Can Therapy Be Bad For You?
The river is wide between our best intentions and the execution of change.
Today kicks off Mental Health Awareness month! This week’s content is all about caring for mental health.
Today’s podcast is a conversation with NYC psychiatrist, Dr. Samantha Boardman. We talk about fixing what’s wrong and building what’s strong. Listen here!
For this week’s Q&A, I welcome your questions about mental health. Submit your questions here.
Health is about having awareness of the data and the stories we tell ourselves, acceptance over the things we can't control, and agency over our life.
I recently saw a patient who told me that his anxiety symptoms weren’t any better despite weekly meetings with the psychotherapist I had referred him to six months prior. He was still waking up with feelings of dread. His heart raced and his palms sweat at work. His sleep was disrupted, and he had started relying on alcohol and Ambien to help him fall asleep. His wife had had enough.
What am I doing wrong? he asked me.
With his permission, I called his therapist. It turns out that instead of rolling up his sleeves to challenge dysfunctional thoughts and behaviors in his weekly sessions, my patient was using therapy as a comfortable place to unwind.
I see this all the time. I’ve done it myself. As a medical student, I used therapy as a dumping ground for the contents of my noisy brain instead of a place to build mental muscles. I certainly felt more relaxed walking back to my dorm room each week, but merely downloading my thoughts didn’t advance the ball down the field.
In a review of hundreds of studies on psychotherapy, The American Psychological Association found that about 75% of people who began psychotherapy saw some benefit, which suggests that 1 in 4 people did not experience any benefits from psychotherapy.
For more on how the stories we tell ourselves impact our everyday health, join our conversation!
In my experience, one of the main reasons patients find therapy ineffectual is that human beings are generally more comfortable chewing on problems than challenging the way they think and behave. Talk is easy; change is hard. Who doesn’t enjoy the cozy experience of venting our frustrations to a trusted friend, only to put ourselves back in the very place that brought us such ire?
The river is wide between our best intentions and the execution of change. Sometimes the water is too deep.
Not to mention that therapists aren’t magicians. In order for therapy to be effective, the patient has to be willing to be honest, vulnerable, and open to change. The therapist has to establish trust and rapport with the patient. They have to meet the patient where they are and offer empathy, compassion, and support in helping the patient meet their stated goals.
My advice to my patient?
Awareness of the data and the stories we tell ourselves
To be aware that his anxiety stems from feelings of inadequacy that began in his teens—and that it will take time to undo the endless loop of negative self-talk (i.e., “I’m unworthy therefore I must overwork to be accepted.”)
To remind him about the clear connection between his anxiety and his physical and behavioral health.
To acknowledge the common barriers to making therapy work, such as feeling “comfortably uncomfortable” enough to resist change.
Acceptance
To accept that our thoughts don’t define us, i.e., don’t believe everything you think.
To accept the dis-ease of challenging our beliefs, habits, and relationships with work, our partners, substances, etc.
To accept that in order for therapy to be successful, he has to be willing to be vulnerable.
Agency
To talk with the therapist about his fear of change itself—and how to feel more comfortable with the process of letting go. Cognitive behavioral therapy (CBT) is designed to help people challenge fixed, firm narratives that drive unhealthy behaviors and, ultimately, to help reroute these patterns to effect positive change.
To set specific goals with the therapist, for example:
Making an effort to take breaks at work to walk outside or to meditate.
Cutting back on alcohol, starting with limiting it to weekends only.
Tossing out Ambien, and starting a nightly bedtime routine of quiet, screen-free relaxing activities including 10 minutes of stretching before bed.
Taking 5 minutes every morning to journal, set a daily intention, and fact-check his thoughts (i.e., What evidence do I have that I’m not prepared for this presentation?).
Working on better calibrating anxiety to the actual threat.
To consider taking anti-anxiety medication as one way to potentially get more out of therapy. Although medication is not a panacea, when used appropriately, it can help patients better tolerate distress in order to “do the hard work” in therapy.
To have an ongoing honest conversation with the therapist about when and if therapy is doing more harm than good—i.e., enabling, instead of rerouting, ruminative thoughts.
Managing anxiety is hard work. No one can do it for us. Therapy isn’t for everyone. It’s not always necessary. But before you decide that therapy isn’t for you, ask yourself, Am I willing to do the work to feel better?
This week on the podcast!
In honor of Mental Health Awareness month, I welcome Dr. Samatha Boardman. Dr. Boardman is a New York based positive psychiatrist who is committed to fixing what’s wrong and building what’s strong.
Dr. Boardman writes a popular newsletter calledThe Dose and is the author of Everyday Vitality, a book about leaning into our strengths to bring about positive change.
Historically, psychiatry has focused on the diagnosis of disease and the treatment of individuals with mental illness. Positive Psychiatry takes a more expansive approach, focusing on the promotion of wellbeing and the creation of health.
Dr. Boardman is passionate about cultivating vitality, boosting resilience, and transforming full days into more fulfilling days. Today Dr. Boardman sits down with me to discuss finding wellness within illness, strength within stress, and how to live with anxiety rather than being defined by it. Dr. Boardman is here to help!
What did you think of today’s newsletter? I’d love to hear your thoughts!
Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
I love this! I’m a psychologist and I encourage people to do the work.... I hear too many experiences of people going to therapy just to dump their feelings and too many mental health professionals just enabling their actions...eventually people get tired and find it useless. I do believe dumping feelings is effective...with a combination of learning about thought and behavior patterns, reframing and coping strategies. Thank you for your fantastic description of positive expectations of the therapeutic process.
Managing anxiety and depression cannot be tackled in six months. It’s kind of a lifelong process that you can finally trade in your old tools that have never worked or have stopped working for new tools. Medication can help but not alone imo. If his wife is fed up maybe they should see someone together?