Why I will continue recommending counseling on this blog FOREVER.

I wanted to expand my response to this comment into its own post:

But this isn’t about me. I want to say something about the “get help” advice. People seem to think it’s that simple. Tell someone to get help, they get help, end of problems. It is nowhere close to simple. There are many obstacles to getting “help” in the first place. Many people who need help are very anxious when dealing with new people, especially authority figures such as doctors, psychiatrists, psychologists, receptionists, etc. And then if you think the receptionist once gave you a dirty look? Or they really are rude to you? Can NEVER go back there again. In addition, depending on your life phase and such, “help” can be prohibitively expensive. Then, even if you do find help, and can approach it, and can , it is often the wrong help, or inappropriate help, and the persistence to keep looking until getting the right help doesn’t tend to be associated with the types of issues one might need help for.

I have been told in my life, by people from boyfriends to casual fucks to professors, to “get help.” It’s condescending. I’m trying to, and it’s not succeeding. Do they really think they’re the first to ever suggest it? I’ve been seeing mostly-ineffective shrinks off-and-on (with the very occasional more effective one that disappeared thrown in, plus one so ill-suited for me I walked out of his practice significantly more suicidal than when I walked in) since I was 14. If it were as simple as “get help” I’d be fixed by now.

I recommend therapy here a lot. And I will keep doing it. Even though it is often prohibitively expensive. And/or difficult to locate. And/or difficult to acquire once you do locate it and can maybe afford it. I have a very strong bias in favor of therapy/counseling/mental health services because I have found them to be personally extremely helpful to me and to people I love – some of whom are alive and breathing because they sought out mental health services in time to save their own lives. My bias: I openly admit it. Therapy: I’m pro.

I definitely do not want to condescend to people who have a hard time getting therapy, don’t believe in it, have tried it and found it unhelpful. You have critical thinking skills and are the expert on your own life. If you’re dealing with some fucked up shit in life and the prospect of getting therapy seems unhelpful, exhausting, unaffordable, and like you’d rather keep dealing with the shit on your own than even attempt getting help, go with that! And own that choice, and make it something powerful for yourself. “You know, the people who keep recommending that I ‘get help’ are basically saying ‘I don’t know what to do for you, but I sure wish you’d talk to someone else about that problem’, so I guess I’ll handle things myself from now on/find new friends/try out other stuff until maybe I feel better. Humans survived on the earth long before the mental health profession existed!” might be the right solution for you. I have answered letters (privately) in pretty much that way. Emailer:Here are my problems, they are large and complicated and feel overwhelming, but please don’t recommend therapy! Me:Look, I have no idea what to say to you. If that were happening to me, I’d seek out some therapy. Ask someone else. I hope you will be ok.”

Also, I say this here a lot: If you read a response to a LW and think “She is maybe talking about me but she doesn’t know my specific situation so she’s getting it all wrong and is excluding me and people like me!” you are correct. I don’t know your specific situation! I am possibly getting it all wrong! I am responding to a person who had a problem and wrote to a stranger (who, may I remind you all again, has an unpaid for MFA in film & video as her sole credential in life) because maybe my best guess at how to go about handling a problem might maybe perhaps shed a little light on their situation. Because sometimes the act of telling your story to a sympathetic third party who can listen and offer an outside perspective is helpful. (Hint: That’s what you do in therapy, but there are lots of ways to do that). And sometimes me being wrong *is* the helpful thing – the LW says “No, you’re wrong about all of it…but an alternate perspective/helpful commenters gave me some insight.”I count that as a victory.

All advice from anyone anywhere is caveat emptor. You decide how much or how little of it you want to apply to yourself and use.

Here’s what I know. Anything on this blog that is any good happens when I am like Meg Murray taking her faults into Camazotz. When I say “Oh god, don’t send FEELINGSMAIL” it’s because I have sent feelingsmail and reaped the resulting awkwardness and shame. When I say “these are some tricks that helped me pull myself out of depression, maybe they will help you” I am writing honestly about my own experiences and what worked for me. After fucking up professionally, after fucking up romantically, after fucking up my family relationships, after being a person who harbored slights and bore grudges and raged silently at people who failed to read my mind, I somehow managed to stitch together a somewhat functional adult persona who can have a feeling and speak up about that feeling within the same month…sometimes even the same week or day!

I did that partly be treating my mental illness like an actual illness, but it wasn’t like someone told me “get help” and I went out the next day and magically got help and got better or that I think any part of it is easy. It took years. It took trial and error. It took being so broke that my level of income meant that I got services for $5/session. It took experimenting with meds, sometimes with very bad results. Just like with getting asthma treated, it took many bad fits and much procrastination before I found someone who could actually help me. It took friends and a concerned boss saying “Have you thought about therapy? It really worked for me” when they saw me acting in ways that were dysfunctional and detrimental to my own happiness. And frankly, it took getting to a place of despair where anything – even the torturous project of picking up the phone and making appointments and figuring out money and telling my darkest secrets to a stranger – seemed better than going on as I was. And then it took the slow, hard work of teaching myself to live in a different way without knowing for sure whether it would ever get better, full of days where “Got out of bed. Fed cat. Put on pants and shoes. Walked outside the house. Didn’t ride my bike into traffic.” counted as victories.  I would have had to do that work with or without therapy, since my other choice was death by my own hand. It went a little easier with therapy. That’s an important thing to tell people, I think, especially when there is such bullshit and stigma surrounding mental illness even when it’s so fucking common. “You get to try to make really hard stuff a little easier on yourself.”

