I'm posing a larger, broader question in this post. There is a lot going on in the world right now that is creating upheaval in many ways. This isn't social commentary, and yet it is. I can't escape it. I frame the world through my therapist's eyes.
So let me explain what prompted my asking the question at the center of what I'm writing about.
I was listening to Seth Godin's newest podcast Akimbo. In the episode, during the segment where he responds to listener mail, he got a question about how to change schools to better address the needs of the students that attend them.
Part of Godin's response was to ask a question - what is school for? His thinking, as he explained it, was that when you answer that question, the way to better help students will become clearer. Certainly, the answer to - what is school for? is complex and highly opinionated. I'm not trying to tackle that one.
However, I do want to use Godin's approach and apply it to my profession as a licensed counselor. He got me thinking:
What is therapy for?
Also,
Who is therapy for?
There are many voices out there, spread across multiple media platforms that claim to know and they will happily inform you of their opinion, insight, and belief. I'm basically doing the same thing in writing this. I'll own that. My reasons for the writing have way more to do with providing practical information along with an explanation of what I do and why it's important to me. Yeah therapy! Go counseling. That's my agenda.
Be that as it may, there are a lot of ideas out there right now about:
1. What mental health is.
2. What mental health professionals are supposed to do.
3. Who mental health professionals are supposed to be working with.
I'll set it up like this, and all of this is my opinion:
1. I have very recently heard that therapy is needed to catch people who are violent before they act violently and treat them so they are then no longer violent. That appears typified with our current debate about the role of access to firearms and who should be carrying. One side's argument focuses on how the perpetrators of gun violence are obviously mentally ill and were in need of treatment, someone missed the signs, and you need a gun to protect yourself. I'm here to say that only a very small percentage of those diagnosed with any form of mental illness are physically violent. It is way more likely that they are violent against themselves as opposed towards others.
Because of that fact, I disagree with how gun violence is being equated with mental illness as a way to explain the rash of mass shootings that have been occurring. Mental health has a role certainly, and other factors lie at the the heart of this issue as well. All that argument does is to prevent people that would really benefit from talking about their stuff from doing so because of a negatively skewed narrative, the negative stigma, and social bias.
2. We have our health insurance industry basically claiming that therapy is for symptom reduction. What I mean is that because a medical model has been adopted by our mental health industry (not necessarily willingly), and a diagnosis is based upon symptom severity, health insurance generally pays for some types of psychological treatments specifically for symptom reduction (along with medications). My role as a therapist becomes finding the best way to reduce or alleviate those symptoms. Once the symptoms are gone, my job is done and the client ends therapy because there is nothing left to treat; no distressing symptoms, no diagnosis, no rationale for services. So most people will leave therapy with some great skills and how to recognize in themselves what means trouble. What they likely lack is a deeper insight into where their stuff came from and patterns of behavior that sprang forth. Yet, depth work is generally ignored for the sake of efficiency and expediency. Right, wrong, indifferent, this is how I see our systems work.
3. I've heard calls to only focus on the severely mentally ill, to move community resources ($$$) to reopen psychiatric wards to treat (house) those who are really bad off and a burden to keep in the general public. As challenging as it is, treatment cannot be forced upon anyone, the exception being those who have been committed to a state facility in a court of law (usually probate court), or have behaved criminally resulting in incarceration. The problem with this "focus on the worst"
approach is that really only a very small percentage of individuals diagnosed as "severe" require around the clock monitoring in a locked facility. Ethically, and legally, the mental health industry operates in a world of "least restrictive means necessary". That means limiting hospitalizations for mental health reasons to only those that require it. Otherwise, all services shall be rendered from the outside community. The over-funneling of money only to serve the most challenging of cases ignores just how many in our communities need and deserve assistance to address their issues because having and being part of a community is vital to their recovery.
Limiting access to health care by keeping health insurance costs prohibitively high is also problematic. So too is underfunding of Medicaid and the limited budgets for most community mental health centers that are the front line of service for so many. You add the burden of stigma on how we view those in mental and emotional distress, now you've see the problem that we have been living through acutely for the past decade or more: too few providing the help to those seeking bare bones services for conditions that are socially stigmatized, yet very treatable.
My caseload when I was in the trenches working at a community mental health center was alway well over 100 as an in-house therapist. Did that job for 2 years before moving on to juvenile work because I had a way with the harder kid cases. I was lucky that I was allowed to schedule some of my clients for hour sessions, however most had to make due with thirty minutes, and often just once a month. For a few, that was all they needed, for others it was all they got. I won't go into any great detail about what a day felt like when I saw 12 of 13 people back to back to back. That happened a fair amount. Got to show how productive you are or your funding becomes even more scarce.
4. Speaking more on stigma, I've heard therapy is only for those who are weak willed and too soft to deal with life on life's terms. They can't pull themselves up by their boot straps, and because of their inability to help themselves, therapy therefore is viewed as only for the defective, the damaged, and the broken. Not a very uplifting message, and one that I wouldn't build a marketing strategy around. It's hard to sell a service, even when you have insurance, that tells you you're less than for needing the help.
Along those same lines, we live in a culture that wants fast results, "instant gratification". That's partially why medications are so frequently sought out as a means to solve mental health problems. But meds don't necessarily solve anything. Yes, they very much give relief and can provide a very different sense of self. They can elevate mood, calm racing thoughts, or help make one feel more grounded for a while. People go back to work, reconnect in their relationships and family; they are normal again because of medications. Despite all those postive effects, they still do nothing to provide understanding of oneself. And because of how they are promoted, along with how our culture is actually rather lazy in regards to our overall health, it makes sense that another part of the stigma associated with therapy is that it is work, and that work takes time for the benefits to be realized. So the "savings and investments" analogies also suck as a marketing campaign because when was the last time you put any money into your own retirement fund consciously?
So, as the person who does this for a living, I'd like to tell you my thoughts about what therapy is for, along with who it's for. Who I have worked with and what I've done has changed over my career. Would you like a list:
children as young as 8, adolescents, adults, and the elderly, the severely mentally ill (i.e schizophrenics, bi-polar diagnoses, severe depression with psychosis, etc), juveniles, sex offenders, couples in crisis, grieving parents, and folks in transition
I've provided in-home services, outpatient care, crisis management, walked both adolescent and adult commitments through court, did intakes, gave diagnoses, ran groups, developed programs, built 6 hour educational lectures, and and started a practice.
I know this industry intimately.
Therapy is for all these things that I stated above and so much more. To sum it up for me, therapy is for change and anyone that wants it. Current statistics show that one in six people are dealing with something that can be diagnosed as a mental illness. I want to stress my personal opinion here; that like all diagnoses of physical health that can change and are healed, so too are many diagnoses that have to do with our mental health. One in six is a lot of people to have something "incurable". However, everybody with a diagnosis needs symptom reduction. Beyond that, what is also helpful is understanding what caused the symptoms in the first place and how to resolve it. I did not say cure. I don't cure people, I help them resolve what they need to in order to live a more fulfilling life.
Counseling also does way more than just reduce symptoms. It can tap individual potential, create deeper understanding of the self, teach life altering skills, and educate. Therapy is for anybody needing help with change, regardless of a diagnosis. People respond just as well to brief therapy interventions, really focused work; as they do going deep into their psyche to better understand themselves. It's the combination of craft and rapport, technique and trust that brings change.
So if you've found yourself stuck, consider talking to a professional, if even for just a short time. Counseling can help set your mind at ease and allow you to see things more clearly. We all need to take stock and reorient ourselves from time to time. You deserved.
Just remember, mental health matters.