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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
A little while ago, one of my blog entries was Freshly Pressed (I’ll link to it shortly; I don’t want to ambush-link it, for reasons I’ll discuss below). I was surprised by this and, to be honest, also a little alarmed: oddly enough, although this blog is public and I know people might read it, it felt a little weird and exposed (in the sense that we use the word in choral music or ballet) to know that suddenly people absolutely and for certain were reading it. Especially since the post in question was one of the more sensitive ones.
I’m glad that that happened, though, because some of the discussion that resulted gave me the means to think about a part of the problem of bipolar — and of mental illness and of privilege, for that matter — that’s sort of been gnawing away at me in a way that I haven’t been able to quite figure out. This particular post is the direct result of sitting with and thinking about some of that discussion.
So the post in question dealt with some of the ways in which bipolar disorder has contributed to positive outcomes in my life that I might not have experienced without it.
Note that I’m not using the phrase “ways in which bipolar disorder has made my life better.” It hasn’t. It won’t.
Bipolar itself is kind of an ongoing train wreck that you have to learn to live with; to manage. It’s not necessarily a train wreck that is guaranteed to destroy your life forever (though in my case it’s taken, like, more than ten years to figure out how to keep the trains, like, more or less on the tracks and more or less running; let alone running on time), but it’s one that absolutely can and does destroy lives in very real and immediate senses, either temporarily or permanently.
As sometimes happens with all disasters, good things sometimes come out of the bad: you meet people you might not otherwise meet. You take a different path in life than you might have otherwise taken, and maybe something good happens.
The thing is, this shouldn’t, doesn’t, and can’t nullify the very real loss that comes with the experience of disaster (literally the breaking apart of the stars, you guys; I can’t think of a better way to describe the onset of bipolar than the cosmos being rent asunder).
Nor does it mean that everyone has this experience: for many of us, disaster is only disaster — and many of us don’t survive to experience anything beyond the disaster (let’s not get into debates about the afterlife right now, if that’s okay).
Because, here’s the thing: a lot of it comes down to luck.
I am the first to tell anyone, everyone around me that I am, in short, lucky. Immensely, unimaginably lucky.
I have had every advantage in the world.
I’m white enough to count, I’m male, I grew up in a wealthy family, I had mental-health insurance, I had access both to special schools for kids with mental illness and special schools for gifted kids, I’m gay but I’ve actually never really experienced any direct oppression about it, I’ve always had enough to eat, etc. My effort had little to nothing to do with all of that. It was just luck.
And, here’s the thing: even with all this luck, bipolar has still managed to screw my life up significantly for long periods of time and, to be honest, waste some gifts I wish I could have developed. It is still experientially hellish from time to time; it still costs me relationships; it still means I do stupid crap like forgetting to pay the house insurance bill for two months in a row, or whatever.
And the good things that I have in my life that I might not have had without bipolar I have because, you know, also luck (and also because, you know, tons of therapy and aforementioned every-advantage-on-earth, which devolve back upon luck).
I didn’t mean my post to be written in a way that would invalidate the experiences of others (and this is why I’ve chosen not to link it at the top: I’ll pop a link in at the bottom, in case you want to read it; I also welcome comments on how to maybe make it less triggery; less potentially-harmful).
I did think about that a bit when I was writing it: specifically, about articles and blog posts that make mental illness sound like a happy coincidence — a serendipitous walk in the park — without also explaining that, you know, there’s a very harsh reality that comes with any serendipity one might experience, and that just because one person experiences some degree of serendipity, that doesn’t mean others can or should. That’s the problem with serendipity: it’s random. It’s chance. We have no control over it.
I hope that the post in question doesn’t read like the articles I hate (to be honest, I’ve read very few of them; the only way in which I seem to be chronically unlucky in regard to bipolar disorder is that I always seem to wind up reading the most negative, grindingly-pessimistic articles about it known to man; OTOH, that might be better than constantly being faced with chirpy BS).
I am still considering what to do about it. I feel like, at very least, I should change the title, because the title alone is enough to make people feel invalidated, stressed out, and pressured — which, frankly, we get enough of already.
Bipolar is one of those conditions that (thanks in no small part to America’s total inability to educate its populace about anything complex) tends to be treated by the average person as a kind of spiritual laziness.
Neither I nor anyone I have ever known who lives with bipolar disorder would choose to live as we do. Some of us would like to be rid of bipolar altogether; some of us wouldn’t mind keeping some parts of it if we could get rid of the hellish ones (IMO, both approaches are valid; neither harms the world in any way). None of us would choose to destroy our relationships, educational and vocational pathways, and financial lives the way that we do when we’re ill.