We teach what we most need to learn, and writing this helps me heal myself a little at a time. Sometimes I write with strong biases and make emphatic arguments, but that doesn’t mean I’m trying to set myself up as an authority on other people’s lives. It means I think it’s fucking exhausting to qualify every statement with “Unless of course that’s not true for you and your situation, 200,000 people who stop by here every month, I’m sure you are all different so only do what applies to you! Love, Captain Obvious of Planet Tautology”  on my website that I write in my free time for free

In closing, I have a strong bias toward mental health services being a force for good in the world. I realize that comes from a place of relative privilege with regards to social class, education, location (large city with a variety of available resources and sliding scale options), access to a phone and computer to research things, free time to go, a form of mental illness that responded well to that kind of treatment, knowing what my options are, etc. I almost always try to recommend it in conjunction with other concrete behaviors or steps. I definitely don’t do it to condescend to people – in most cases I am trying to validate the letter writers by saying “Yup, that sounds pretty serious, and you might benefit from having a trained professional on Team You.” I accept that therapy doesn’t work for all people. I don’t accept that because it doesn’t work for you that I’m not allowed to recommend it to people as one possible solution.

And if therapy doesn’t work or hasn’t worked for you, I don’t know what to tell you. I’m sorry. I wish it worked for you. I wish it were easier for you. I hope someone smarter than me can give you a better road map.  I’m sorry that people tell you to “get help” when they really mean “please go bother someone else about this problem.”  That is never not painful to hear, even if friends and family are within their rights to set boundaries around how much of your pain they can carry. I hope you find out what does work, and that if you do, you come back tell us. I support you in whatever helps you live to tell the tale.

61 thoughts on “Why I will continue recommending counseling on this blog FOREVER.

  1. Another excellent post. If not for therapy the right meds, I probably would have killed myself years ago. It took a long time to find a therapist with whom I connected and even longer to find the right meds at the right dose — and some of the side effects along the way were awful — but I’m forever grateful to the friend who got me to promise I’d give it a try.

  2. Part of what makes you so helpful, CA, is your willingness to put yourself & your life experiences into these blogs. I think that’s brave & soooooooooooooooo useful. It addresses one of the big things about mental illnesses that makes them so bad for us- the social isolation. Your blog helps me feel connected, like i belong & that I’m not alone in my despair/anxiety/ awkwardness!
    Good job on this – & don’t let the world of people needing help get you down. 😀

    P.S. I agree, re: therapy – awesome stuff, but sooooooooooo very very very hard. It takes time & lots of energy to be committed to it & also the RIGHT person. You must shop around for one! Remember it’s also a journey or process, not just an outcome. My therapist recently reminded me that my progress in therapy isn’t graded 🙂 a useful thing to keep in mind if you need/want it long term or you need/want to go back.

  3. I’m truly not trying to stir up controversy here, and I hope it’s not taken that way. But I have what may be an odd take on both this issue and the Internet Diagnosis problem (which I contributed to) on the “My parents hate my partner” post.

    I was C for a really long time. Not really C – I don’t live with my family, thank Maude! – but I shared (and still sometimes share) far too many similarities with her. I rarely expressed my feelings of self-loathing to others, but oh boy were they ever there. Stay at the computer all day and avoid people because no one likes, or could ever like, me? Yep, guilty.

    Like Dr. Confused, I tried getting help time and again. At best the therapists, psychiatrists, and psychologists had no effect; at worst they made me actively feel more depressed and hopeless. There must really be something wrong with me if not even therapists can help me.

    You know what finally fixed me? At age 38, I stumbled across a blog where the author was describing difficulties with her mother that were eerily similar to my own mother. Then I read the comments, and one of the commenters Internet Diagnosed the author’s mother as a Narcissist. So I did some Googling, came across the website Daughters of Narcissistic Mothers, and proceeded to stay up all night alternately reading and crying my eyes out. Suddenly, everything made sense. Suddenly, I realized – for the first time (srsly) – that I wasn’t a fundamentally horrible and worthless person. Rather I had just been told that my whole life, and came to believe it, but it wasn’t necessarily true. Moreover, there were hundreds (thousands? more?) of other women who had been through the Same Exact Thing – and nearly all of them stumbled across the diagnosis the same way.

    That’s the weird thing about Narcissistic mothers – the similarities between them far exceed the differences. Time and time again, someone in one of the forums will post something their mother said, and my mother will have said the Same Exact Thing, word for word, and so will mothers of many other people in the forum. We’re talking very stereotyped behavior here. Because of this, I would argue, it’s easier for someone familiar with Narcissism to recognize it in others than, say, other PDs. Conversely, thanks to the constant gaslighting and manipulation typical of someone with NPD, children of Narcissists very rarely recognize it as such until they meet others who have been through the same thing and can point it out.

    So I guess I’ve become an evangelist about Narcissism, pointing out behaviors and traits that are characteristic of NPD when I see/hear/read them. I realize that I went too far with this in my comments on that post, and I apologize, and will greatly tone it down in the future. But I wanted to offer, in addition to an apology, an explanation of why I went there – and why (in some very limited cases) it could be (and, for me and many others, has been) helpful.

    1. Sasha: ditto, almost all of it, only I was 50 years old before I found out about NPD, found the websites, wept all night with the stories, some of them verbatim what I had gone through… it is eerie, to say the least. I never sought therapy, because I didn’t think anyone would believe my twisted story. Or I told myself, eh, get over it, I’ve been an adult far longer than I was a child. Or I thought a therapist would secretly think I was just a whiner. Guess I thought I didn’t even deserve a good listen. But now I do, and putting a name on this thing has helped in so many ways. I now know that when I do go to seek therapy (and I am going to!), the first question will be if the T has dealt with this before. It is so specific. I know I’ll feel like I’m at least starting off on the right foot if there’s some common ground, and not digging into a bag of unspecific issues popcorning around before we figure it out. This whole post has encouraged me to start the process. Not because I want to rehash my childhood, but because I want to get better and shake off those little demons that have been hounding me.

