Context: J and I are both part of an online circle of friends who have known each other for years. Although several of us have never met in person, we consider each other close friends. Since we’re geographically scattered and many are dealing with our own issues of mental health, stress, strained finances, etc., we have limited bandwidth for socializing, making the main group chat an important point of contact, and alternatives to it hard to construct.
J has issues I’m not going to try to diagnose here, but they result in periodic outbursts of self-loathing. When this happens, it generally takes over the entire group chat for hours. We used to try to help, but never seemed to get anywhere. Over time things have gotten worse, to the point the rest of us agree they should be talking to a professional, but they’re highly resistant to seeking any help. Now we commonly say nothing because it’ll at best not help and at worst result in their self-loathing becoming anger directed at us, and usually this results in them complaining that no one listens or cares.
I fear this will reach a point where others start leaving the chat entirely to avoid them, and/or J getting kicked for exhausting the admin’s patience, resulting in people I care about dropping out of contact and losing important supports. While this isn’t exactly my responsibility to deal with, I’m generally one of the people with the most metaphorical spoons available within the group, and I don’t want to push the problem onto those with less.
On the one hand, we can just plan for the eventuality of having to kick J entirely and the fallout from that, but I’m hoping there are strategies we can try before it gets to that point to keep their outbursts from poisoning a communal space, while also encouraging them to get help (especially if it doesn’t involve in-person counseling or therapy, to which they’re particularly resistant) in a way they’re more likely to actually listen to. Other than the admin muting them, everyone refusing to engage at all, or broken-recording with “seek professional help” when J gets started, I’m at a loss.
– Not a Doctor
Dear Not A Doctor,
Here are some related posts:
- I love my friend but their Jerkbrain is draining the life out of our conversations
- I lent an ear to a friend, how do I get it back?
Let’s talk about the group chat dynamic of this and what kind of help you can actually recommend in that context.
You could try structured venting within the group chat, like, “Ok, everyone, what’s bothering you, nothing too large or too petty. I’ll start: I have one of those zits that makes my earlobe feel like it’s 4x its normal size, also, the USA’s freefall into fascism is really bumming me out. Who’s next?” where there isn’t room for the long-form venting J is doing and also everyone gets a turn.
Let’s talk about the part where if y’all don’t respond at all to J’s posts, they complain that no one listens or cares. I understand the instinct. You don’t know what to say. You don’t want to reward or encourage the behavior by giving it a lot of attention. But the “TOO AWKWARD, PLEASE STOP” signal isn’t getting through to J. Also, the silence must be an awful feeling for them, right? You’re J, you’re pouring your guts out to your friends and nobody says anything at all. You wonder, are they even reading?
So I think it’s important to respond in some way.
“Hey J, that sounds awful. I don’t know what to say, but I read what you said.”
Don’t give advice. Don’t offer solutions. Don’t feed the spiral. Just sit there with the person for a second and say “I see you.”
You could also try:
“J, that sounds like it feels awful, I’m so sorry. Sometimes I don’t say anything because I have no idea what to say and I’m afraid of saying something that will make it worse. Is there anything I could say right now that would help you feel better?”
Even if J doesn’t know what would make them feel better, I think it’s good to ask them to think about it for a minute. “What are you looking for right now? A place to vent? Advice? Acknowledgement that everything is terrible? Cute animal videos? As your friend I don’t always know how to help but I don’t want to leave you hanging.”
Over time that might prompt J to be more specific about what they want when they start venting, like, “Sorry y’all, I know I’m doing that thing again, but I’m just venting for a second – no need to offer advice or send me 10,000 links to therapists.” That would be better than it is now, right?
Sometimes acknowledging the awful feelings while also asking the person how they want to handle the problem can help keep the conversation from spiraling endlessly, as in, “Wow, that’s awful. What do you think you’ll do about it?”/”What do you want to do next?” Don’t pressure the person to come up with or have answers to those questions, especially immediate answers, just change the habit from eternal doom to eternal doom + maybe naming one tiny action.
Sometimes just communicating your own ability to engage is better than nothing. “Hey J, I’m sorry you’re feeling low. I don’t have the focus or energy to be the listening/comforting friend today, but I didn’t want you to think nobody was reading.”
Then there’s “J, I’m so sorry, that must feel terrible. I know I’m not the first person to say this, but I really think it’s time to call in the cavalry and get some professional help.”
Important: There are no perfect responses to what’s happening that will make J 100% feel better or definitely seek help or not get their feelings hurt or not prompt them to lash out or feel alienated if you change up the way you’ve been interacting. Maybe there is no feeling better for J right this second. Maybe imperfect (but honest, and kind) is the best you can do. (I mean, kinda the whole point of your letter is that the situation with J isn’t fixable by you, so, don’t beat yourself up if things are still awkward even after you speak up).
Since starting this site, I’ve run across a lot of people who get very defensive about recommendations to seek professional help, and that’s understandable. It isn’t unreasonable for someone to have their feelings hurt when someone says “I think you should tell someone about this…someone who is not me.” I don’t think they’re paranoid or wrong to hear “Get a therapist please” as “My friends all wish I would stop talking about my pain with them.” That is in fact part of what they are saying, even when it comes with a side of “I love you but oh god please get help so you can feel better!” I mean, one conscious reason I drag my ass to therapy every week is so that I have a designated place to dump out all my anxieties and negative feelings so I’m not overburdening my peoples. The “feeling better” part is nice when it happens but not even the point sometimes. We can’t pretend that access isn’t a real problem, and the effort to get affordable care can seem insurmountable when you’re already down. Online alternatives exist, but it also takes effort to research them and find something that works for you. Even if you can access care it takes a lot of courage and hard work to actually go and do the work on yourself. If people don’t want to go to therapy and are sure it won’t work for them, they’re the experts on their own lives and me recommending it for the 1116th time won’t change that.
Still. As imperfect as our fraying & unequally resourced mental health system is, I think that there are limits to what friends, even concerned friends, can personally absorb when someone is in a down cycle. Therapists have set office hours, with 50 minute sessions, and they have structure and boundaries and limits around how they do their work. While they can’t prescribe medication, they can direct their patients to people who can and advocate for them in seeking out more comprehensive mental health care for instances where talking through it isn’t enough. If trained carers don’t think the answer is to listen to someone’s self-loathing comments for hours at a time is a best practice, then how can the expectation be that y’all can absorb that on demand in a group chat setting? Caring about someone and taking on the full load of their emotional well-being in real time for as long as they need to talk about it aren’t the same thing and you’re not a bad or selfish person if someone else’s mental health struggles make you feel like you’re in over your head.
J is very resistant to the idea of therapy, but the irony is, like this guy, J clearly wants to talk about their feelings and problems. And I think you can use that, and say that.
Like, “Hey bud, I know you are very resistant to the idea of therapy, but since you’re already talking a lot about feeling terrible and down on yourself, can’t you at least try sharing all this with someone who knows more than we do and who might be able to really help? There are services where you don’t meet in person, you just chat with someone like you are here. The difference is that the person you are chatting with will probably know way more than us about what might help you feel better, and the chat will be 100% focused on you (vs. a group space where all of us are trying to talk over each other). Want us to put together some links* for you?”
J might be receptive to this but chances are they won’t be. That doesn’t mean you shouldn’t try and keep trying. The follow-up answer either from you or the group’s admin might be “J, you’re the boss of you, and whether or not you seek professional help is ultimately your choice. That said, I need our group chat to be a place we can all hang out and seek support sometimes, and if [1 specific recent instance of J monopolizing chat] happens in the future, you might see me interrupt you more, or change the subject more, or ask you to take it to a professional even more, or even mute you when I reach my limit and want to be able to focus on what other people are sayig. It’s not because I don’t like you or care about you, but because I have limits on how much I can be a listener or a counselor, especially in this medium. Are you sure you won’t give online counseling a try, just for a couple of sessions?”
Notice the “I” language. J’s monopolizing behavior is affecting the whole group, and the whole group is feeling a certain way, and it’s very tempting to use the authority of the group when you talk to J, but there is nothing more distracting or alienating in a tough conversation about boundaries than “The whole group talked about you and we agreed that you should do x.” By owning it and making it your issue – “I sympathize, but also I need the community to function as a social space and not always be a helping space” – you are actually making a stronger case because it’s more personal to you.
