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How to make therapy work?

  • "You can't get over this unless you really want to." Do I not want to? I need to want to, and I'm a self-sabotaging ball of nonsense. Have therapist and group therapy, intake appointment for medication on two days, feeling like I'm maybe just making it all up. Or I'm using my intelligence to pull one over on either my therapist, or myself. Long, sorry. Anxious, or maybe depressed? Or just a bad coper? And a crier. And a magnifier of my problems, like maybe if I can get a better diagnosis and meds it will mean that I am a real fuckup instead of a fake fuckup and then people will really believe that I'm huirting and not making it up. And I'm not hurting as bad as so many people. and I go to my job and I have friends and I'm FINE five or six days in a week, and then that last day, something sets me off and I lose the whole day to crying, or anxious thoughts, or most probably zoning out on the internet all day because I just can't face whatever it is I need to do. And most days I'm on the internet at least half of the hours I'm there, because I can't get my head into or around the endless work I have to do, and even especially the work of figuring out what work I need to be actually doing. (Think dissertation in a science department with absolutely free reign to do whatever science I want, and relatively hands off mentorship, AND an expectation that students from this department will change the field and populate the best research university faculties around the country.) I have a lot of smarts in the toolbox (I guess I can say that since this is anonymous), which means I don't know if the 'fine' that my therapist sees is me being pretty good for your average bear but not performing at my potential, or if I'm overanalyzing myself into unneded therapy and medications. The diagnosis my therapist has for me (she told me for an insurance document a few sessions ago) is something lame and very minor, which it literally says on the wikipedia page for the diagnosis is a nice thing to have so you can have *something* to put down for clients who don't have another diagnosis. But I worry that maybe I'm fooling her, because I'm smart enough that my anxious self is still going to graduate school and doing experiments and *functioning* and I haven't yet destroyed my relationship with my partner. And then again I think maybe I'm magnifying my problem for some twisted reason, everyone says there's nothing really wrong with me and I'm a good person, but I just feel like I'm creating this deeper and deeper pit for myself that I don't know how to get out of. I've been in therapy (group therapist for 2 years, therapy for a bit more than 1) and I just don't know. I've seen a few different therapists and like the one I see now, but I think I'm not doing it right. She keeps saying, when I talk about how I interpreted a situation, that we will work on helping me see things differently. And I can rattle off the story about how the parents I grew up with and their issues have shaped me, and why being anxious and sad and self blaming was safer than anger, why that was adaptive for the kid I was. I feel sick of that kind of discussion, honestly. And intellectually I know the CBT reframings, I know how to turn all those messages around and what I should think instead...and I just don't. Or can't. Or don't want to. Or crying and being the fucked up one is to much fun (ha) or something. I read in Metafilter threads to imagine that I was saying these things to a child, to help me be kinder to myself. Or to think about how I don't care how awesome my friends are at every aspect of their lives, just that they are good people. I feel like I hear/read those things, and just feel....tired. Like they just won't work - or I can look at those thoughts from a distance, but they just don't penetrate or change anything. Today I cried in my advisors office, over a series of failed experiments and a continuing conversation about the fact that my work is "good...but not worthy of you. Not as exciting as it should be." She says I'm one of the smartest students to come through my program, and it just feels like smart is not enough, smart is maybe actively bad because I don't have the intuitive talent to just know how to pick the right problems and find the new theory and dazzle everyone. I really really don't say that to brag, in fact I find it terrifying and it makes me guilty that I haven't done better than I have. And now I feel like I've gone down irreparably in her eyes by crying in front of her. I have two years until I am supposed to graduate and I feel like I'm staring down this road of three uninspired postdoc appointments and then nothing, and then my boyfriend supporting me while I struggle with dead end jobs. Last week my therapist said something along the lines of how it only works if I want it to. Which makes me feel like I'm choosing to be a mess. Except I'm not really a mess, AskMe is just catching me on my 'bad day', but there have been slightly more bad days these past two months, but that only puts me up to maybe 2 days a week bad, 5 fine, instead of maybe 3 days a month where I feel like this. Do normal people feel like this at this rate and I just suck at managing it? And good days are often days where only 4 out of 9 hours are on the internet avoiding work. And usually more internet at home, instead of hobbies I wish I pursued or keeping up the house. When I cry, I'm stuck in a weepy place for the rest of the day. I don't know if its physiological, or if I have some weird either phobia of crying which keeps me terrified and upset, or attraction to crying and being upset because it's better than...some alternative. I have a terrible time calming down when I get upset, and I RESIST any and all advice on how to calm down. Everything in threads like these (http://ask.metafilter.com/72267/Big-girls-dont-cry) feels like too much work, and doomed to not work, and anyway I could stop if I wanted to and if those things are all it takes to feel better then I'm clearly just being a drama queen. And I feel very guilty about not...wanting to, not being able to do my CBT (? I think it's CBT? This week I have to wait a few seconds rummaging to get out my wallet at cashiers, to practice getting in people's way just a little bit), and not being able to put things in perspective and feel calmer. It's clear that being upset is filling some kind of psychological need (like it's just easier than doing science, or thinking about my actual problems, or feeling angry of something), and that makes me feel like an unfixable sicko. Except saying that makes me feel (again!) like I'm just overstating my problems a huge amount. I don't know if I"m pulling one over on my therapist or on myself or what. And the bad day two weeks ago was bad enough to finally request medication, and I have an intake appointment, at which I predict I will both cry like a ridiculous unprofessional mess, and also be a waste of their time, and I'm still worrying whether I'm running away from my problems. tl:dr I don't know if I'm trying to talk myself into or out of medication for my possibly very minor anxiety issues, and I feel alternately bored with, resistant to, and totally hopeless about whatever steps I'm supposed to take to feel better, and that fact makes me feel like some kind of drama-seeking vulture. throwaway: [email protected]