      I know though, with all this newly found info, it’s so easy to spot those red N flags and rats. Yak! I’m seeing it everywhere, but trying to temper any judgments by first telling myself, “well, maybe she’s just a garden variety bitch, or maybe it’s a case of just plain selfishness, or whatever.” Or not! I realized I was irritating my sweet husband (whose family is the total opposite of mine) by yelling out “god, another narcissist!” at TV characters. Now that’s just silly. I am also trying to tone down my (totally non-professional) diagnoses, but damn, they’re everywhere!

      Meanwhile, thank you, Captain Awesome! I just stumbled onto your most excellent site, and am totally wrapped up in it. Supposed to be working now… uh oh.

  4. For what it’s worth, Cap, I don’t think you’re being at all dismissive or condescending when you suggest therapy. I think you’re a pretty even-keeled advocate. I could see how it might be irritating to hear “get help” if you hear it often from people you wish were more invested in your life. But I don’t think that’s a good reason to write-off the whole profession as worthless.

    Just to kind of throw another perspective into the fire, here’s my take on therapists derived from personal experience and from people I know:

    It’s entirely feasible that a therapist might not work out for you — they have personalities and approaches like everyone else, and like every other social relationship things need to gel for it to work. Also, they might just suck at their job; people who suck at their job exist in every profession.

    But, I also think it’s important to walk into therapy with an open mind. A therapist’s office can sometimes be a useful place to vent. But if you walk into that therapist’s office just to have everything you already believe validated, you’re doing yourself a real disservice. If you want your life to improve, you have to be willing to actually consider and act on advice. Otherwise, you may as well just keep a journal. Nobody is as good at reinforcing what we already believe than ourselves.

  5. I will be following this and have more to say in the future I think, but first I want to respond to the basic crux of what you are saying here to my comment, and possibly clear up a slight misconception about what I was saying.

    I am NOT suggesting in any way that you, CA, stop recommending counseling to your letter writers. While I myself have struggled to find the right therapy for me, it has helped many of my friends and internet-acquaintances and in general I do believe that therapy can be A Very Good Thing (which is why I have not yet given up on looking for it myself – though I had given up briefly after the bad therapist and that’s what made me so very, very, very sad). You letter writers are people who have specifically approached you for advice, generally on fairly mild interpersonal matters, and perhaps really to them getting counseling is something that has never occurred to them. Giving advice to people who have solicited advice is good! Giving ideas to people who have likely not thought of those ideas is also good!

    In fact, I’m not even sure my response was addressing you, Captain Awkward, but rather more adding to the good discussion in the comments.about the right way to approach people in your life who clearly need therapy. In fact, re-reading your column, your particular advice to the LW in HOW to suggest therapy to her sister was quite good (especially “Would you like some help in making appointments?”)

    In that particular column, it was not the person who clearly “needs help” that wrote to you. It was her sister. And there seems to be a consensus in the comments that the LW needs to tell C she needs help. I don’t even disagree with that. It’s more – I guess I’ve seen enough situations now where someone is CLEARLY fucked up, someone else approaches them and says – “Hey, dude, you seem pretty fucked up. You need help.” and then walks away. So what I was saying was not aimed at people who need help, but at people who know people who need help.

    The things I said in my comment, about the anxiety, and the expense, and the often poor match between therapist and client, and the difficulty in figuring it out and finding the right therapist, are not even reasons to not suggest to a friend that they need therapy. But maybe they are reasons to not give up on the friendship if the person doesn’t immediately run to do as you suggest. Maybe they are reasons to have some more compassion with the person, to continue to engage with them, and to try to help them overcome some of these obstacles. That is, if, despite their problems, they are still for whatever reason someone you want to continue to have a relationship with.

    I guess what I’m saying is that I’m not actually arguing with you. And I’m sorry if it seemed like I was.

    1. The first time I tried to get help for my attention problems I was struck by how humorously cruel it was that I had to find a GP who took my insurance, make an appointment, show up on time for the appointment, get a referral to a specialist who took my insurance despite the GP’s complete disinterest in working with me to figure out who took my insurance, make an appointment with the specialist, find the specialist’s office, show up on time, all the while filling out endless paperwork, processing the inevitable insurance screwups, etc. etc. To people without attention problems these may sound like simple everyday tasks but of course for me they are tantamount to running a marathon while writing an epic poem using a pen that’s encased in jello. Actually I’m a good runner, and a writer, and I can eat jello pretty fast, so that still is probably easier. But I digress.

      When I got to the parking lot of the specialist’s office I was running a bit late, and couldn’t find a parking spot. I parked and walked to what I thought was the right building, but it turned out it was the wrong building. By the time I found the actual office I was 20 minutes late and they told me I needed to make another appointment. I went back to my car and just cried and cried.

      None of this is helpful in any way I realize but your posts just kind of reminded me of this. Sometimes it’s pretty hard to get meaningful help, and when you’re going through that, when people tell you to get help it’s totally normal to want to punch them.

      Nonetheless I hope you succeed in getting help, as I eventually did [ducks]. ;-D

      1. I haven’t managed to schedule an appointment with mt school (free) therapist for a similar reason. I need to walk in past all the gym people to the receptionist who tells me I can schedule for sometime in four or five weeks, and I never get the guts together to tell her “I really need to see someone Right. Now.”


        1. Take a friend with you and have them tell the receptionist for you. Seriously.

        2. Does your school have a regular health center, where you might be able to see a doctor or nurse practitioner on shorter notice? The only reason I got help for my depression in grad school is that I finally managed to pull myself together long enough to go student health and tell the nurse practitioner that I was concerned about my sleep issues. The NP agreed that my alternating bouts of not sleeping at all and not being able to get out of bed for days were, indeed, cause for concern, gave me the standard depression screening on the spot, and then walked me down to the counseling offices, talked to the receptionist there for me, and did not leave until they’d found someone to see me yet that afternoon. I walked out of the student health center that day with a psychologist, a psychiatrist, a therapy plan, and a prescription for Prozac.