Nobody feels great either hearing OR saying “I love you, but I am reaching my capacity for how much I can listen and help, so I need to tap out of certain kinds of conversations before I get overwhelmed, would you like help finding other outlets though?” Setting limits is hard, especially when someone is so clearly suffering, but in the end I think it is kinder to set and communicate limits than it is to silently endure everything until you reach your breaking point and kick J out of the group/end the friendship/cut off all contact with them/remove this part of their support system from them. You can use that, too, when you talk, especially since it’s gonna be real easy for J’s jerkbrain to interpret “my friend is setting limits on how much I talk about how much I hate myself” as “oh god everyone hates me even more than I hate myself.” Before wading in, remind yourself and remind J that feedback is an investment in the relationship.
Script: “Listen, if we didn’t want you here, we’d just mute you/set up a different group/kick you out. When I don’t like someone, I don’t bother to have super-awkward conversations with them about mental health or tell them ‘hey, my ability to engage with this is pretty small today, I’m sorry,’ I just disengage. I’m talking to you about this because I care about you and I want you here. I’m recommending professional mental health treatment both because you deserve the very best care and because I need to be honest with you about my own struggles and the limits of what I can do. I know you hate this – I feel awkward as hell right now, too! But if you’re going to say [super upsetting thing J recently said] in group chat, you can’t be surprised if people don’t know how to respond and you can’t be mad if people who care about you start thinking of ways you can actually get all the care and support you need and deserve.”
*Here are some online therapy providers. I haven’t used them personally so YMMV, but hopefully it’s a start.
These are the big ones that come up all the time in Google searches and lists:
There are more in the guest post here.
Anyone used a really great online mental health resource? The comments welcome your suggestions.
121 thoughts on “#1116: Helping someone who doesn’t seem to want help (group chat edition)”
http://www.joyable.com for anxiety and depression (it’s $99 per month after a 7 day free trial, and you get a coach not a therapist, but it helps with negative thought spirals).
Thank you for that information. Unfortunately all of these sites seem to follow the frustrating model of “you have to hand over your email before we’ll even tell you what our pricing structure is.” If I can’t afford something, being evasive and withholding information isn’t magically going to put money in my pocket!
And if you’re going to be coy about that, what else are you hiding?
I don’t know what forum y’all are using for your group chat, but a norm of responding with emoji can be really helpful in this scenario. Emoji can be a way for people to acknowledge what J is saying without spending any real spoons; carefully chosen emoji might help a bit with making J feel heard. It’s another way to enact the Captain’s advice of “Just sit there with the person for a second and say ‘I see you.'”
I second this. A quick ❤ can go a long way towards indicating you've heard and sympathize but don't have helpful words to respond with. If emoji aren't an option, I think "I'm sorry you're feeling down, I hope you feel better soon" is the verbal equivalent.
If emojis aren’t available, there’s always text gestures like *hugs* or *cookies*, which can serve the same function.
If you have the wherewithal to go looking, a gif of cute animals hugging/petting each other also works.
I’m a big user of the ninja hug gif, or the one of Sully hugging Boo from Monsters Inc. It’s a way of saying “I heard you and I care” without having to come up with an actual response.
Captain, great scripts! kind, compassionate, and direct.
LW, J sounds like me when I was near my worst. My jerkbrain was so jerky that I had to get some control over it before talking to a trained professional did me any good. I was “in therapy” but it wasn’t helping until my therapist recommended “Feeling Good” by David Burns. CBT to the rescue! Being able to read the book on my own time in my own safe space let me process it without my defense mechanisms that were triggered by another person’s presence.
CBT doesn’t “cure” anything, but it helps shut up the brainweasels so you can get out of crisis mode and into healing.
My script when I recommend the book is, “This really helped me. Maybe it can help you too.”
Thanks for posting this. I’ve been seeing recommendations for this for a while, but your comment for whatever reason made me realize I could just get it instead of “someday” doing research on what book to get. Sitting on my Kindle right now. 🙂
You made my day! I hope it helps you.
Like I said, CBT doesn’t cure anything, but it helps you to stop sabotaging yourself and making things worse. I think of it as a leash on my brain: CBT won’t solve my underlying issues, but it’ll keep my brain from taking off after a squirrel or running into traffic while we’re working on being a better brain.
I too am putting this on my kindle and will try to remember to report back!
I’ve had a lot of success with Feeling Good and related stuff (I have an app on my phone called MoodKit that makes doing thought-checking exercises more convenient, for instance, and David Burns has a podcast now as well.) There’s a lot of focus on therapy and/or medications as *the* proper, appropriate way to deal with mental health issues, and while I’m pro-therapy and recognize that drugs can help a lot…sometimes they don’t. Or they don’t for the first few months. Or there’s access issues. I kind of wish there was more of a focus on self-help strategies, because that’s what’s been most helpful for me (even though self-help strategies aren’t necessarily fast-working either), and because they’re cheaper/free/lower barrier. And the self-help strategies I’ve collected have with one or two exceptions NOT come from a therapist. I’ve only had one therapist who was even willing to talk about self-help strategies.
And again, it can be really awful to do everything right and go to therapy and take your pills and still feel shitty. Like, people who are seeing therapists, who have seen a therapist for years, sometimes still do that talk everyone’s ear off about their problems thing! J getting a therapist won’t necessarily keep J from engaging in this behavior. J’s possible mental health issues and the way J participates in group chat are separate issues.
I really appreciate the Captain’s framing of feedback as an investment in a relationship. I know when my depression was at its worst I would have taken “why don’t you see a therapist!” as “I don’t really care about your feelings” so…yeah, that’s a tough line to walk. (And when I first got CFS I took “fatigue can be caused by depression, why don’t you see a therapist!” as “I don’t think your problem is real”, but that’s a whole ‘nother issue. Yeek this subject is hitting a nerve with me.) And yeah, I’ve also been on the other side of it so I know sometimes drawing out lines is necessary.
In my experience with such chat groups, the people who repeatedly engage in this behavior usually end up escalating to the point where they get kicked out or people are so vocally frustrated with them that they leave. This might be the case with J — even if you follow all the (really good!) scripts laid out here. Just know that even if this is the outcome, it really sounds like you tried to be compassionate and thoughtful and helpful, and it’s not your fault.
LW, if I don’t know the person in question, I literally know their clone.
So I totally feel you and know how hard it is to get through.
Better Help is a great resource. I met my current in-person therapist through the site (I actually decided to see her in person after using the site for a while). I was one of those people who resisted the idea of therapy for stigma/cost reasons, but after my now-fiance urged me to seek therapy out (and told me that he wasn’t capable of providing all the support I needed), I tried it, and I’m a huge advocate of therapy now. It’s too bad it’s not as normalized as having a primary care doctor, because it’s not like we’re naturally prepared for all the curveballs life throws at us. In spite of my initial reservations, I was probably more open to the idea than it sounds like J is, but I hope J can reach that point too.
I remember reading an anecdote online a couple of years ago (I can’t remember exactly where), where someone mentioned that for their kids’ 16th/18th(?) birthdays they were gifted with a session with a therapist.
The point was
– low stakes visit
– take some of the mystery and stigma away from mental health care
– the occasional check-in can be a good idea (particularly if big life events are nearby, like moving house, starting uni/job, significant other break-up, bereavement etc)
– if the kids ever felt the need to talk to a therapist in the future they already knew what to expect and how to go about it
I love this idea, but I reckon I’ll do it when my kiddo turns 12/starts high school.
Just meant to link this to the normalisation of the idea that having a mental health provider should be just as unremarkable as having a GP.
This is such a great idea!
One thing my mum did right, despite all our other issues, was get me into therapy when she and Dad were divorcing. It allowed me a space to process that, and set me up to feel comfortable and empowered to seek out therapy later in life when I needed it for anxiety, or even setting boundaries with mum.
My mum did this, but I wish she’d found somebody different – the guy seemed convinced that I should feel worse, and if I was feeling pretty okay about it then I wasn’t processing it properly, or was in denial. I wouldn’t have minded a place to talk about it in general, neutrally, but being pressured into inventing some reasons why I should be upset that my dad was gay, really made me wary of therapists for a while.
My mum unfortunately didn’t read the guidance that says “ffs don’t take your teenaged daughter to YOUR THERAPIST during your divorce” and her therapist wasn’t good or professional enough to point this out to her. I knew anything I said *might* be reported back to mum, so I said nothing for the whole hour and then refused to go back.
Wow, that’s so unprofessional! Trying to tell a patient how to feel, let alone a child, I can’t even. I’m sorry you experienced that.
That is so brilliant!
I’m reminded of something my parents did right.
