To Shrink Or Not To Shrink: When Is a Good Time to Consider Psychotherapy

23 Dec To Shrink Or Not To Shrink: When Is a Good Time to Consider Psychotherapy

Breaks and holidays are times of self-reflection. Away from their routines, people take stock of their lives, and often at these times they make a commitment to a fresh start. Since these periods emphasize unstructured time for bonding and socializing, it is in these times that people often notice how their social and romantic relations are lacking. As the break is about to end and a new structured study/work time approaches at the horizon, people may start having negative feelings and anxiety, dread, and sadness, and the anticipation of boredom may start to creep in. Indeed, it is in the period just after the winter holidays as well as in the period just after the summer break, that prospective patients start calling in great number to inquire about therapy.

Therapy is one of the many options for self-improvement and well-being. Since I believe in therapy and it is my passion, I made it my profession. I am enthusiastic about it and recommend it liberally to anyone, even if nothing at all is seriously bothering them. For instance, I recommend it as preventive care to couples that are about to engage and to anyone that is about to make big decisions or is going through changes. I believe in an integrative approach, which takes into consideration the different aspects of the individual: the emotional, social, and professional component, as well as the bodily aspects of nutrition, sleep, sex, and exercise. All these aspects are interconnected. Indeed, some people experience tremendous improvement in all aspects when they are able to improve just one of these elements. Sleep is a good example. When insomniacs are able to implement a good sleep routine, for instance, by following the guidelines of cognitive behavior therapy for insomnia, all other aspects of their lives improve as well.

Often my acquaintances update me about what is not working well in their lives or relationships, or troubles they have with their children. Perhaps they feel comfortable revealing their private details to me because I am a therapist. I am often quick to recommend therapy. Sometimes they and look shocked. They seem to be thinking: “Why is she suggesting sending me/my children to therapy? Is there a problem? Am I doing something wrong as a parent?” Or they look at me in disbelief, like they may be thinking, “How can she say something like that!”

Indeed, perhaps I am a bit too forward. But my suggestions are not based on criticism, but on enthusiasm and care. I speak this way because I think therapists can offer an outside perspective when people feel confused. Since therapists have no particular stake in the outcome, they can provide a safe space to play out ideas and feelings. Therapists can suggest areas of possible growth and offer help on how to take life’s challenges differently. I realize I am a bit biased. One can go through life without therapy. But I truly believe that even for some of the lighter challenges, a bit of therapy makes things go much smoother in the long run.

I recommend therapy more strongly if people are persistently dissatisfied with their lives; if their negative and anxious moods are not just occasional and situational; if their bad days are more frequent than their good days; if their work, relationships, and social life are suffering; if they realize that they are not just going through a phase, but that a phase has become a rut; if, because of their distress, they change relationship, country, and workplaces but still find themselves trapped in the same negative dynamics; if they find themselves talking to a friend over and over about the same issues and there is no internal or external change; if they are using damaging substances and activities to manage their feelings.

In these cases, a therapist can help people figure out if they are adding a filter and are distorting the situation and/or if their personality or mood is actually contributing to create a negative situation. A therapist can help them see if patterns set out in childhood are repeating automatically, locking them in a self-sabotaging mode.

Therapy alone cannot change larger social structures. But if people are stuck in a situation that is sociologically disempowering, for instance, if people belong to a group that is marginalized and disempowered; if they are immigrants; if they feel ostracized because of their practices, beliefs, or ways of beings, a therapist can still help. When there are real disadvantages and injustices at play, the origin of the malaise may be more material than psychological. But in the end, real circumstances also have negative psychological effects. In such difficult situations, therapy can help people clear their minds and set out tactics for success. For instance, it can help uncover personal strengths as well as fruitful opportunities in the environment that people have not yet tapped into; a therapist can be a cheerleader, someone that helps people build the courage to make changes. The future feels scary and completely uncharted when people are venturing far away from their homes, diverging from social and family expectations, or experiencing intersectional oppression. Being trailblazers can be exhilarating, but it’s also hard because people in these circumstances often lack the reassurance of belonging and deserving and cannot look back at their parents and grandparents for a feeling of reassurance and belonging. Therapy assists in making and solidify these life maps, helping people situate themselves both in the world and in their internal experience.

