Thursday, June 16, 2011

Mad Therapy

Greetings, Citizens.

It's's 12:51pm as I begin writing this particular Madness, which is much earlier than I usually get Mad on a Thursday, but I've been feeling particularly Mad lately and I just couldn't wait until this evening to discuss with you a very crucial issue.


Now it should be no secret to regular readers of the Weekly Madness that I am not a huge fan of psychiatry. Psychiatric meds have proven to be little better than a stopgap measure for myself and most of my companions, which I would not have as much of a problem with if it was better understood by the populace as a whole and Psychiatry in particular that this is the case. Though it is undeniably true that some medicine provides concrete and needed help to some individuals, it is equally undeniable that much medicine forces itself on unwilling and un-needing individuals in order to uphold a status quo, in the best of cases (personal vainglory and ambition in some of the worse cases.)

But there are alternatives to psychiatry for treatment, and one in particular that is more or less valued by the system at large, and it is called Therapy. My relationship with this strange entity is long, storied and rather complicated, and from it I feel I have learned much about Therapy's nature and uses. In today's Madness I am going to discuss the pros and cons of Therapy as a model for aiding the mental and emotional well-being of the Mad, and focus in on what specific things can make Therapy helpful or toxic.

I would like to begin with the most important disclaimer of all: the right time to go to therapy is when you want to try going to therapy and have the support necessary to do so. Not when your psychiatrist suggests it, not when your family pushes you towards it, and not when anyone in your life threatens to cut you out of theirs if you don't go to it. With only a very few outlier exceptions, therapy will be more destructive than constructive if you are not there willingly and with the support of those around you.

That said, people will try to "convince" you to go to therapy. To those people, I encourage you to reference my Crash Course in Care segment on being an advocate; to those dealing with such people, well....don't listen to them too much. Therapy has some things to offer and a lot at stake, so it is worth hearing out the testimony of others and reaching your own conclusion about the information presented.

Now, on to the topic itself. The big T. What is it good for, what is it bad for, and what are the signs and qualities of good and bad therapists?

Therapy is dangerous. You are walking into a room with a stranger and sharing your most intimate secrets, with absolutely no assurance of being judged fairly. You have to lay your heart and soul on the line every time you try out someone new, or discuss a new topic with someone familiar. Make no mistake, therapy is a stressful, scary process, even if you have a long-standing relationship with the therapist in question, and so it is best engaged in only if you have some kind of external support system to fall back on. Essentially, Therapy is best used as a supplemental processing tool in a stable, supportive environment. You need to know that, after the Therapy session, you can come back to a friend, roommate, parent or relationship partner who will be able to give you unconditional support in recovering from the session.

Very bad things can happen if you do not have this kind of support network in at least one person outside therapy. If you have no one at all, you may end up trying to find that unconditional support in the Therapist - this is particularly common of survivors of a few particular kinds of abuse. It leads to a very unhealthy relationship that many practicing Therapists will not hesitate to take advantage of in a most destructive way. If you do have a support system, but their support is conditional, or inadequate, or otherwise toxic, all of the work you process in Therapy can be completely undermined by that system. If you make an important realization, they may deny it; if your therapist makes a troubling suggestion, something you really aren't sure about, they may push you to consider it; ultimately, this dynamic creates and fosters the development of a dual state of being, where you are caught between your "true self" and your "patient self," the self you present to your family, friends, and doctors. They will be working on the "patient self" because the "True self" is not being spoken to or allowed to speak.

When I say "unconditional support," what I mean is unconditional support of YOU. That means, if you say "I hate this therapist and I never want to go back," their response is "Great. You never have to." Note: they should not ask about helping you find another one until it comes up organically in the conversation; Therapy must always be your choice.

Now, if you do happen to have that kind of support, then Therapy might be a viable option for helping you to deal with your distress. When the therapist is doing their job well, they will provide a sounding board for you to process your struggles off of, and can help you set goals and specific challenges in your internal processing. This can be extremely helpful for survivors of various kinds of abuse, as well as for people with any kind of powerful emotive cycles. I don't think there's anything wrong with a powerful emotive cycle, but you have to know how to ride it, and a therapist can be very helpful in this respect. Sometimes.

