Reflections on Hundreds of Hours in Therapy

The first time I ever went to see a therapist, I was 18 years old and a freshling at BYU. I’d finally gotten up the nerve to admit to my bishop that I was suicidally depressed, and he referred me to the university counseling center. I’d never been in therapy before, and I didn’t know what to expect. Unfortunately, it turned out to be kind of a disaster from the very beginning. The person who did the intake asked me about my suicide plans. When I hesitantly told him what I was thinking of doing, he said dismissively, “oh that would never work.” I was seriously burned by that brief interaction; years and years later, therapists would plead with me to share the specific details of my suicidal thinking and I would remain reticent, not wanting to re-live the shame of being told that my plans (and by extension, me) were not worth taking seriously.

The therapist who baptized me, so to speak, into the world of the weekly fifty-minute session, was not someone whom I liked. At all. In fact, I kind of hated her. To this day, I don’t really know why. I can hardly even remember anything she said. I just knew that she seemed cold and distant and even a bit scary. I dreaded going to see her, to the point where on days when I had therapy appointments scheduled, I would be sick to my stomach all morning with anxiety, and only finally feel a weight lifting from me as I exited the building where I was seeing her after enduring yet another session.

In retrospect, of course, it’s fairly obvious to me that we were a bad match. To be fair, a whole lot of it may have been the baggage I was bringing and what I was projecting on to her, and not anything she did. But regardless, you simply can’t do therapy in any meaningful way if you don’t have a basic relationship of trust and respect. That seems so obvious as to almost go without saying. But I find myself saying it over and over, because I’ve seen a certain problem arise again and again for first-timers in therapy: namely, without any experience or baseline to draw on, it can be hard to make a solid judgment call about whether the experience is working for you. In my case, all those years ago, I thought well yes, this is hard to the point of horribleness, but from what I’ve heard therapy isn’t supposed to be easy, so maybe this is normal and I should stick with it.

Years later, when I was in grad school, I had a roommate who was experiencing her first episode of severe depression. She dutifully went to see someone at the university mental health center. After a few months, she asked me somewhat tentatively if she could get my perspective on what was happening. She was nearly non-functional by that point, hardly getting out of bed and definitely not attending her classes; her life was completely in pieces. But her therapist, she reported to me, was—no lie—telling her that if she would just make an effort to smile more, things would probably look up. I was dumbfounded; I found myself wanting to scream DON’T WALK RUN FAR AWAY FROM THIS PERSON. But like me at 18, this was her first time in therapy, and she thought it was maybe normal and something was perhaps even wrong with her for having different expectations or finding it unhelpful. (The story does take a positive turn after that; after dropping out of therapy with this smiley person, she called around and found a local therapist in private practice who was an amazing match for her and had a way better experience.)

And this is the thing. I say this as someone who is a hard-core believer in therapy, who has invested literally hundreds of hours and thousands of dollars in the ritual of sitting in a quiet office and talking to someone about my life—so this isn’t coming from some sort of generalized prejudice against therapy. But the unfortunate reality is that there are a lot of truly terrible therapists out there, and finding a competent therapist who is also a good match for you can be ridiculously hard. I’ve certainly had some unhappy experiences over the years (though honestly, I don’t think anything has ever been as awful as that first time). After I saw the therapist I hated for a few months when I was a freshling, a lot of things in my life blew up, and long story short I ended up getting kind of forced into therapy with a different therapist. I lasted all of four weeks with her. I had some basic sense that something was off—looking back now, I think the woman had some serious boundary issues and I was totally right not to trust her—and happily I got out before we could get too enmeshed. I was pretty disillusioned by this point with the mental health system, both because of these experiences and some other stuff that had happened, and I had no intention of ever returning to therapy.

Fast forward five years to my first year of grad school. I had an awesome Relief Society president that year, who also happened to be my visiting teacher, and who herself struggled with depression. When I got up the courage to tell her that I was a complete mess, she encouraged me to seek treatment. First I went to see someone in LDS Social Services. I could not take the guy seriously. He asked me about my sexual adjustment, and I said something flippant like “oh I’m Mormon, of course I’m messed up in that area.” And he got rather defensive, and informed me that he had also been raised in the church and he was nonetheless Perfectly Adjusted With Regard to Sex, with No Issues At All. Based on this and other things that happened in our one meeting, I realized that this was not going to work.

