Loud, dated, and probably not effective. The padded rooms, however, are great fun for kids.
Getting Your Fill of Treatment
Therapy is a lot like dating someone; the only thing harder than knowing when to get involved is knowing when to walk away. There is no marriage in the therapy analogy (just among therapists, as with a certain author of this book), so at some point down the line, your current course of therapy must end.
Most people assume, logically, that treatment doesn’t last forever, but as long as they expect it to make them feel better and gain more control over their lives, they find themselves engaged in a process that never seems to end.
The reason, of course, is that treatment is seldom completely effective, and expecting it to be so means you can stop therapy only when all your pain goes away; i.e., when you stop living. Quitting before you get there, even if “there” doesn’t exist, makes you feel more responsible than ever for the things about your life you’d most like to change.
Similarly, if treatment lifts your spirits and gives you perspective that rapidly disappears when you stop for even a week because your shrink needs bunion surgery, it’s natural to feel you’re not finished yet and won’t be until your good feelings last longer and you’re able to maintain a positive, realistic perspective on your own.
Since treatment of any kind, no matter how frequently it occurs or how deeply it delves into your hidden feelings and painful issues, seldom achieves the kind of change that people expect, it’s reasonable to stop at any time you think you’re no longer benefiting, regardless of whether there’s lots that’s still wrong with you.
Your goal is to get what you can out of treatment and accept whatever ills you can’t solve. Don’t cling to the idea that it has more to offer if you just try harder and longer. You haven’t failed; treatment just isn’t that powerful, and maybe not that necessary.
It’s also reasonable to stop treatment (or at least pull back) if it’s not bringing about measurable improvement, even though you still feel you need it. After all, it’s costly and you may do fine without it, regardless of how anxious you are not to lose it. Ideally, treatment should show you that you don’t need certain things as much as you feel you do, even though it hurts to let them go—like finding the strength to leave an abusive partner or quit drinking—and gaining the courage to quit treatment itself is often a sign of success.
Of course, just because treatment stops doesn’t mean you should ever give up on managing bad behavior or getting on with life in spite of bad symptoms, without a therapist; there are plenty of tools out there, including readings and support groups, that can fill the therapy void. Don’t rely on treatment unless you see strong evidence that it’s making a difference and doing so in a way you can’t replicate otherwise.
Sometimes you’ll find that continued treatment is, indeed, necessary to maintain stability and prevent you from relapsing. If so, use it only when necessary, as measured by how well you do as you cut back. Never depend on treatment for support if you can find another source, because therapy is the high-maintenance ex you can stay friends with only if you don’t fall into old habits again.
Of course, people who know about your problems will always think you need treatment, but that’s their worry talking. You must rely on your own knowledge of available treatments and your experience with them to tell you whether or not you do need treatment again.
In the end, you probably don’t need treatment for a long period of time and are better off relying on what you’ve learned and other sources of strength, knowledge, and comfort to manage problems. In other words, you may have moved on, but the time you and treatment shared together will always be special.
Here are reasons for stopping treatment that you’d like but probably can’t have:
• Removal of the angst center of your brain
• An acquired immunity to criticism
• A learned inability to bicker or create conflict
• Solid confidence in your ability to take care of yourself, regardless
Among the wishes people want to fulfill before stopping treatment are:
• To first get better control of symptoms
• To first figure out why they can’t stop their troubling behavior
• To completely finish healing
• To find a way to hang on to the one thing that has helped them; i.e., therapy
Here are three examples:
I like seeing my therapist and she has helped me get over my shyness, but my social life is fine now and I’m just not unhappy, so I wonder whether I really need to see her anymore. She says we haven’t gotten to the root of my problem, so my shyness will probably return and get in the way of having a serious relationship, but I just don’t know. My goal is to figure out whether I need to continue and why.
My therapist has been my lifeline for the past five years and I don’t know what will happen if I have to stop seeing him. I can tell he’s worried, too, but my insurance says that it’s not “medically necessary” and won’t pay for it. Before I saw him I was very depressed and made a suicide attempt. Now I’m still depressed, but I’ve been working steadily and have a couple friends. I’ve got a long way to go, and I’m afraid of going back to the way I was before. My goal is to get the insurance company to see that my treatment is medically necessary to keep me from sliding back into the pit.
I was put on two antidepressant medications a year ago when I was very depressed, but I’m not sure I need them anymore, and I think they do nothing but make me fat and tired. I’m back to my usual blah mood, and I don’t see why I should continue medications that may be doing me no good and are probably making me feel worse by making me look and feel like a hibernating bear. My goal is to get off medication.
Treatment and its results may always feel personal—and how could they not, given how they focus on your private thoughts, honesty, and commitment—but when assessing therapy’s effectiveness, it’s best to imagine that you’re a management consultant, your therapist is an employee, and the client is your life. It’s your job to figure out whether your therapist is still a valuable part of You, Inc., or whether, based on his performance, it’s time to let him go.