Sometimes they can be remarkably UNhelpful, however. If your issue involves an external source, the therapist's ability to be helpful immediately and sharply declines; if you are lucky, though, they may be able to give you some good ideas for how to deal with those external sources in a way that ends up working out for the better. But this requires you and your therapist to have a similar worldview of "better," and any schisms in this field become more noticeable when third parties get involved. This gets even force when the third party is not a person, but a concept or force.

One of the most destructive pieces of advice I've ever received from a therapist is the advice of integration. It is a very popular concept in psychology these days, and refers to the idea of coalescing the scattered parts of a psyche (or, in the case of people with multiple personalities, their various alters) into a single, working whole, thereby eliminating the conflict between those parts. To me, that sounds about as feasible as solving the Middle East crisis by taking every single country, dissolving their borders, and putting one big border around the whole area and labeling it "Middle-Eastistan." It is my fervent opinion that portions of a persona separate out because they need to. Trying to force, coerce, or even coax them back into a whole is to deny the truth of their purpose.
Now, it is possible that some fragments will eventually fulfill their purpose and, with no more reason to be separated, will begin integration on their own. That is fine. But it should never be assumed this is the case.

Trying to integrate certain parts of my psyche has led to terrible damage to my self-esteem and to some absolutely wild coping mechanisms on the part of those fragments at risk of integration. Reasonably, they resisted. It wasn't pleasant.

Having said all of this, I think we are beginning to get a picture of what Therapy can be good for, and what Therapy can be very bad for. But for Therapy to be good, the therapist must have certain traits, and they must never do certain things.

A good therapist must work for you, never against you. They must directly challenge only the most outright and explicitly dangerous ideas you present, and even then in a gentle, non-combative manner. They are the professional and you are the one who is proverbial on trial, so they owe it to you not to get defensive if you present an idea that they disagree with. If they can't do this, they have failed and should be dismissed.
They must never pressure you, but rather allow you to reach your own decisions and conclusions. They must be ready to engage with your issues in the manner that you wish to engage with them, and not try to force you to look at anything in particular.
They must not be Behaviorist in nature unless you have a phobia so crippling that you would rather go through a very disturbing therapy than continue to endure it, but even then I might recommend trying to find an alternative. I will probably rant about Behaviorism in more detail on another occasion, but the short of it is that in my humble opinion it is the purest bane of all healing psychology.
Edit 1: The following point is concerning therapists and therapy as it exists now. I am not inherently opposed to the creation of a system whereby spiritual and emotional counsel could be wed - indeed, I believe they should be, ideally. But most practitioners in the world we occupy are simply not prepared to do this effectively. That is my belief.
A therapist must never counsel you in spiritual matters. Even if you have the same spiritual worldview, spiritual counsel should remain separate from the active processing of serious emotional issues. Putting these things too close together is a recipe for disaster. Spirituality can help you with emotional processing, and therapy can hep you with emotional processing, but combining the two causes a bleeding over between various areas that just isn't wise to attempt to deal with. If your emotional issues are directly related to a spiritual matter, you may want to avoid personal therapy until you have enough of a support system - even if it is just through online forums - to try to separate these issues in your processing.
Similarly, I don't advise seeking overt emotional counsel from a spiritual figure in your life, but I am less insistent on that point.
This one should be obvious, but a therapist who is rude to you, insults you, belittles your intelligence, invalidates you in any way, or otherwise tries to harm or take advantage of you, is garbage and deserves to be disposed of. Immediately. This is usually hard to do, unfortunately, but if at all possible it should be done.

A therapist must be prepared to act like an advocate for you, which means they are on your side. This means that, as you process, and your opinions start to change, their opinions will also appear to change. This is because they must help you to reflect yourself, and so they must take on a similar affect. This doesn't mean they should outright lie, but rather that they should acknowledge YOUR truth as the most important truth in the room. Anything less is unacceptable.

Please share this list around and please feel free to add to it. See you next time, Mad Nation.


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