          I don’t know how things are set up at your school, of course, but if you need an advocate, you may be able to find one among the regular health care staff.

  6. Just wanna put out there: a therapist is like a pair of shoes. One size does not fit all. Some are awful (for you) or indifferently good (for you) or great (for you) regardless of how well they work for your best friend/boss/mother/whoever. You try on different shoes before you commit and don’t feel bad personally. If at all possible try looking at schools of therapy/individual therapists in this same light.

    1. That’s a great metaphor, not least because few people would object to being told “Shoes might help” if they spend all their time walking around in bare feet.

    2. Yes! So much this. Last year when I was talking to a friend about her beginning therapy, she was shocked (SHOCKED!) by the idea that you could fire a therapist. If the practitioner you’re seeing isn’t working for you, you’re not breaking any rules by finding someone else who will work well for you. They understand, they’re not going to be insulted, heck, they might even be able to recommend someone.

      1. The number of friends I have who continue with a therapist that isn’t working for them because of the unwillingness to fire them out of the embarrassment, their perception that it’s an implied judgment on their therapy skills, wanting to give them another chance, etc…sometimes it’s much harder to convince people to try another therapist than to talk to a therapist in the first place.

        1. I’m one of those people. 😦 And if it doesn’t count as a derail, I would love to hear any scripts or strategies people could offer for firing a therapist.

          1. “Therapist, I appreciate your time and effort, but I feel like this isn’t working for me and this should be our last session. Can I ask you to recommend a colleague that might be a better fit?”

          2. For the ultimate in non-confrontation, call/email the reception desk and cancel your next appointment. If they ask if you want to reschedule, you can say, “No thanks, I’m not sure when I’ll be able to come in again. I’ll call when I’m able to make another appointment.” And don’t call. They’ll take the hint.

          3. Captain Awkward’s script is what therapists are taught to expect. “Just not feeling it” is a 100% acceptable reason. However, in my experience, most people fire a therapist by refusing to rebook, or cancelling their next appointment, and dropping completely out of touch. It’s less scary, though it doesn’t give you a referral to another therapist that the one who knows you thinks might be a better fit.

          4. As someone who is a therapist and has experienced/overcome mental health problems in the past, I *strongly* encourage you to talk directly to your therapist if you feel like it isn’t working. There could be a number of reasons why it isn’t working for you, and its possible that these things could change if you bring them up in therapy. I try to ask my therapy clients intermittently how they feel things are going, and then alter my treatment plans based on their feedback. I know that it is scary and anxiety-provoking to actually have such an uncomfortable conversation, but if your therapist is any good, he or she will appreciate your honesty. If they do not respond positively and try to problem-solve ways to improve with you, then they do not deserve to work with you as a client. If that is the case, I would go with JenniferP’s script, thank them, request a referral, and not reschedule.

            Any therapist that knows their stuff knows that not all types of therapy work for all people; as such, your therapist should not feel offended if you decide to seek services elsewhere. Staying with a therapist that does not work for you only hurts people in the long run – you, because you will not reap the growth and change you seek even though you are putting forth the effort, and others, who may be waiting for the chance to see a therapist just like yours. And if your therapist doesn’t know his/her stuff or is simply not that good – why waste your time, effort, and money when you could be getting WELL elsewhere?!?

            Good luck!

        2. I do understand the reluctance to try someone new. Retelling your history and developing a relationship with multiple new therapists can get very frustrating.

          As an aside, though, I don’t know what regulations are like in the States, but here in Canada, it can be very difficult for a therapist to stop seeing a patient. Ethically, they’re only allowed to fire a patient if they believe they cannot help them, and that continuing the therapeutic relationship would not be in the patient’s best interest. Just to reinforce that when you goes to see a therapist (in almost all circumstances) the ball is completely in your court as to whether you want to keep seeing them or not. No guilt or fuss required.

        3. Ha! I saw someone who wasn’t that great for me for years and years. I relate to all those reasons. But the biggest one was: I was just really bloody depressed and I couldn’t tell the difference between hating therapy because this person wasn’t working out for me, and hating therapy because it involved talking about myself and I really, really hated myself.

          Also there is the thing where you believe you are crazy; therefore, you do not trust your perception that the therapy is not working out, or you presume it’s your fault that it’s not working out.

          Now, of course, I found someone who does work for me, and I am like, OH MY GOD I NEVER KNEW IT COULD BE LIKE THIS.

  7. I definitely don’t do it to condescend to people – in most cases I am trying to validate the letter writers by saying “Yup, that sounds pretty serious, and you might benefit from having a trained professional on Team You.“

    This is absolutely it, I think. When someone says to “get help” (assuming it’s someone who has the type of relationship where that’s warranted and it’s not a brush off), it’s absolutely a way of validating, of saying “yes, what is going on for you right now is bad, really and truly”, and not only that, but that you (the person who should maybe seek help) are worth the effort and resources involved in GETTING that help. Obviously it’s in the delivery and the context sometimes, but I think “please, get help, you are worth it” is a powerful thing to say to someone who might be despairing of their own value and their own resources. I know it has been for me.

    1. I wonder if some of the static on suggestions of therapy — not in this specific case, but in general — comes from third parties (and some hearers) who conflate “you should try therapy” and “you must have a mental illness” and “your problem isn’t real” — the last being the opposite of “what is going on for you right now is bad, really and truly” and obviously not what is intended.

      Of course, the first doesn’t imply the other two and the second doesn’t apply the third (though people too often think it does), but that’s a lot easier to see from the outside.

