Paul's Internet Landfill/ 2016/ On Therapy

On Therapy

As my (boring, tedious) midlife crisis deepens, I am finding myself more stuck, more unhappy, and more lonely more of the time. I have tried to change some things over the past year, but nothing has worked out. Meanwhile I have developed some new bad habits which are getting worse. My basket of anxieties is getting bigger and bigger, which is inhibiting my life more and more.

In light of this I have been thinking about therapy, and as usual my thoughts are a jumbled mess.

Aesthetically I dislike therapy a lot. I think of therapists as professional friends who are paid to listen to your problems. I have problems with professionalization. Firstly, professionals displace roles that family members and community members would otherwise play. Secondly, in order to stay "professional" therapists ought not get too involved with the lives and problems of their clients. Therapists are supposed to foster the illusion of caring about their clients, but it is pretty thin (try not paying for your therapy and see what happens).

Therapists might go "pro bono" occasionally, but they do so knowing full well that it costs them potential income. Therapists don't have relationships. They have clients. Given that I simultaneously crave caring and am convinced that nobody will ever care for me, this is an problem. Paying people does not fill that hole.

If I don't want to turn to professional friends, how about regular friends? Unfortunately, most friends are terrible at therapy. It is so easy to rush to judgement and shower others with advice, and so difficult to listen nonjudgmentally and let others find their own insights. Furthermore, when kind people offer to listen to my problems I clam up and refuse their offers. (That is a pretty good trick for not getting any help at all.)

Therapy is also expensive. Since mental health does not count as real health therapy is not covered by medicare. Sometimes therapists offer "sliding scale" therapy, which sounds good but does not apply to miserly cheapskates like me: I might have sufficient income to pay for therapy, but I don't have sufficient budget. Even sliding scale therapy is expensive. I had some sessions with a therapist for $30 an hour, which is unheard of. Nonetheless I found the sessions uncomfortably expensive. I ended up paying for my sessions in advance in order to avoid obsessing about the cost each week.

In some sense it is good that therapists are privatized. That means that there are lots of therapists to go around for those who are willing to pay (which is the same situation as for dentists). But what do people who are either too poor or too miserly to pay for therapy do? I feel that the cost of therapy is one of the biggest reasons we push pills so hard -- psychiatric medications are expensive, but they are much cheaper than paying therapists.

Just as I am (slowly, ineffectively) learning to keep my self-deprecation to myself, there is something that feels indulgent about therapy. Therapy sessions consist of talking about one's problems to a captive audience who is paid to listen. Maybe talking problems out really does give us insights to move past them. But it is also the case that the more down I feel the more self-centred my thinking becomes, and vice versa. My mood improves when I stop talking/thinking about my own woes and do something good for somebody else. Focusing my attention outwards does not solve my problems, but it helps. Sitting in therapy situations hyperfocused on myself and my problems is the opposite of helping others, and there is some aspect of that that feels deeply unhelpful.

Among most rationalists, the only form of therapy that has any credibility is Cognitive Behavioral Therapy (CBT), which has been tested in clinical trials. My relationship to CBT is as strained as everything else. I have read The Feeling Good Handbook, and I suppose that being aware of one's cognitive distortions is helpful. To this day my inner Dr. Burns pops out to remind me that I am a fundamentally irrational being. But CBT always feels so prescriptive, and it seems to me that its premise is that there is a single right answer about how to think and how to live, that cognitive distortions are unhelpful in every case. I don't think is true at all. Normal people have cognitive biases towards positivity, and it seems to serve us well. Apparently, depressives assess situations more realistically, but it does not help them much. If that is the case then it cannot be true that all cognitive distortions are bad.

My other problem with CBT is that I have a difficult time internalizing its insights. You can use lawyer-tricks to get me to admit all kinds of uncomfortable things rationally, but as long as they continue to feel uncomfortable I will resist them.

Is therapy effective? I don't know. In my experience there is a lot of variance. I have done three sets of professionalized therapy and a few other sets of weird inappropriate quasi-professionalized therapy. During my first round of professionalized therapy I admitted that I am an abusive monster out loud, which was probably for the better. The other professionalized sets have felt less useful, although I did make a life decision during one of them. Some of the quasi-professionalized sessions have been useful. It would probably be unfair to assert that therapy has been useless in my life. But maybe it has not been very useful. I suspect that listening to Buddhist podcasts from Audio Dharma might be doing more for my mental health than therapy ever has.

I am deeply mistrustful of people, and I have a difficult time meeting people whom I respect and like as people. When I do not respect people I tend to ignore their advice, which is not so helpful in therapeutic contexts unless I luck out and find "the right" therapist.

I have a tendency to play logic and word games when feeling defensive, and since therapy is intended to expose one's sore spots, I get defensive a lot. Therefore if therapy is going to work then the therapist has to be able to work around those defenses.

One of the bigger barriers to therapy for me is that I do not feel I can express myself openly to anybody. That is doubly true for professional therapists. If I bring up certain topics (some of which tend to be exactly the ones I think about a lot) then my therapist is professionally obligated to report me to the authorities. Thus in order for me to stay out of trouble I have to clam up.

Having written all this, I am undeniably stuck in my thinking, and it is increasingly obvious that I am not getting unstuck on my own. So what do I do?