Get some Therapy?

By James N. Dillard, M.D.

Has a doctor or friend ever suggested that you might benefit from seeing a psychotherapist? Were you frightened or enraged by the suggestion? Have you tried psychotherapy, but had a bad experience with it? Maybe you are curious about therapy, but you’re uncomfortable with the social stigma.

The Greek philosopher Socrates wrote, “An unexamined life is not worth living” in the fourth century B.C.E. His words have been a mantra for psychotherapists and the self-help movement for decades. But as the novelist John Barth quipped, “King Oedipus and I aren’t so sure. Self-knowledge is always bad news.”

Most people who see a psychotherapist just need a little help during a tough time or insight into a thorny issue. But there are also those who have actual mental illness. One in four American adults suffers from a diagnosable mental disorder, according to the National Institute of Mental Health. This includes mood disorders like depression, phobias, anxiety problems, schizophrenia, eating disorders, attention deficit hyperactivity (A.D.H.D.), and personality disorders.

The popular antidepressant Prozac came on the market in 1987. Since that time the number of people on government disability due to mental illness went from 1.25 million to almost 5 million today.

As with the BP oil spill, most of the toxic material is below the surface. We learn always to put our best foot forward, to present an acceptable facade, and to hide anything that feels shameful from others. Unearthing hidden feelings and fixed ideas is the work of good therapy.

Though the recent trend toward giving drugs for all that ails us will continue, most experts contend that effective psychotherapy can be enormously important. Taking drugs without psychotherapy doesn’t change things.

Two East Hampton residents, Bonnie Maslin and Christina Lindstrom, are both clinical psychologists with more than 30 years of experience

Thinking about therapy

each. I spoke with these two experts about the challenges of starting psychotherapy.

“People who have never been in therapy before usually won’t come to me until there is a crisis,” Dr. Lindstrom told me. “But crisis can be the impetus for change.”

Dr. Maslin remarked, “The longest distance between two points is from the point of referral to therapy and the point of arrival at the therapist’s office.”

Work challenges, problems with a child, the death of a family member, or a dissolving marriage may drive a person into therapy. But perhaps the work could be done better before crisis mode arrives.

This begs the question “Is emotional pain the only force that can make a person change?” Most therapists don’t think so, but perhaps there’s some truth to this. Tiger Woods probably would not have changed his behavior if he hadn’t been caught.

Still, you can decide to find a new understanding of what you might do differently to make your life better or to cope better. It’s like trying to start a broken engine. Just sitting there cranking the starter will not give you a different outcome. You need to do something different, to take a new approach.

Many folks resist going for therapy because they fear opening up to another person, they fear exposing themselves. But how much you disclose is up to you. Some think therapists are mind readers and will divine their dark personal secrets. Others believe that going to psychotherapy means that you are admitting that you are crazy or personally inadequate. These things are not true.

The contemplation of any change, of any delving into one’s own depths, is anxiety provoking. Often tutors, occupational therapists, bartenders, or school counselors seem less frightening than seeing a psychologist. “Fear can be paralyzing,” Dr. Maslin told me. “It feels like a sanctuary, but it’s really a prison.”

To choose a therapist, ask your doctor or other professionals. Another resource is the American Association for Marriage and Family Therapy, aamft.org. It can be wise to first have a conversation on the phone. If you have the energy, interview a couple of therapists in person. You should feel a connection with that person, a sense of trust, and that the therapist is engaged with you. The therapist’s job is not to give advice, but to help you find a new perspective.

Don’t go into therapy to have the doctor tell you that you are okay, or to have the therapist confirm for you that the real problem is someone else — your boss, your spouse, your children, or your parents. This approach will fail, as you are the only person you can change.

What is the goal of psychotherapy? It is probably not happiness. The realist Sigmund Freud wrote that his aim was only “to transform neurotic despair into the general unhappiness which is the usual lot of mankind.” Despair was thought to be far worse than everyday unhappiness.

The philosopher Immanuel Kant challenged us to distinguish appearance from reality, and Freud also sought to dispel the patient’s illusions about himself.

The pragmatic British psychiatrist R.D. Laing was focused on the ability of the patient to function in the world, writing, “The range of what we think and do is limited by what we fail to notice. And because we fail to notice that we fail to notice, there is little we can do to change; until we notice how failing to notice shapes our thoughts and deeds.” This is where a good therapist can help.

People who injure others don’t usually seek real therapy; they don’t want to examine their own actions. These people can be maliciously sociopathic, have a personality disorder, or just be badly damaged. The one redeeming feature of the Ben Stiller movie “Greenberg” is the line “Hurt people hurt people.”

Do you find hyper-self-conscious people annoying? Does it seem like just another version of self-obsession? As with the principles of Chinese medicine, it may be a yin-yang balance. Sometimes introspection is critically important, and other times it can get to be too much. In the words of the Old Testament book Ecclesiastes 3:1, “To every thing there is a season, and a time to every purpose under heaven.”

There are different styles of therapy, short-term versus long-term, and there’s brief work just to get some different behavioral approaches. Look at therapy as an opportunity for growth and understanding. You don’t have to believe in therapy — it’s not a faith. It is a gift that you can give yourself.

“After 30 years, every referral is still exciting for me,” said Dr. Lindstrom. “As I get to know a client and we begin to generate solutions, I can see what this person will be like as he gets better. This is why I still love what I do.”

As Dr. Maslin said, “The examined life can free you to be more present in your own life and more present for others.” So be open to personal change, and remember — if it’s not one thing, it’s your mother.