      1. I think you make a good point, and I wouldn’t be surprised if it boils down to a larger societal belief that mental illness means you’re weak, or that it’s somehow just a big character flaw rather than an illness like anything else.

  8. Delurking to say that as someone who’s been told to “go see a psych” way too many times I actually find your stigma-free “no really, go see a psych if you can” rather refreshing. Too many people act like they should just be able to fix it themselves and then just add that to the list of things they fuck up. Which isn’t to say that no one you give that advice to could fix things themselves, but, to continue on the shoes metaphor, trying to will oneself out of clinical depression is like trying to limb oneself out of a broken leg, it just doesn’t work (I can’t take credit for that metaphor, nor do I claim it’s perfect, but it’s good enough and fits nicely with the shoes)

    But as Britt said, “’please, get help, you are worth it’ is a powerful thing to say to someone who might be despairing of their own value and their own resources” — it’s also a far cry from “get a psych and stop bothering me” or the flat out condensing “you need help”. The times I’ve seen you tell people to get therapy though have always read more like “because this is possibly available and might help” than “because you’re annoying me, stop it”.

    I think what I’m trying to say is that I like how you treat it as another available resource, almost the way you’d tell someone with a backache where to get a massage, it’s directly counter the usual stigma of being mentally ill.

  9. Hi there, first time commenter, hope you guys don’t mind my throwing in a couple cents. My main point is to thank the good Captain for her suggestion to own one’s own decision and comfort level. It doesn’t malign the therapeutic approach to refuse to take it, contrary to the opinion of many, and therapy is no panacea.

    I’ve struggled with depression and thoughts of suicide for a while, occasionally seeing therapists but never managing to open up to a greater degree than meaningless pleasantries. Even that was difficult, as entering therapy is to me the most shameful admission of crippling weakness I could ever make, and I consider “get help” to be up there with “aw, you’ll get ’em next time champ” in condescension level. Seriously, it’s like saying “you don’t know how to be alive, you need help to do even that you fuck-up.” I’ve cut people out of my life completely for saying it to me, and never regretted it. All that said though, the shame and stigma and the notion of needing help just to make my brain work aren’t my primary reasons for avoiding therapy, it’s the inherent danger. I want to work in a field which is intolerant of suicidal tendencies, much less the terrible secrets which drive them in me. Beyond that, it seems risky to the point of recklessness to reveal compromising information to someone who, if those secrets are dark enough, is legally bound to take away my freedom with what I would call a lack of due process. The mental health industry may profess rigorous confidentiality, but the only sure way to keep a secret is never to reveal it.

    My question for the Captain is this: How to navigate that minefield? How can I possibly get any benefit from therapy while looking over my shoulder and rigorously policing what I say to someone who wields that much power over me? Sorry to sound so… vehement, I don’t mean to indict therapy as a whole, it undoubtedly helps many people in many ways. And for the record, I’m pretty much emotionally stable now, with only irregular and brief pockets of depression so, you know, no need to be alarmed. Just trying to contribute to the discussion.

    1. My opinion, sweet dancer, is that it takes thrilling, frightening amounts of strength to do many things. Two of them are:

      1. Care for yourself: *really care*, as if you were your own most precious friend.
      2. Be vulnerable.

      In my experience, the best therapist does not “hold power over [you].” They might kick your butt down the path or hold your hand through rocky parts, but if they’re any good for you, they won’t be about power games.

      I wish you well.

    2. From my perspective, the thing to do is talk it over with your therapist. A good therapist should be able to really clearly articulate what the limits of confidentiality are, and will let you know when you approach them–which sometimes means the therapist stopping you mid-sentence and saying, “You may be about to tell me something I have to legally act on. Do you want to rethink that for a moment?” Where I live, the system and laws are such that we only call the police or do involuntary treatment when someone is an imminent danger to themselves–as in, has a plan, has means, and has a very short deadline. Less than that, we might consult with colleagues or come up with a safety plan, but not spring into action in a way that compromises confidentiality. Laws vary all over the place; the person who knows best is the therapist themself, and this is the kind of question they should be able to answer up-front, possibly over the phone before you book a first session.

    3. “I want to work in a field which is intolerant of suicidal tendencies, much less the terrible secrets which drive them in me.”

      I don’t know exactly which field you’re talking about, but it seems like perhaps there are real reasons you might not be a good fit for this field? You can’t always get what you want, and all that.

      It sounds like your secrets are already weighing pretty heavily on you – creating a great deal of stress. If your job depends on no one ever finding out that you even HAVE secrets, that’s going to pile the stress on higher.

    4. My situation was not entirely unsimilar to yours, and my solution – after much soul-searching and discussion with friends – was “don’t”. Therapists are meant to help, but whether you have one helping or not, you’re still going to have to do the work, just like the Captain said. It’s possible to do that work without one, and in some situations that is the better option. (I don’t know if it is for you, obviously. For me, it was a matter of self-care; I’ve been abused by psych professionals before and can barely even interact with them socially without having a panic attack, so intentionally deciding that I’m going to do what needs doing on my own rather than put myself through that trauma for the sake of ‘doing it right’ was actually quite positive for me, and was something of a turning point.)

  10. I personally really can’t wait until more therapists use online booking systems. I’ve absolutely had months where I could throw myself into the client’s chair and spill my guts out, but ask me to pick up the phone and wrangle with the receptionist? HELL NO.

    I’ve had therapists I hated who were useless, whom I hated but were useful, whom I loved but were useless, and whom I loved who were useful. It’s such a crapshoot sometimes, because someone who looks really good on paper turns out to be a total mismatch in real life (sometimes with added bonus “How did you pass your board exams?!?!?”), I did have more success more often when I asked my doctor or the local professional organization for who they’d recommend for my age group/gender/problem, instead of going in blind.