Therapy is not a welcome aid in every circle and every household. After all, therapy is a relatively new thing, born, among others, from the efforts of Breuer and Freud at the end of the nineteenth century. It competes and at times supplants other forms of religious counseling and community support. If initially therapy was a profession exercised by upper-class white European men, who used their practices to unreflexively maintain the status quo and label oppressed and distressed women as hysterics, my sense is that the therapist population is very different nowadays. Therapists often do not belong to privileged categories, don’t necessarily make tons of money, and are more patient centered, embracing a patient’s point of view and desire rather than trying to fit the patient into normative categories of how people should behave and feel.

Many people feel unwell but tend to downplay their malaise and postpone or avoid seeking therapy, until it’s their last resort. Being in therapy still holds some stigma, as if by going to therapy one would admit that something is terribly wrong with them. Occasionally, I receive calls of disgruntled partners or family members that would like to coax loved ones into therapy. At times a spouse forces their partner into therapy; other times the loved ones resist, saying that they are not ready for therapy or that it’s not them, but it’s their spouse that needs therapy. Therapy cannot be imposed. I only have a partial view of the family, work, and social environment through a patient. But, paradoxically, I sometimes have the feeling that it’s the most insightful and better-adjusted member of the family that ends up in therapy, while the others flounder on their own. And yet, in many cases, the treatment of an individual alone can have positive repercussions in the whole family or work environment.

When people have been managing their distress for too long alone, often by using tools like distraction, suppression, and denial of feelings, they are afraid of opening up the floodgates of their feelings; they fear they may lose control; they fear unleashing the beast within and being shaken by emotions, memories, scary behaviors, and desires. Instead of looking forward to increased self-knowledge and relief, they hold back, afraid of falling into a hole without a stairwell. They may also fear that an inexperienced therapist may lead them astray. People may have many reasons to put off coming to therapy. This may be due to shame, because they believe that they should be able to manage on their own; they may mistrust therapy and fear they do not have the instruments to select a good therapist. Therapy is not a safe bet: it can be expensive and does not come with a money-back guarantee if one is dissatisfied.

These are important concerns, and people have good reasons not to trust going to a therapist. Why would they trust a stranger? How can they make an educated guess that a particular therapist is good and, most importantly, good for them? As a therapist who was once a consumer, I have my own share of “bad therapist” stories. It makes sense to me that people may feel they cannot risk putting their lives and emotional well-being in the hands of a stranger. Perhaps it’s easier to deal with a doctor that treats one’s heart, bones, or lungs, something that although vital, feels more concrete and objectifiable, than someone that has something to say about the most private and somewhat unique part of oneself: one’s mind. Also, there are people that have invested time and money in therapy and felt that the change was minimal and a waste of time and money. Indeed, even Freud (and Breuer) in Studies on Hysteria in 1895 set quite a low bar for therapy: “Much will be gained if we succeed in transforming your hysterical misery into common unhappiness. With a mental life that has been restored to health, you will be better armed against that unhappiness.”

Unhappiness may be an unchangeable part of the human condition, as Freud believed, though I tend to be a bit more optimistic. Progress in therapy in some aspects is very tangible, and symbolized by big milestones, such as a marriage, a baby, a separation from a toxic partner, a more authentic sense of identity, or a new, good, fulfilling job. Also, an increased sense of well-being and self-worth, though abstract, is very tangible. Other aspects of progress in therapy are less palpable and become known only through time. Perhaps one of the most important intangible benefits of therapy is the growing capacity to be flexible and capable of withstanding the difficult and painful situations that life throws at you and bounce back. The capacity to manage one’s “attachments” to life, people, and objects (as a Buddhist may say) and be able to go on and thrive, despite all the losses.

Therapy can also be life changing in unexpected (and painful) ways. People can change a lot during a deep extended treatment. Then their old relationships, even their commitments, cannot be maintained as they were, because they are now very different persons, more authentic and in touch with their needs and wants. But their environment has not changed at the same pace, and this may shake relationships up.

Despite the above limitations and caveats, I still believe that therapy is a very good investment and an adventure worth engaging, on either side of the couch.