Authors: MD Michael Bennett
F*ck Feelings (43 page)
â¢Â Develop a good idea of what treatment does and doesn't have to offer and what its risks and costs are
â¢Â Develop your own reasons for determining whether higher-risk, higher-cost treatment is worth pursuing
â¢Â Make treatment decisions that are worthwhile, whether or not they get you a good result
Here's how you can do it:
â¢Â Determine rationally whether your problems are worth getting treatment for, or would actually get worse with too much attention
â¢Â Ask questions and do a little research to figure out what treatments have to offer and the risk and cost of trying them
â¢Â Shop for a therapist thoughtfully
â¢Â Evaluate the effectiveness of a particular treatment, and its costs and side effects, without assuming that a poor result is anyone's fault
â¢Â List your criteria for considering treatment worthwhile, aside from its making you feel better
â¢Â List your criteria for stopping treatment to see whether or not you continue to need it
Here's what to tell yourself/friends/your therapist about your treatment decisions.
Dear [Self/Concerned Friend/Therapist Who Would Like to Take Me On],
I feel like I should be able to [feel/do/relate/function/pitch] better than I do, but I won't let [frustrated ambition/comments of others/peer comparisons] get me to waste time on treatment unless I believe my problems will possibly [cost me my job/drive away my spouse/cause me to burst into tears or rage in the middle of ordering a burrito]. If I think treatment is necessary, I have no doubt I can learn enough about it to decide what's [worth trying/inappropriate/total bullshit] and whether the risk and cost are worth it.
While we try to avoid shrinky jargon in this book, there's no way to avoid it when describing the different types of therapy, many of which (e.g., CBT, DBT, psychopharmacology) sound to the average person like the names of chemical weapons used in Vietnam.
Below we explain these terms by giving a brief description of several therapies, including how likely they are to be covered by insurance, who performs them, their negative aspects, and a one-to-ten rating on the BTPS, aka, the “bullshit-to-pragmatic scale.” According to the BTPS, a therapy with a rating of one is totally flaky and subjective (e.g., new age crystal-type bullshit, relying on willpower, etc.), and a therapy with a rating of ten is supremely objective, measurable, and unbiased (e.g., a kind of therapy that hasn't been invented yet and is performed by a robot, but some existing therapies get close). Ratings are based on the assumption that the patient is a willing and eager participant in therapy; if not, he'll rate everything as 100 percent bullshit anyway.
Of course, you can always learn more about each treatment by discussing it with your primary care doctor, looking online, or talking to friends about their own therapy experiences, but for now, here are the basics.
Therapy Basics | Done By | What It Is | Drawbacks |
Old-School Talk Therapies | Psychiatrists (MDs), psychologists (PhDs), social workers, nurses, the professional hand-holders on | Therapist asks “How do you feel?” followed by painful silence, followed by the therapist's suggesting squirm-inducing reasons for what you did or didn't say or why you get angry when you're really sad or vice versa or something about your mother, etc. | Still popular on TV and among older clinicians, but younger clinicians have more faith in cognitive and behavioral techniques. Not very popular among most patients, who want direct answers and have less patience for painful processes that take forever to show results, especially when it's on their dime. |
Current Talk Therapies | Those in all major clinical disciplines, but talking more like consultants or teachers than stereotypical shrinks. | Therapist asking questions and giving advice, support, and criticism. Basically a professional friend who is legally prohibited from gossiping to others or even acknowledging they know you. | It isn't standardizedâvery dependent on the talent and steadiness of the shrink and whether you're on the same wavelength. |
Psycho-pharmacology | Psychiatrists and nurses only, at least in most states. | Quick visits centered on assessment and prescribing medications that can reduce depression, anxiety, distractibility, crazy thoughts, and hallucinations. | Visits should, but don't always, include talk therapy about your attitude, illness, and medication. Also, medications are frequently unreliable (fail to work), weak (some symptoms remain), and have side effects. |
CBT (Cognitive Behavioral Therapy) | Those in all major clinical disciplines, but more often psychologists and social workers than MDs. | Identifies standard negatively distorted thoughts usually caused by anxiety, depression, and other conditions, and then teaches you mental and behavioral exercises for fighting their impact on your beliefs and habits. | No quick relief, but makes you feel stronger if you do CBT exercises, negotiating with and dismissing the negative thoughts that make you feel bad in the first place. |
DBT (Dialectical Behavior Therapy) | Those in all major clinical disciplines, with special DBT training. | A kind of CBT that focuses on thoughts of despair, self-hate, and self-injury and teaches a set of thought-and-behavior exercises for staying positive and not giving in to dangerous impulses. | Doesn't immediately reduce your |
ECT (Electroconvulsive Therapy) | Doctors in hospitals. | A method for causing seizures in people who don't have epilepsy, because seizures tend to clear up depression (as was probably discovered thousands of years ago). Only administered in hospitals under anesthesia. | Impairs recent memory and requires lots of time and money, because you need to be anesthetized first so the seizure won't hurt you. However, trust that it is nothing like the bullshit shown in |