    I will say, sometimes books can be really, really helpful, if they’re a match with you, and they’re way cheaper than most therapy. The Mindful Way Through Depression and The Feeling Good Handbook are both books with a lot of concrete advice, that are well-written and well-researched enough that many therapists actively use them in practice. If you just can’t bear the thought of seeing a stranger, a user’s manual might be the first step forward.

    Or it could be total crap a mismatch. YMMV, obviously.


      Grubhub for doctors. OMG. Does anyone with programming knowledge want to help make an app?

      1. Seems like confidentiality would be a minefield with something like that. If it’s on the internet, it can be hacked. I bet that’s why it’s not more common (well, that, and because the technological acumen amongst therapists can be pretty low).

      2. Is there a ZocDoc for mental health? I’m using it to schedule dental appointments now… [pause for internetting] OH GOOD. ZocDoc has mental health entries, too! Could probably be better set up to account for sliding scale, but the basic premise is there.

      3. There are a ton of good-enough sites out there. Right now it’s just the mental health field’s job to wise up and shuffle on over. Like AmyJ said, there are a few little hurdles (like figuring out WHICH sites are secure enough) but it’s totally doable today.

  11. Captain, I think your advice has always been spot on, and you’re very clear about how it’s not the absolute only thing someone can or should do. As someone who struggled to find a good therapist (AND afford it–I finally had the insurance to cover it AND she had a sliding scale, so I’d be able to go either way), it was worth all of the effort and time.

  12. Sometimes people just need a little validation, some coaching, some perspective, and to hear that other people have been through crap like “this” (whatever theirs may be) and hacked their way to a better place, and some suggestions on how to do that. That’s something a talented, empathetic, been-there-and-have-the-scars-to-prove-it advice blogger and her like-minded community of commenters can help with. A lot!

    Sometimes a person’s issues are more deeply ingrained, intractable, even medical. That person can still benefit, maybe greatly, from the above. However, I don’t care how well-grounded or articulate or empathetic you are, no blogger (or her backup band) can magic away the damage caused by years of environmental damage and/or biochemical imbalances in a few carefully crafted paragraphs. You’d be a fool (and full of hubris) if you thought you could.

    The way I see it, when you recommend therapy you’re just acknowledging that the person’s problem is real, and worthy of some investment to get it fixed, or at least made bearable, but a bit big for this format. You’re saying you want them to have someone in their corner, preferably one of those people who have made it their life’s work to help folks get through this kind of stuff, because you really hope they make it.

    Sure, there’s a little bit of “punt” involved — but its a recognizing your own/the medium’s limitations punt, not an “I can’t be bothered” or an “I don’t care about your stupid problem” punt.

    1. EXACTLY. “This problem is too real/big for me to help you. Find someone who is skilled in this type of thing.”

      1. This is how I always put it to my friends if it comes up: that I love them and I am totally willing to keep listening to them, but I am so not a trained professional and I can only help so much.

  13. I’ve been in therapy on and off for the last fifteen years (ugh) for depression and PTSD. I always favored cognitive behavioral therapy because it helped me make sense of the depression, but at the same time I always had a low level of anxiety and depression that talk therapy and meds never touched. I got back into therapy a couple of years ago because my life was falling apart and I felt like crap and I was tired of feeling like I couldn’t handle my problems anymore. Last year, this new therapist I found was like, “We’re not going to do CBT anymore. You need to learn how to feel feelings again.” I panicked, because I didn’t understand why she was flipping the script on me, or why I needed to feel more feelings. I always thought the problem was too many feelings. Why couldn’t she just explain this to me in the right way, damn it?! And then in a controlled setting, she peeled off all the old scabs basically induced a mourning period for me, using all kinds of woo-woo stuff that made me feel like an idiot, and I cried for three weeks straight, came home from work and crawled into bed every day and slept and slept, walked around with the kind of body aches that felt like the flu. As I started to feel better, all these symptoms fell away, along with the constant slog of low-level anxiety and depression that always plagued me. The symptoms are still fading — except the nightmares, will those ever go? — and it’s like I have my life back in 3D. It’s amazing.

    Which is only to say that there are success stories, and some of them are hard won and after many years and a lot of cash. The difference for me this time around was that I finally decided to prioritize my mental health and could no longer cut my therapy sessions with the rest of the time and money budget, AND that I was going to see this through and not run when it got difficult. My insurance has never covered individual counseling, if I had insurance at the time, so all of my counselors have been paid for out of pocket on a sliding scale fee (which is really common, and most offices will bend over backwards to get paid in cash or checks). Also, since I’m not messing with insurance companies, I have the freedom to choose smaller, independent offices that don’t even have receptionists, so I only deal directly with my therapist for scheduling, payment, and sessions. I live in a smaller, rural-ish community, and have still found progressive therapists that work on a sliding scale fee, have evening hours and are not afraid of working with my piles and piles of bullshit. If you can make it work for you, it’s worth it.

    1. Do you know if there’s a name for the stuff she did that wasn’t CBT (the woo woo stuff)?

      1. Yes, it was a combination of things, including “inner child” therapy, dream analysis, and guided meditation. I didn’t believe it was going to do anything at all, but she asked me not to google it and intellectualize it and just do the process. I felt like an asshole trying to do this stuff for the first couple of months because I was just sitting there with my eyes closed thinking about my to-do list at home and trying to focus my “inner self”. Then a couple of small things clicked and the floodgates opened. If I had to describe it, I think it just opened me up to face the darker stuff, the core anxieties, and mourn the real losses, and to really feel them for the first time in a way that is safe, and in a way that is teaching me to self-soothe, which is making the array of good/bad choices I’ve made over the last decade extremely clear, which is helping me look at the present and the future in a much more positive and knowing way. Does that make sense?

