F*ck Feelings (44 page)

Of course, people who know about your problems will always think you need treatment, but that's their worry talking. You must rely on your own knowledge of available treatments and your experience with them to tell you whether or not you do need treatment again.

In the end, you probably don't need treatment for a long period of time and are better off relying on what you've learned and other sources of strength, knowledge, and comfort to manage problems. In other words, you may have moved on, but the time you and treatment shared together will always be special.

Among the wishes people want to fulfill before stopping treatment are:

• To first get better control of symptoms

• To first figure out why they can't stop their troubling behavior

• To completely finish healing

• To find a way to hang on to the one thing that has helped them; i.e., therapy

Here are three examples:

I like seeing my therapist and she has helped me get over my shyness, but my social life is fine now and I'm just not unhappy, so I wonder whether I really need to see her anymore. She says we haven't gotten to the root of my problem, so my shyness will probably return and get in the way of having a serious relationship, but I just don't know. My goal is to figure out whether I need to continue and why.

My therapist has been my lifeline for the past five years and I don't know what will happen if I have to stop seeing him. I can tell he's worried, too, but my insurance says that it's not “medically necessary” and won't pay for
it. Before I saw him I was very depressed and made a suicide attempt. Now I'm still depressed, but I've been working steadily and have a couple friends. I've got a long way to go, and I'm afraid of going back to the way I was before. My goal is to get the insurance company to see that my treatment is medically necessary to keep me from sliding back into the pit.

I was put on two antidepressant medications a year ago when I was very depressed, but I'm not sure I need them anymore, and I think they do nothing but make me fat and tired. I'm back to my usual blah mood, and I don't see why I should continue medications that may be doing me no good and are probably making me feel worse by making me look and feel like a hibernating bear. My goal is to get off medication.

Treatment and its results may always feel personal—and how could they not, given how they focus on your private thoughts, honesty, and commitment—but when assessing therapy's effectiveness, it's best to imagine that you're a management consultant, your therapist is an employee, and the client is your life. It's your job to figure out whether your therapist is still a valuable part of You, Inc., or whether, based on his performance, it's time to let him go.

As you may have learned from films (
Office Space
,
Up in the Air
) or from the personal experience of being brutally laid off from your job, management consultants are neither sentimental nor compassionate. That kind of objectivity can be difficult when reviewing your own treatment, but if you can accept the evidence of your own experience, even if it's disappointing, you can make hard choices the smart way.

Other people may urge you to continue treatment because they wish you didn't have to suffer so much, and while it's easier to dismiss those people when they're friends and relatives, it's harder when the main person who believes you need more from therapy is your actual therapist.

It's important, of course, to value your therapist's advice—if you'd never taken his advice to heart, you probably wouldn't have made any gains at all—but ultimately, you're the only one who can evaluate therapy's effectiveness, both for your life and your wallet, and decide whether it's
still worthwhile. He may be a problems expert, but you're the only
you
expert, and your opinion on your progress is the final authority.

Ask yourself whether the lingering fears and insecurities that therapy hasn't alleviated are doing you any harm, other than causing you to be anxious, unhappy, and self-doubting. Sure, these are not enviable emotions, but at normal levels, if they don't impair your ability to work, be decent, or live, they can actually be beneficial, since fear can help you be aware of dangerous situations, and self-doubt can get you to double-check your results. Simply put, feeling bad is sometimes good for you.

You're doing a respectable job proving to yourself, day by day, that you can take risks, do new things, and become accustomed to doing things that scare you but won't bother you nearly as much after you get used to them. Your therapist did a good job, too, which is why you should feel confident telling him it's over.

If you feel your therapist is doing a job for you that no one else could and are worried that something—running out of money, an insurance decision, your therapist's departure—will cut off your therapy and your lifeline, remember that feelings are not necessarily reality, and that severe depression and anxiety have their own way of making you feel like you're much more vulnerable and dependent on treatment than you are. If your therapy is making you feel even less independent, it's also less beneficial than you think.

Test out the reality of your need for treatment by cutting back on the frequency of your visits and finding other sources of encouragement, like twelve-step groups, depression-support groups, and friendships with people you can count on. If you haven't done it already, educate yourself about DBT exercises that you can practice when you're feeling self-destructive and hopeless. Yes, you may not feel comfortable sharing intimate information with anyone other than your therapist, but it's something you can learn and it's well worth doing.

