therapist must be fully present and an active listener. What does this mean, exactly? Well, for starters, therapists need to be with you in the moment. If your therapist gives exclusively “mmm-hmms” when you’re talking or checks their watch repeatedly, I urge you to bring that up with them. If they don’t seem to be with you, you should ask them if they are trying to give you the space to explain what is going on with you, to bear witness to your story – that’s perfectly acceptable. If, however, they are simply out to lunch, they are likely overwhelmed in their chosen profession, and that’s on them, not you: in this case, run fast and far and do not pass go until you find a suitable replacement.
A therapist who checks their watch constantly might simply have a bad sense of time and is trying to honor the next patient’s appointment time just as he/she is trying to honor yours. A good therapist, however, hangs a clock somewhere in the room where he/she can easily check the time without appearing to be bored – or wanting the 50-minute hour to be over.
Therapists have wildly different approaches. Some use CBT (cognitive behavioral therapy), an approach that teaches a different, systematic, and less emotional way to look at one’s problems. Dialectical Behavioral Therapy (DBT) is a form of CBT that teaches specific skills to implement when one is overwhelmed or is having difficulty making healthy decisions.
Acceptance and Commitment Therapy (ACT) is a newer therapy that posits that one acts in accordance with their values. The most talented psychologist I have ever worked with refers to his therapeutic approach as Plain Old Therapy (the shorthand, POT, is very much tongue in cheek), and it’s the best approach if you ask me. A treater, in my humble opinion, should be able to pull from various approaches in their treatment of a patient. Pulling from a variety of approaches gives each patient an opportunity for a custom-tailored treatment – and a way to save lives from the Beast that is suicidality.
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