        It still sounds really woo-woo to me.

        1. It does make sense, and thank you. I tend to be skeptical of the woo-woo, myself — glad to hear it can be effective even if you’re skeptical.

  14. The “shoe” metaphor is so apt. I found my therapist, who was extremely helpful in sorting out a couple of really rough patches in my life because his last name is a homophone for the doctor on the Simpsons. Seriously. I got lucky. But, if the first therapist isn’t helping, there are others.

  15. I want to let you know that I really appreciated this! I have serious mental health issues and I’ve been dealing on and off with the mental health profession since the late 70s. I’ve got a couple of ridiculously funny (in distant hindsight) stories of incompetence, shady ethics, and overworked burnouts. I’ve been trying to find a helpful medication cocktail since the late 90s. Right now I’m on meds of dubious worth, and the county-funded pill-pusher suggested DBT, but couldn’t refer me to anyone (the mental health agency stopped covering therapy for me years ago, and the person they were sending me to was an awful fit anyway).

    And people still think it’s acceptable to toss off a snide “get help” if I annoy them by existing.

  16. I just want to share my experience, which is that I have never been diagnosed with anything (except maybe a tendency towards pessimism?) and I found therapy hugely useful. It’s not just for people with diagnosable conditions, I very much viewed it as someone giving me a tool kit to deal with negative events both large and small.

    I am probably one of those people who tells everyone to get therapy (although I have always tried to be wary of doing that, and after this thread will be more so!) because I kind of view it like going to the dentist. You don’t have to have a cavity for it to be a good idea.

    But I DID have to shop around! First therapist was a total loss.

    1. I have had more bad dentists than bad therapists–I wish I had shopped around more for dentists! (OK, I’ve seen a whole *three* therapists in my life, but they have all been very good. I feel luckier every time I read about others’ experiences.)

  17. Say it with me everybody: Simple is not the same as easy!

    I feel like we’re all on the same page with that. Even in the rare event where we can tell a letter writer that “All you have to say is [thing]” we KNOW that it’s not always (or ever) easy to actually say the thing. Be as well as you can, awkwardlings. Super post, Captain.

  18. Thank you so much for mentioning low-cost options. There have been *many* times where I’ve been talking to friends going through especially rough times, asked them if they’d considered professional help, and immediately been told “I can’t afford that.” That has rarely been actually 100% true.
    Personally, I haven’t found individual therapy especially useful since I was in high school – but I also haven’t sought it out with too much determination. What did and continues to work for me is Al-Anon, a 12 step program for the loved ones of alcoholics. It addresses the behaviors and thought patterns that came from growing up in a substance-abusing home, but also helps me with a lot of stuff I feel I picked up from just living. Support groups of various sorts (which I feel 12 step programs kind of are) are a pretty great alternative to individual therapy, when they’re being managed well.

  19. Therapy is a mixed bag, and finding a good fit with an accessible, affordable therapist can be really tough. I had some super terrible experiences with incompetent psychiatrists as a teenager (one of whom put me on an antipsychotic drug when really I was definitely showing the effects of trauma from some very violating abuse and bullying). The school felt I was the problem, as opposed to the people who were assaulting me. Obviously this is a fucked up response, and as a victim I was certainly blamed. This was not helpful !

    I found books — both self help type books and books aimed at counseling professionals — to be very helpful for me. While there is not the guided interaction with a real live therapist I did find many explanations and answers for some of the troubles that were plaguing me, and I could go back again and again to re-read and process. There are also some DIY workbooks as well. They also helped during the times I was having 3:00 a.m. freakouts.

    Books like real life therapists also run the gamut from terrible to life-changing. Thankfully there are libraries, online forums, and Amazon reviews that can help to sift out the dreck. This is especially important when scraping up $ 20.00 for a book feels insurmountable — let alone $ 100.00 per hour for a therapist.

    Support groups if they are well moderated can also be very helpful, in both breaking the isolation and providing a glimpse into others experiences. It may take several support groups for the specific things that are going on that are causing the depression, dysfunction, etc. — and as a participant I think it is very important to be open and willing to be an active part of the process (ie a group is not a lecture).


  20. So late to the party but a wonderful post! I wanted therapy for a long time, knew I needed it, knew it could be somewhere safe to work things out but had to battle through the assumptions of my parents to get it. My stepdad in particular made a big deal of being too clever for therapy and said that it would never work on him because he could always second-guess and out think the therapist. It never really made sense to me – it felt like having a car accident and injuring your leg and taking all the pain meds (both my mum and stepdad took anti-depressants at one time or another) but then refusing to do the physio because, what? You’re too smart to do exercises?

    The idea of treating mental illness like it’s an actual illness – that idea can change your life.

  21. Therapy can also be extremely helpful not only for those who are having serious problems with daily functioning, but also for those who are quite functional and basically OK, but not feeling like they are living up to their intellectual, emotional, and social potential. It doesn’t have to be just for curing mental illness.

    1. That’s the place I am in currently. I’ve got a couple of issues that just keep coming up and I want better ways to deal with them. However, I’m having trouble motivating myself without the big emotional push to ‘get into therapy NOW!’

  22. Oh Wow. I have been working on a letter for the Captain but I feel like this has probably covered most of it. So I’ll maybe just give the super quick version here. I — and this diagnosis is entirely from Herr Doktor Google — am something in the ballpark of “avoidant personality” or reasonably serious social phobia or some such. I’m 35 so I’m not going to grow out of it or benefit from putting myself in new social situations (been in most possible ones many times), rehearsing scripts don’t really help etc etc. Alcohol helps, the proliferation of smart phones helps (because standing in a corner pretending to tweet by yourself is more socially acceptable than staring into space by yourself), that’s about all that has helped of everything I have tried so far. I thought for ages it was Depression (of the chronic, lifelong kind) since that’s what everyone talks about but a lot of that doesn’t track so now I think it’s that social phobia/anxiety cluster stuff and any depression is the consequence of that underlying jerkbrainality.

