Good Therapy, Bad Therapy (Maybe Part I)

I’ve had a bunch of both, and therefore I feel fairly qualified to say a few things about them, though I’m not going to try to claim that my experiences will resemble anyone else’s or that the lessons I’ve gleaned from them are universal.

But, you know. Just because my experiences are guaranteed not to be universal doesn’t mean that they might not be helpful to someone else.

So here goes:

  1. There’s therapy that’s actually going to fix things on a long-term basis, and then there’s therapy that’s basically Field Medicine — trying to keep you in one piece so it’s possible to get back out there and fight another day. Or another hour, or week, or whatever.

    They’re very different things: which is to say that they might look exactly alike, and involve the same methods and techniques, but in the long run, they play roles as disparate as military field medicine and civilian obstetrics.

    My first therapist, who was very gifted and who I adored, was stuck in the unenviable position of practicing Field Medicine Therapy. Maybe she couldn’t get me off the battlefield, so to speak, but she kept me patched up well enough to keep me going during that time. That was important work, back then.

    When you’re stuck in a high-stress situation but are lucky enough to have good therapy, it often functions as Field Medicine Therapy. That means you might still need therapy (maybe totally different therapy) afterwards, and that’s okay.

    Then again, you might not, and that’s okay, too.

  2. Some of the worst therapy I’ve had has been provided by PhDs (which doesn’t mean all PhDs are bad therapists; read on). Also some of the best.

    Some of the best therapy I’ve had has been provided by people with Master’s degrees — and, in particular, by my current therapist, a great lady with a Master’s in Education (which is actually a reasonably common therapy credential in Kentucky due to our state licensure system).

    It’s worth remembering that a PhD, at least in the United States, is a research-based, academically-oriented degree, and few US PhD programs in Psychology are actually aimed at producing therapists. Many are aimed at producing clinicians who are also academics, but not necessarily clinicians who practice psychotherapy.

    PsyD programs, meanwhile, tend to be more practice oriented, but they also aren’t necessarily geared towards producing better therapists. Unfortunately, I don’t know a heck of a lot else about them, except the fact that they’re generally less oriented towards an academic career track and more towards a practice-oriented, clinical one.

    So a PhD-level therapist isn’t necessarily going to be a better therapist than a Master’s-level therapist — which isn’t to say that PhD- or PsyD-credentialed practitioners can’t be awesome.

    Just that you’re not getting short-changed if your therapist doesn’t hold a doctorate of some kind.

  3. Some of the worst therapy I’ve had has been provided by very good people with the very best of intentions.

    I was really pretty angry for a long time at some of the practitioners who were responsible for my care when I was in high school.

    It’s been long enough now that I’m comfortable stepping back and recognizing that, while at least one of them was a complete dick (who was asked to resign from her position after an episode of particular dickishness), most were good people doing the best they could with what they had. They were also unwittingly practicing field medicine; sending me back every time I walked out the door into a situation that, at the time, was pretty harmful (though the worst part was behind me by then and, ironically, took place in a gap between therapists).

    That didn’t make it easier to cope with at the time, but it does make it easier to forgive them now.

    As does, I suppose, knowing that whatever damage might have been done by therapeutic decisions that led to unforeseen consequences (hellooooo, meds), I do to a great extent owe my life to the people who did their best to take care of me when I was in high school.

    But it was still terrible therapy … and they were still good people.

  4. The best therapist for you might not be the best therapist for someone else.

    The best therapy for you might not be the best therapy for someone else.

    Heck, sometimes, it may not even be possible to delineate what’s therapeutic about the best therapy: while my current, brilliant therapist is influenced by the classical talk-therapy school, including the practical (but not the weird theoretical) ideas of Freud, I’d describe her style as eclectic.

    Often, we just Talk About Stuff — but somehow the Stuff we talk about is real stuff even when I manage to walk into a session manic as a crack-addled ferret and convinced that Everything Is Just Fine.

    And, while I couldn’t outline exactly how she’s done it, D. has operated as a mirror of fresh insight in a way that has been transformative for me in a way that no other therapist has (in part because even my best prior therapist, who I adored, was practicing field medicine).

    And this is a lady with a Master’s in Education, so once again, if you’re worried about credentials … sometimes the best credential is a jillion years of experience and a recommendation from someone you, the patient, trust.

  5. Like school, therapy is something you pay for.

    That means that if your therapy isn’t working for you, you’re totally allowed to speak up about it.

    And if your therapist is a jerk, you’re allowed to fire him (or her; jerky therapists come in all sexes, sizes, etc). You’re even allowed to fire your therapist (and, one hopes, find a new one) if your therapist just isn’t a good fit for you. Sometimes that happens.

    True, as with school, therapy is something that isn’t going to work as well if you don’t do your end of things.

    That said, as with school, if you’re not doing your end of things, you might be over-faced — and it’s okay to say, “I’m not ready for this level yet; I need to step back to therapy without fractions and work on the basics some more.” I have totally done that, and my therapist totally did not kill me.

    Also as with school, you’re not doing your end of things just because, you’re screwing yourself outta money! Why you wanna do that?!

    But if you’re doing what you can and it’s not working, it’s okay to speak up.

  6. Therapy doesn’t have to be forever, but it doesn’t have to not be, either.

    It’s okay to stop, then start up again, or cut back, then step it up again. It’s a service.

    If it helps, you can compare it to physical therapy: you might start physical therapy to address some kind of longstanding muscle imbalance, get that sorted over the course of therapy, be fine for a while, then end up with an injury (maybe even one that causes the old problem to re-surface) and need another course of therapy.

    That doesn’t mean that the original course of therapy didn’t work, or that you don’t deserve the new course of therapy.

    Likewise, sometimes you might get assigned a course of physical therapy and not actually do the exercises for whatever reason (which as TOTALLY NEVER HAPPENED TO ME, okay? I am the BEST PHYSICAL THERAPY PATIENT. …Um, is my husband looking?). So that therapy might not work as well as it could have, and you might need to try again later. Your physical therapist might be all, “Did you do your exercises?” … but she’s not actually going to kill you, and if she’s really good at her job, she probably won’t guilt-trip you, either.

    Good psychotherapists kind of work the same way. They don’t guilt trip you about not doing those million leg lifts, or whatever their psychotherapeutic equivalent is, between back when you finished your last course of therapy and now. They just help you get down to work.

  7. Lastly, good therapy is not always easy to find.

    People can be really judgmental if you’re not in therapy and maybe you should be.

    Those people are jerks, and you can tell them I said so.

    Even though I just said bad therapy was nonetheless partly responsible for saving my life, bad therapy can also be worse than no therapy (you could make a physical therapy analogy here, too: a bad physical therapist, especially one who’s heavily invested in some trendy new modality, can seriously hurt you and leave you needing way more physical therapy than you did when you started).

    Sometimes you just kind of have to do what you can and forego therapy until you find a good therapist.

    And that’s okay, too.

    You gotta do what you gotta do.

So that’s all for now.

Again, your mileage may vary (and, in fact, it may vary enormously, which is also totally okay) … but I hope some of it might be useful to somebody, somewhere.

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About asher

Me in a nutshell: Standard uptight ballet boy. Trapeze junkie. Half-baked choreographer. Budding researcher. Transit cyclist. Terrible homemaker. Getting along pretty well with bipolar disorder. Fabulous. Married to a very patient man. Bachelor of Science in Psychology (2015). Proto-foodie, but lazy about it. Cat owner ... or, should I say, cat own-ee? ... dog lover. Equestrian.

Posted on 2015/10/26, in bipolar, life and tagged , , . Bookmark the permalink. Leave a comment.

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