3 ms·

It's worth considering a therapist as similar to a medical intervention - yes, good eating, clean living, and regular exercise can keep you healthy, but after a

It's worth considering a therapist as similar to a medical intervention - yes, good eating, clean living, and regular exercise can keep you healthy, but after a very long time of not doing so, it's possible to find oneself too far down the road for that kind of change to sufficient on its own. Similarly, the help of friends, family, etc. can do wonders for one's mental health, but after a very long time of neglect, that can be beyond one's reach. I say this as someone who rather successfully turned things around with a therapist - I simply did not have it in me to have those conversations with others and I didn't feel I had the relationships or support to do so (in retrospect I probably did, but that's the thing about mental health). I don't think your diagnosis is wrong, particularly - there's a lot in the modern world that promotes alienation, feelings of low self esteem, and depression, but I think a lot of people find themselves at the bottom of the well before realizing quite what's happening and without the support structures to get out on their own. (Edit just to note that, like physical health, mental health is not just the consequences of one's own actions - both genetic predispositions and unexpected life events can necessitate professional intervention by no fault of one's own. It's not what we're talking about, but just so nobody takes my post to be a psalm from the church of the self-sufficient.)

mancerayder 4y ago
I don't disagree with anything you've said, and I don't think therapy is useless. Especially when one is past a point where there are few other options. It's just a sad state of affairs that there are so few other options for people. I continue to pin the blame on the remote-first nature of society, which seems to make in person interaction secondary. It perpetuates loneliness which perpetuates mental health issues.
- crtified 4y ago
  Jumping in here. I suspect that the number of people who could benefit from quality therapy, greatly outnumbers the amount of quality therapists that exist in the world. To the point where, I surmise, a vast majority of the world's population simply would not have meaningful access to it, due to location, finances, availability, introversion, etc. So for me, it's not that "get therapy" is bad advice. Good thing is good. Therapy has proven techniques and results. But that doesn't help the majority of the world's population, who do not have access to the luxury of visits to high end trained professionals that only exist in suitably affluent settlements of certain countries.
  - roughly 4y ago
    Honestly, echoing some of mancerayder's sentiment here - I actually think there's a ton of mileage one can get from a not particularly extensively trained listening partner - I think there are cases where you genuinely need a highly qualified therapist, I think there are situations where an under-qualified individual can do a great deal of harm when dealing with someone with particular types of mental issues, but I think there's also a huge amount of therapy that can be done by someone a whole lot closer to an RN or a PA than an MD. I also suspect that the broad lack of coverage for therapy and other kinds of mental care in most medical plans, as well as a "treatment/cure"-type paradigm when it IS covered ("we expect your 40 years of accumulated neurosis to be adequately addressed within 6 months, otherwise we're not going to pay anymore") is part of why this is out of reach for many people. (I also suspect providing the population with broad access to mental health care would almost immediately pay for itself in terms of better physical health outcomes, improvements in the crime rate, and better economic outcomes, but that's the kind of second- and third-order thinking we're pretty notoriously bad at in this country, policy-wise)
    - gorffit 4y ago
      Therapy, and consequently the background and training of the therapist you see, is broadly subdivided into 2 different fields: 1) what I refer to as "psychiatric" therapy, with a specifically "medical" way of doing things. It's based on diagnosis and pathology, with a focus on treating the underlying causes of mental health problems. This typically amounts to chemical intervention. The provider will always be someone with a medical license, typically an M.D. or PsyD, although it can also be an RN or PA; someone who can prescribe drugs. While not always the case, talking with them is generally limited in scope to what is necessary to provide a diagnosis and appropriate medication management. It's normal to have appointments on a monthly basis initially, often stretching to a brief visit every 3 months as one's condition stabilizes. You will need to continue to see them for as long as you take medication (although you can sometimes convince a primary care physician to take over medication management once an effective treatment regimen is established). 2) what I refer to as "psychological" therapy, this is often in the form of talk therapy, and focuses more on cognitive understanding and behavioral modification, and can even be as simple as having someone listen to your shit, put it into a reasonable perspective, and provide emotional support or even just providing human interaction. Often the provider will have a Master's or Doctorate in psychology, which is NOT a medical degree. While some psychiatric doctors will also handle this type of therapy, it's much more often they'll refer you to someone who does this. It's quite common to see this person for an hour each week, but can be more or less often and may also include group therapy. They focus on teaching coping skills and can provide CBT and the like. Some people may continue to benefit from this therapy and go for years, others may stick around just until they establish the coping skills needed for their situation. I'm probably over generalizing, but it's uncommon to start out not knowing what to expect at all, so if even one person reads this and benefits, it was worth me writing this long post on my phone at 2 a.m. I also have a bit of a warning, with either type of therapy, it's not uncommon for patients to think they should see results pretty quickly, and when they don't they will assume it's not working and discontinue treatment or assume their therapist is inept and jump between several in short order. Imo, this is the worst thing someone can do, it may take a few months for medication to show results and more often than not the first few tries can fail to help, and it can literally take years to develop behavioral changes and coping skills to the point they show real benefit. People that give up on therapy too quickly can end up losing all faith in therapy for the rest of their life, and losing that kind of hope can even worsen their problems. I struggled from my late teens and all the way into my 30s before I really began to really feel like I hit an appropriate balance in daily life, and that isn't guaranteed. However now if I fall apart, I can put myself back together in a matter of days instead of wallowing for years.
- johnchristopher 4y ago
  > I don't disagree with anything you've said, and I don't think therapy is useless. That's really not how you framed your comment. > There are friends, elders, books, and a number of other ways to climb out of a mental rut. > I continue to pin the blame on the remote-first nature of society, which seems to make in person interaction secondary. Which doesn't concern the majority. > It perpetuates loneliness which perpetuates mental health issues. You seem to think mental health issues originates in loneliness. I can see how convenient that outlook is but it's nowhere that simple.