Whether it's your own bank account or your insurance benefit that's running dry, don't let panic discourage you. Create a program
for shifting your sources of support and, almost always, you'll find you can reduce your dependence on weekly treatment. Even if you continue to need treatment, you will probably not need it regularly or weekly, so you will lower your costs and make it easier to negotiate continued support from your insurer.

If you're less worried about becoming dependent on a therapist and more worried about dependency on medication, then your assessment requires slightly more objectivity, since you're trying to ignore not just feelings of panic but also the stigma of psychotropic medication.

Assessing medication also requires you to weigh a whole new set of costs and benefits; i.e., is not being miserable/anxious/paranoid worth not being thin or able to stay awake or capable of getting a boner?

Since you're the one who knows best whether your symptoms are severe enough and happen frequently enough to be worth preventing, you're also in the best position to decide whether the medication is effective enough to justify the side effects. If you're not sure, talk to your doctor about stopping your meds, at least temporarily; it may give you an opportunity to test the medication's effectiveness and also to see whether it's responsible for symptoms that may be side effects. (Just don't go cold turkey on your own, because some medications can be harmful if discontinued too quickly.)

Another thing you might learn from talking to your doctor is that, if a medication is obviously effective and you tend to get relapses without it, taking it forever as a preventive may actually protect your brain from subtle damage that occurs to some people who have chronic depression over many years. If the idea of being dependent on a medication that long is unacceptable, just think of your meds as brain insulin; diabetics aren't ashamed that they require a lifelong drug treatment, and neither should you be.

The higher the risk from side effects (like the tendency of certain antipsychotic drugs to actually cause diabetes), the more important it is for you to stop the medication as soon as you know it's ineffective or you find a less dangerous substitute. Your job is to consider the
risks of stopping medication versus the risks of continuing it. Then, whatever decision you make will be a good one, even if it's not good for your waistline.

Don't make decisions about stopping treatment any more emotional, frightening, or mysterious than they have to be. If you trust your own observations and accept the fact that all treatments have limitations, you can be sure you'll get the most out of whatever treatment you're evaluating and do whatever's best to make You, Inc., as successful as possible.

Here's what you wish for and can't have from treatment:

• Relief from all intractable, no-good-reason-to-have-it depression and anxiety

• An understanding of why you do unreasonable things that actually gives you power to control those things

• Elimination of the dark, nasty, angry, obnoxious, addictive, and otherwise self-destructive parts of your personality

• Better relationships with people who don't want or expect to have a good relationship with you

Here's what you can aim for and actually achieve:

• Develop rational methods for determining what you really control

• Rate yourself according to how well you cope with what you don't control, regardless of what your instincts tell you

• Learn tricks for managing your weaknesses

Here's how you can do it:

• Use treatment as a tool to discover the limits of what you control

• Find out what treatments are available, what they offer, and what risk they pose

• Define the conditions of illness or disability that, in your opinion, make looking for treatment necessary

• Define the conditions for progress that, in your opinion, make treatment effective and worth continuing

• Stop, suspend, or reduce the frequency of treatment if you don't see your problem improving

Here's what to tell yourself/your shrink when you're considering starting or stopping treatment.

Dear [Self/Shrink/Concerned Friend],

I often feel that my life is a [mess/sewer/vale of tears], but even so, I'm actually coping pretty well overall. I want to find out whether treatment can help me stop [crying/swearing/being afraid of everything, including my own shadow] and I've read up on what's available. I will continue to look for help until it's clear that I'm as [antonym for “broken”] as I'm ever going to be, and then I'll know I've done my best to manage my psychiatric/life problems.

Lower-Cost DIY Treatments

Before you commit to therapy, or if you just can't afford it, we recommend you try less costly alternatives to professional treatment. Below is a sampling of such alternatives, listed in order from those with the highest benefit-to-risk ratio to those with the lowest (and highest absurdity factor).

If “Things You Can't Control” was a round on
Family Feud
, then the number one choice, above “natural weight” and “the weather,” would be “other people's will.” When you want to get mental-health treatment for someone who believes they don't need it, it's natural to push them in any way you can, but if you thought controlling someone was difficult, try controlling someone who can't control his own mind. Your urge to drive him to treatment may just drive you nuts.