Be Prepared: Reactions from Friends, Family, and Lovers When You Get Therapy

http://upload.wikimedia.org/wikipedia/commons/thumb/4/49/Brittany_001.jpg/500px-Brittany_001.jpg

Sometimes the standing ovation is a long time in coming.

Sometimes those expected to be most supportive of you are just the opposite.

Sometimes those you think are on your side are actually working against you.

When even your family dog looks doubtful, then you are really in trouble!

Who am I talking about?

A few of your friends and relatives when you enter therapy; especially, if you begin to make significant progress.

The Boy Scouts of America have it right: be prepared.

Therapy still carries a stigma in some quarters. Men, in particular, tend to believe that they should be able to handle problems without a “crutch;” that talking too much about “feelings” is not the thing that a “real man” does. For these people, going to a therapist is thought to be a moral failure — a weakness of the will.

Parents, too, can be threatened by an adult offspring’s decision to enter treatment. The public stereotype of counseling is that you will be required to explore your childhood and that, before long, you will blame your parents for everything.

An exaggeration, of course.

But, the more likely that your problems do have something to do with your parents, the more likely that they might discourage your efforts to engage in treatment.

On the other hand, unsupportive parents can use your decision to seek professional help as evidence that you are “broken.” Your need of counseling can be counted as “proof” that there is something wrong with you (as opposed to themselves or to your siblings who have not sought this kind of assistance).

But what if you suffer from alcohol or drug abuse or addiction? Surely everyone would want you to overcome this, wouldn’t they?

Not so fast.

You probably have friends and family who “use and abuse” substances, as well. If, in the course of treatment, you try to cut-back or become abstinent, little approval will follow from this group. Rather, you will find yourself with as many or more offers of drinks and drugs, as well as pressure to resume the same behavior as before, lest the change be seen as an indictment of this group and the habits of its members.

Comments like, “what, do you think you are too good to have a drink with us?” or “it’s only one drink,” or “geez, it’s really great weed; you’d really love it,” or “let me buy the drink” are commonplace. This is why such relationships inevitably either break down or the person attempting to change himself “falls off the wagon” due to social pressure and criticism.

It is also a part of the reason why support groups for addiction like AA (Alcoholics Anonymous) are so important in providing the understanding, back-up, and encouragement that is lacking elsewhere.

Even if your treatment doesn’t involve alcohol or drug abuse, you may discover that parents or lovers will try to become “back seat drivers” of the ongoing discussion between you and your counselor. Some of them will wish to know all the elements of your private conversations, including the most intimate details.

This can be a problem. People frequently go to therapists because they have issues that are tremendously painful or embarrassing to confront. It can be hard enough to open up such matters with a psychologist without the knowledge that you will be debriefed at home. If your partner or parent “requires” you to talk about those delicate subjects, it can discourage you from speaking to the therapist about them, or even engaging in treatment at all.

Sometimes mom or your spouse will go so far as to suggest that your revelation of family secrets and any negative commentary (about them) to the therapist is a personal betrayal of your family bonds and obligations.

For the record, there are many times when therapeutic conversations must be absolutely confidential and free from the review of other interested parties. Your therapist knows this and will not divulge information without your clearly directed permission (unless you are dangerous to yourself or others). You should not feel compelled to make regular reports to spouses, friends, parents, or other relatives simply because they want you to.

And what if you do change, with or without the encouragement or support of the people closest to you?

They do not always welcome those changes.

If you have been docile and passive in relating to loved ones and you now become assertive and independent — not willing to “go along in order to get along” — people who used to manipulate you will be frustrated. Should you now be capable of standing up for yourself, saying “no” — refusing to be hostage to others’ disapproval or direction — you must expect that there will be “push back.”

“You’ve changed — you’re not as nice as you used to be. Therapy has made you selfish. I liked the way you were before,” and similar comments can be expected.

If they can, some of these alleged “friends” will make every effort to have you retrace your steps and resume the second-class status that has been yours historically. If, however, you withstand their efforts to restore the relationship to its previous terms, some of them will adjust to the “new you” and accept the change as a good thing for you, or a least something that is tolerable.

Others, however, will end the tie they have with you, or diminish their contact and availability to you.

Yes, you will be rejected. And, the rejection can make you wonder whether all the time, expense, and therapeutic effort were worth it. Grieving will be necessary.

But, if you can persevere, you should be able to find new friends who are healthier for you and less self-interested, while at least some of your old friends will stick around and be more enjoyable to be with.

It can be quite a disappointment to find that some of those you hoped would be most happy for you and encouraging of your growth are the least supportive.

But, as the old saying goes, “with friends like that, you don’t need any enemies.”

Opt for change and hold your ground. If you cling to your dysfunction in order to keep these pseudo-friends, you have chosen their needs over your own.

The best of your friends and family will want what is best for you.

Always.

The apparently disapproving visage of Brittany Dog is the work of Uber Phot. It is sourced from Wikimedia Commons.

What Do Antidepressants Really Do?