As you may have learned from films (Office Space, Up in the Air) or from the personal experience of being brutally laid off from your job, management consultants are neither sentimental nor compassionate. That kind of objectivity can be difficult when reviewing your own treatment, but if you can accept the evidence of your own experience, even if it’s disappointing, you can make hard choices the smart way.
Other people may urge you to continue treatment because they wish you didn’t have to suffer so much, and while it’s easier to dismiss those people when they’re friends and relatives, it’s harder when the main person who believes you need more from therapy is your actual therapist.
It’s important, of course, to value your therapist’s advice—if you’d never taken his advice to heart, you probably wouldn’t have made any gains at all—but ultimately, you’re the only one who can evaluate therapy’s effectiveness, both for your life and your wallet, and decide whether it’s still worthwhile. He may be a problems expert, but you’re the only you expert, and your opinion on your progress is the final authority.
Ask yourself whether the lingering fears and insecurities that therapy hasn’t alleviated are doing you any harm, other than causing you to be anxious, unhappy, and self-doubting. Sure, these are not enviable emotions, but at normal levels, if they don’t impair your ability to work, be decent, or live, they can actually be beneficial, since fear can help you be aware of dangerous situations, and self-doubt can get you to double-check your results. Simply put, feeling bad is sometimes good for you.
You’re doing a respectable job proving to yourself, day by day, that you can take risks, do new things, and become accustomed to doing things that scare you but won’t bother you nearly as much after you get used to them. Your therapist did a good job, too,
which is why you should feel confident telling him it’s over.
If you feel your therapist is doing a job for you that no one else could and are worried that something—running out of money, an insurance decision, your therapist’s departure—will cut off your therapy and your lifeline, remember that feelings are not necessarily reality, and that severe depression and anxiety have their own way of making you feel like you’re much more vulnerable and dependent on treatment than you are. If your therapy is making you feel even less independent, it’s also less beneficial than you think.
Test out the reality of your need for treatment by cutting back on the frequency of your visits and finding other sources of encouragement, like twelve-step groups, depression-support groups, and friendships with people you can count on. If you haven’t done it already, educate yourself about DBT exercises that you can practice when you’re feeling self-destructive and hopeless. Yes, you may not feel comfortable sharing intimate information with anyone other than your therapist, but it’s something you can learn and it’s well worth doing.
Whether it’s your own bank account or your insurance benefit that’s running dry, don’t let panic discourage you. Create a program for shifting your sources of support and, almost always, you’ll find you can reduce your dependence on weekly treatment. Even if you continue to need treatment, you will probably not need it regularly or weekly, so you will lower your costs and make it easier to negotiate continued support from your insurer.
If you’re less worried about becoming dependent on a therapist and more worried about dependency on medication, then your assessment requires slightly more objectivity, since you’re trying to ignore not just feelings of panic but also the stigma of psychotropic medication.
Assessing medication also requires you to weigh a whole new set of costs and benefits; i.e., is not being miserable/anxious/paranoid worth not being thin or able to stay awake or capable of getting a boner?
Since you’re the one who knows best whether your symptoms are severe enough and happen frequently enough to be worth preventing, you’re also in the best position to decide whether the medication is effective enough to justify the side effects. If you’re not sure, talk to your doctor about stopping your meds, at least temporarily; it may give you an opportunity to test the medication’s effectiveness and also to see whether it’s responsible for symptoms that may be side effects. (Just don’t go cold turkey on your own, because some medications can be harmful if discontinued too quickly.)
Another thing you might learn from talking to your doctor is that, if a medication is obviously effective and you tend to get relapses without it, taking it forever as a preventive may actually protect your brain from subtle damage that occurs to some people who have chronic depression over many years. If the idea of being dependent on a medication that long is unacceptable, just think of your meds as brain insulin; diabetics aren’t ashamed that they require a lifelong drug treatment, and neither should you be.
The higher the risk from side effects (like the tendency of certain antipsychotic drugs to actually cause diabetes), the more important it is for you to stop the medication as soon as you know it’s ineffective or you find a less dangerous substitute. Your job is to consider the risks of stopping medication versus the risks of continuing it. Then, whatever decision you make will be a good one, even if it’s not good for your waistline.
Don’t make decisions about stopping treatment any more emotional, frightening, or mysterious than they have to be. If you trust your own observations and accept the fact that all treatments have limitations, you can be sure you’ll get the most out of whatever treatment you’re evaluating and do whatever’s best to make You, Inc., as successful as possible.