When I turned 14, my mother made me an appointment with her gynecologist. She said, and the gynecologist also said, that health issues my parents needed to know about (like the lump in my breast!) were probably not going to stay secret, but anything else was private.
This was pretty great.
Seeing a shrink as a Regular Health thing would have been great too.
That sounds like it’s about up there with socks as a present. Eh, I guess the point about normalizing it is good, not all presents have to be sparklyfun.
I did get sent to a therapist for a while in ninth grade, and I think it did me very little good. I hated it at the time. I think a lot of the reason I’ve had better experiences with therapy as an adult are 1. I got explicit permission to choose whether to talk about any given thing or not (when I was a teen it felt like there was an obligation for me to disgorge my private thoughts on demand, which I was obviously not happy about) and 2. I could choose my therapist. I’d suggest that while you’re imparting your wisdom on therapy to your offspring that you point that out — when I was a teen it never occurred to me that I could ask for a different therapist. (Not that mine was bad, just that I resented the lack of choice/control.) Really though I suspect therapy is often less helpful overall to teens vs adults because at some level therapy only works if you choose it.
If you’re in a good space and can function as a psuedo-faciltitator, I think, under the umbrella of setting boundaries, it would be perfectly accetable to formally conclude J’s discussion and refocus. Something like
“Well, J, we’ve been hashing out your (issue) for almost an hour. I wanted to make sure we got back to Sarah, though, who had started to tell us about (X). Sara…you still on?
“You know J, maybe we should take a break and give you some time to think some more about (issue). In the meantime, Joe’s on! Hey Joe,long time no chat. What have you been up to?”
Round out the J topic and transition to another participant, or yourself. He doesn’t get to monopolize the conversatoin and it’s OK if his issue doesn’t get a formal conclusion.
This is great! MODERATION SOLUTIONS FTW.
Some of us tried this with a person engaging in this behavior in a chat group, and eventually the result was a series of complaints that “you only ever moderate me” and “you target me unfairly and cut me off.” I’m not sure what the solution to that would be, except what actually happened: the person left of their own accord.
ideally you have the focus on the behavior and ideally you have guidelines in place at the start, before anyone has done anything, and yes if anyone else does the same behavior you call attention to it. Really though there’s always some risk that someone is going to feel unfairly picked on; not all chats/groups are for everyone. (I’m basing this on experience facilitating an in-person discussion group.)
Having had something like J’s experience, but it wasn’t handled this or similar ways, I like this idea a lot.
I agree with all of this. I’ve been on both sides of this, and I think one thing that can also help is to cut the spiral off after the first circle round. So, when J starts to repeat, that’s when you start to shut things down. Maybe something like, “J, I know you’re in pain, and I want you to feel better. I’m just not sure that spiralling down around [issue] without doing anything to break the spiral is helping you feel better?” Then give a quick recap of everyone’s [comments or suggestions], then round it off with “can anyone think of anything new to add/suggest?”
And if J can’t stop and you feel you have to mute them, then be honest about that, too. Saying, “J, you’re spiralling and refusing to accept any of our help or suggestions, and I want to stop this downward spiral before you and other group members start getting frustrated with each other, so I’m going to put you on [mute or block or whatever] now for [time period].” I think the specified time period is important, because there’s nothing worse than feeling your support has been completely taken away from you.
I really like this idea!
Also, a gentle reminder of J’s they/them pronouns.
The good Captain’s advise and scripts are great, as well as the comment above mine suggesting moderation to give J space but also allow others to shine.
My local Distress Centre offers online chat during certain times of the day – great for people like me who do our best communication through typing. And I live in a really great health region in my part of Canada – there are drop in mental health hours at clinics for people who need immediate support.
If you’re close friends with J, I really encourage you to have the “I love you but for the sake of my own mental health I cannot be your go-to venting person all the time, what other resources can we get you” conversation. I’ve been on both sides of this, and it’s hard either way. But it’s also necessary, and (assuming everyone involved is well-intentioned and not actually trying to abuse the relationship) I think it actually strengthens friendships in the long run. Having clear boundaries lets the struggling person plan their attempts to get help better, since they know what resources they actually have access to, and lets the supporting person maintain their own stability in the process.
If J is more of a ‘we interact in the group, but we’re not really close one-on-one friends’ type friend, though, this might honestly not be your battle to solve. You won’t be able to solve J’s problems, and guiding them towards seeking more effective solutions themselves is a lot of work–work that’s generally more effectively done by someone who’s already emotionally intimate with the person. I hear you on the wanting to help since you have spoons, but if this is the scenario, it might be more effective to support mutual friends who are closer to J than to try to help J directly.
Longtime lurker (and avid archive reader! I have read all the things!) but wanted to temper your suggestion of talkspace/better help. They’re fairly shady and expensive according to users. Link for your consideration https://theoutline.com/post/3462/the-sketchy-world-of-text-therapy?zd=3&zi=e2jrgn3p
THANK you for that link. I’ve been looking into online therapy since there’s a severe shortage of traditional providers in Western Pennsylvania, but every service I’ve looked at has seemed sketchy and way overpriced. Glad to see some corroboration of that impression, makes me feel better about not going through with an actual trial.
Captain, this is as good a post as any on which to say: when asked at a work event to name three people I admire, you were on that list. Your work here has changed my life for the better.
Aw! Thanks for reading.
I think certain forums would be a good place to start. They generally don’t cost money, and people can read the posts if they want. it may not be real time, but it doesn’t have to be. city-data.com/forum has a psychology section.
BetterHelp and MyTherapist have that “almost all the exact same words, except a different images/front page and copyright” thing going on that I see so often lately. Like look at the FAQs, they are word for word the same.
Does anyone know what is up with that? Are they the same company?
This idea of getting therapy without physically going somewhere is very appealing.
I don’t know if this is what’s going on with BetterHelp and MyTherapist, but there are companies that market software solutions to therapists–“Just give us your name and a little basic information, and we’ll build you an entire website”. It sounds a lot like both companies bought the same software package, and didn’t put much work into customizing the result.
I’m wondering if it might be helpful to use the same kind of approach as CA uses around Christmas/Thanksgiving/holidays, where there’s a ‘happy holidays’ thread and a ‘holidays suck’ thread, and don’t cross the streams. Maybe you can have 2 group chats (with all the same people in), one where you all keep it light and one where heavier stuff like J’s stuff can be discussed? On the same platform – 2 discord channels or 2 WhatsApp groups or whatever. This way you can decide what kind of group chat you have the spoons/inclination for today – casual chat with your friends or supportive difficult talks?
And you can always decide ‘OK, I’m going to talk supportively and listen to J in the Heavy Stuff chat for 5/10/30 minutes, and then I’m going to gently disengage and return to the No Bummers chat for something more upbeat and sociable’. It might make it easier to stop J from monopolising the group chat if they have a space where venting is always welcome (even though it might not always be responded to).
My friend group takes this to an extreme, we have TONS of channels, one for video games, one for movies, one for general chatter, one for serious real-life stuff (#adulting, which I find amusing), and so on.
Sometimes it gets a little annoying with how much channel policing there is, (Grave of the Fireflies? does that go in Anime or in Movies? it’s not really a traditional Anime at all, is it too depressing for the general Entertainment channel? A discussion about Battletech, the video game, does it have to be moved to the tabletop gaming channel if you start talking about the tabletop game that preceeded the video game? what if you’re comparing the two, do you have to cross-post to both?!) BUT it also means you engage only with what content you want. If you want inspiration you stick to the #feedMe channels (FeedMeMusic, FeedMeArt, etc, ironically the food channel is Noms, not FeedMeFood), if you want to chat but don’t want anything negative, you stay out of the #Adulting and Politics. Because one of our members gets SERIOUSLY upset about puns, those go to the Pungeon, and someone says something you have a great pun reply to you just poke those that may be interested with *poke Pungeon* and they join you there to hear the pun (and occasionally I post an epic shaggy dog story like the one about the woodcutter near Prauge who discovers uniquely-grained wood from tree tumors that ends with “it’s a typical goy meets burl story”).
It works really well for us because we have a lot of people that have various mental problems, diagnosed and not, and it lets us compartmentalize as much as we need to. And no one is EVER made to feel they OUGHT to be in this channel or that channel (except for aforementioned policing of putting the wrong thing in the wrong place).
This is a good idea. We did something similar in a FB group I’m in – we spun off a mental health subgroup. There are strict ground rules re: confidentiality in that group, the mods we chose have policies we’ve all agreed to l, and it allows us a segregated and safer space to discuss the heavy stuff while keeping the main group fun. It’s been really successful.
