I’ve been in psychotherapy for over a year now, since Oct. 2013, and have been pretty open about it with family and friends. I see it as a good thing I’m doing for myself, a long-overdue exercise in healing and self-care. I’m really touched by all of the support I’ve had in my process from people in my life, and I’ve also fielded a lot of questions. Several people are interested in trying therapy or are considering it based on my experience, and I think that’s wonderful. In the course of these conversations, I’ve been saddened to see how stigmatized talk therapy is compared to drug therapy, self-help, or bootstrapping, and I wanted to collect some of my experiences and observations here to help others who are looking for healing and think psychotherapy might be right for them. My intention is in no way to convince those who don’t want therapy that they need it. This essay is for the curious, specifically.
Therapy is like yoga. I believe most people could benefit from it. However, like yoga, you need to be motivated to get those benefits, and you have to do it for yourself, not for someone else or as an exercise in self-flagellation because you think there’s something wrong with you. It’s an “I care enough about myself and am prepared to work very hard” choice, not a “there’s something wrong with me and people think I should do this” choice.
What is therapy and why do I need it?
Psychotherapy is as much art as science, but so is conventional medicine, so don’t let that scare you away. I dismissed therapy for most of my life because collectively the field of psychology failed to cure my schizophrenic mother. The only thing that helped her at all was powerful antipsychotic medication, and that only helped about 50 percent of her symptoms. To me, talk therapy was bunk. I couldn’t understand why none of my mother’s therapists could talk her out of her damaging fixed beliefs. Now I understand that those beliefs are a deeply hardwired symptom of schizophrenia, and that the therapy was probably crucial in helping her cope with her disease, which she actually did really well. There is no cure for schizophrenia. My expectations were unreasonable. I was also afraid of developing or being diagnosed with her illness, or something equally horrible.
And that’s too bad, because therapy isn’t necessarily about curing organically-based serious mental illness. It’s about healing woundedness and bringing to resolution an interrupted process of maturation–issues that equally affect people with clinical mental illness and most of those without. If you think about physical therapy, it’s much the same. The therapy is designed to optimize your functioning and restore your full range of movement and comfort, and you can benefit whether you are fully able bodied or confined to a wheelchair. For some conditions, talk therapy can bring total cure. For others, it’s an adjunct therapy, a necessary but not sufficient condition for wholeness.
Traditional psychotherapy has phases. Most insurance plans place a cap on therapy visits, such as 10 or 20 visits per year, and that’s a shame because a handful of visits barely scratches the surface, and does not really get you past the coping skills phase, and what you want to achieve is self-insight, “corrective emotional experience,” and true growth. That’s not a quick fix. No one can explain to you how therapy really works until you’ve been through the process yourself. This is why psychotherapy training necessitates undergoing psychotherapy. It helps you understand how all the moving parts of the self fit together, and it helps you identify your own projections and unconscious triggers and behaviors. When you have been to enough therapy, your insight into others, and your compassion for others, levels up substantially.
Healing woundedness is not a do-it-yourself endeavor. I’m not ready to say that you can never heal without therapy, but mostly people don’t. They get older, they cope, they develop defenses, and their personalities develop around their wounds like a topiary on its wires. Reading a lot of self-help books is nearly worthless because your “stuff” is buried in your unconscious, where you can’t see it. It’s like trying to lance a boil on your own butt. There are parts of yourself that you can’t reach. Sometimes we all need help from another person who has the distance and perspective to see what we ourselves can’t.
Every wounded person is different, and yet also the same. Children under six do not have the cognitive capacity to contextualize trauma or abuse. As a young child, you can’t reason that Mom is an alcoholic and her behavior is related to her illness and that she loves you and is doing her best. Nor can you understand that tragedy and loss happens for no reason. Instead the young child blames him or herself for those events, and develops a profound and life-altering shame. Usually that shame is unconscious, but it affects adult behavior and relationships in deep ways. This is where self-defeating behaviors like avoidance of intimacy, procrastination, being “difficult” etc. come from. That woundedness can also drive depression and anxiety
You may be wounded even if you’re not aware of anything specific that caused it. Children raised by significantly wounded parents can pick up their own wounds by osmosis. Behavior leaks out of the parent and infects the child with shame. Maybe your parents had a habit of invalidating your feelings, or maybe they were distant and uninvolved. Don’t judge your degree of woundedness. Just heal it.
None of this is about blaming parents, either our own parents or ourselves as parents. We’re all doing the best we can, and damage happens. The good news is there are ways to repair that damage. Psychotherapy is one of the best, most effective tools we have, and, yes, young-cynical Catherine, it is scientifically validated.
