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Psychotherapy: How does that make you feel?

August 15, 2011

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 Linda Robinson 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. Edmund Griffin, and a therapist with a degree in social work here in New Haven (Linda). I see Dr. Griffin 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 Linda 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 Linda 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. That interaction I described with Monica, 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 reminded me of my sister. Kate reminded me of my sister. Monica reminded me of my sister. Linda, who is a bit older than any of the past female therapists, reminds me of a really important mentor in college, Nancy Klien 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 Linda doing the same thing. She’s 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.

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5 Comments leave one →
  1. judy permalink
    August 15, 2011 5:55 pm

    You are a wealth of information on many subjects but this one is of special intrest to me. Your teacher qualities are shining through. Therapy is not a quick fix but something that takes time and is often emotionally painful. I don’t think I would have had the courage to start the therapy I needed if I had not met you. You are my inspiration. I saw where you were and the progress you made. I think therapy freed you to be your authentic self. You are one of the most loving and giving people I know. (Funny how other people see that in us before we see it in ourselves.) Your doing this blog is just one example of your progress, you are willing to share yourself for the benefit of others. Thank you for being a light in my life. Love You!

    • August 15, 2011 6:12 pm

      I love you, too, Judy! You are the best mother-in-law anyone could ever want. I think you’re totally right that therapy let me untangle an authentic self from all the masks and habits I had acquired to “protect” me over the years. So often, a therapist will ask “Why do you think of it that way?” And I’ll realize wow, I don’t, that is totally my dad’s opinion. Maybe I should come up with one of my own! And that’s only part of it. When I came out of my protective shell, I met people like you, who were always so happy with who I am. I don’t need to be perfect. And, for the record, we all love you just the way you are. I wish you could love yourself as much as we love you.

  2. August 16, 2011 12:13 am

    There’s a million more types of therapy and as research is produced it’s very exciting to be able to get closer to finding what the mechanism is behind treatment that actually does the work. I like hearing points of view on therapy from clients because it’s candid and helps me (as a therapist) understand what’s getting across to the general public. Obviously it’s different than what I learn straight from class, conferences or between colleagues. It’s also part of why I’m in therapy myself! To add to types of therapists: marriage/family therapists (MFT’s), drug/alcohol counselors and the term “clinician.” Also, psychologists (Ph.D. or Psy.D.) are the ones who can do psych testing. You’re accurate about psychiatrists w/meds, legally that’s their gig (they get MD’s, they’re biology not behavior), though a few states allow psychologists to have prescription privileges (w/post-doc degree). Also in general, pay attention to licensing requirements for various therapists in your state, ea state is different, and it’s a good way to judge level of experience, training and up-to-date knowledge w/in the field. And as always, thanks for sharing!

    • August 16, 2011 9:54 am

      Wow, thanks Jess! Yeah, that link I have up there goes into 10 more kinds of therapy than I listed. My psychiatrist does psychoanalysis and other kinds of therapy, just not with me. But he’s an M.D./Ph.D. What’s the difference between psych testing and diagnosis? Because I know a family doctor can write down “depression” and prescribe Prozac, but that’s definitely not a psych test. I’ve been tested that way (they always think I’m bipolar at first. I’m not, I was just really high-achieving for a depressed person. =P) but I guess I’m wondering when they decide to do it. Would your family doc send you to a psychiatrist in a hospital if s/he was worried you were bipolar, for example? One more question–what do you mean about the term “clinician”?

  3. August 17, 2011 1:54 am

    Ooh good questions! Psychological testing (psych testing) include written or performance assessments that look at achievement, personality, cognitive, neuropsychological or other socio/emo/psychological patterns. Diagnosis can often be made without an assessment; many mental health professionals use the DSM (Diagnostic Statistical Manual, now in revised 4th edition). This is the book that is put out by the American Psychiatric Association which provides codes that is used in insurance billing -and there’s a ton of controversy with this and could be a whole other blog. So basically anyone w/the manual and training in assessing symptoms can suggest a diagnosis. Psych testing can help differentiate between various diagnoses, and also help identify the cause behind certain symptoms are shown in multiple diagnoses (poor concentration, for example). Counselors or MD’s can give checklists which have various symptoms that a client would indicate, this is more of an aid to observation rather than an assessment that requires understanding of behavioral measurement and interpretation. So if your family doc noticed symptoms that are often indicative of certain mental illness and they were concerned for your safety or well-being they could refer you to a psychiatrist or psychologist (or often both, along with other professionals on a consult team, as you had mentioned in an earlier blog). “Clinician” – I guess I don’t know where that term comes from, but it’s used in the field so maybe it’s jargon. I think it’s primarily used in place of “psychologist”, such as a Psy.D. in Clinical Psychology. Did that make sense?

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