TMS (Transcranial Magnetic Stimulation) | Those in all major clinical disciplines. | A painless method for applying intense magnetic fields to specific areas of the brain, it may help depression without requiring anesthesia or causing memory loss. | Not cheap, not welcomed by insurance, not backed by tons of research. It may require many daily sessions followed by refresher sessions. |
Couples or Family Therapy | Those in all major clinical disciplines. | Meeting as a couple or family, uses many different techniques to identify problems and conflicts and get people to work together on solutions. | Not guaranteed to keep things from exploding (think Jerry Springer), particularly if the therapist gives people too much encouragement to air, or fart out, their grievances and share their feelings (see analogy on |
Freudian Psychoanalysis | Used to be psychiatrists (MDs), now those in all major clinical disciplines who have received years of training in specialized institutes that teach the theories of Sigmund Freud (1856â1939), granddaddy of talk therapy. | Lying on a couch, usually several times a week, with your back to a relatively silent therapist, you are asked to talk about whatever comes into your mind and then analyze it with the invisible therapist's guidance. Just as Freud did it. Mothers are a frequent topic. | Costly and slow, but impresses some people as very interesting and stimulating, so if you like that kind of thing and have the money ($50K/year) to spend, enjoy. |
Jungian Analysis, aka, Analytical Analysis | Those in all major clinical disciplines, but with years of training at specialized institutes that teach the theories of Carl Jung (1875â1961), frenemy of Freud. | Like Freudian analysis, except Jungian analysis asks the patient to focus on dreams, myths, and folklore-based archetypes so they can become one with the unconscious. PS: Jung might have had schizophrenia. | Equally costly and slow as Freudian analysis, but impresses some people as very interesting and stimulating, if you like that sort of thing (and the Deptford Trilogy by the legendary Canadian author Robertson Davies). |
Primal Scream Therapy | Those in all major clinical disciplines, but mostly well-meaning psychologists with MAs or PhDs. | Nearly extinct method (popular in the 1970s), held mostly in padded rooms where patients were encouraged to work out their childhood trauma by having tantrums and generally losing their shit. | Loud, dated, and probably not effective. The padded rooms, however, are great fun for kids. |
Therapy is a lot like dating someone; the only thing harder than knowing when to get involved is knowing when to walk away. There is no marriage in the therapy analogy (just among therapists, as with a certain author of this book), so at some point down the line, your current course of therapy must end.
Most people assume, logically, that treatment doesn't last forever, but as long as they expect it to make them feel better and gain more control over their lives, they find themselves engaged in a process that never seems to end.
The reason, of course, is that treatment is seldom completely effective, and expecting it to be so means you can stop therapy only when all your pain goes away; i.e., when you stop living. Quitting before you get there, even if “there” doesn't exist, makes you feel more responsible than ever for the things about your life you'd most like to change.
Similarly, if treatment lifts your spirits and gives you perspective that rapidly disappears when you stop for even a week because your shrink needs bunion surgery, it's natural to feel you're not finished yet and won't be
until your good feelings last longer and you're able to maintain a positive, realistic perspective on your own.
Since treatment of any kind, no matter how frequently it occurs or how deeply it delves into your hidden feelings and painful issues, seldom achieves the kind of change that people expect, it's reasonable to stop at any time you think you're no longer benefiting, regardless of whether there's lots that's still wrong with you.
Your goal is to get what you can out of treatment and accept whatever ills you can't solve. Don't cling to the idea that it has more to offer if you just try harder and longer. You haven't failed; treatment just isn't that powerful, and maybe not that necessary.
It's also reasonable to stop treatment (or at least pull back) if it's not bringing about measurable improvement, even though you still feel you need it. After all, it's costly and you may do fine without it, regardless of how anxious you are not to lose it. Ideally, treatment should show you that you don't need certain things as much as you feel you do, even though it hurts to let them goâlike finding the strength to leave an abusive partner or quit drinkingâand gaining the courage to quit treatment itself is often a sign of success.
Of course, just because treatment stops doesn't mean you should ever give up on managing bad behavior or getting on with life in spite of bad symptoms, without a therapist; there are plenty of tools out there, including readings and support groups, that can fill the therapy void. Don't rely on treatment unless you see strong evidence that it's making a difference and doing so in a way you can't replicate otherwise.
Sometimes you'll find that continued treatment is, indeed, necessary to maintain stability and prevent you from relapsing. If so, use it only when necessary, as measured by how well you do as you cut back. Never depend on treatment for support if you can find another source, because therapy is the high-maintenance ex you can stay friends with only if you don't fall into old habits again.