My RS president friend suggested that I give a therapist on campus a try, one whose methods she had found helpful. I ended up seeing this guy for over a year. It didn’t seem particularly helpful, but I had a very low bar that point in terms of what I expected, and I figured that at least it wasn’t completely horrible or making me worse, so I kept going. He did EMDR on me, which I don’t think really did anything. I’m familiar from the research and also some anecdotal accounts from friends that some people find the technique amazingly effective, but it wasn’t the right thing for me. I didn’t tell him that, though. He would ask me about disturbing memories and then move his fingers back and forth and have me follow them with my eyes while thinking about those memories, and have me rate my emotional state before and after he did this. I wanted to be a good patient, so I helpfully always made the numbers indicating distress go down. He meticulously recorded this on his laptop; in fact, he typed up verbatim every single thing I said. I found that a little weird perhaps, but again, it didn’t seem to be hurting me. And you know, participation in therapy is kind of expected by the cultural narrative which tells you that if you are depressed, you need to do meds and therapy, and then you get a gold star for being a person with mental illness who is at least trying to Work On Your Issues. Honestly, looking back at that year, I think I mostly stuck it out in therapy for that gold star, plus my awareness that the mere fact that I was seeing a therapist was clearly reassuring to many of the people in my life.

After I left my graduate program at that university and started a different academic program in another state, I decided to give the therapy thing another go. So I went to the counseling center at my new university. I liked the guy who did the intake; he was genuine and caring and somewhat wry, and we connected well. I remember that after our initial meeting he told me to come see him again the next week and we’d finish the intake and he’d get me assigned to someone at the clinic. But somehow instead I just seemed to slip into seeing him every week. That was my first experience of therapy actually being helpful, and something positive in my life. He had a good sense of humor and laughed when I made witty and/or cynical observations, and didn’t take the mental health profession or himself too seriously. He confessed to me once that he was somewhat of a depressive type himself, and admitted that he didn’t like the The Feeling Good Handbook (by David Burns), which is kind of the CBT Bible, because it was “too cheery.” His view was that probably life was more down than up, but that it could still be worthwhile. That resonated with me; I really appreciated that he didn’t push positive thinking of any kind. One of the most helpful things he ever did, in fact, was early on in our work together. I was saying that I was depressed but had no right to be because there was so much good in my life, and I should really should be grateful and make a list of all the positives (“count your blessings!”), etc. And he made what to me was a radical proposal: he told me that actually he wanted to hear about all the bad things I was dealing with, and assigned me to come up with list of 25 of them to share with him. As it turned out, I had a hard time getting all the way to 25. But I felt incredibly liberated by the experience, like maybe there was room in the world for me to have negative feelings and someone would be willing to listen to them and not try to shut me down.

I saw him regularly for the two years it took to finish my master’s degree in theology. My time at that school ended very badly; a lot of things went wrong academically, I fell completely apart emotionally, and I was regularly in crisis. (I didn’t realize that, of course; I remember him saying once, “You’ve had a breakdown” and thinking something like, “No I haven’t! I’m really okay; I just need to pull myself together.”) I think there were points when he wanted me hospitalized—he admitted to me that he was a worrier by nature—but I was adamantly opposed to the idea, and he respected that and said that given my deep antagonism toward that option, it would probably do me more harm than good. That actually kind of touched me, because I felt like he was putting concern for my needs and desires ahead of his own anxieties. Near the end of our time together we argued and argued about what I needed to do next, and he finally wrote me a letter outlining his requirements (like that I would commit to calling a hotline if I were in real danger of hurting myself, and that I would seek out treatment wherever I landed next), as well as the consequences of my not going along with these recommendations (he was going to contact a family member of my choosing and tell them what he thought I needed if I refused). And then he simply stopped engaging me in arguments about those issues. It worked; I opted to do what he asked, and despite all the arguing, I think I was on some basic level okay with it because I knew it was coming from a place of caring rather than a desire to control me.

My most vivid memory of working with this therapist was one afternoon when I was acutely suicidal, and I was talking as usual about how I couldn’t go on. And something came up, maybe he laughed at something I said, but it prompted me to say something about how I appreciated that he didn’t take himself too seriously, that I liked that about him. And he said, “you know, there are a lot of things I really like about you too, Lynnette, and I don’t even know if this is the right thing to say or the therapeutic thing, but I would be devastated if you killed yourself.” It was a powerful moment of genuine connection, and it meant a lot to me. Years later I was visiting that campus, and had the chance to touch base with him, and I told him that I’d always remembered that, and he said that he remembered it, too. I also apologized for never expressing any kind of gratitude for everything he did, and he said it was okay, that the fact that I kept showing up week after week conveyed the message that I valued our work.