Bipolar disorder is a neurological illness. Positive thinking won’t cure it. We cannot simply choose to be well. That’s not how this works; that’s not how any of this works (yes, levity is one of my many coping mechanisms). Positive thinking is a tool that can be helpful at some points, harmful at others — but it doesn’t cure bipolar disorder, that’s for sure.
Nor can those of us with bipor choose to see gifts where there are none. For some of us — for many of us — disaster is simply disaster, unmitigated.
And here’s the thing: those blog posts, those articles? The ones that talk about disaster just being disaster?
People are writing them.
But they’re not getting Freshly Pressed.
Those articles, those posts, aren’t getting published on Huffington Post (which apparently hosted one particularly egregious article about bipolar being awesome; one I haven’t read, and hadn’t even heard of until I wrote the post I discussed above — I’m going to chalk this up to luck as well).
Those experiences are genuine experiences of mental illness, real voices that Need. To. Be. Heard. They are the experiences that are pretty much universal to mental illness: that’s why it’s called mental illness, because it’s suffering, it’s hard.
And they’re not being heard, and it’s not because they’re not writing — not because they’re not out there speaking, or singing, or creating poems, or dancing it out.
It’s because our culture (at least in the United States) admires “positive thinking” to a degree that’s actually kind of unhealthy.
It’s because posts like mine can be seen as a justification of several major cultural paradigm — be grateful; think positively; if you just work hard enough everything will turn out fine — even when their authors do not intend them to be.
It’s because, frankly, people who aren’t living with mental illness mostly don’t want to hear those messages.
(Or at least, that’s kind of how it looks from where I’m standing.)
The thing is, we need to hear those messages.
We need, in short, to know how bad it really is.
Until we know how bad it really is — how hard real, actual individual human beings; actual people, for G-d’s sake — have it, and that they are freaking well trying with every bone in their bodies, or have tried until there is no more try (because, honestly, it’s okay to give up; it’s okay to not try sometimes!) — until all of this happens, nothing, nothing is going to change.
Here’s a fact: a long time before I was born, institutions were pretty horrible places to be (not to say they’re never horrible now; but they were, on average, more universally horrible back in the day). People didn’t know that, though, because the people in institutions didn’t have voices in the culture around them.
They had lives and stories to tell, but there was no internet back then; no way for them to easily get their stories out into the world except maybe by escaping and, frankly, nobody was going to listen to someone who escaped from a mental hospital.
Then a few reporters starting taking major risks on their behalf to go into some of these institutions and bring out footage: footage that showed how bad things were on the inside; how actual living human beings were suffering in totally needless ways.
That footage, the stories that come out of that, reached people’s hearts and helped spark some real changes (admittedly, they’re not changes that have always worked out too well: we kind of dismantled a broken system but didn’t replace it with a working one, which has left a lot of people with disabilities SOL — but that’s a post for another time).
Things only changed because people started seeing the problem as a human problem: an us problem, instead of a them problem.
The cool part is that, nowadays, we have the internet, and not as many locked institutions, and it’s much easier for those of us living and struggling with mental illness to tell our stories. We don’t have to get other people to speak up for us; we’re already speaking up for ourselves.
The hard part is still getting our voices heard.
This is the part where “typical” people — people who aren’t living with mental illness, or who at least aren’t living with debilitating mental illness (because things like dysthymia are real and suck in their own ways, but don’t always prevent one from participating in the dominant culture quite as effectively as, say, bipolar or schizophrenia do) come in.
For better or worse, there’s still a kind of gatekeeper thing going on, where people who are more successful at doing what’s expected in our culture kind of get to decide which voices are going to get heard.
I don’t know how to help the gatekeepers see that posts like mine aren’t the only ones they should put out there; in fact, that posts like mine kind of aren’t even the important ones.
Because, frankly, we’ve heard the “overcoming” or “good coming from bad” kind of story over and over again; we’ve heard it so often that it’s reached the level of cultural mythos.
It’s time to put the hard stories out there.
We have the message. We just need to have the means.
So that’s it for now. As always, I hope this post hasn’t stepped on anyone’s toes. At least, if I have stepped on your toes in this post, please know that it wasn’t intentional, and I’m sorry to have caused you pain.
Same goes for my other post. Sooner or later I’ll figure out what to do about it, and how. I’m still thinking about it.
Edit: Oh, yeah. I guess I promised you a link, so here it is. Opens in a new tab.