  • Answer:

    Oh honey. You sound so much like me fifteen years ago. It's been a long journey, but it got a lot better over the past fifteen years. Here's some stuff I've learned that might help. 1) If you would find a diagnosis comforting or reassuring, that does not mean you're a faker. It is comforting and reassuring to get a diagnosis. It means that someone smart has some ideas for things that might help! And guess what — there are things that might help! And that's great news! So go ahead and feel comforted and reassured. 2) Your diagnosis is not a value judgment. Just because some people diagnosed with (dysthymia/depression/BPD/anxiety/whatever you got labeled with) are malingering, or lying to their insurance company, or whatever, that doesn't mean that you are. 3) It only works if you want it to. But "not wanting it" is just one possible reason it might not be working, and there are so many other possible reasons. You can want to get better, and be trying your hardest, and still feel like shit because (a) you just need to keep at it longer (b) you haven't found the right sort of treatment (c) there are underlying physiological issues you need to deal with first (d) you're in a shitty situation where anyone would feel like shit (e) all of the above. Feeling bad doesn't automatically mean you secretly want or deserve to feel bad. 4) Your therapist can't see inside your head, or inside your soul. If your therapist says something you find insulting or damning, it doesn't make it true. You know what's going on inside your head way better than your therapist does. 5) There is no minimum amount of suffering you need to experience before you "deserve" help. Everyone deserves help and kindness. There are people who have it worse than you, and there are people who have it better than you, and they all deserve help and kindness. 6) There is no minimum amount of suffering you need to experience before you "deserve" to see a therapist, or a psychiatrist, or any other kind of health professional. You are allowed to try medication no matter how good or bad you feel. You don't even have to "need" it. Even if you can technically function without it, you can still keep taking it just because it makes you feel better. It's nice to feel better! And you're allowed to do things just because they feel nice! So there's the general truths. Here's one more thought, based on my own experience with these particular unhelpful thoughts that you're struggling with. You sound obsessed with authenticity and honesty and the fear that you're "just faking" or "just going through the motions." I've been there. Those thoughts kept me out of treatment for about a decade of my life — which was a decade that I spent flailing around desperately, suicidally depressed, hurting myself and everyone else within shouting distance, and oh man it was awful. So I really sympathize with what you're going through. And it was so hard to convince myself of #1-6 up there, because I was so sure that I was just a no-good lying lazy piece of shit and that was really the source of all my problems. Here's what I've found has helped a bit. First off, I started talking to my shrink about this stuff. If I found myself rattling off some glib fake-sounding story about my childhood, I'd say, "Look, you taught me to talk like this, but it doesn't feel honest, it feels like I'm just telling you what you want to hear." If I was worried I was outsmarting my shrink or playing some sort of game with her I'd say so: "Look, I've got a lot of practice at being a Good Patient, and I think I'm better than average at manipulating people when I have to, and I'm worried that I'm just doing that with you and that's why we're not getting anywhere." One of the nice things about therapy is that you're allowed to say things like "I worry sometimes that I'm ten times smarter than you and I'm just manipulating you with my giant brain" and you don't get punched in the face or hung up on. You just get, you know, "Huh. Let's talk about that." It's sorta cool being able to come clean about that stuff. And the second thing I did, actually, just recently, was get away from CBT and start seeing someone who does Dialectical Behavioral Therapy. There's a lot of stigma associated with doing DBT, because it was designed for "difficult" or uncooperative patients and for people with a couple of specific really stigmatizing diagnoses (mostly BPD, anorexia and drug addiction). And I worried about trying it out because I "just" have run-of-the-mill depression, which it isn't specifically designed for. But the way I look at it is "Look, these people are experts at dealing with patients who lie and cheat and try to manipulate them. I'm worried I'm doing that shit. But I figure if I start, they're probably gonna call me on it." CBT therapists, you sometimes have to worry that they're just being nice and accommodating. But sure enough, the DBT therapist I'm seeing, she will absolutely say things like "Look, it sounds like you're just giving me a canned speech here, what do you really think?" or "You say you have such-and-such experience all the time, but I don't actually think that's true. Prove it — gimme some specific examples." Having that reality check has been incredibly helpful for me. I've learned that most of the time I am actually pretty honest (and just have a nasty self-defeating tendency to doubt my own perception of reality), and that on those few occasions when I do start exaggerating in a bad it's possible to just catch myself calmly and stop without having to make it into the Spanish Self-Inquisition. And also, weirdly? AA cliches. I've started collecting AA cliches. A lot of them are really effective against this sort of "Oh well I'm a special case because of X and Y and Z and so I'll never be able to recover" (in our case "oh well we're such nasty clever manipulative bitches that we'll never be able to etc."). I don't actually do AA, but there's a current running through it of "This is so dumb it could never work, and yet it does, so just do it" that I find helpful when I'm tempted to overthink shit. David Foster Wallace (the PATRON MOTHERFUCKING SAINT of brainy overthinking slightly-manipulative deeply-ashamed-of-being-manipulative motherfuckers like us) has written a bunch about that aspect of AA, and I found that stuff to be really enlightening too. Okay, that was not just one more thought. Sorry to be long winded. Some of that really resonated with me, and I'm hoping some of my own reaction is helpful. If not, if I'm barking up the wrong tree entirely, feel free to ignore me.