I ended up in Utah for a while after that, and I made some effort to find a therapist there, with the help of a former stake president who was a friend of my family as well as a clinical psychologist himself. The first guy I saw was very interesting and we had four weeks of engaging conversations, but he was a CBT practitioner, and I wasn’t sure that working with him was going to do much for me. To his immense credit, he realized that too, and told me that while he thought I was a lot of to fun to talk to, he wasn’t sure that what we were doing was all that therapeutic. So we parted amicably. The next guy I tried was a bit wackier; I’m not sure how many sessions I lasted, but when he shared with me his view that the pioneers were able to tough things out without Prozac and therapy, and that such things were just luxuries for our generation, I hit a breaking point. I actually got up and walked out, mid-session, and never returned. I never did find out anyone that worked out for me there, and since I knew I was leaving the area again soon, I eventually quit trying.

My adventures in graduate school next brought me to the Bay Area in California. I thought I should probably seek out therapy, but even as a bit of a therapy veteran by that point, it was hard to know where to begin. Also, I thought I’d never find anyone I liked as well as the therapist I’d been seeing at my last school, and that made me feel reluctant. I was active in an online mental health community at the time, and one day I whimsically posted my requirements for a therapist, one of which was that they needed to have a PhD; as a doctoral student myself, I guess I figured that I needed someone with at least as much education as I had. And one of my friends pushed back a little, and told me that her work with a therapist in training had actually turned out to be quite helpful. That made me stop and at least question my assumptions, and left me open to more possibilities. (To this day, I’m so grateful to her for sharing her experience, for reasons that will shortly become clear.) I’d been in California a little over a year when I found myself repeating a highly dysfunctional interpersonal pattern that had landed me in crisis in the past, and that was the catalyst for my finally picking up the phone and calling someone. A perk of the Bay Area is that it is kind of overrun by therapists, and I had a couple of options as far as clinics where you could see therapists in training for a sliding-scale fee (that was a dealbreaker for me, given the state of my finances). I really wanted to avoid CBT, of course, so I selected an institute which offered a postgraduate training program for psychodynamic therapists. I called, answered some familiar standard questions, and went in to see my new therapist for the first time about a week later. That was in November of 2004. It’s currently April of 2017, and I am still in treatment with him. If I’d had even an inkling that I would be embarking on that long of a therapy relationship when I decided to give this person a try all those years ago, I think I would have been paralyzed with fear and bailed out before I ever started.

I don’t even know where to begin in talking about my experiences in therapy over the past decade; there’s just so much I could say. Obviously I hit it off well with this person. But one interesting thing is that unlike my initial experience with the therapist prior to him, whom I’d clicked with right away, I wasn’t initially sure about this guy; it took me a few weeks to feel comfortable and okay about working with him. I didn’t feel wrong about it, or like anything was clearly off; I just wasn’t sure. Over the years, we’ve had ups and downs and drama (on my part) and one person once storming out of a session in the middle and announcing they were done forever (yes, that was also me) and occasional misunderstandings and oh so much intense emotion. But when I think about it all, we’ve both put in a lot of effort into building the relationship, and we’ve constructed something that’s made a huge difference in my life. When I moved away from California a year and a half ago, no way was I going to quit and start over with someone new, so we’ve kept things going via Skype. I was actually pretty skeptical at first that that would work, but while it’s not quite the same as being there in person, it’s turned out to be pretty darn effective. My therapist graduated from the training program he was in at the institute where we met just two years into our work together, and simply brought me with him as he shifted into private practice, without raising the very modest fee I was paying. I felt a bit guilty about that for a long time, and once said something to him about how he’d kind of gotten stuck with me and I wondered whether he resented that (I was thinking that if he didn’t have to keep working with me for a financial pittance, he could use my time slots to make good money off of a more affluent therapy-seeker). His response was to point out that it went both ways; I could equally assert that I had gotten stuck with him. After all, we’d been kind of randomly thrown together. He also reassured me that it was important to him to be able to offer some low-income slots, especially because he himself had received financial help at various times in his life.

People sometimes ask me, what factors make therapy work, when it does? What is it about it that’s helpful? My therapist is thoughtful and insightful and says things that make me think, definitely. I value that. But I don’t think that’s actually at the core of what’s going on. In the end, the underlying relationship is what’s really therapeutic, I suspect, even more than the specific content of our interactions. It’s been kind of amazing for me to have someone there, consistently there, week after week, month after month, year after year, willing to offer empathetic support while modeling good boundaries. That last is crucial; even when the boundaries chafe a bit, and I need more than he can give and have to deal with the disappointment of not getting it, it’s tremendously reassuring to know that he has those boundaries and won’t neglect his own needs (which would inevitably lead to resentment and burnout and maybe even ending things on his part).

