What is therapy?
Therapy and counseling are types of treatment to improve your mental well-being. These treatments can help people who are experiencing emotional or behavior problems, or people who have a mental health disorder. Therapy is sometimes called psychotherapy (say: sike-o-ther-apy) or talk therapy. If you are taking medication for a mental health disorder, therapy will usually improve the results you get from the medicine.
Different types of therapy use different techniques. In most kinds of therapy and counseling, the person receiving treatment will talk with a professional therapist. However, therapy is more than just talking about your problems. Therapy can teach you new ways to think about the situations that bother you and help you cope with your feelings. It can help with feelings of anger, fear, anxiety, shyness and panic. It can also give you tools to help fight low self-esteem and depression.
The American Academy of Family Physicians
My therapist’s office is in my neighborhood, only about a 3-minute drive from my house, but I arrive early for this first session. I’ve thought about it all weekend. Lynn’s been discernibly worried about me. She gives me an extra hug before leaving, looks me in the eye and reminds me that it’s going to be okay.
She’s had a hard time with my taking medication the past year. She doesn’t like the idea of dependency. It’s hard for me to explain to her that it’s not that, but it’s an illness; that what’s going on with me can’t be fixed by going to an AA meeting or going for a run. I say that I can feel it, literally feel the depression as a physiological thing. Maybe I’m making that up, but I really believe it. It is a physical sensation, that looming black cloud. It’s almost like it has a life of its own and I simply can’t control it.
Seeing a therapist, though, is something she can better understand and believes it will be helpful. I think she means “more helpful” and that it is really all that I need right now. I don’t know. I continually find myself saying, “I have to trust these people. I have to trust that they know what they’re doing and that what they do will help. I simply need to do what I’m told right now.”
The office is one of several in an older house. I note on the way in the names of MDs, massage therapists, other counselors, and a couple of businesses. It seems that I’ve arrived first.
There’s a bulletin board to the right of the office door. There are flyers on it for different support groups. There’s confirmation that it’s a “safe place” for the GLBT community. I see that my therapist shares the space with her husband, also in the profession. I recall this from the message I heard on her answering machine. There’s a coat rack in the corner, so I take off my coat and hang it there. I feel kind of stupid at the thought “Make yourself comfortable”.
I sit on the couch in the waiting area for only a few minutes before I hear the door open and the sound of one of those backpack bags on wheels wheeling in. A woman rounds the corner, introduces herself and says that she hopes I’ve not been waiting long, unlocks the door to her office and asks me to give her just a minute while she settles in. Less than a minute later, she invites me in.
We’re roughly the same age. She’s older, but I doubt by all that much. I guess she’s probably in her 50s. She’s dressed well, stylish, but gives off no pretentiousness, kind of like Hillary Clinton, or at least how I always think Hillary Clinton would be if I ever actually met her, confident and capable but still approachable. My therapist strikes me like this, only without the Secret Service agents.
She gives me some paperwork to fill out and we go over how this process works with my insurance company. I loathe insurance companies, but don’t feel quite up to feeling those feelings now. Then she tells me a bit about herself and how she goes about her practice. She tells me that she practices cognitive based therapy. She explains that thoughts, feelings and actions are all related and she believes that a person can learn to think differently by acting differently, act differently by thinking differently, feel differently by thinking differently, and so forth. In other words, each affects the other, sometimes in very powerful ways.
She digs through a see-through file holder box and hands me a couple of copies of handouts that explain this type of work. She says that she’d like me to read them over, think about them, think about how some of the statements do or don’t apply to me, and then we can talk about that – a little now and then some more next time. She thinks we probably need to have a few “next times” to see how this will go for us.
I look at the sheet entitled “Cognitive Restructuring”. “The goal in cognitive restructuring is to learn increased cognitive flexibility.” I think to myself, “I’m flexible. I’m a lesbian, recovering alcoholic, former Southern Baptist minister. What could possibly be more flexible? A mold doesn’t even exist for me, I’m so flexible.”
I read the section “Questions to ask yourself about your stressful automatic thoughts”:
1. Is this really true?
A. Is what true? I’m here. This is true. I’m not sure what else.
2. Am I exaggerating or overemphasizing a negative aspect of the situation?
A. I do note how every morning when I walk my dog lately, I release a string of profanity at the garbage thrown about the park. “People are (blanky blank blank) filthy creatures! Every last one.” I admit that this could perhaps be a bit of an exaggeration, especially the “every last one” part.
