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Ch. 9 Get Your Head Shrunk

I’m not sure why you picked up this book. I am so thankful that you did and I owe you a mega sized hug for it, but I don’t know your particular reasons. However, I do bet that there are quite a few of you out there who bought this book because you wanted to see what you could figure out on your own without the help of the therapist. Well, good on you. You’re a badass and I hope that this totally works out for you. I want to at least mention psychotherapy, though. After all, it is my full-time real person job. People have a lot of different expectations and impressions of therapy, so I want to just talk a bit about what it looks like and how it can help you.

First of all. Therapy is not a club. You don’t have to be an A-lister with co-existing OCD and PTSD to get in. Therapy is for everyone. There are also different types of therapy. The most common model in the United States is talk therapy. Depending on who you see, this could be as frequent as once per week or as infrequent as a monthly check-in.

Therapists vary quite a bit in their approaches as well. A more behaviorally oriented therapist will look into the circumstances surrounding your anxiety. What situation provokes the symptoms and where did you first learn to respond that way? They will then work to help you “unlearn” those responses. A cognitively oriented therapist will really dig deep into your thought patterns (we did a little of this earlier). You will be collaborative scientists together and test your thoughts to get to the bottom of whether it makes any sense for you to feel this way. Psychodynamic or insight oriented therapists will take things a bit further and look deep for the origins of your anxiety. They will view anxiety as a symptom of some deeper underlying issues and work to help you achieve insight into how those issues are playing out in your life.

That is a small sampling of the different types of therapeutic approaches that are utilized currently in the field. There are many more. The other thing to consider is that not all therapists are created equal. I mean it when I say that there are some shrinks that really just suck at their job. It’s okay, we are people too. Some people are not good at their job. Maybe they are burnt out from years of clinical work and they know it, or maybe they think they are the best ever and can’t see that they are just too awkward to ever help you open up. Don’t feel bad if you have a bad experience with therapy. You are allowed to shop around. Don’t forget that you are a consumer. No one wants you to be wasting time and money on something that isn’t going to work for you.

Don’t let a single awkward or negative experience prevent you from trying other therapy in the future. The first time I tried Thai food, I thought I hated it. I thought that it was just something that other people could like but it wasn’t for me. I realized later on, after shopping around a bit and sampling some other restaurants, that it was just a bad chef that gave me that impression. Thai food kicks ass. So hungry right now.

The length of treatment can vary quite a bit. Some issues can be resolved in just a few weeks and others might take a lifetime to unearth. In my opinion, a good shrink will start with the immediate stuff, help you find some solid ground to put under your feet, and then when you are a bit more stable, they will work to dig a little deeper to find out where all of this shit really came from. You might also engage in different forms of treatment like group therapy. Groups can be a lot of fun. Typically, they involve some educational component where someone much more eloquent but probably less funny than me will explain the topic of the day, such as “managing worries” or “how to know when you are panicking,” and then the group will discuss together about the topic. Groups are made up of people. Some people are awesome and some people suck. The quality of the group depends on the quality of the people. Again, don’t be afraid to shop around.

How do you shop around for therapists? Well it depends on your particular situation. If you are a college student at a university, chances are you’re already hooked up with free access to psychotherapy with students in the training program at your school. Don’t worry, they won’t make things awkward if you see them elsewhere on campus. There are a lot of really strict rules in place about confidentiality. If they were to not respect your privacy, they’d basically be screwed anyway. I worked as a therapist during my doctoral training and some of my regular clients were able to make serious changes in their life. It feels pretty damn great. Often times at these “training clinics” you don’t have to be a student to get services, but you would just end up paying for sessions at a much lower rate than you are likely to find out in the community. If you don’t have insurance, start there.

Do you have mental health coverage? If so, groovy. These days, you can often go to the insurance provider’s website and use their own search engine to find covered providers near you. If they don’t have one, you can just use something like Psychology Today’s “Find a Therapist” tool and look for therapists that accept your insurance. The neat thing about searching for a therapist online is that you can filter by specialty or type of therapy. You can also check to see if they have their own website, which for someone like me speaks to the character of the therapist.

Don’t have insurance? It sucks, I know… been there. There are still options. Look up therapists that have what’s called a “sliding scale.” This means that the therapist will charge a rate consistent with the client’s income. If have no income, you could be looking at mega cheap, or in some cases, free sessions. You typically have to provide some sort of proof of income (or lack thereof) so that they know you aren’t just trying to work the system. Don’t let the discounted price scare you. It doesn’t mean that you are going to get budget quality therapy… it just means that some people are awesome and legitimately want to help you. Finally, if you are strapped for cash and without insurance you could also look into community resources. Many counties have non-profit organizations that offer free services to those who are really in need. I should reiterate that my experience is in the United States. I’m not entirely sure how similar therapy and mental health services are in other countries.

I’m going to cut the funny shit for a second here. If you are in need of help that is probably above and beyond what you can do on your own right now, please seek professional help. Family and friends are great, but there will always be a limit to what they can help you out with. From me to you, there is absolutely nothing to be ashamed about. We all fall down sometimes and we are all allowed to have periods of recovery. The help is out there and if you aren’t able to find the strength to do this for yourself, that’s okay too. Let someone who loves you know and they will be able to help you out. It’s not worth it to keep suffering, friend. Let’s get you better.

The last thing that I want to mention in this chapter is medication. Now this is something that I initially left out of the first edition of this book. I did that because I wanted to cover my own ass. My role is as a therapist, and while I have a doctorate in psychology, I am not a medical doctor and it is beyond my scope to advise you on which medications to take. Many of you wanted to hear more about medication, though, so I am going to give you some of my thoughts about it. At the time of writing this, I am currently working at a large healthcare organization as a therapist. At the end of every intake session with a new patient, I ask them how they would like to follow up. The main buffet of options includes psychotherapy, educational or support groups, and consultation with a psychiatrist to talk about medication.

People fall on many different sides of the fence when it comes to medicine. There are a lot of misconceptions out there about medication. People think about movies that they have seen where it zombifies you and makes you unable to feel. There are certainly some medications that have a bit of a sedating effect, but in general this is not what happens. They also aren’t a miracle drug. Many medications take a few weeks to alter your brain chemistry and begin working their magic. Some medications are for emergencies only such as when you are actively panicking. As for which are right for you, that is definitely something that you should talk to a psychiatrist about. Psychiatrists are medical doctors that specialize in psychiatric medication. Your primary care can certainly write you a prescription for some anti-anxiety medication, but these particular types of medications can be a bit tricky to dial in. If you have access to a psychiatrist, I would definitely suggest talking to one.

My opinion about medication is that it doesn’t solve any problems for you. A pill will not make the issues that create anxiety for you disappear. That said, I think that medication can be invaluable in its ability to help you cope with the crushing pressure of anxiety that sometimes makes it so damn difficult to find solutions on your own. Basically, the long term medications (non-emergency) help to bring your baseline level of anxiety and reactivity down to a point that you can focus on learning good coping skills in therapy or through your own problem solving. On that note, I also want to say that I definitely suggest taking advantage of both therapy and psychopharmaceutical (drug) treatment if you decide to try out medication. With few exceptions, nobody wants you to be on medication for anxiety for the rest of your life. The point is to help raise you up while you build your own emotional scaffolding underneath. That way, if at some point, you feel like you have made progress and want to try this shit out on your own, that scaffolding that you built in the form of skills, knowledge, and perspective will hold you up when that medication support is taken out from underneath you.