The wounded child in you
Would you hand a three-year-old child the keys to your car? Would you put that child in charge of your huge presentation at work? Would you let that child parent your children? That would be crazy, but that’s exactly what a lot of us do. When we’re wounded, we split off a piece of ourselves that is the age we were at the time of wounding, and that wounded child surges up and starts driving the bus when we get triggered.
When you see irrational or immature behavior in adults, that’s them acting from their wounds. Road rage. Selfishness. Addiction. It gets pretty intense when two or more wounded children are summoned. When a group of people gets triggered, watch out! Drama central! Some people are so wounded that they don’t even alternate between a mature self and a wounded child self. They just walk around with their woundedness hanging out 100% of the time, and they trigger those around them continuously. Those people are commonly described as toxic, but that toxicity only works on the unhealed wounds of others. Heal your wounds, and the toxic people may still annoy you, but won’t have any real power in your life. The only people with literal power to hurt you are those who resort to literal violence. We have enough of those types of people in our society to trouble us without getting ourselves all worked up over people who are simply mean, overly demanding, or flailing in their own unconsciousness. You can even have compassion and help in your own way for those more heavily damaged individuals by having healthy boundaries, holding them accountable without blame and encouraging any small steps toward growth. That’s it. Adults don’t need your rescue or fixing. Focus on yourself and your children.
We have a powerful drive to heal our wounds. As adults, we unconsciously seek intimate partners that let us re-enact our childhood traumas so that we can heal them. Unfortunately, the woundedness in us attracts other, equally wounded people, and while it would be nice if we could find a partner that reminds us strongly of our abusive/mentally ill/addicted/emotionally distant parent, then fix them and get the love we craved all along, that behavior is more likely a recipe for retraumatizing and revictimizing ourselves. Ouch ouch ouch. The partners that really would help our wounds to heal are likely not to be attracted to the childish behavior we often exhibit in our pain. Double ouch. We all know someone who cycles from one abusive relationship to the next. That person is relentlessly trying to heal a wound, but is instead retraumatizing herself (or himself) by throwing herself in front of the same bus over and over. That is the drive to heal in action.
It often happens that a child will be wounded or traumatized, and will “grow up” very fast and become a people-pleasing overachiever. These kids are commonly praised for resilience and strength, but in reality, this is another manifestation of unhealed wounds. If this describes you, you’re a “red zone case,” as dog trainer Cesar Millan would term it. You’ve learned how to repress your emotions so effectively that you’ve become a ticking time bomb. Your lack of depression, high functionality, and high level of achievement in the face of significant early childhood trauma shows that you are a strong person with an equally strong risk of breakdown or crisis.
When I started looking into therapy, and I told therapists my childhood history, they invariably asked, “Have you ever had any trauma work?” and I said, “No.” And then there would be this very subtle, very discreet, “Oh boy we’ve got a live one here” expression as they scribbled furiously on their clipboards. So much scribbling. I’m at the point where I kind of love it when I say something and the session screeches to a halt while my therapist scribbles a full page of notes.
There’s no shame in this. You survived, and you did it the only way you know how. Therapy is about healing and moving forward, not judging what you had to do to get where you are.
What happens in the room?
A lot of us have a perception of psychotherapy as a place you go to have a white-bearded analyst tell you what’s wrong with you so you can stop being crazy. That is not what happens in therapy. When you begin therapy, you can expect to encounter a sympathetic, nonjudgmental person who will guide you not only toward insight, but toward inner change at a pace that you can handle. You may be surprised to find your therapist much more supportive than “friends” and family members who stigmatize or blame you for your struggles with very deep feelings. You may have been shamed or blamed into therapy to begin with, and expect more of the same. If you start therapy, and you’re uncomfortable or feel judged, you haven’t found the right match. That’s normal. Therapy works through relationship, and there are innumerable valid reasons why you might not connect with a particular therapist. Don’t overthink it. Just keep searching until you find a good match.
It’s very common that therapy will chug along quite well for a while, and then get “stuck” or stagnate as you bump up against your own defenses. You may find yourself disillusioned with your therapist or wanting to quit. That kind of crisis usually precedes a big breakthrough, if you stick with it.
Therapy is tremendously hard work. It involves facing losses in the present and in the past. You may for the first time in decades truly grieve a loss after living in repressed bitterness, blame and resentment. You may frighten yourself with your own anger. You may struggle to assert yourself in the workplace for the first time ever. You may have to, for the first time, acknowledge your disappointment in your loved ones as you let go of attempts to control them and their choices. You may have to take an honest look at your own behaviors and then forgive yourself. All of this is extremely hard.