3. Am I catastrophizing?
A. My friends in seminary did call me “The Prophetess of Doom”, but weren’t they kidding?
I start to get a gloomy picture and so I look at the second sheet. This one is called “Distorted Thinking”. All-or-nothing thinking, over-generalizing, discounting positives, jumping to conclusions, magnifying, minimizing, labeling, blaming…
She feels I’ve had enough time to look at them and breaks the quiet. “Do you recognize any of these? Do they make any sense to you?”
“Yes. I can see them sometimes. I know that I do #6 – blowing things out of proportion.” I relate the thoughts about trash in the park.
She explains that I can start by paying attention to myself. I need to take notes, write things down. Where does sadness spring from? Where does my lack of happiness come from? Are there patterns I can recognize between what I’m doing when I feel this way, or vice versa? It’s an exercise. It’s not easy. It’s something that has to be learned, but I can learn it if I want to.
I sit and look at the papers some more and am grateful she doesn’t expect a response.
Then we talk about my family. I tell her about my mom’s death, some of the fallout from that. I tell her about my dad, that he’s remarried and lives in San Antonio. I have one brother who lives in Virginia with his family. We all get along – me and my brother, me and my dad – as best as to be expected. We don’t have a great deal in common, any of us, so we’re not really close, but we don’t dislike each other, that’s for sure. I tell her that I’m sober, that I’ve been with my partner for 15 years, that we’ve lived in Worcester for five years, that I work at the library, that I’m lost in my job at the moment and finding it not very satisfying, that I left the ministry a number of years ago, that I’ve had good luck with therapy a couple of times, that I’ve recently tried to get back into church, that I don’t have any close friends nearby, that I’ve been on an anti-depressant for a little over a year, that really things in my life are fine, I’m just sad.
And I have no reason to be at all.
She goes back to my mom. I say, “Really, I’ve worked on that before. That’s not it. I’ve done that already. It’s been years. Twenty-five years. There is no way that my sadness today is related to that. It’s not related to my mom’s death. It’s not related to anger at my dad. Yes, I’ve been angry in the past, but I’m not now. That’s old stuff. I’m not someone who stuffed all of these feelings and now they’re creeping out. I’ve not ignored them. I worked on them. I actively worked on them. That’s finished. Done.”
She asks me to tell her some more about my mom. She asks me to tell her what happened.
It was winter break and I was home from college. I’d had my wisdom teeth pulled the day before and my mom stayed home with me. She made me egg custard. I had to go back for a check-in with my dentist that day, so I needed a car. My mom took my dad to work in the other car and then drove herself to school. They were both teachers.
There was a snowstorm and schools closed early. My mom came home in the early afternoon to check on me, and then left to go pick up my dad. She was in a car accident, hit by a car filled with some guys from the high school who were driving too fast and lost control on the ice. They hit her on the driver’s side and she was pinned against the steering wheel. It’s kind of ironic that had she NOT been wearing a seat belt, she probably wouldn’t have been hurt as badly. I didn’t wear a seat belt for a while after the accident, pretty much out of spite. She was about three blocks from the high school where my dad worked. She lost consciousness on the way to the hospital. She died there from trauma to her chest and heart.
My dad called me from the hospital, before she died, and told me Mom had been in an accident. He said he’d just spoken with one of the doctors and they said that they thought everything was going to be okay. I asked if I should come down there and he said no. A couple of hours later, he got home. Our minister and his wife were with him, one on each side. I’ve known the Plott’s my entire life. I saw them with my dad and I knew she was dead. I said to my dad, “But you said everything was going to be okay”. He fell to his knees, put his head in his hands, crumbled to the floor and let out a moan, sobbing, “I know”. I knelt on the floor next to him, wrapped my arms around him, and said, “Everything is going to be okay, Dad. Everything is going to be okay.”
I cry a little bit as I tell her the story, but not much. I tell it as it happened. It was the most god-awful day of my life. I remember it easily, every detail, and I have remembered it so often that I can tell it without tears. But in this context it does make me sadder than usual and so I cry a little.
Then we sit there in silence for a minute. Afterward, she tells me that the loss of a parent, particularly the loss of a mother-daughter relationship (or a father-son), is not something that I will ever get over. It was traumatic. It was not normal. And I’ll never really be done with it.
This isn’t exactly the message I’d hoped for, in fact, this is downright depressing. I start wondering if this is going to go like AA meetings go for me, meaning I never think about drinking until I go to one. Then after listening to people talk about all that’s going on for them, I feel the need for a drink. I start wondering if going to therapy to work on my depression is only going to make me more depressed.
She finishes by saying that it’s true, that the loss of my mom and my family story may not be what’s at the root of whatever is going on with me right now, but still, it’s not really accurate to think “I’ve done that, now let’s move on”. I’ll never really be done.
