I’ve been going to therapy for years. Most recently since about a year before I filed divorce and then steadily after that for the last going on eight years. There’s a lot to talk about here, so if you are an old salt at mental health or if you have questions about getting started with it, I hope I can tick some of the boxes to help. I’m not a professional, but I might be an expert at the process from a patient’s perspective. The last couple years have been rough on everyone. Mental health is very real.
It’s not just about childhood trauma
The old trope of “Tell me about your childhood” exists, but therapy isn’t limited to just this. A lot of the time they want to know how you feel about something right now. You can bring childhood trauma into it, which often plays a part, but it’s not the whole picture. Sometimes it’s your current situation. Stress about money. An abusive partner. Your own anxieties or stress. A sense of meaning or purpose you seem to be lacking. It’s not always going to be about your past, though that will come up if you think it’s important and want to talk about it.
They aren’t your friends
The crazy thing (sorry, pun not intended) about getting therapy is it is a relationship of sorts. It’s not a friendship, though you will be sharing some very personal things with someone who will listen and offer feedback. They aren’t your friend, but I don’t mean that in a menacing way, like I would say about co-workers or the police. Friends tend to…indulge us sometimes. Enable us. Therapists don’t. At least they shouldn’t, but they will often listen and empathize with us to get the full story. Let them. This is good. Our friends like to see us Happy. Sometimes that means if we are lying to ourselves about stuff. I had a therapist tell me it was her job to hold up a mirror. Sometimes we don’t like what we see in that mirror. And no, life isn’t always about being Happy. Whoever told us that probably made their fortune off selling billions of hamburgers. Or oxycontin.
It’s a relationship
Just like any relationship, you have to find the right fit. I’ve been to therapists who just didn’t listen. Or others who thought they had me figured out. Others were such a soft touch with my feelings we got nothing done, because they were afraid to ask the tough questions. Others became more like friends and too familiar, and let me get away with bullshitting them for too long. Others just weren’t very good. I’ve probably seen a dozen different therapists. This happens. People come and go. It’s weird spilling your guts to someone only to hear later that they have taken another job someplace else or are retiring. But the important thing is finding someone that you click with…and not in a way that you click with friends. Someone you trust to share with, but also trust that they will call you out and you will feel safe with that. Even if being called out is uncomfortable.
But if the relationship is working, and your treatment isn’t, you can pick a different therapist.
Don’t self diagnose
I have a friend who is a psychologist. She gets so mad about TikTok and how people are using the app to self-diagnose ADHD, BPD, Narcissism, etc. Though I get the validity of her statement, that an app designed for teenagers to show off their dance moves is NOT a therapist…the problem with this country is we don’t have a lot of resources for mental health. It’s either prohibitively expensive or like I mentioned above, our choices are limited in who will be effective in our treatment.
As much as I have been going to therapy, my personal therapist has never run a DSM-IV or DSM-V on me. I have taken the DSM twice, however. Once due to a Parental Rights Evaluation due to my divorce, and another which was done because of a CPS investigation I got sucked into. That’s a whole other story, which I’ve talked about a few times. Here’s the thing. Both evaluations said pretty much the same thing. The things I was struggling with were due to the trauma I had endured during my marriage, and were likely treatable. But I wouldn’t have ever learned this just by going to therapy once a week. And a DSM isn’t just some online test you can take, like finding your Enneagram or your horoscope. It asks over 300 questions and the answers are interpreted by the psychologist to come up with a diagnosis.
So, no. You can’t tell if you have ADHD or Borderline Personality Disorder based on TikTok, but it’s a good place to start asking the right questions. Anyone who says “Only 1% of the population is a clinical narcissist! Stop saying your ex has narcissism!” The only reason the stats are that low is because you have to be diagnosed, which in and of itself is rare. So your sample size (especially for a disorder where the person thinks nothing is wrong with them) is going to be skewed.
There’s a good chance your ex is a narcissist. If it walks like a duck and quacks like a duck… And if that is what helps you deal with their bullshit, that’s not a bad place to start either. Unless you are using it to excuse your own bullshit of course.
