How do therapists deal with their own mind
A little guide to psychotherapy
If my ten years of therapy were a marriage, I would be celebrating a rose wedding now. I'm 25 and have been to a child psychologist for the past decade, have had cognitive behavioral therapy and psychotherapy paid for by the health insurance company several times, and have also been privately treated by various therapists. I've often toyed with the idea of throwing it all out, but in the end it was just the painful outgrowth of a good cause.
The reasons for my treatments: Anxiety, depression, premenstrual dysphoric disorder (PMDS), psychosis, dissociation, mania, eating disorder and other things that are not easy to classify. I'm not saying that I understand how therapy affects every individual mental illness, and of course each person reacts differently. But from years of experience I've learned a lot that I wish someone would have told me sooner. And that's exactly what I'm sharing with you now.
It's hard to get a place in therapy
Health insurance companies do not like to pay more than necessary. And even if your health insurance company pays the costs because you want to treat a recognized psychological problem with a therapist with health insurance approval, the next problem follows: specialist practices are hopelessly overburdened in many regions. If you wait months for your first appointment only to find out that it doesn't work out with that person, it can get pretty messed up. You may have to call your fingers sore, and if your problem just can't wait that long, there are some bureaucratic hurdles before you are given higher priority (if at all).
Because of such hurdles, however, do not convince yourself that you are "not sick enough" for therapy. And with all the searching and waiting, try not to think that it is too much of a hassle. Once you have your appointment, that was half the battle. Well, except for ...
Sometimes you have to search longer to find the right person
Therapists are people, and people can be annoying. You don't have to like your therapist, but you should at least find them comfortable and, most importantly, be convinced of their approach to therapy.
I was once treated by a dear man who kept going well beyond the agreed hour, sometimes even two or three. He recommended books and TV series to me that he knew I would like. When I went to see him, it felt a bit like visiting Grandpa, only with more existential topics of conversation. At the end of the session, he waved to me from his front door. I went around the next corner and burst into tears because he was so nice to me - I realized how little nice I was to myself.
Other therapists are clinical and tough. You can read pretty much anything you want in her facial expression. You sit curled up on the sofa, snot on your nose and red eyes, you have just recounted a trauma in detail, and the face of the person opposite is smooth as a mirror. You almost want to shout, "Hey, did you even hear what I just said bad?"
Neither approach is wrong as long as you are comfortable with it and it helps you. Strangely enough, I now like the second type.
Therapists are there to help, not to feel entertained. You are the person who reveals yourself spiritually, but in reality there is no power imbalance here.
If you are being treated privately, you can also test a second person behind the back of your therapist. Finding someone else is perfectly legitimate - just don't fall into this courtesy trap just because you don't want to reject someone. This is about your health. Even if your therapy is covered by the health insurance company, it is worth talking to the health insurance company if there are problems or if you are dissatisfied. After all the anger you had to get into therapy at all, you shouldn't let up at this point.
Even if your therapist is a good match for you, at some point this person may no longer be enough for you. Perhaps you have a specific problem that this person cannot help you with. After an important relationship ended, I had sexual issues that I needed to sort out. But I quickly noticed that the straight man I was receiving treatment did not really understand the problems a young woman has when dealing with men. I ghosted him because I couldn't bring myself to quit therapy. That was very immature, but the decision to break off was in principle the right one. I soon found a therapist who had her own life experience in the field.
Also on VICE: Maisie and her struggle with paranoid schizophrenia
You will want your therapist to like you - forget that real quick
It's normal for us to want to be liked. If you, too, are someone who likes to be particularly liked and is very happy to receive praise, you have to be particularly careful about this.
Sometimes I tell my therapist a story, and without realizing it, I take art breaks to add tension or gesticulate as I tell the story. The only explanation for this is that I want to keep her entertained. If she laughs, that's a success. When I'm doing relatively well, on the way to the therapy session I worry that I might bore them. I rack my brains so that I can at least tell one stupid thing about myself.
But just as you don't necessarily have to like your therapist as a person, the therapist doesn't have to like you too much either. If you don't fight the complacency, it will affect your therapy and make psychological breakthroughs less likely. Therapists are paid to help you, not to be entertained. You are the person who reveals yourself spiritually, but in reality there is no power imbalance here. This person is not your teacher, boss, or a parent.
Don't hide the worst things
Be terribly and cruelly honest. It took me years to stop holding back information. And every time I go to a new therapist, I have to overcome the urge anew. "If I tell her this, she'll think I'm a slut, or a bad person, or an idiot." Thoughts like this surely come to me partly because of the age difference, but mostly they just come from the fact that some things are terribly difficult to tell.
But what do you get out of it when you censor yourself? Your therapist has most likely heard much worse, and if you hold back the truth, they won't be as good at helping you. Talking about all the bad things is a process that is about being honest with yourself. Work your way up until you can admit the problem, then treat the therapist like an extension of yourself. Therapy is not about someone else giving you the roadmap for life. But so that he or she can support you in the best possible way, you have to disclose everything.
Communicate early on what you are hoping for
Back then, when I went to a new therapist to talk about sex, it was the most efficient treatment I've ever had. I had recorded with grim precision what my problems were, where I thought they came from, and that I wanted to solve them in order to be able to have healthy relationships again afterwards. At the first session, I walked into the room like a boring business lady with lists and tables, and after I finished my pitch, the therapist sat wide-eyed and said, "Wow". The easier you make it for your counterpart, the faster you can tackle the root of the problem together. And the very act of writing a plan can calm you down. When I've been very sick, I've found it helpful to repeat the plan over and over, like a mantra.