mancerayder 4y ago

I don't disagree with anything you've said, and I don't think therapy is useless. Especially when one is past a point where there are few other options. It's just a sad state of affairs that there are so few other options for people. I continue to pin the blame on the remote-first nature of society, which seems to make in person interaction secondary. It perpetuates loneliness which perpetuates mental health issues.

crtified 4y ago
Jumping in here. I suspect that the number of people who could benefit from quality therapy, greatly outnumbers the amount of quality therapists that exist in the world. To the point where, I surmise, a vast majority of the world's population simply would not have meaningful access to it, due to location, finances, availability, introversion, etc. So for me, it's not that "get therapy" is bad advice. Good thing is good. Therapy has proven techniques and results. But that doesn't help the majority of the world's population, who do not have access to the luxury of visits to high end trained professionals that only exist in suitably affluent settlements of certain countries.
- roughly 4y ago
  Honestly, echoing some of mancerayder's sentiment here - I actually think there's a ton of mileage one can get from a not particularly extensively trained listening partner - I think there are cases where you genuinely need a highly qualified therapist, I think there are situations where an under-qualified individual can do a great deal of harm when dealing with someone with particular types of mental issues, but I think there's also a huge amount of therapy that can be done by someone a whole lot closer to an RN or a PA than an MD. I also suspect that the broad lack of coverage for therapy and other kinds of mental care in most medical plans, as well as a "treatment/cure"-type paradigm when it IS covered ("we expect your 40 years of accumulated neurosis to be adequately addressed within 6 months, otherwise we're not going to pay anymore") is part of why this is out of reach for many people. (I also suspect providing the population with broad access to mental health care would almost immediately pay for itself in terms of better physical health outcomes, improvements in the crime rate, and better economic outcomes, but that's the kind of second- and third-order thinking we're pretty notoriously bad at in this country, policy-wise)
  - gorffit 4y ago
    Therapy, and consequently the background and training of the therapist you see, is broadly subdivided into 2 different fields: 1) what I refer to as "psychiatric" therapy, with a specifically "medical" way of doing things. It's based on diagnosis and pathology, with a focus on treating the underlying causes of mental health problems. This typically amounts to chemical intervention. The provider will always be someone with a medical license, typically an M.D. or PsyD, although it can also be an RN or PA; someone who can prescribe drugs. While not always the case, talking with them is generally limited in scope to what is necessary to provide a diagnosis and appropriate medication management. It's normal to have appointments on a monthly basis initially, often stretching to a brief visit every 3 months as one's condition stabilizes. You will need to continue to see them for as long as you take medication (although you can sometimes convince a primary care physician to take over medication management once an effective treatment regimen is established). 2) what I refer to as "psychological" therapy, this is often in the form of talk therapy, and focuses more on cognitive understanding and behavioral modification, and can even be as simple as having someone listen to your shit, put it into a reasonable perspective, and provide emotional support or even just providing human interaction. Often the provider will have a Master's or Doctorate in psychology, which is NOT a medical degree. While some psychiatric doctors will also handle this type of therapy, it's much more often they'll refer you to someone who does this. It's quite common to see this person for an hour each week, but can be more or less often and may also include group therapy. They focus on teaching coping skills and can provide CBT and the like. Some people may continue to benefit from this therapy and go for years, others may stick around just until they establish the coping skills needed for their situation. I'm probably over generalizing, but it's uncommon to start out not knowing what to expect at all, so if even one person reads this and benefits, it was worth me writing this long post on my phone at 2 a.m. I also have a bit of a warning, with either type of therapy, it's not uncommon for patients to think they should see results pretty quickly, and when they don't they will assume it's not working and discontinue treatment or assume their therapist is inept and jump between several in short order. Imo, this is the worst thing someone can do, it may take a few months for medication to show results and more often than not the first few tries can fail to help, and it can literally take years to develop behavioral changes and coping skills to the point they show real benefit. People that give up on therapy too quickly can end up losing all faith in therapy for the rest of their life, and losing that kind of hope can even worsen their problems. I struggled from my late teens and all the way into my 30s before I really began to really feel like I hit an appropriate balance in daily life, and that isn't guaranteed. However now if I fall apart, I can put myself back together in a matter of days instead of wallowing for years.
johnchristopher 4y ago
> I don't disagree with anything you've said, and I don't think therapy is useless. That's really not how you framed your comment. > There are friends, elders, books, and a number of other ways to climb out of a mental rut. > I continue to pin the blame on the remote-first nature of society, which seems to make in person interaction secondary. Which doesn't concern the majority. > It perpetuates loneliness which perpetuates mental health issues. You seem to think mental health issues originates in loneliness. I can see how convenient that outlook is but it's nowhere that simple.