I believe that the oldest reference to an antidepressant medicine comes in Homer’s Odyssey, which “could not have been completed much before the end of the eighth century B.C” according to Richmond Lattimore. The reference occurs when Menelaos (brother of Agamemnon),  Telemachos (son of Odysseus), and others are grieving the loss of friends and relatives in the Trojan War. Helen, the wife of Menelaos, is also present. It was her departure to the walled city of Troy with Paris that triggered the assault on that fortress to retrieve her. Having since returned to her husband, she wishes to salve the emotional pain of the men who are gathered at her home. The passage reads as follows in Lattimore’s translation:

“Into the wine of which they were drinking she cast a medicine of heartease, free of gall, to make one forget all sorrows, and whoever had drunk it down once it had been mixed in the wine bowl, for the day that he drank it would have no tear role down his face, not if his mother died and his father died, not if men murdered a brother or a beloved son in his presence, with the bronze, and he with his own eyes saw it.”

That would be a potent brew indeed. But the idea of it prompts me to say a few words about what an antidepressant can and cannot do, for there is much misunderstanding on this point. And, by the way, the first real antidepressants only became available in the 1950s.

An antidepressant does not make you giddy about your life or impervious to emotional pain; it doesn’t make you forget bad things. In other words, it is not what Helen of Troy administered. If an antidepressant is working well, it helps put a floor under you. That is to say, many people with depression feel as though there is nothing holding them up (metaphorically speaking), no bottom to their suffering.

An effective medication creates that bottom, relieving them of the sense that they are without any support underneath them. It reduces their suffering too, makes them less prone to crying, less exhausted, and less subject either to over-eating or having no appetite, and usually able to sleep better. In other words, the medicine helps you tolerate life and helps normalize that life.

Some people, including quite a number who shy away from psychiatric medications or medication or any kind, actually are attempting to “doctor” themselves with drugs or alcohol.

There is danger here, naturally.

You probably know some of the dangers, but one I want to mention in particular is the depressant-effect of alcohol. It might make you feel better in the short-run, but in the long-run it is likely to fuel your depression, not to mention create a dependency.

As the old Chinese expression goes, “First the man takes the drink, then the drink takes the man.”

I suspect that you know someone who believes that psychotropic medication (and perhaps psychotherapy too) is a crutch. There is no denying that being treated for emotional problems can produce negative judgments and a stigma. Moreover, historically speaking, insurance companies have paid less well for therapy and psychotropic medication than for “physical” illnesses. That has just changed in 2010, but the stigma won’t be legislatively erased by the US congress, as was achieved by “parity” legislation that now requires equal insurance coverage of both physical and “mental or nervous” conditions.

Yet some categories of depression are certainly just as “physical” as an imperfect gall bladder is, for instance. Specifically, Bipolar Disorder, also called Manic-Depressive Disorder, is one such biologically-based psychiatric category where medical intervention is often enormously helpful, if not essential.

Would you want your severely diabetic loved-one to avoid the “crutch” of necessary medication? If your answer is “no,” then you shouldn’t be put-off by treating a biologically-based depression with a proper medication to stabilize his mood.

Nonetheless, it is true that many depressed individuals do not have any biological flaw or chemical imbalance, but rather are reacting emotionally to difficult life circumstances such as repeated losses (e.g. divorce, job loss), unfinished grief, or abuse of one kind or another. Very often psychotherapy is able  to successfully treat these people without the benefit of medication. Indeed, sometimes patients are too quick to obtain antidepressant prescriptions which take the edge off their feelings enough to reduce their motivation to address difficult life circumstances, including repetitive patterns of behavior that lead to unhappiness.  In that event, they will risk having to stay on antidepressants lest they fall back into depression.

For those patients, on the other hand, who successfully address their issues in psychotherapy, antidepressants may never be needed or, if they are used, might be required only temporarily.

If you are seeing a therapist for depression, talk with him about medicine for your condition, especially if you feel that you need immediate relief or are having suicidal thoughts. Beware equally of therapists who never want their patients to go on medication, as well as those who always do.

I should mention that while many depressed people obtain medication from their family or primary-care physician or general practitioner (GP), this isn’t always the best source of psychotropic mood-altering substances. While some GPs are both comfortable with and experienced in prescribing such medication, some are hesitant or unsure. The latter group may be less adept at identifying the precise antidepressant which is best for you given your particular symptoms; moreover, their hesitation can cause them to give you too low a dose to obtain a therapeutic benefit.

A good psychiatrist, by contrast, is absolutely up-to-date on everything about the medications available to treat you, adept at identifying which of the available antidepressants is the best fit for your particular situation, and knows how to get you to a therapeutic level of the medicine as quickly as possible. Since those in pain so often feel as if there will be no end to their suffering, and since antidepressants often take a several weeks to produce relief, getting the medicine right as quickly as possible is very important.

If you do choose to obtain medication, be sure to educate yourself about your condition and the possible side-effects of the medication being suggested. Not all physicians are good about describing those side-effects before-hand, even including the sexual side-effects produced by some antidepressants. Be your own advocate. Don’t be passive in treatment. It is your body, it is your life.