You won't remember what was said and why it was so good
Before there are aha moments during the treatment, you put the puzzle together with your therapist. You add a piece, he adds a piece, and suddenly a wonderful explanation comes from him that strikes you like a bolt of lightning. Something inside of you shifts, clicks back together. Everything makes sense! Your brain is finally feeling better, your life is getting better! As soon as you leave the room, you will think about what was said and find that you no longer remember. That can drive you crazy.
I always try to take a few notes afterwards. But often you just have to accept that the great, knot-untying insights are dormant somewhere in your subconscious and do good from there. When my therapist told me that because of my childhood trauma, I saw loneliness as the safest option, I was speechless, even though in retrospect it seems very obvious. These things seem like big revelations at first because you haven't heard them like that before. But now you take a step further, whether you really understand it or not.
Don't let a therapist tell you anything
I had a therapist who kept telling me to make a certain big decision. I ended up doing what he said, but I know I did it because of him. My health and life weren't in danger, so he should have left that entirely to me. Therapists are there to advise you, make suggestions, and guide you. Never let them lead you to a place you don't want to be. You should always be in control of all of your decisions.
Your relationships will change
After ten years of therapy, I don't even know whether I was always so talkative or just because of that. I'm incredibly shameless in real life. Regardless of loss and without self-censorship, I tell what goes through my head. Hardly anything embarrasses me. Nothing in my real life can be more stressful than what I do in the treatment room every week - and that same attitude rubs off on my relationships. I cannot put into words how much better my contact with others is thanks to the therapy. I can talk to a complete stranger on the street about anything. I have friendships where we both know we can talk about anything. But because it's only a few days before I have to talk about my psyche the next time, I don't have to bother my friends with it (unless I feel really bad). The people I date or with whom I have relationships think it's great that I can also talk through our common problems in my sessions. It's like couples therapy, only they don't have to pay for it or show up.
When my therapist tells me that she's going on a three week cruise, I get angry and think, "How selfish. What should I do during that time? Cope with myself?"
Do your homework, even if it seems pointless
Roughly speaking, psychotherapy asks why you are thinking the bad thought, while cognitive behavioral therapy asks how you can deal with or change the bad thought. I don't like cognitive behavioral therapy. It is my very personal assessment, but I find that this form of therapy is presented far too much as a universal remedy for all anxiety and depression problems.
However, I did not go along well with my first such therapy. I felt stupid ticking boxes and filling out tables - at least I couldn't even type on the laptop at the time without my hands shaking. I resisted the whole thing because it felt patronizing: first I should record exactly how my thoughts turn into feelings, and then how those feelings turn into thoughts again. It seemed pointless and like an insult to my intelligence and complexity. When at some point I gave up my arrogance and still went along with it, it helped a little.
The homework also applies to things that you plan with your therapist. Are you planning to apologize to people you treated like dirt while they were manic? Or do you want to make sure that you are in bed by 11 p.m. at the latest when you have depression, without a cell phone, tablet or laptop? Then do what you can to stick to it. And even if it's only tiny steps - don't be too strict with yourself. Every little bit helps.
You will believe that they are spying on you
Maybe you already think I'm self-centered, if not, I can go one better: I always think that therapists get curious and google me. In my defense, a therapist once mentioned something I had never told him. I asked and he said - as if it was the most normal thing in the world - he looked at my Twitter profile. In between appointments he'd rummaged through my tweets about Tinder, therapy, sex, and hangovers. All of my therapists to date have known that I am a journalist. But now when I write an article about sex or mental health I imagine them reading it and comparing my internet self to my therapy self. Perhaps her thoughts on this will wander into her own next article for a trade journal - something about the psychology of self-expression in digital media. Perhaps my therapist is reading these lines right now. (If so: I could start again on Wednesdays from now on, same time.)
You can no longer imagine your life without therapy
I was wondering if the therapy might be some kind of expensive blanket for me. When my therapist tells me that she's going on a three week cruise, I get angry and think, "How selfish. What should I do during that time? Cope with myself?" Sometimes people ask me, "Aren't you running out of topics at some point?" But chronic illness, mental health issues, and the ability to bullshit are all very permanent things.
But why should I try to stop my therapy? I can't remember when I've ever felt this consistently good. Some people take antidepressants or other medications their entire lives; I only take such drugs in phases. In the last ten years I have interrupted my therapy every now and then - for example because the health insurance company has been stubborn or because I thought I no longer needed it. And every time I crashed badly. By the time I looked for a new therapy place or had my old therapist in front of me, my overall condition had deteriorated and I had to work harder on myself again.
My biggest fear is that real madness could hit me at any time. The kind of serious mental illness you never really recover from. I know that it can happen that I lose touch with reality and create things that are not there. Even if I don't constantly make breakthroughs in depth psychology - at least every week I have a person in front of me who knows their way around and who says to me: "You are a normal person and you are not disturbed."
Maybe at some point I'll let it be and start something new that gives me stability. But at the moment I can well imagine gossiping about myself for another 20, 30 or 40 years until I feel better. I wish you the best for your own marriage with your psyche. Be good to her.
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