If a diagnosis is what they need to show they are a narcissist, well, good luck with that, because in order to get diagnosed, you have to be evaluated. Anyone who is a narcissist is likely going to think they are the only one in the world without a problem. So good luck getting them in for a diagnosis. Unless a court orders it.
Don’t self-diagnose, but go into it with some good questions. Ask them to test you. I was involved with a narcissist who made me feel like I was the narcissist. I have two tests showing it wasn’t me. So I’ve got that going for me. Which is nice.
It’s not just about meds
People are worried that if they go to therapy they will be medicated. Some stuff needs medication, such as bi-polar disorder or things that your tendancy to self-harm has to be regulated with controlling your bio-chemistry. Some forms of depression, insomnia, and schizophrenia are like this too. But if your life sucks and you are depressed, there’s a good chance they can’t throw a pill at that.
In all my years of going to counseling, I’ve only been offered meds once and that was because my depression was so acute they were worried that something had to be done right now. The problem is it takes weeks to regulate with meds like that, and even then your body chemistry adapts. One day it all could stop working. And if you don’t have good insurance…well, you’re up shit creek.
But they will respect your wishes to be medicated or not. I know what my problems are, and CPT and other types of therapy have worked better than pills could. Same goes for self-medication. All the booze, weed, and hard drugs you throw at a problem won’t fix it. You have to do the work.
Do the work
It’s hard work sometimes. But it is worth it. It’s like coming out of a fog, even if it’s just for short bursts sometimes. But that fog gets less frequent until you start to forget the familiarity of the fog. It can be scary at times living without that fog. It’s a whole other way to perceive the world around you. You tend to act more instead of react. And sometimes that feels like you aren’t doing anything. You’ve lived so long the other way that you might backslide into dysfunction, or gravitate towards people with problems because you know what that is all about. You just have to keep doing the work. Chaos can be cozy, but you know what is better? Not having to deal with chaos. Trust me.
What comes next?
At some point, you might feel fine. It’s not a time-share, you aren’t stuck in it forever. It’s treatment. Just like how you wouldn’t keep going back to the doctor for that leg you broke in the third grade, at some point your visits will become less frequent. You’ll start to realize that something that would have gutted you a couple years ago just ruined your day and you were able to get on with your life. You no longer spiral. You cope. You overcome. You might even thrive. Your relationships are healthier. You cut out the toxicity voluntarily.
Every day isn’t going to be sunshine and lollipops, but you no longer feel that darkness consume you over little things. You are striving for balance. Not bliss. We all have good days and bad days. Therapy helps you avoid turning those good days into shitstorms because that’s all you know. You trust that life has an ebb and flow. Today might be good. Great even. Tomorrow might be bad. Knowing that one extreme or the other isn’t going to last forever has helped me immensely. At some point, you might decide you don’t need to go anymore, because you’ve got this.
Like really actually got this this time. And if you don’t, you can always go back.
What mental health isn’t
Mental health, unlike going to church or temple, isn’t about judgement. Unless you are hurting yourself and other people. There’s a stigma attached to seeking mental health. Like you’re “crazy”. We equate sanity with morality in this world. Being crazy isn’t about good or evil. It’s more like what you do with that crazy that matters. Someone who is psychotic or sociopathic has the capability to do bad things to other people without remorse. But treating that tends to curb the damage they can do to others.
There’s nothing that bugs me more about mental health than when people use their religion as a substitute. Why? Because a pastor or whatever the hell runs the place will just tell you to pray more, and it’s your own weakness and lack of faith that has caused this. Just pray. And tithe. Don’t forget to tithe. Bring your friends. Tithe.
Some personality disorders–like the ones I have experienced by proxy–are things that if they were treated would have meant the lives of their loved ones would have been better. But when you don’t treat it, it’s the same as letting someone have access to firearms who doesn’t possess the empathy or mental maturity to not walk into a school and start shooting.
There’s a guy I follow on TikTok who is a diagnosed, self-aware narcissist. He knows what he has done, and he understands how he has hurt people. Guess what? He’s doing something about it. That’s pretty badass right there. You are not your diagnosis anyway. You get to choose how you want to live.