Last I heard, you only get one of each.

What Happens in Psychotherapy?

What does psychotherapy do and how does it do that? Good questions, and even some therapists might have a hard time answering them. Of course, some of the goals are obvious: reduce depression, have better relationships, eliminate anxiety, enjoy your life more, and stop worrying. But what are the elements that get you there? I’ll give you a sense of some of the factors that permit those goals to be achieved.

1. Trust. Many people entering treatment have trust issues: they trust too easily or not at all, usually the latter. Trust will start with the relationship between you and the therapist. Simple things: does he listen? Does he understand? Does he seem interested and dedicated? Is he dependable? Does he care? If the answers to these questions are “yes,” then it will be a bit easier to begin to trust others. The experience of a benign relationship with one person can open you to the possibility that this experience can be achieved elsewhere in your life.

2. Validation. Many people coming into psychotherapy having been told that they should “get over it,” that they “shouldn’t feel that way,” that they shouldn’t complain or “whine;” or having been ignored, dismissed, or criticized too often when trying to express themselves. Some folks believe feelings are unimportant; others might state that it is not “masculine” to feel too much, and so forth. As a result, many new patients have so buried their feelings that they are alienated from themselves and don’t know whether it is appropriate to think or feel as they do. A good therapist creates a safe place for talking about such things (trust again), and gives the person a sense that there is value in what they feel and think. Over time, this action, by itself, can help improve self esteem and reduce sadness and alienation.

3. Grieving. If one has not had supportive relationships (with people who are both trustworthy and validating), the sense of loss or absence contributes to sadness, and sometimes to depression. The relationship with the therapist allows you to express the emotions related to loss (both sadness and anger) to someone who listens patiently and shows concern. As you process those feelings of loss, your sadness should gradually diminish. The therapist serves as a witness and again, as someone who validates your pain. Grieving in isolation too often contributes to the feeling of disconnection and alienation from the world. Grieving with someone who cares reconnects you to one of the things that can be good in life: human contact.

4. Learning new things. Any good therapist needs to provide some guidance and tools that enable change. This might come in the form of helping you learn and practice new social skills (including acting these skills out with the therapist), assisting you in changing how you think (cognitive restructuring) that helps you reduce self-defeating thoughts, training in how to be assertive (again with role playing in the therapy session), or meditation.

5. A change in perspective. A good therapist will provide you with new ways of thinking about the world and about your life. Since he can see you from the outside, he is more likely to see you in a way that you cannot see yourself.

6. Facing things, not avoiding things. We all practice avoidance some of the time, and some of the time it is a useful thing. Unfortunately, many of us practice it all too much. We distract ourselves from pain and avoid challenging situations. We can use food, TV, shopping, sex, drugs, alcohol, the internet, and computer games to get us away from whatever it is we can’t handle. We worry about problems rather than coming up with a plan of action and taking them on. We don’t ask out the pretty girl for fear of rejection, or say “no” to people who want to befriend us for the same reason. We stay at a “dead-end” job because of our insecurities. And, of course, unhappiness is the result.

A therapist can assist you in identifying the patterns of avoidance, help you to gradually become able to tolerate anxiety (by use of such things as cognitive restructuring, role playing or meditation) and give you tasks that gradually increase in difficulty so that you reduce avoidance and begin to take action that works.

7. Acceptance. By acceptance I am referring to acceptance of the nature of life and the discomfort that comes with living; acceptance of the fact that being open to life allows you to experience satisfaction and joy, but also opens you to pain; and awareness of the temporary nature of most of that discomfort. The more that you take life on its terms, the less you will be trapped by it.

Remember playing with the Chinese Finger Puzzle as a kid, the cylindrical woven structure made of bamboo, open at both ends? You put your two index fingers into it, but when you pulled hard to get your fingers out, you became more stuck. Only by releasing the tension and moving your fingers toward the center of the device, did it collapse and no longer held you tight. Life is a lot like that to the extent that we must stop engaging in behaviors that only make us more “stuck.”Acceptance allows you to free yourself, at least somewhat, from what is distressing about life.

8. Valued Action. If you are caught in the struggle with your emotions, or focused on avoidance of pain, what is good in life will be hard to achieve. Therapy can help you to think about the life you would like to lead, the life that is consistent with your values, and help to relieve you of the habits that keep you so wound-up that you don’t have time to think about what it is you would really like to do, and what it is that would lead you to a sense of satisfaction and accomplishment. What is your true self? Therapy can help you find out and encourage that person to exist in the world.

The description I’ve given you is based, in part, on my experience in life and training, especially training in such therapeutic approaches as cognitive behavior therapy (CBT), mindfulness-based behavior therapy, Acceptance and Commitment Therapy (ACT), and psychodynamic psychotherapy. Other therapists may have a different view of what is important and how to help you get to the point that your life is more satisfying and less fraught with depression, anxiety, or chronic relationship problems. But here, at least, I hope that I have given you some sense of direction and some reason to be hopeful about the possibility of change in your life.