    So ANYWAY, I finally went to a therapist (psychiatrist with all the proper licenses and credentials) last year and had a very underwhelming experience to say the least. I had 5 or 6 sessions most of which were 45 minutes of a monologue by him of his metaphysical theories of everything, which basically boiled down to repressed feelings causing physical trauma in various scientifically unlikely ways. Now, no doubt mental health issues *do* have physical manifestations in a variety of ways but this was “negative emotions causing cancer” type stuff. He said he put his hand on a stove top once but didn’t get burnt because he breathed the right way. He did ask me about my family etc and wrote that down but only he said to satisfy “the system.” He strongly hinted at my star sign being relevant. I am a super skeptical, atheist, Carl Sagan-worshipping type so this did not enthuse me to say the least but I was prepared to stick it out if the guy could help me in any way. What made me stop (and yes,I slunk away by just canceling my next appointment and never going back) was that he said to me “you continue to be silent” and said he found this challenging because something about his father using silence to punish him as a child. Having difficulty speaking even in the most innocuous social situation is chief among My Many Issues and my whole adult life have felt intensely self-conscious, inadequate, worthless, obviously freakish and unpleasant to be around to/for other people etc etc because of it. I just couldn’t bear to cop it from my fecking therapist also.

    I’d like to go to another therapist. I don’t need help with that in a financial or resources sense; I can afford to pay market rates (given the above you would positively snort with laughter if you knew what job I have), have some rebate options, intend to seek out someone with particular expertise in the area. My questions are more practical and some of them have been answered a bit by this thread. What can I and can’t I expect from a therapist (who is not a quack)? Like, how does it work? How should it work? Can I give them a written account of myself to read before hand (paid for their time of course) since I find it so hard to just start from the beginning? It feels like there is so much stuff (20 years worth), sometimes I think I can’t ever possibly express it all so what’s the point. I can answer questions better than if I’m expected to start cold, I presume therapists learn techniques to elicit usable stuff from people like me? Please reassure me this is true? What is realistic to expect and what is not? Things like this I wonder.

    The two reasons I have started thinking more urgently about seeing a therapist recently is 1) reading Captain Awkward and 2) watching the TV show Awake and I keep thinking if I got either of these 2 shrinks instead of the clown I got I COULD BE NORMAL BY NOW. Ha, no not really. I actually have modest ambitions for any therapy (not changing myself but changing how I deal with myself). (At least that is what I am thinking in between thinking Jason Isaacs needs to take off his shirt again).

    OK I said this would be short, it’s not sorry but seemed relevant to tag on here rather than send a whole new email about it.

    1. Again, I’m a huge fan of trying to pay for therapy out of pocket because you have SO many more choices of counselors. Many therapists will do whatever possible to get paid in cash and avoid having to deal with the rigmarole of billing an insurance company. If this is at all a possibility for you, add this to your criteria list. Ask about whether they will work on a sliding scale fee if your budget is tight.

      Regardless, you’re going to be shopping for a counselor. Most offices will have a website of sorts where they counselor will give a brief bio and a briefing of what kinds of issues they deal with. You’re going to look for someone who deals with social anxiety, or general anxiety. This person may be a psychologist, a psychiatrist, a social worker, a licensed therapist, or grad student studying any of these things. I am more comfortable with women therapists, so I start there in the phone book. At this point I start making phone calls to find out their office hours and payment criteria. All of your initial questions about what kind of therapy they do, the cost, their training, should be done before you ever step in. Your experience with this last guy sounds like a joke. When you get there, there shouldn’t be a lot of therapist talk for the first session. Usually they give you a variety of forms to fill out asking about medical and mental health history, basic relationships with immediate family, why you’ve been brought to therapy, what you hope to get out of therapy, and whatnot. They should go over this with you and clarify any question marks. Then over the next few sessions, they should start looking at the cognitive and emotional business that started everything.

      A psychiatrist, as in the medical doctor, just prescribes medicine. In my experience, you’re lucky if they look up from their notepad during your $120, five minute session, or even listen to what you’re saying at all. But a counselor is where all the meat of talk therapy will get done. Make sure you like your counselor, or that you at least feel like there is potential there.

    2. “I can answer questions better than if I’m expected to start cold, I presume therapists learn techniques to elicit usable stuff from people like me? Please reassure me this is true? What is realistic to expect and what is not? Things like this I wonder.”

      They absolutely do.

      I guess one last thing (since I didn’t read your comment as well as I could have the first time, I apologize) is to trust the process. Once you find a person you like well enough to see for any length of time, stick with it and don’t let the jerkbrain talk you out of going because it feels weird, you’re talking about embarrassing and shameful stuff, and you’re way out of your comfort zone. To some degree, you have to be willing to verbalize what you’re dealing with inside.

      Your last therapist, well, that’s not how it’s supposed to work. At all. *Maybe* he was trying to develop a relationship with you by identifying with some of your experiences, or he was perhaps fishing for something from you, like expecting you to identify with struggling against a silent father archetype. I don’t know. I’m fishing here. The only time a therapist has EVER brought up their parental relationship or personal feelings with me is when I’ve casually asked about their personal lives, which is totally fine to do within reason as a client developing a relationship with a clinician.

  23. Thanks Lauren. We had talked quite a bit about my father so if he wanted to make it a teachable moment on that topic he could have just done so and he didn’t take the comment anywhere. Just said it and left it. Anyway! I guess its a good experience in I know much better what works for me now and may be more able to ask for it.

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