I was going to recommend this too. My friends’ chat group has a bunch of channels, and it’s really handy.
We don’t specifically have one for Heavy Stuff — though we also don’t have any Js, and people are generally very ready to put things in a thread if it seems like something that might take over or that people might not want to be surprised by. (I don’t know which chat platforms do and don’t do threading, but Slack does, at least, and it’s great sometimes. Only the first line is visible, so you can say something like “putting this in a thread for medical shenanigans” or “screaming about XYZ in thread:” or whatever, and then people have to click on the thread to see what else has been said. So you can opt into any given discussion, or not.) We do have one for anything politics-related, and one for potentially gross-out stuff, then another for adorable baby animal pictures, and so forth.
The great thing is that then you can decide whether you’re up to talking in the Heavy Stuff channel on a given day — or even at all, and mute the channel or don’t join it in the first place — or you can chat supportively in the Heavy Stuff channel, while simultaneously talking about lighter stuff in a different channel. This can give your brain a break, if you’re up to the multitasking, and either way it can stop J from taking over the entire group chat for ages without making her shut up. It also means that you know what you’re getting — if you’re looking at that channel, it’s because you’re willing to deal with the conversations that go there, and if you’re avoiding that channel, you won’t be ambushed by them.
Obviously, if the effect (intended or accidental) of this is to sequester J in a channel where she can vent to the void and no one ever engages, that won’t work; it’s only a crueler and more drawn-out version of shutting her down or kicking her out, at that point. At least some people will have to engage some percentage of the time — and other people should get to use the same channel to talk about their own problems, or it’s just The J Complaints Channel, which I doubt she’d appreciate. (I sure wouldn’t.) But, if everyone accepts the idea of doing some level of subject sequestering, and if your chat platform supports it, it might be helpful for everybody.
Baby animal thread for the win!
Also, a gentle reminder that LW uses they/them pronouns for J.
Yes, I’m sorry — not sure if I was reflecting someone else’s comment or just getting my mental wires crossed, but either way I should’ve double checked the LW’s pronoun use instead of misgendering J via blithely assuming I was remembering right. Sorry about that!
Don’t worry about it – I was just anonymizing the post, and so long as people’s advice isn’t strongly influenced by their assumptions about J’s gender, it doesn’t matter (to me) what pronouns they use in comments.
I use TalkSpace and it’s been great so far!
I joined a support group on FB and being a part of that community and having a designated somewhere to be witnessed and to talk about stuff I’m struggling with really helps me refrain from things like dramatic, cryptic, cry-for-help status updates to my whole friends list, or dumping too much in forums that are not really intended for that. But at the same time it’s free and a much more informal arrangement than therapy, which I’m not currently in the right headspace for, so might be a good fit for your friend.
Captain, thank you very, very much – this is just the sort of response I was hoping for, and the scripts and resources you recommend are likely to be highly useful. I know I can’t guarantee J will get help or get better, but I hope to avoid solutions that protect myself or others at the cost of worsening J’s chances, and this advice seems like it’ll help with that.
Part of the problem is that we have asked J what kind of response they want, and the nature of their issue is that there doesn’t seem to be an answer. What logical or emotional reassurance any of us can offer isn’t adequate, and what they say would do the trick seems specifically (though not deliberately) constructed to be impossible for any of us to provide. So if I and some others can agree on scripts for gently asking J to stop beating up on themselves when they get started, and a variety of lower-stakes quasi-therapy approaches we can recommend when they’re not at a low point that they can try without having to clear the hurdle of contacting a specific person to set up an appointment or similar, I think that’ll go a long way towards helping the rest of us manage the group problem without having to harden our hearts too much to J’s individual problems.
I’ll definitely keep an eye on the thread for any further recommendations. By the way, as it may affect recommendations, neither J nor I are in the USA.
You mentioned asking J what kind of response they want– just checking if you’ve brought it up at a time when J is feeling more positive, not just when J is in the midst of a self-loathing spiral? It’s possible that J has a more constructive side which simply isn’t accessible to them during a loathing-spiral. Good luck with the scripts.
Yeah, if this is only coming up when J is already in the midst of a low, that might be part of the reason why asking what they need has been ineffective. I’ve been in J’s shoes before, and a friend talking to me about it on a good day and setting that boundary when I wasn’t already beating up on myself meant I was able to process it better and dial it back from then on.
Also this might not be something to suggest to J for the LW, but for anyone else who worries about being J: set up a rule that when you vent to friends about terrible things, the next conversation (at least) will be positive. It doesn’t matter whether that positive is unrelated like sharing a picture of a pet or addresses it like “thanks for the support, I’m doing xyz and its helping.” Just something to keep it from being the Misery Show all the time (no shade, that’s literally what I mentally call it when I do it).
I’m seconding the recommendation to circle back to the topic of J getting help once J has had some time to pull out of the depressive episode. Getting help takes work, and that work is likely to feel less impossible when they’re not breaking down.
Also, do you and the others in the group chat talk to J and pay attention to them when they are not in self-loathing complaint mode? It’s totally understandable if you’re not, because J sounds like they already take up an outsized amount of your emotional labor. But since you say that you want to keep this friendship, it may be worthwhile to reach out to J at regular intervals to talk about literally anything that isn’t their brainweasels.
Sometimes, when the weasels are noming on your brain, it’s really hard to think rationally about the best way to get your social needs met. So you just blindly flail out with the thing that will get you immediate attention, and since most people who are not assholes will respond to a friend in crisis with immediate attention, it can train you into using that as a method of meeting your social needs. But if there’s some other easy and effective way to get those needs met (like a friend who regularly reaches out to you to talk about other things), it’s easier to break that habit.
I think the initial “well, what kind of response are you actually looking for?” conversation occurred outside of one of these episodes, early on. Unfortunately, the answer was unhelpful – quite literally, they want a response they’ve fenced around with enough conditions that none of us can meet them. Since then, bringing up the issue outside of an episode has tended to either bring on an episode, or end with J making excuses for why there’s nothing they can do, or flatly refusing to do anything. It’s not just that J’s jerkbrain sometimes takes over, but also that they don’t acknowledge it as such when it’s in the back seat, and keep on the course it’s set. Seeking help is shameful; needing help is shameful; having a problem that can’t be overcome by sheer willpower and recognizing it as such is shameful; so J will candidly describe their totally toxic thinking, agree that it harms them, then dismiss any suggested means for changing it, because it’s just who they are.
I should clarify that the majority of interactions with J by time are fine and normal – the outbursts aren’t the only contact we have. They’re involved in daily conversation about all kinds of random topics. And if J simply felt really bad sometimes and needed space to vent, that’d be manageable. The problem isn’t simply that giving them space costs us too much, but that it’s begun to seem harmful in its own right. I don’t want J to talk to a therapist because I don’t have the energy for them to talk to me any more, but because I suspect at this point they may literally need to be prescribed medication before their jerkbrain will ease up on them, and if not then they certainly require better qualified, more methodical, and in all likelihood more confidential help than any of us can provide.
Look it’s great that you care about J but there’s NOTHING shameful about needing help. I bet if you take inventory of your life I guarantee that every single thing you have done you needed help with, sought the advice of someone more experienced, or provided the help to someone less experienced at one point or another. From learning to breathe, to eating, to manners, to math, to cooking, to every single thing we do we refer to other people for help. No one is born with a fully conceptualized self of sense, even the people who are masters in their expertise need help. And same goes for needing help with mental health. And if there’s nothing shameful about looking up how took cook pasta on YouTube, or taking a class on Microsoft office, there shouldn’t be anything shameful about needing emotional help.
This is all true, but I think the LW meant that J has contempt for needing help.
The Captain is correct; I was trying to describe how J seems to see it.
I recommend taking a look at the Drama Triangle model of understanding how peoole behave. I am not a big pop psychology fan but it has really helped me tune into when I am rescuing or playing the victim after the person I am trying to help begins to annoy me. You might not be able to stop J behaving this way but you can be aware of your chosen response.
It is really hard to stop shielding people like J from the natural consequences of refusing to get help (I have been in J’s shoes and have friends who also had a J phase.) However there is a case to be made for respecting a friend enough to trust that they can cope with the consequences of their actions, that you can be there when he gets his mental health crisis more together and gets therapy.
Sometimes refusing to go around the same old cycle with someone is a kindness.
I don’t know specific resources which could help you, unfortunately. Especially given the wide range of potential countries and income levels of J (i.e. it’s possible that J lives in a country with no social supports and a low relative income).