anonymous at Ask.Metafilter.Com Visit the source

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nebulawindphone is wise. I think you're tripping yourself up with the intellectualizing and storytelling. Your therapist sounds weary and uninspired. Some therapists aren't creative and they bank on the idea that just being listened to will be transformative. That's rarely the case -- when clients drift away, they think it's because they "weren't ready to change." Rather than distracting you from the intellectualizing and storytelling, or modeling a different kind of conversation with yourself, she's basically complaining to you that you're not doing something different. Honestly (IANYT) I'd be tempted to go walking with you during the session. And I'd ask you surprising questions to interrupt your line of thought. I'd find a place where you are delighted with yourself -- and then ask you to notice how you feel --what your physical sensations are, what kind of metaphors can you come up with for how you're feeling. And then I'd wrap them in a little package, tie it with a bow, and give it to you to take with you so that you can open it up when you need to at home. I'd ask you to be brave. I'd give you zany homework assignments that could also lead to delight, puzzlement and wonder. All the things your "smartness" is stealing from you. Every session would be an opportunity to learn surprising and lovely things about yourself, to think critically and compassionately about your dilemmas -- not an opportunity to rehash Big Problems That Are Unsolvable. You're already smart. You don't need a smart therapist who can apply techniques. You need a therapist who is an artist and artisan. Someone you have faith in. He or she should be able to surprise you.

vitabellosi

Last week my therapist said something along the lines of how it only works if I want it to. Fire your therapist. Talk to your pdoc and get new meds. But first...fire your therapist.

xingcat

Having an anxiety disorder is like being severely nearsighted. It is absolutely not your fault. It is not "minor" -- it needs to be fixed, it is always with you, and it is not something you talked yourself into. But when you get the right professional and the right aids, it can be so well taken care of that your whole life flows right on over it. I have so much to say that I can't say any more. Best of luck to you.

Countess Elena

"You can't get over this unless you really want to." Ugh, bullshit, wanting has nothing to do with it. Would you tell someone who had a broken arm or cancer that they couldn't get over it unless they wanted to? This is no different.

Violet Hour

Oh, anonymous. I kind of just want to give you a hug. I didn't go to grad school but you are describing exactly what would have happened if I had! These big brains of ours are awesome at thinking but unfortunately also awesome at overthinking. I agree with a lot of what nebulawindphone says, though my post-CBT approach has been Acceptance and Commitment Therapy rather than DBT (which I haven't tried). ACT would say that your current life is a recipe for panic: you have high expectations both from yourself and outside people, a vague idea of how to succeed, lots of clear ways to fail, very few clear deadlines and therefore lots of time for avoiding and fretting, and big consequences. You're not freaking out because you're some freak of nature or a drama queen, you're a stressed human surrounded by ambiguity. Are you going to succeed in grad school? No one knows! And that not-knowing feels unbearable. So you avoid with internet time, and you fret with crying/panic days, and surely you strategize. But the ambiguity is still there and the stakes are still high. ACT would lead you to learn to sit with that ambiguity and fear and learn that you are able to survive that feeling, no matter how uncomfortable it is. You don't actually need to have an anxiety-free life to take control of your life back. It would also lead you to focus on your true goals -- including your reasons for pursuing this line of research -- and make choices based on your goals rather than your fears. This wouldn't mean that your experiments would be bound to be successful or pleasing to your advisor, but that you would have been freed up to spend your energy on them rather than on finding ways out of that ambiguity. If that sounds interesting, try picking up a copy of Things Might Go Terribly, Horribly Wrong.