That’s a lot for our first session. She asks if I want to give this a try for now and I agree. We decide to meet on Monday mornings at 9:00 for a while, at least until we both think it’s time for a change. I say that I’ll work it out with my boss to come in late on Mondays and that I’ll see her next week. I take my papers, my assignments, put on my coat, and head to work, feeling more than a little beat up.
Lots of people have a hard time with the holidays, so you might think beginning therapy in December, dredging up old sad thoughts and feelings this time of year might not be the best idea. Fortunately for me, though, I love the holiday season. It’s certainly difficult at times, knowing that my mom died during them, but it was after. Before January rolls around, we have December, thus we have Christmas trees and Christmas lights and Christmas music. I find all of that lovely. So the start of therapy coincided with colored lights, easing the hard part of not knowing by an infusion of the familiar.
Still, opening the lid, even if only a crack, at first can have dramatic effects. A few days after my first session with my new therapist, I sat in a meeting of managers and supervisors at my library (me being one of the latter) where we discussed, among other things, chipping in for holiday gift cards for the rest of the staff. Everyone was in agreement that we should do this, but when it came time to decide how much we’d all chip in, several options were brought up. It was a light-hearted discussion, lots of laughing and such, but then someone made a comment that hit me wrong. Better put, it hit me as unfair.
Remember the assignment from Monday, the one about stressful automatic thoughts? The one, “Am I exaggerating or overemphasizing a negative aspect of the situation”?
***FAST FORWARD BACK TO MEETING***
I ask, “May I speak frankly?”
“Of course. That’s what we’re having, a frank discussion,” says my Library Director.
And this is the part where I learn that “speaking frankly” has different meanings to different people. This is the part where I’d have done really well to rewind my memories all the way back to our family supper table and the old adage about NOT bringing up politics, money or religion.
I brought up money.
What I meant to say was that everyone in the room didn’t earn the same income, thus it would be fairer if we contributed in the same way. What came out was more along the lines of “I took on this position for the past year, doing more work for no more money, and I’m not the only one (I did at least bring some of my colleagues down with me). This is really unfair and I think this should be taken into consideration.”
It was a true statement. Several of us had taken on some new responsibilities and with the budget the way it was, hadn’t been compensated as we might have been in better economic times. But I knew this going in and had agreed to it. And reflecting back on it, it wasn’t the right thing to say at the right time. AND I was emotional. Not good. But at the time, I felt okay about it. I’d gotten it off my chest. We all agreed upon an amount to contribute, finished up the meeting, and then went on with the day.
The following morning I received a call from my boss asking me to come to her office. I sat and she closed the door behind me. We have been here before. I knew what’s coming.
“I need to talk with you about yesterday. Elaine wasn’t happy with what you said.”
What triggers certain responses? What patterns do you see? Write these down.
***FAST FORWARD BACK TO MEETING”
“Did I not ask if I could speak frankly? Did I not hear the answer, ‘Yes’?”
“She CANNOT change the rules! That’s changing the rules! If she says that I can speak frankly and then gets angry about what I’ve frankly said, well that’s just wrong. She cannot do that. No!”
Then I start to cry, something I’ve never done in front of anyone at work. I think my boss is a little taken aback. I have a very “happy go lucky” outward persona. I am, to a fault, good at remaining calm and easygoing through situations, regardless of the level of stress or insanity. Outwardly.
I share about starting therapy. I share about the stress of trying to make ends meet. I share about feeling like we can never get ahead financially at home. I share that it’s a really difficult time right now. I share that I’m taking medication to manage. I share that I’m going to need to come in late on Monday mornings for a while.
My boss gives me some background on things that explain, in part, why the Director hadn’t cared for what I said. She tells me that she understands what I’m saying and that it’s okay about the Monday morning thing. Then…
“Are you happy with what you’re doing? Is this what you expected in this role? I need to know that I made a good decision in recommending you. I need to see that we made the right decision.”
I stare blankly. I stare at the floor. I think, “What the hell?!” I say that yes, I’m happy in my role and that I feel like I’m doing my job well.
I am ready for this to be over.
The rest of December rolls by. I pay attention to my reactions and responses as best I can. I look for triggers and patterns. I take a lot of notes. We take in the season and enjoy the holidays. I teach Lynn about the joy of putting together jigsaw puzzles, something she’s never done before. Maybe this is an attempt at unconsciously playing out some metaphor. I go to therapy and I go to work and I go to the gym. My life pretty much continues as before, except with a renewed sense of awareness of things I’d hoped I’d not have to think about much anymore.