Why Therapy Is Not For Everyone
Therapy can be counterproductive —even harmful— for some patients.
Link to the original blog
While the stigma attached to mental health has not fully been done away with, its veil is the most lifted it has ever been. Given the former, the latter is profoundly revolutionary in the most positive way imaginable. According to the CDC — citing studies from 2005 and 2012 respectively — , only 20% of those with a diagnosed with or have self-reported mental health issues have seen mental health professionals seek help. Fundamentally, this staggeringly low statistic is due to the embarrassment and shame that stigma against mental illness creates.
It seems that modernity is beginning to catch up to the cognitive dissonance which the topic of mental health seems to generate: that is, the discrepancy between how we perceive treatment for mental health issues, and how we perceive those suffering from such issues. From the same CDC report, in 2005 over 80% of people were said to understand that mainstream sources of mental health treatment (e.g. psychotherapy and psychiatry) are useful, and work. However, from the same year, only about 35–67% of people agreed that people are caring and sympathetic towards people suffering from mental illness. It seems that in the latter statistic, it has shifted towards the upper number from 2005. Indeed, according to a recent CBS poll, about 2 out of 3 Americans find mental illness to be a very serious public health issue. This has even seeped into our politics, whereby, [former] candidates such as Andrew Yang cite the fact that depression and anxiety are on the rise, and in turn, are strategizing political actions to combat such staggering rises. And this is not just a political ploy: it is the truth. The second leading cause of death in 15 to 29-year-olds is suicide and roughly 10 to 20 million people suffering from depression attempt suicide every year.
In terms of ensuring the worst-case scenarios are prevented, in terms of the side-effects of mental illness — such as suicide, self-harm, or harming others — this shift is ultimately a positive one, which has made the stigma of seeking help fundementally easier for more and more people.
What is often left out of this discussion is twofold: (1) those who seek help but are unhelped by conventional methods and (2) how difficult getting good help is.
I know, because I fit both categories, as do many of my friends and family. Hence, why so many people have simply opted to cease treatment, both as clinicians and as clients.
Now, before getting into this, the last thing I am attempting to suggest or promote is some sort of anti-mental health treatment dogma. Personally speaking, I think that if you’re dealing with some sort of mental health issue, even if it is minor, you should seek help. It could do something, which is better than nothing.
What I am rather attempting to suggest, is that mental health practices outside of the private sector need to increase their quality, and high-quality mental health services need to increase their accessibility — as, the majority of high-quality mental health services exist in the out-of-network domain, and in turn, gets extremely expensive.
Full disclosure: I have been diagnosed with social anxiety disorder, generalized anxiety disorder, post-traumatic-stress-disorder, and dysthymia. I have gone to multiple therapists for several years and have found little to no success in treating my symptoms through therapy. All of the therapists I went to had a cookie-cutter approach to therapy: they would initially ask me to share brief biographic history of myself, what my symptoms are and then each week, I would come in and be asked “how was your week”, and essentially spoke about my previous week, each week; there was never any structure or plan for treatment, but rather, cliches such as “how did that make you feel” accompanied by a monologue from myself explicating — at best — semi-significant events. Even when events were significant, nothing of significance was said about them. I personally went to therapy for guidance for interpersonal problems which I believed were at the root of my symptoms, but when I asked for guidance, I was almost always told “you have to figure it out. I can’t tell you what to do.” How exactly is that helpful, when I am going to you due to my confusion on how to act?
The search for a therapist, which entailed using sites like psychologytoday.com, entailed many unanswered phone-calls, many assertions from therapists that they did not take my insurance and many forlorn days of giving up my search. These searches more often than not made my psychological symptoms far worse. This is not an uncommon experience.
And this common experience is buttressed by the facts issued by leading experts in the field of psychology and psychiatry. According to the World Health Organization, and its “Mental health action plan 2013–2020”, four objectives are in need of implementation in the domain of mental health care: “more effective leadership and governance for mental health, the provision of comprehensive integrated mental health and social care services in community-based settings, implementation of strategies for promotion and prevention, and strengthened information systems, evidence, and research.” This is in light of the fact that low-income individuals — i.e., those who are generally in need of mental health services the most, as low-income individuals are most susceptible to developing mental illness — either have no or little access to mental health services, the sparse efficacy of psychiatric drugs, the discounting of diet and exercise in therapeutic settings (whereby, these factors are rarely, if ever, brought up by therapists), and generally poor-quality therapy in in-network settings. It is no wonder mental illness rates are rising.