However, I recently read an article which says that the typically hard-to-reach group of young men have been using telehealth services for mental health:
I have no idea of J’s gender or age, so this isn’t meant to specifically address this situation, but the data in the article shows that alternative options – something outside of the ‘sit on a couch and talk’ stereotype – are effective in reaching people who might otherwise never get help. Even if J isn’t a young man, the greater variety of options can only be a positive.
As a community manager, I’ve solved this in a couple of chats that had multiple channels by making one that is explictly for mental health/strong negative emotions (one chat has a mental health channel, another, larger one has one channel called #kvetch (for griping) and one called #angst (for self-directed anger/sadness/etc)).
In both of those chats, splitting them out that way has let people with compassion fatigue manage their own boundaries, and has kept the main parts of the chat from being overwhelmed by the kinds of intense negative conversations that are really hard to segue out of into how the latest action movie went. It’s obviously not a solution for a single-room chat, but if you can split out channels, I really recommend it.
I’m in a chat with multiple channels that handles it the same way, and it helps SO MUCH, especially since everyone understands that when you are low on cope you may not go to the #angst or #kvetch channels precisely /because/ you are low on cope and thus might not respond and it’s not personal.
I have another support community that uses the term “Witnessing” when they don’t know what to say but want to express support and camaraderie.
Yes, this is really common in my community too! Also “validating this” or “validating your feelings/experience/etc” but maybe in this case that might be little less helpful and could be seen as affirming negative self-talk.
I have a question about therapy in America: I often see US people (like the Captain) mention going to therapy weekly, and I wonder how that can be affordable? In Australia, therapists are usually $150-200 a session, and private health insurance coverage is negligible, or else it raises premiums so much that you might as well pay out of pocket anyway.
Is therapy cheaper in the USA? Or is insurance coverage much better than Australia? I’ve had times I would have benefited from going weekly, but really struggled to afford even fortnightly, and I wondered how US folks a managed it.
Kitty, look into getting a mental health care plan from your GP. A plan means that medicare will give you a rebate for your sessions up to $90 or so. There are also psychologists that bulk bill, or charge a nominal amount ($5-10) above the rebate. There are also free counseling services for students at uni, if you’re studying. If you’re in Melbourne I can give you some names if you like.
Thanks! I did get a MHCP, but that only covers up to ten sessions in a calendar year, which tuns out pretty quickly. 😦
I’ve never seen a psychologist that bulk bills, do you know any in Melbourne? Do you have to have the Low Income Healthcare Cars to access it?
It took me a while to find a psychologist I really clicked with and who could give me the help I needed, which is why I’m wary of trying a new one. I have tried reduced rate student counsellors before, but I didn’t find them very helpful, alas.
Yeah, the ten sessions thing sucks. You can get an extra five sessions by getting a “chronic disease management plan” from your GP, which gives you a medicare rebate of around $50 for those sessions. A lot of GPs don’t know you can use these plans for psychologist visits, but you totally can.
Having a healthcare card definitely makes things easier, but Dorothy Minca and Angie Paton in the northern suburbs bulk bill, as does “The Talk Shop”. Healthy Minds used to bulk bill, though it looks like they’ve put their fees up to $130 a session now. Googling for bulk billing psychologists comes up with a few more, but in the end, if you’ve found a good psych that you can click with, I’d probably stick with them anyway. I’ve also found that local councils also run group therapy sometimes, and personally, I find Lifeline chat invaluable.
I wish you the very best ❤
Thanks Mice Dancing!
Yeah our government has such terrible support for mental health.
I actually did try to use an Enhanced Care Plan that my GP suggested because I see several specialist doctors for other health things, but sadly my Psychologist’s practice would not accept it, apparently that plan is only supposed to be used for shorter 30 minute sessions which they don’t offer.
Not in Melbourne, but my psychologist bulk bills because I asked. I otherwise wouldn’t be able to afford the service, and she’s been incredibly generous with me. It was not displayed on her website, or given to me as information starting off. I know this is super hard to do, but you could ask your long term psychologist and see how they respond.
US person here, and there are a few different ways it can work:
1) If you have good insurance AND a formal mental health diagnosis (at least a “provisional” diagnosis) that means the insurance company is willing to agree to pay AND your therapist a) holds a type of license that the insurance company says is good enough and b) accepts the insurance, you pay whatever your normal co-pay is and your insurance pays the rest. The state I’m in has a reasonably strong mental health parity law that says visits to the therapist need to be treated like visits to any other medical provider as long as there is a formal diagnosis of what they call a “biologically based” mental illness (and this is still Not Good for a long list of reasons but it’s better than what we had before the law).
2) If you don’t fit the above, a lot of providers work on a sliding fee scale where they will charge you based on income. Or if there is a nearby graduate program that trains some form of therapists, sometimes you can see a student therapist for *very* reduced rates.
3) Some workplaces have employee assistance programs that retain professional counseling staff for anything from “short term crisis intervention and referral” to 12-week courses of CBT or solution-focused therapy, and this can be free for employees to access.
Note that marriage counseling is generally a separate matter and not covered by insurance, sometimes they’ll cover couples/family sessions for a person who has a mental health diagnosis but that diagnosis is going to be the basis for the sessions.
That’s interesting, thanks! I wish insurance here covered that much.
I hadn’t thought of using an employee assistance counsellor, though I think my work has such a program. But it probably wouldn’t help long term, and I’d have a little background worry of connecting something so private with my employer.
I have tried some sliding scale and student counselling services before, but had mixed results. I guess it’s always a bit of a crapshoot finding a therapist you really click with!
Group Therapy can also be cheaper if that format works for the issues you are facing.
Sometimes nonprofits offer cheaper therapy (generally group therapy) for social issues that related to their mission.In my town there is a non profit for sexual abuse survivors that offers cheaper therapy and a domestic abuse crisis center that offers free groups. In one of my friends town, there is a center that offers free/cheap therapy for eating disorders.
Universities often offer cheap therapy for students
Interesting. My health insurance covers my therapist the same as any medical provider. I pay my co pay ($25) and can go as often as I need. I have no formal diagnosis of mental illness, not did I need a referral. I just made an appointment with a therapist who accepted my insurance (which is a group plan through my employer).
Sorry, that was supposed to include a “I had no idea how lucky I was to be able to do that” statement. It’s unfortunate (and frustrating and angry making) that mental health care is so difficult to obtain.
In my experience mental health fees fall into the same unnecessary black box of insurance-secrecy as any other medical procedure in the US. Say the practitioner has an uninsured price of $120. This is different than the insured reimbursement (aka maximum allowable) rates from Insurance A $66, Insurance B $75, etc.
Back when I was waiting for my insurance to kick in, I told my practitioner that I would have Insurance B in the future. I asked if it would be OK to just pay $75 a session instead of $120. They were totally OK with this. Then when I had a gap when switching between Insurance B and Insurance A I just kept paying $75 per session until the new insurance kicked in.
If I was totally uninsured I’d ask the practitioner what their max reimbursement from Insurance A, B, C was and offer to pay a rate in the middle somewhere. I’d offer to pay in cash to sweeten it. (They are visibly delighted these days when I pay even my bitty $8 coinsurance in cash.)
I am 100% not shy at all about negotiation and money. Not sure how I’d approach this if I was uncomfortable with money discussions.
Many psychologists in Australia have a sliding scale if you are on a low income. The one I’ve been seeing charges $180/hour but reduces that by half if you are on a low income or benefits. I’m not sure if you have asked your psychologist about that but it may be worth doing so.
Thanks, but I’m not on a low enough income to qualify for that
I did even ask my GP about the Enhanced Primary Care plan, for people with multiple specialty Dr needs, and he wrote one but my psychologist’s practice doesn’t accept them. This is the first one I’ve found who is right for me, so I’m gonna stick with her anyway. Have had mixed luck with sliding scale places.
How frustrating! I’ve had better luck with psychologists taking my EPC thing (I usually try to use those 5 sessions for whichever of my allied health people is likely to be the most expensive that year, because we always hit the Medicare Safety Net, and I get back the higher-level (80%) rebate for those EPC appointments once that’s kicked in. But I completely understand sticking with one who is right for you!!!
(Between myself, friends and family, I’ve seen/heard about experiences with a LOT of different psychologists and counsellors, and I’ve yet to come across one in Melbourne who charges so little that there isn’t still a substantial gap fee after PRivate Health Insurance or Medicare rebate. It is absolutely a significant barrier for many people.)