heatherann

Well, do you want it to work? It is a question that deserves some consideration and soul-searching besides "If I say 'No' it means I'm choosing to be a mess I'M A FAILURE FOREVER". As you said working on it is really hard. Staying in familiar thought patterns is comfortable. Not "comfortable" in that "life is easy and carefree" but it does not require the same levels of focus and psychological effort. First, an anxious perfectionist worried about performance may feel once they start applying these techniques they've entered another situation where they are judged on performance. After all, there will be moments where you don't apply them, right? There will be moments when the techniques don't work, or you give up, or you forget to use them. And then the practitioner may feel that this means they're a failure because they didn't apply these techniques perfectly and wholly from the very beginning. It is easier to not try and not enter the perceived sphere of winning or losing at mental health. Of course, that's a false dichotomy. The whole point of CBT is that you are dealing with a difficult road of rewriting self-talk and neural patterns. It is expected you will fail early and often and that is OK--the important part is that you are moving forward. Second, when I was in your position the issue was not that I didn't want to fix my life, but I didn't want the life I was living. In my case, I was attending a prestigious school and had a road of achievement behind me and before me, and I was miserable and wanted none of it. Of course I was completely unwilling to admit this to myself because growing up I was taught academic achievement was literally the most important thing in life. The idea of dropping out of school for good was too terrifying to contemplate. So I continued to self-sabatoge, both in tanking my classes and, in retrospect, not making the efforts in therapy that I could. What's the point if I'm still going to be miserable anyway? I eventually did drop out for good. And you know, suddenly fixing my brain became a lot easier. Previously my brain had been another onerous task to complete on top of all the other onerous, unfulfilling tasks I needed to complete. Now that I had goals I deeply, desperately want to accomplish there was a light beyond this issue providing motivation. (don't be tempted to use that as another way to further hyper-intellectualize or self-flagellate yourself--if you follow the question "Am I happy?" with "I should be happy" you are not going to make progress)

schroedinger

Also have you tried something like mindfulness meditation? That will give you space from this anxiety to distance yourself from your emotions. Can you actually feel the emotions when you relate your childhood story or are you intellectualizing them? I used to do this in the beginning and it wasn't until I explored feeling feelings instead of just talking them that I made a break through.

kanata

When I am suffering from tremendous anxiety, I sure sound a lot like you do right now. xingcat is right: get the meds and let them help you enough that you can listen and participate in therapy. I think that might be the "want" your therapist is talking about - you've got a lot of noise rolling around in your head and it sounds like you're focusing on focusing on focusing - metaworrying - rather than being able to get involved in what's going on. It sounds like you're trying to jump to the end, where you've already done the work and stabilized and feel better. This is understandable, one of the characteristics of anxiety is a loathing to do things you're not an expert at, and needing to feel like the smartest person in the room. Also, you're worried about qualifying for therapy, which is not how it works. Athletes go to therapy to be better athletes, managers go to therapy to be better manager, doctors go to therapy to be better doctors. You don't have to be "sick enough" - if you feel bad and like you're not wrangling your stuff to the best of your ability, therapy is AWESOME for helping you with that. It does kind of feel like maybe you and this therapist don't have the most fantastic personality mesh, but I would encourage you to maybe spend a couple of weeks with some xanax-type assistance before you decide that for sure.

Lyn Never

It's clear that being upset is filling some kind of psychological need (like it's just easier than doing science, or thinking about my actual problems, or feeling angry of something), and that makes me feel like an unfixable sicko. Except saying that makes me feel (again!) like I'm just overstating my problems a huge amount. I don't know if I"m pulling one over on my therapist or on myself or what. These are key points. There is some psychological need that is being fulfilled by your current behavior and emotions, and in that sense, and in that sense alone, there is a part of you that wants things to stay as they are. There is clearly another part that does not like the way things are. Your guilt, worries about being a drama queen, worries about "pulling one over" on yourself or therapist, etc -- all connected to this same set of issues. They are themselves partly responsible for your anxiety, which you then again worry about exaggerating, and so on -- it's a cycle. There are reasons you have all these self-berating thoughts as well. You need to work with your therapist to figure out what benefits you are drawing (or at some level feel you are drawing) from the status quo.

shivohum

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