In light of this, people like myself, and those I know who have had similar therapeutic experiences, get fed up with hearing “get help.” It’s from an endearing place, yes, and it is a testament to how far we have come on the social-stigma side of things, but, to those who are informed, it feels condescending. If you’ve tried and failed, as I have, you know this feeling. It essentially feels like being told, “risk making your symptoms worse through your search so as to be quite likely to end up in an office of a poor-quality therapist for an hour a week to waste your time making no progress on your psychological issues.”
In part, therapy — which has far more evidence to support its efficacy than psychiatric drugs do, the latter of which has a plethora of evidence to suggest adverse effects — has become ineffective due to the self-esteem movement. This movement, when psychology was fundamentally overtaken by its social-facet, rather than its psycho-analytic, behavioral, humanistic and existential facet, reshaped the whole of therapy, in a manner that has reversed its efficacy. The clinical data suggests that the way in which therapy becomes most effective at treating mental health issues is by encouraging clients to confront issues in their lives — practical and/or interpersonal — which they are avoiding. The social-psychological turn has basically made therapy into safe-spaces, whereby you are never judged and are told you are fine just the way you are; most of us realize deep-down that, no, we are not fine the way we are, but we are easily persuaded by this comfort, as, confronting our issues is challenging and uncomfortable. But, such confrontation is the first — and very often, last — step in fixing symptomology. All of the clinical data supports this supposition. Indeed, gradual exposure to uncomfortable/triggering psychological experiences is the overarching joining factor in all of the major schools of psychological thought. Insofar as these schools are effective, they are making clients braver, not safer. Now, this is not to say that therapists should have no compassion: rather, compassion should be the force that is pushing clients. Compassion without push is not helpful.
Hence, the first step in improving our situation with regards to poor quality mental health services is to encourage clinicians to push their clients, not coddle them. Ensuring that in-network providers are given the tools they need to do this should be the number one priority of insurance companies and the institutions that are educating such providers. Whether it is with regards to real-world issues or inter-psychic ones (which Cognitive Behavioral Therapy has been shown to be particularly effective for, when done right — which is, again, mostly done by out-of-network providers) — exposure to what is chaotic and unknown, gradually, so as to make clients braver, is how therapy becomes effective. Asking clients questions they already know the answer to — ” what did you do this week? “How does that make you feel?” — is shown nowhere to help anything. In my therapeutic experience, I know I needed pushing, but there was a refusal to push. This did not help me.
Next, is opening our collective minds to advances in psychiatric alternatives in the domain of psychedelics. Substances like ketamine, psilocybin, and LSD are showing promising results, without any of the uncomfortable and sometimes deadly adverse effects that come with conventional psychiatric drugs — though, the latter should absolutely not be demonized, as they do help people.
Finally, part of decreasing the stigma of mental illness, not only entails encouraging people to seek help but also, respecting people who have sought it but have not found it helpful. Many individuals find their own routes to coping, due to therapy and psychiatry making things worse. There is nothing wrong with this. But when such people are still insisted upon to find therapy, it makes such people feel as if they are morally and/or mentally in the wrong for going their own way to try to resolve their issues. In light of the evidence suggesting that mental health services have a long way to go before effective services are widely accessible, to continue to insist that everyone who has an issue needs help, becomes condescending, when many of us know very well that “help” very often isn’t all that helpful and that seeking such non-help, often makes us feel far worse. Part of diminishing mental health stigma is respecting that everyone has their own ways of coping, and therapy/psychiatry is not the only way to cope. If I can exercise, use nutrition, and supplement my way to great mental health, then great. If not, and I try therapy, yet, therapy does not help, I think the response of “well, keep looking until you find a better therapist” isn’t always the right solution: such a response, often makes symptoms worse and might be futile, as, it might just be that therapy as-such is not right for such a person.