Most of us grown-up wounded children have dysfunctional relationships resulting from our woundedness. As we heal and change, as we develop boundaries and start asking for what we need, some of those relationships will inevitably fall apart. You will probably find that the “exciting,” “popular,” or “sexy” people become impatient, offended, or deeply triggered by your new boundaries and directness (they are wounded children, too). At the same time, the “boring” Steady Freddies in your life may surprise you by stepping up to the plate and supporting you or making their own changes in order to maintain the relationship. While all of this is for the good, there is additional grief and disappointment as you go through those changes.
I’ve been fortunate to receive a new psychotherapy modality called EMDR that accelerates healing from past and present trauma. It involves the use of visual, aural, or tactile stimulation to accelerate processing of “stuck” emotions in the brain. A number of studies have supported EMDR, particularly in the treatment of PTSD. It is also effective for disorders such as depression, anxiety, and addiction. In addition, many emotionally-well people use EMDR for performance enhancement, as it can remove emotional blocks such as fear of failure or fear of public speaking. EMDR has been an intense and life-changing experience for me, and I think it may be the only truly effective way to reverse early life trauma. There are many accounts of people who have had years or decades of talk therapy and still struggle with their triggers and negative behaviors in spite of working through their childhood traumas over and over in therapy, who then experience total healing through EMDR.
If you have a memory that is “charged,” such that when you think about it you experience an emotional reaction, and perhaps even need to alter your life such that you avoid triggers, then you could probably benefit from EMDR. My experience is that a memory loses its “color” when processed. I can think about it without that strong jolt of electricity. It’s just a thing that happened to me, not the thing that defines me.
Nuts and bolts
Therapy is expensive and time-consuming. Many people don’t have insurance coverage or don’t have adequate coverage. You may not be able to access as much therapy as you want and need. It’s worth it to make therapy a priority, as your career and economic stability will benefit from the self care and confidence that you gain, but none of us can spin flax into gold.
You are legally and ethically entitled to confidentiality in a therapy setting. Nothing leaves the room except under a very narrow set of circumstances. Your employer does not have access to the health services you are receiving under their provided plan. Your personal thoughts, feelings, and struggles are not in any way amusing to your therapist, and generally they will be upfront if they have an emotional reaction to some behavior of yours or something you’ve shared. Whoever they are, they were called to their work to help people with problems. They are not interested in sitting in a room hour after hour with someone who is perfect.
You may have to call your insurance company to get a solid answer on what your mental illness coverage is. I know my plan documents are hopelessly opaque. If you have a choice, it helps to opt for a POS-type plan rather than an HMO, as it gives you the option to go out-of-network, which may be necessary to find the right fit in a therapist. Your first step is usually a referral by your primary care physician. In order to get insurance coverage, the therapist will need a diagnosis code, but it’s usually something vague. I think mine was “adjustment disorder.” Diagnosis or characterizing what’s “wrong” with you is generally not a priority. It’s usually not even relevant.
Some therapists offer a sliding scale for people who don’t have enough insurance coverage on their own. It may take some creativity to pay for therapy, but if you want to give it a try, you can usually find a way.
It’s a good idea to ask for referrals not only from friends, but also from professionals, if you can find them. If you have a friend who is in the field of psychology professionally, that is probably a good person to ask.
I recommend looking for therapists who have expertise in identities that are important to you. Shame around your racial, gender or sexual identity can be extremely toxic, and you want a therapist who can support that identity and bring you to wholeness and self-acceptance. That won’t happen by accident if your therapist isn’t aware and trained to deal with your identity. If you’re a white male, a race/gender/sexual identity-aware therapist may actually benefit you more than you expect, as they are also more qualified to help you deal with your privilege and the guilt you may have around it. It’s win-win.
I recommend against using a therapist aligned with your religion, not because they aren’t equally qualified, but because it’s extra hard to tell which ones are truly nonjudgmental and which are pushing a shame-based religious agenda that will hold back your healing. A good secular therapist will support your religious values. Just like you shouldn’t choose a brain surgeon based on religion, please don’t base your choice of mental health professional on religion. If your religion were going to heal your wounds, it would have already. That said, it’s your choice and if you find a religious therapist that feels like a good match, it’s worth pursuing.
If you contact an office with multiple therapists, you may be asked if you prefer a male or female therapist, so think about that in advance. You might also be offered a young/older choice. Your gut response is usually the right one. Don’t choose a therapist that reminds you of your childhood abuser. Right?
Show up on time and be prepared to pay for your session. Otherwise, there are no rules. The more candid and open you can be in therapy, the better. Ask for what you need, trust the process, don’t give up on yourself, and don’t freak out when crazy feelings come up. Embrace your crazy. You are a beautiful topiary, after all. Whatever you’ve been through, you survived. You will endure.
Well This Sucks (Depression)
sometimes happiness can only emerge from periods of unhappiness
“No. I’m Fine.”
EMDR International Association