Quick Diagnosis
Here’s what you wish for and can’t have from treatment:
• Relief from all intractable, no-good-reason-to-have-it depression and anxiety
• An understanding of why you do unreasonable things that actually gives you power to control those things
• Elimination of the dark, nasty, angry, obnoxious, addictive, and otherwise self-destructive parts of your personality
• Better relationships with people who don’t want or expect to have a good relationship with you
Here’s what you can aim for and actually achieve:
• Develop rational methods for determining what you really control
• Rate yourself according to how well you cope with what you don’t control, regardless of what your instincts tell you
• Learn tricks for managing your weaknesses
Here’s how you can do it:
• Use treatment as a tool to discover the limits of what you control
• Find out what treatments are available, what they offer, and what risk they pose
• Define the conditions of illness or disability that, in your opinion, make looking for treatment necessary
• Define the conditions for progress that, in your opinion, make treatment effective and worth continuing
• Stop, suspend, or reduce the frequency of treatment if you don’t see your problem improving
Your Script
Here’s what to tell yourself/your shrink when you’re considering starting or stopping treatment.
Dear [Self/Shrink/Concerned Friend],
I often feel that my life is a [mess/sewer/vale of tears], but even so, I’m actually coping pretty well overall. I want to find out whether treatment can help me stop [crying/swearing/being afraid of everything, including my own shadow] and I’ve read up on what’s available. I will continue to look for help until it’s clear that I’m as [antonym for “broken”] as I’m ever going to be, and then I’ll know I’ve done my best to manage my psychiatric/life problems.
Lower-Cost DIY Treatments
Before you commit to therapy, or if you just can’t afford it, we recommend you try less costly alternatives to professional treatment. Below is a sampling of such alternatives, listed in order from those with the highest benefit-to-risk ratio to those with the lowest (and highest absurdity factor).
Useful For
Effectiveness
But
Exercise
Depression, anxiety
Reduces anxiety and depression within hours, or at least distracts you from them for a while
Relapse is rapid after an injury (as if you weren’t already hurting)
Diet, Vitamins, Health Foods
Depression, anxiety
Very hit-and-miss, so you don’t know until you try it, but diet means what you eat, not necessarily eating less; nobody feels happier when they’re starving
Don’t get superstitious about all the things that seem to hurt or help, with very little real evidence, and wind up on an all-Cheerios diet because your depression cleared up the morning after you had a bowl
Twelve-Step Groups
Almost everything
Helps you fight addiction of any kind, or even just negative thoughts when they’re not rooted in addiction
You have to find a group that has what you need, and some don’t
Meditation/Yoga
Anxiety
Definitely helps a little bit, and some people are helped a lot
Doesn’t help everyone, the effect is limited, and like exercise, yoga has an injury factor
Scientology
Gives a certain kind of person a feeling of meaning and community
May fill a void? Or at least get you closer to Tom Cruise.
It’s not cheap, and it’s not, shall we say, inclusive to outsiders or forgiving of insiders who decide to leave
Lobotomy
Stops life-threatening symptoms, like depression and suicidal urges, but may leave you with seizures from just a wee bit of brain damage
Very often effective when nothing else is, but we’re talking serious Hail Mary here
Not without risk of taking away some function or part of your personality you value, so not administered by almost anyone sinc
e the 1960s. That’s why it’s available only if you do it yourself with a chopstick or golf pencil (but never, ever do that).
Getting Treatment for the Unwilling
If “Things You Can’t Control” was a round on Family Feud, then the number one choice, above “natural weight” and “the weather,” would be “other people’s will.” When you want to get mental-health treatment for someone who believes they don’t need it, it’s natural to push them in any way you can, but if you thought controlling someone was difficult, try controlling someone who can’t control his own mind. Your urge to drive him to treatment may just drive you nuts.
Perhaps your hope is that once he’s “in treatment,” even if he feels coerced and reluctant, something about the shrink or treatment process will grab him, change his mind, and allow him to be helped. Then he won’t just forgive you for pushing, he’ll thank you for your lifesaving heroics.
Unfortunately, treatment for mental illness is the same as for medical problems and usually requires patients to be actively motivated. Push too hard, and she won’t be thanking you, just ignoring you out of frustration and even rage; if you’re trying to help a relative, you’ll have an actual family feud on your hands.
The problem is that if someone enters talk therapy reluctantly, they wait for it to do something to them rather than for them, passively complying rather than getting involved and doing the homework. If she complies with medication prescriptions, she will quickly object to side effects and stop taking them before they might be effective. If your goal is to show her that treatment can save her, her goal then is to show you that treatment won’t work, and she will usually succeed.
There are exceptional circumstances, however, when forcing someone to get help may be worthwhile, and there are other circumstances when advising someone to get help may pay off in the long run, even if your advice is ignored for the time being. Knowing those circumstances, and accepting the limits on your ability to get people to accept treatment, will make you much more effective than if your philosophy is to push hard whenever you see someone who needs help.
F*ck Feelings Page 34