Sadly, no. Which is why, I think, so many people push back so vehemently against repeated suggestions of therapy. While *lots* of time- and energy- intensive research and phoning around and explaining your personal issues 50 times to rushed receptionists may (or may not) yield the few underfinanced exceptions to the rule, for most folks “find a weekly therapist!” sounds a lot like “maybe some diamond necklaces and a new Tesla would solve your problem!”
And of course, the kinds of things that drive someone to seek therapy also tend to be the kinds of things that make research and phoning around and re-explaining your issue a thousand times prohibitively difficult.
This has been my experience. I was lucky to grow up in a relatively wealthy household and have great insurance coverage for my entire life. I’ve still found accessing mental health care that is even slightly useful for me to be impossible.
When I’m doing well, there’s nothing extant to treat, I don’t know what I’m doing there, and a handful of psychiatrists and psychologists have declared that there’s nothing wrong with me (before I realized I needed to change my approach to screening them).
When I’m not doing well, I don’t have the wherewithal to find help on my own, and even when someone is willing and able to do most of that work, I have to cycle through first appointments with dozens more psychologists and psychiatrists to find anyone who even seems able to understand what my issues are and where I’m coming from (and so far nobody who has been able to actually help in any meaningful way).
Trying to figure out medication is a joke when the period over which the medication is supposed to take therapeutic effect (weeks or months) is longer than my typical acute mental health crisis, and when the crises are spaced out by anywhere from months to years.
I’m sure there are disorders that our system is set up to treat – I know people who have found therapy and/or medication helpful – and I am a huge supporter of increasing access to our current model of mental health care for the people whom it might help. I don’t want to dissuade anyone from seeking help, becasue lots of people can be and are helped all the time. Sadly, even having access to care doesn’t ensure the quality, scientific basis (I’ve had so many licensed mental health professionals recommend all kinds of utterly unsubstantiated and even disproved and potentially dangerous treatments, like unregulated supplements, which have a disproportionately high chance of being toxic to the liver or kidneys), or effectiveness of that care.
I’m not even really sure what it would take to make the system function well for someone like me; it’s possible that there simply is no effective help on an individual scale, and radically reorganizing society to not exacerbate human misery in the pursuit of the concentration of personal wealth and power is what it would take for me to not be miserable. So, I know it’s also the case that some of us bristle at suggestions of therapy and/or medication becasue we’ve been trying it for literal decades and it’s simply been a time and money sink (bearing in mind that there’s a big difference between saying something doesn’t help without trying it, after four sessions, and after 600 sessions), though that is a useful thing to mention in the first place when e.g. seeking advice from and advice writer or friend group.
So I guess it’s another avenue for medical related debt? 😦
If you happen to have really excellent insurance (which is often expensive in and of itself) and live in an area with good provider availability, accessing weekly therapy may not be a significant additional cost.
However, insurance that covers mental health care well is rare and you generally need both a reasonably high income and some luck to have access to it. It can also be hard to find a therapist, even if you do have useful insurance–many areas don’t have enough therapists to cover the need, and many people have requirements (someone who specializes in their problem or in a specific kind of therapy, someone who takes their insurance plan, someone familiar with LGBT+ identity who knows how to not perpetuate further harm, just plain someone they feel they can trust, etc.) that make it harder to find a workable provider.
Most people I know (myself included) who have gone to therapy started with weekly appointments and tapered off to every-other-week or once-a-month once we started getting a grip on whatever sent us there in the first place. Most of us were either paying out-of-pocket or our insurance’s out-of-network-provider rates, so the cost adds up quickly. I also know a fair number of people who think they’d benefit from therapy, but either can’t afford it or can’t find a viable provider and therefore can’t access it at all. The US definitely isn’t a paradise in this respect.
Yep. When I was going weekly I was paying $110 per session, but I had put money into my Flexible Savings Account that can only be used for health expenses. Since it never actually went into my proper bank account and I never budgeted with it, it made it easier to swallow the high session cost. But now I go once a month to just check in, make sure I’m doing what I need to do, talk through things I’m not pleased with myself about, and generally try to find solutions to problems that are still bugging me. (This last visit was right before a big trip so it was half check-in, half talking about ways to manage my flight anxiety.)
Thanks to the Affordable Care Act I now pay $15 co-pay/session (same as if I saw any kind of doctor).
It’s been as high as $40.
Without that insurance (and without the law that mental health dx must be treated like any dx) I would have to find a sliding-scale person or a get on a waiting list for community clinic.
I can’t answer for the US, but for the UK: I’ve recently paid between £50 and £70 per week for therapy, which is 90 – 125 AUD. Yes, that’s double my weekly food budget. Yes, that was incredibly expensive during the year that I was working paycheque to paycheque on strings of zero-hours contracts. Given how severe my depression was at that time, though, my options were pretty limited, so weekly therapy was worth the skipped meals / overdraft fees / borrowing money from friends.
Not everyone in is a situation where they can scrounge up an extra £50/90 AUD/whatever-it-is-in-USD, though, no matter how much they sacrifice/borrow, hence these lists of low-cost alternatives.
Good luck! I hope you’re able to find a solution that works for you.
One part of this is that insurance coverage varies hugely in the US. The plan I was on a few years ago, through my spouse’s employer, had very good coverage for therapy (and a lot of other things). When my doctor recommended “I think you should talk to a therapist, and there are a few affiliated with our clinic” it was just a matter of finding room in my and the therapist’s schedule, and didn’t cost me anything extra.
That was for relatively short-term therapy, which was what I was looking for then; I don’t know whether that insurance would have covered weekly sessions for a couple of years instead of ten or so not-quite-weekly over a few months, and then two more a year later.
Also Australian: the professional culture of therapists also seems different here from what my US friends experience.
Note I’m in a different situation to you, I have mental illness symptoms that come and go, with multiple year periods where I don’t have a DSM diagnosis on present symptoms. But I think my experience with how therapists in Australia respond to that is useful to know.
I’ve encountered several therapists in Australia who consider offering ongoing weekly therapy, which is very normal in the US, without clear, ongoing symptoms of diagnosed mental illness, to be professional misconduct on their part. They are always actively working towards discharge with me. My partner’s therapist offered them ongoing therapy after symptoms had subsided but referred to it as “American style” or something like that, making it clear that a lengthy therapist-client relationship without immediate illness is something they see as outside the Australian norm.
Likewise, my GP refused to refer me for therapy when she judged I didn’t presently have a DSM diagnosis (on the grounds that receiving therapy limits my ability to get life and travel insurance).
My US friends experience: in addition to therapy for acute or ongoing mental illness, they report going to therapy extensively without a diagnosis or feeling they need a diagnosis, or when they’re having a period without mental health symptoms, kind of like ongoing maintenance, self-care, and an opportunity for growth.
Their advice in the US: “Literally everyone can benefit from therapy!” My experience: the Australian medical and insurance system won’t pay for it, and beyond that quite a few therapists will not offer it and regard it as somewhat unethical to offer it. Now I’m not a therapist myself, I’m guessing there’s some nuances and professional cultures I’m unaware of. But this is my patient experience.
Reading this, I’m wondering if the word ‘therapy’ here in the US gets used to cover a wider range of things than it does in Australia? Like, we use it to talk about what you’re describing, but we also use it to talk about a more life-coaching or social-skills-education style approach. Some people go to therapy to treat a diagnosed mental illness; others go because although they may not have a firm diagnosis, they don’t feel mentally well either; others go because they need someone to coach them through a specific problem improving a bad relationship or navigating a tense situation at work. The ‘everyone can benefit from therapy’ thing usually refers to that last case, since everyone has room to improve their communication and problem-solving skills.
Very interesting point about the difference in culture. I think you’re right that it is probably uncommon to have ongoing weekly therapy without an ongoing diagnosed issue.
This part surprised me a lot:
“Likewise, my GP refused to refer me for therapy when she judged I didn’t presently have a DSM diagnosis (on the grounds that receiving therapy limits my ability to get life and travel insurance).”
Can it really affect your life and travel insurance? I’ve never experienced that.
And the GP refusal seems super odd to me. Plenty of Australians benefit from psychology even if they don’t have a diagnosed illness, and also how are you supposed to *get* diagnosed if you can’t see a psychologist?
I’m a therapist practicing in the UK, and I too would consider it unethical to be providing long term, open ended therapy to somebody without any ongoing mental illness or serious life issues to work on. The concept of just seeing someone regularly who is not experiencing any mental health issues or distress seems unethical to me too, from day one in therapy it is about looking towards an end where the client doesn’t need me anymore and has learned the skills and techniques and introspection about themselves so that they can be their own therapist and be self sufficient. I don’t want to set up or encourage a dependency where my clients are only okay when they’re seeing (and paying for) me.
