I want to start this week with a post or two about therapy. There is still a stigma attached to mental illness, and therapy is still widely misunderstood. I also want to write about therapy this week because I have no therapy this week. The wonderful, talented, empathetic and possibly even psychic “L” is on vacation. I am constantly thinking of things to tell her and then remembering that she won’t be back for another two weeks.
A note before I begin: Psychiatrists, psychologists, social workers and people with various other degrees can all practice therapy. Only a psychiatrist should be prescribing any drug or making any recommendations to you about medication. I see a psychiatrist in Manhattan, the incomparable Dr. C, and a therapist with a degree in social work here in New Haven (L). I see Dr. C about four times a year to talk about changes that need to be made, if any, to my medications, and to check in. I’ve been seeing him since 2006. I’ve been seeing L for about eight months. Because I see her twice a week, it’s important that her office is close to home.
Types of Therapy:
The Mayo Clinic website lists thirteen types of therapy. I won’t go through all of them, just a few.
- Pyschoanalysis is the opposite of what I do. I am absolutely interested in doing it someday, though, after talking with people who are trained in it. It is easily the most misunderstood type of therapy out there. Yes, it’s what Freud pioneered. Yes, you often lay on a couch. Yes, you often avoid looking at your analyst. Yes, you often go up to five times a week. But today’s psychoanalysts are not judgmental like Freud (anyone read Dora?) and the couch thing is optional. Rather than define it (the Mayo Clinic does that quite well), I’ll tell you why I want to do this someday: I tend to try and come across as perfect, even to a therapist, and not being able to see her reaction seems like a pretty good way to circumvent that impulse. I once asked my therapist in Queens why she wasn’t happy for me when I improved at something (I don’t remember what it was anymore), and she said that she had been trying to keep her face neutral. Why? I was taking her smile as approval from her. She didn’t want me to need her approval. Smart lady. I sure was interpreting a smile as approval and the absence of a smile, or a neutral expression, as disapproval. You can get to those thoughts and feelings that your conscious mind doesn’t really want to think about a little easier when you’re not trying to gauge your therapist’s reaction like that. It can also feel disorienting, I’m told. I haven’t done analysis yet for that reason; the last thing someone with tons of anxiety needs is to feel disconnected and disoriented even in therapy! One day, I’ll be even better at dealing with my anxiety, and that will be the day
- Interpersonal therapy is what I have chosen. My visits with L feel like visits; we have an ongoing conversation. We focus on my relationships with other people–anyone counts–in order to help me feel less anxious, more connected, communicate better. She’ll ask me to expand on something or to describe my feelings about something. An interaction I with M, my therapist in Queens, is a perfect example of why interpersonal therapy works so well for me: “Anne-Marie, you are interpreting my facial expression as disapproval. I was trying to be neutral. Does that happen often?” “Why, yes, actually, now that I think about it, I’m constantly looking for approval from my boss, my husband, my mom, my sister, in just the same way. And now that I think about it some more, it feels kind of gross for everyone.” What I really like about interpersonal therapy is that the relationship is very close. We’re not friends, and it’s a one-way thing. But the best therapists are even good at talking about their own feelings about your relationship (how can you see someone twice a week and not have a relationship?) in an effort to help the patient understand the other relationships in her life. Note: the concept of transference is a Freud thing, but one that I believe in quite strong. I don’t agree with him in that he tended to think that it was all a kind of romantic love, e.g., Dora thinks she’s in love with me because she can’t work out her true sexual feelings for the other guy or her father. It gets creepy. What is true is that because I never find anything substantial out about who my therapists are outside our sessions, I tend to subconsciously compare the relationship to other close relationships in my life. Claire (long ago and far away) reminded me of my sister. Kate (college days) reminded me of my sister. M reminded me of my sister. L, who is a bit older than any of the past female therapists, reminds me of a really important mentor in college, Nancy Klein Piore. During our first office hours session to talk about my writing, Nancy looked me straight in the eyes and said “Anne-Marie, you are insecure.” I cried. She gave me oreos. I will love her forever. I can totally see L doing the same thing. She would probably say “Do you think you’re insecure?”
Note: the constant questions, coming from a good therapist, are supposed to be real questions. They often know the answer in advance, but if you come out with a totally unexpected answer, they embrace that. We’ve had some huge breakthroughs in undoing harmful patterns when I’ve said “No, it’s not like that, it’s like THIS! I never thought of it that way!” It can be pretty exciting to undo a years-old habit that way. Of course, you can’t just say “NO. I DON’T FEEL THAT WAY!” Because come on, these people deal with denial and lying for a living. You’ve got to have an alternate explanation, and if I personally get angry or defensive, it’s less convincing, even to me.
- Cognitive Behavioral Therapy or CBT has been an important component of my life in therapy. But because my anxiety is an ongoing thing and my mood disorders are not related to a specific event, like a death, I wouldn’t benefit from straight-up CBT. But say there’s something specific that really bugs you, like being too confrontational and too defensive in your relationships. CBT takes your current unhealthy behaviors (yelling at your spouse), examines them briefly, and then works hard to find alternate behaviors that you can put in to practice. This actually changes the way you think. You get less angry. I’ve used CBT techniques when things like overwhelming anxiety about leaving my house crop up. Example: I HATED walking to the subway. I bought audio books, put them on my iPod and put my iPod on about 15 minutes before leaving the house, while I was getting ready. This habit replaced the habit of procrastinating getting ready to go, with much healthier results. It worked because it distracted me from the anxiety–I get caught up in books really easily. There’s a reason I spent so many years studying literature. If you feel anxiety about something specific, but don’t have generalized anxiety like me, you might find that a set number of sessions with a CBT-trained therapist enormously helpful.
That’s my take on therapy. I hope it helps debunk some myths. Please, ask questions. It’s hard to be objective about something I’m so close to! And, for the record, I cannot wait for Linda to come back. I LOVE that safe space. I’m tempted to ask for keys to her office so I can just hang out there when she’s on vacation. (Joke. That would not be legal.) But seriously, bring on the questions! I love talking about therapy, because it saved my life. Meds only do so much. It’s therapy that actually creates lasting change. And everyone who knows anything agrees that the combination of the two is usually best. Thank you to all the therapists I’ve ever known. I’ve been lucky to encounter some brilliant minds.
A final note: this post is dedicated to someone who is starting therapy relatively late in life. You are brave. You are one of my heroes. I love you. You inspire me daily.
See how it looks like their friends? They're just talking? That's what therapy can look like.