One of the things I particularly like about this therapist is that his underlying philosophy isn’t one in which a sick person comes to therapy to be cured by a healthy person, but rather one in which two people work collaboratively toward the ongoing growth and development of the client. (So yes, though it’s something we’re working on together, it still is ultimately about me. He doesn’t have the kinds of problems I’ve heard about and occasionally encountered in therapists who spend most of their sessions talking about themselves.) From the beginning, he’s never set himself up in the vein of an authority figure whose task is to dispense wisdom and enlightenment to someone less developed; I feel like he respects my intelligence, takes me seriously, and sees me as a genuine partner in the process. He also thinks long term about that process; when I’ve felt guilty for not moving fast enough, or expressed anxiety about not making sufficient progress and getting kicked out as a result, he’s said things like, “You can’t make a tree grow faster. Some things just take time.” I am well aware that there are therapists out there who would have apoplexy upon reading this, who see the practice of keeping clients in therapy for years as nothing short of malpractice and as invariably the problematic outcome of conniving therapists who encourage their clients to be unhealthily dependent on them (the therapist), so that they (the clients) will never leave. That may well happen in some cases; I’m not going to say that every long-term therapy relationship is necessarily helpful or positive or healthy. But while, I used to feel somewhat defensive and self-conscious about the number of years I’ve been in therapy, I’ve come more to terms with that over time. What it comes down to for me at this point is that I have a chronic mental illness, and regular therapy is something that helps me tremendously in dealing with it, and quitting just to meet someone else’s expectation of how long therapy is supposed to last would be utterly nonsensical.

Therapy at its best, I think, is a chance for someone outside your situation to offer perspective on what’s happening, in a way that even caring family and friends can’t quite do just because they’re closer to it. My therapist once said to me that he thinks that all of us, just because we all have limited vision when it comes to ourselves, need people in our lives who can point out to us that when we get to a particular intersection, we always turn right—and maybe we could once in a while try going straight instead, or even left. That analogy has really stuck with me. Therapy is a safe place for me to articulate and sort through my thoughts, and quite often in the process put pieces together in new ways. I find, in fact, that the insights in our work that have impacted me the most haven’t usually come from him, simply because I don’t always internalize what he says, no matter how brilliant it may be—they’ve come from me, from things that have dawned on me in the course of our conversations. And there are less intellectual factors at work as well. For one thing, it’s immensely powerful to share your darkest secrets and have someone still accept you and stick around; I think it helps you develop a kind of security that can only come from experiential knowledge. Also, my experience is that transference is an absolutely real thing, and holy cow can it ever mess you with your head and your emotions, but having a chance to work through all the things that it triggers can be a super valuable process. For the first couple of years, therapy triggered a lot of abandonment issues for me, fears that I was getting too dependent and my therapist wouldn’t be able to handle the enormity of my needs and would leave. We talked about that all the time; I would up bring up various life challenges, and somehow in the course of the conversation we’d land there yet again, because it was such a deeply-rooted issue for me. It’s interesting to me to note that that rarely comes up now; I might disagree with him sometimes or question his judgment or be annoyed at something he said, but unlike those early years, I don’t often question his commitment to the relationship and to our work together, or his genuine care for me. And on a very practical level, speaking as someone who has a tendency to attempt to turn my friends into therapists when things are bad, having an actual therapist in my life to play that role is just good for everyone.

But honestly, while I’ve put a lot of real work into therapy and I don’t want to downplay that, I’ve also totally lucked out in finding someone who both is a good fit and has been willing to put in the time and effort of building something long term with me. None of my siblings, many of whom have also played therapy roulette, have had this kind of experience. Quite the opposite, in fact; they tell me stories of therapists who accused them of “intellectualizing” if they raised questions of any kind, or who did the classic Freudian thing of trying to get you to you lie on a couch and then not responding to anything you say, or who perkily told them that they loved them and gave them a hug every session (that one makes me shudder on a very visceral level—people! boundaries!), or who ran out of ideas and suggested that they spend the session playing in a sandbox, and then asked them, when they refused, why they were resistant to new things. When various of my siblings say that they’ve about given up hope for therapy to ever be helpful, I can’t really blame them.

This has already gotten way too long, and there’s so much more I could say about this topic—I didn’t even mention my experience with groups, or with another superb therapist whom I saw specifically for help with eating disorder issues for a few years (yes, for a while I had two therapists, who fortunately complemented each other well). And the last six years of my life have been Mental Health Central, with hospitalizations and residential and PHP and IOP and oh so many therapists in all of those settings. Most of them, to be quite candid, were mediocre, and some were downright harmful. So again, when people express skepticism about the whole therapy thing, I really do get it. But for all that, I am a complete and total therapy junkie.