The overall ethos here seems to be along these lines. A short term helping relationship where the best metric for success is that the client no longer needs therapy! In the US it seems very different, like people can attend therapy just as a helping hand for years at a time. But this seems to fit more with the US approach to healthcare, take gynaecological care for example: in the UK other than a smear test with a nurse every three years women never see a gynaecologist as routine. You’d only see one if you have a problem to diagnose and treat. Whereas in the US I’ve heard women have an ‘annual’ visit to the gynae just to check everything is okay.
For what it’s worth I don’t think the UK approach to therapy is necessarily better than the US approach, our ethics are very much linked to where we grow up, what we are taught and the system we work in. I just feel it needs to be made very clear to a patient: once work on the presenting issue at the start of therapy has concluded, a therapist needs to make it very explicit that they’re happy to continue seeing the patient, but it will be considered a place to vent, to discuss current issues, maintenance rather than necessary treatment. And if the client values that enough to want to keep going and paying that’s fine. But if a therapist is seeing someone for months or years at a time without ever telling the patient they feel they’ve done all they can around a particular issue I would consider that unethical.
Personally I don’t feel it’s ideal to encourage someone to use therapy as a crutch, as they’re gonna be stuck then if it’s ever unavailable or financially non viable. But I guess if therapist and client are both okay with the risks of that and are making an active decision to use therapy in this way then it’s above board.
A few more online short courses:
This Way Up
Centre For Clinical Interventions (a variety of short courses on different mental health issues)
I also like to check these sometimes to remind myself of mental health principles:
You feel like shit
How to make a safety plan
Self-compassion and how it is good for you
When I’m feeling like J does, there’s not much other people can say to make me feel better. I’m kind of almost in a state of panic about the crapness of me, but also have the urge to argue with anyone who says nice things about me or points out my achievements. For me, I’ve found it most helpful when friends acknowledge that self-loathing is a symptom of a disease, and sympathise in the same way they would if I had an outbreak of purple spots or whatever, or either to talk about something I feel I have some expertise in, like the relative merits of various cat food brands. Therapy can be really scary, because it can be expensive, you might not find the perfect therapist straight away and have to shop around (which is exhausting), and you might find that therapy isn’t any good and you’re beyond help (a jerkbrain fear, but a real one).
I really love mental health workbooks when I’m not up for in-person therapy. They’re not going to work all of the time and for every person, but they’re very low cost (especially through a library), can be done on your own time, and don’t involve a relationship with a therapist which can sometimes bring its own stresses. There’s also some great evidence that they’re effective. Mind Over Mood was my favorite and comes recommended by professionals for a wide range of things including depression and anxiety. This may or may not be a good option for your friend, but it’s another low-cost, not-in-person option.
I don’t think they’re paranoid or wrong to hear “Get a therapist please” as “My friends all wish I would stop talking about my pain with them.”
This is a spot on summation of how I feel about this, specifically, I’m terrified of turning into a J and making all my friends dread being around me.
Well, I think there are some concrete things you can do to avoid being a J.
– Timebox when you talk about your pain. “15 minutes of discussion then subject change” or whatever.
– Do SOMETHING to actively help yourself. Is this mediation? Colouring in? Making an effort to go on a walk each day? Going to bed early? These things won’t fix your mental health but there are a lot of things you can do to support yourself and in my experience my friends/family find it easier to help me when they see I am also trying to help myself, even if it is only a little help.
– You’re friends with them, so, make sure you are doing friend things together! Then they are like “Here is Jenesis my friend who I can’t wait to watch the next episode of Sailor Moon with plus talk about dogs” or whatever.
– Remember that your brain weasels are probably the ones talking when you say you think your friends may dread being around you. Take a moment to be like “Oh I see you there little brain weasels, you rapscallions you. You’re wrong.” Then give yourself a little moment of self compassion.
I have one to add– when things are going better or you have made a small achievement wrt mental health, talk a little about that too. If someone has listened to you when you’re in a crisis, it can be very uplifting to hear about the positives, too. I usually only write in my diary when I “need” too, that is when I’m feeling terrible, even though I don’t feel terrible all the time. But reading it, it is nothing but bleak! Don’t treat your friendly listener as the Very Bleak Diary.
They might not be wrong–it is a “Please talk about this with someone other than me” statement. But there’s a big difference between “My friends wish I would stop talking about this with them because they don’t care/hate me/want me to go away/think I’m a bummer” and “My friends wish I would talk about this with someone other than them because every response they give seems to make it worse, they can tell they’re not really helping, and they want better than that for me” or “My friends wish I would talk about this less often because this being the sole topic we discuss is impacting their own mental health/the stability of our relationship/etc. and they value those things and want to maintain them”. Hopefully LW can couch their discussion as less ‘shut up you dreadful person’ and more ‘this isn’t helping you and it’s causing other problems, let’s find you a more effective approach to handle this’.
Pretty much this, yes. Others in the group frequently feel bad and talk about it, and I think we’re decent about being supportive. When J feels bad, not only does speaking up seem to be no help, but either we come in for attack for not being able to say anything less platitudinous, or the concrete things we do say are attacked to undermine them – if we mention J’s accomplishments as evidence they’re not useless then those are declared worthless and invalid, if we tell them we like them and they’re not awful then we’re told it’s pathetic and humiliating to need such reassurance. It’s for this reason that having a designated venting space or similar on the platform doesn’t seem like a good idea to me – J isn’t simply letting off steam, but seeking accomplices in rooting out every good thing in their life and tainting it for themselves. And when an outburst ends, they don’t walk this back – the damage, as far as I can tell, festers.
I think you should tell j that you are not willing to be a participant in tearing themselves apart. “J I am sad that you are lying to yourself and warping reality to make yourself feel worse. I think you are a successful/terrific/awesome person and I want you to know I care about you. However, I refuse to fuel your self hatred and I don’t know what to say to you when you take my genuine comments and warp them so you can flog yourself”
I’ve had some success both hearing (when i was in a bad place and feeling like J seems to) and having heard by others who were, a version of :
“I don’t stand by and let people denigrate or bully my friends –not even themselves. You’ll not get me to agree my friend is horrible and worthless, so may as well stop trying.”
“Maybe [self denigrating thing] is true for you. I disagree; I think [reasonable/positive thing]. You don’t have to believe me or agree with me, but I don’t like being told I’m lying or wrong about my own feelings, and I’m not going to debate about it. Let’s talk about something else.”
One possible line you could try: “I wouldn’t let anyone else talk about you like that in my presence, and I’m not going to let you do it either.”
I have found that strategy of saying something positive and then saying you don’t have to believe or argree with me is esp. helpful with people in this state. It lets the person’s brain weasels let the comment in a little without having to fight it.
This. “I am not the person who can help you” is not the same as “I don’t care.”
I don’t have the expertise to splint my friend’s leg if they fall. That doesn’t mean I don’t care about them or their pain.
I don’t mean to pile on, it isn’t you – but I think the cultural expectation that loved ones can handle/fix mental illness seems to carry the suggestion that it is fundamentally different from physical illness. I don’t expect my friends to treat my broken leg OR my depression.
Care is complex and difficult to access, absolutely. But if I can’t afford to go to a doctor (US, yay), I don’t blame my friends for not being doctors.
Having reached the stage of becoming J myself (honestly apart from the ‘group chat’ element this could have be about me last year) it’s better to leave than to be engineered out of the group. In my case getting ‘help’ just made people more frustrated with me because I should have magically been better and back to doing whatever they wanted me to be doing, instead I’ve spent 18 months in a spiralling battle with health services that I also can’t talk to the group about. I ended up inventing good life stuff to talk about because people were pissed I was withdrawn. I wish I’d taken the hint and just left in the first place
I’m so sorry you had that experience! How awful.
I think this is an example of why clear boundaries are important in general but especially settings like this.
It helps to articulate exactly why a limit is being set and also sets the framework for not taking that limit personally.
It saddens me that in many people’s minds that therapy is the place to go to when everyone else is sick of your shit. I used to think this too for a time and while I was never a J, it created a different problem wherein I didn’t think I needed help because nobody was sick of me yet. It made me think that my isolation and keeping my depression secret actually meant that I was managing it better. Stated in plain english like that, that’s clearly rubbish.
I think part of the reason we’ve gotten to that point is because of the feelings of obligation and the tendency to overextend ourselves before any limits are even discussed. I imagine it would be much more comfortable for everyone if we could calmly express the fact of our limitations on emotional labor/expertise *before* it gets to the point of exasperation. By that point, while the words used may be the same, annoyance will begin to show through whether we want it to or not. That’s just additionally distressing for all involved.
I’m not sure if this will work for your friend, but when I had a friend who was in crisis, it was so, so, soooo important that we had some pre-set scheduled time where we agreed in advance to talk about other things (and my things!). The problem was that she was ONLY calling me during crisis, so I was never hearing any good news – and never having the chance to share anything about my life. My poor friend would take my entire night up on the phone just sobbing, and even though I wanted to be a great, compassionate friend, I quickly got to the point where the sight of her number on my phone made my heart sink. And I started feeling resentful although I tried not to – I had my own problems too, after all, and after these phone calls I would be so drained, and nothing helped her anyway.
I thought talking to her *more* was the LAST thing I needed, but by widening our conversation it made me better able to deal with the bad times. This only worked because, when she was not actively in a crisis, she was capable of talking about other things.
LW – this could have been me and my friends a few years ago. We had a small group of us, mostly friends from school (at this point we are all 29/30) One friend had recently moved interstate (a 3 hour flight away) We went through pretty much what you describe (but up to and including suicide attempts), along with all the responses you – nothing we said was right, not responding was also wrong etc, didn’t want to seek outside help. It got pretty abusive
None of lived near her and none of us could really afford to go visit, although we did manage it once.
The problem became that all of our mental health issues flared up as a result – I had a panic attack at work after a bombardment of horrible messages, anxiety flare ups and so on.
I wish we’d had the Captain’s scripts – I think some of them would have helped, as we were completely at sea as to how to deal with any of it. Her advice (as always) is gold.
A couple of things I learnt:
1. Keep a separate group chat for you to decompress, strategize if needed (for things like ‘Guys, I’m having a bad mental health day today so I’m not going to be responding to messages from J’.) and also just to have a space that doesn’t get co-opted by mental health dumps
2. Give yourself space to nope out if you aren’t coping. Step back for a day or a week – you don’t have to be gone for ever, but take breaks if you need them
Eventually our friend found some help that worked for her, we all gradually reconciled and and things are pretty good now.
Jedi-hugs and good luck. It sucks watching a friend go through something like this.
It’s not therapy in and of itself and it may not help someone in J’s position where they really want direct and personal validation more or less on tap, but one thing I’ve found immensely helpful as an adjunct to therapy was becoming part of the WordPress mental health blogging community and writing my own blog. It allowed me to spend hours and hours and thousands of words talking about myself without having to worry that I was boring the shit out of other people because hey, no-one’s forcing you to read, but on a less self-centred level reading other people’s blogs and interacting with them helped to validate and normalise a lot of what I was experiencing and to untangle some fairly complicated stuff by writing it out over and over, plus I also saw helpful and constructive behaviour modelled and was able to copy it.
There are also online support groups for specific topics which I’ve found very helpful, in particular Surviving Antidepressants (for antidepressant withdrawal) and Pandora’s Aquarium (for sexual assault and abuse). It’s a bit trickier with depression and anxiety though. I’ve found in both online and IRL support groups that people tend to drift away when they’re well so it ends up being just the currently-not-coping people all competing for the attention of the moderators. No answer to that, sorry.
I feel for you, LW. I’m a doc and trying to help someone who doesn’t seem to want help is one of the hardest challenges I face regularly. But as my therapist says to me, “you can’t care more about their problems than they care.” In the end, it doesn’t matter if J is unable or unwilling to get help – you simply cannot do this work for J (as you already know).
I love the Captain’s scripts, and she is right about setting boundaries. That is why I have office hours and only accept interaction on my work phone/email. It is also why I will not discuss people’s health problems in depth outside of the office – we need to set up a consultation. When you are helping people, you need to have healthy, (professional) boundaries. It can be harder to set them in something like your group chat where you currently do not have any/many, but I think it is necessary.
And like you have realized, it will most likely end with J leaving the group. That is not your fault. Like I said before, it doesn’t matter if J is unable or unwilling to get help – you need to maintain your own mental health. You definitely cannot help J if you get unhealthy yourself!
Good luck, LW!
I think that the Captain’s scripts are grand and that separate channels are also a good idea.
J is so stuck right now that they will refuse any changes (let alone solutions).
I think your friend group is so drained that you’d prefer a J free chat. Maybe the group is tacitly (or even loudly) awaiting something so egregious that removing J makes sense. If this is accurate (at least, for some of the group), don’t berate yourselves. J has been very difficult.
At the same time, if (part of) the group is kind of hoping for an explosion, maybe acknowledge that. Afterwards, you might be able to work with separate chats and shutting J up.
Regardless of what you choose, I admire the compassion you and your friend group display.
I can sympathise. I am part of an international group discussion based on a specific topic, and one person has legitimate safety and financial concerns in their country due to this topic. They occasionally ask for help (although the mods are good about filtering requests for money), but none of us are really in a position to be able to help, and it sucks.
I like the Captain’s scripts and other suggestions, as I have at least been commenting on their problems so that they feel acknowledged, so this post makes me feel better about that. I’m not sure what else to do… and that’s a shitty feeling. I feel guilty when I see their posts for help, but I also know that I can’t solve everyone’s problems, and I have to balance that out!
> keep the conversation from spiraling endlessly, as in, “Wow, that’s awful. What do you think you’ll do about it?”/”What do you want to do next?”
As a person sometime possessed of _remarkable_ powers of avoidance: this may also result in less venting over time because the idea of being expected to take responsibility for oneself is even more painful than going unheard.
WHICH, I ~hasten~ eventually think to add, is NOT on you.
But that would be a good thing, wouldn’t it?
If it’s likely you’re going to end up in an impromptu therapy session anyway? Re-route the spiral. Validate that you’ve heard him (“that sounds really difficult”), and then frame this as a solvable problem that he himself can do (“what are you going to do about it?” “what have you tried already” <—–this especially is going to feel less futile than "have you tried this?"). If it's going nowhere, because it really is unsolvable or J is just not in the headspace to do more than vent, validate his situation against and then close it out which even therapists have to do ("J that whole situation sounds awful, I wish there was something I could say that would solve it, but I really do hope you feel better. Mary you said something about a tea table. Did you get that in Maine?")
Then, I agree with everyone else, be preemptive. Try to talk to J before he is in that head-space or before he started venting. If you asked about the problem, then it's going to feel less hurtful when you close it out.
I’ve used Talkspace for almost 3 years and it’s been an absolute life saver. A couple of things about this service:
– Flat cost is now about $200 per month which can be quite pricey for some.
– Certain states have laws that limit who your therapist can be.
– My therapist is a near perfect match and amazing on the platform.
– However, not all therapists have mastered the art of online style therapeutic interactions. If your friend does sign up for an online subscription, they might need to try several different therapists before they find one that is suitable.
– The good thing about online platforms is that it is very easy to “fire” your therapist and try someone new. This can be so challenging in real life! I ghosted my first in-person therapist because the idea of firing him felt too daunting. On an online platform, it gives the patient a structured way to try different therapists and hire the best therapist for the job.
Hope your friend eventually gets the help they need. Good luck with those boundaries!
Would J at the least maybe read a self-help book? Something with worksheets they could process on their own? There are lots of things that can be “therapy”. And not all the same – if J has a specific idea in mind on what therapists do, it’s highly possible they could find one who does something different than what they are rejecting the idea of. CBT gets mentioned a lot, for example, but when I went to counseling I only made it two sessions before my therapist said “Yeah, CBT is not going to work for you, we have to do something different. Here, take this test.” (Nerdy me:”Oooo, a test!” *claps*). Him: “Now read this book and do the things.” (Me:”Reading and homeworkl! *more clapping*) So our sessions were more “tell me about your homework results” rather than “tell me about your feelings and what happened this week” which was much more comfortable for me. And the foundation in this case was schema therapy, which made much more sense to me than CBT ever did.
Point being that J might benefit from learning about different therapies out there, and may be able to help themselves some if they want to try a few different workbooks on their own. It’s not all baring your soul to a counselor or nothing – there’s a big variety out there.
One of the most useful habits I’ve picked up recently is starting out a conversation with “I just need to vent for a minute,” or “Do you have any advice about this?” and, likewise, asking people what they need. It’s so simple, but it makes things so much smoother. (Kinda off topic)
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