Dr. E's Blog

Treatment Myths

One of my hopes in writing this blog is that I can demystify the process of seeking psychological treatment.  When I started to work on this entry I generated a list of common misconceptions about treatment.  For every “myth” I noted, there was always another myth on the opposite side.  The truth about treatment was usually somewhere between the two.  Without intending to do so, I realized I was starting to write a list of the dialectics in treatment, one of the central components of Dialectical Behavior Therapy (DBT).

DBT, as the name suggests, is based on the philosophical principle of dialectics, the concept that in everything exists two opposing poles and that “truth” can only be found by looking for the middle ground between those poles.  The primary dialectic in DBT is that of trying to find the middle ground between acceptance and change.  As DBT therapists, we are always trying to strike that balance between giving our clients the skills to accept reality as it is while striving to change it for the better. 

So, without further ado, here is my dialectical list of treatment myths.

You need to take time off to work on yourself


Therapy is just one hour a week

Therapy does take time.  Good treatment usually includes a weekly therapy session and may include a weekly group (depending on the type of treatment).  Really good treatment includes homework; therapy is unlikely to be helpful if you only think about it once a week.  You will need the time to attend your sessions consistently and to complete your homework each week.

AND, good therapy should be a natural extension of your life.  In most cases you shouldn’t need to “take time off” from your life to engage in treatment.  If therapy is targeting the appropriate problems, homework should be a natural extension of or shift in what you are already doing.  Homework helps bridge the gap between the weekly sessions and the rest of your life.  If therapy is working, you should be able to incorporate the concepts you are learning in treatment into your real life without having to put your life on hold.

You have to tell the therapist everything


If you say too much you’ll be locked up

What you talk about in treatment is ultimately up to you, and only you.  Some people feel comfortable sharing a great deal early in treatment, and others never tell their therapist everything.  The more you tell your therapist, the more they have to work with, and that’s normally to your benefit.  If you feel uncomfortable sharing something, you don’t have to it.  Your therapist may try to find ways to make it easier to talk about a difficult topic, but ultimately will respect your wishes.  Involuntary hospitalization is very rare and only occurs in extreme circumstances when someone cannot commit to their own safety or is a threat to someone else.  In most of those situations, people voluntarily take themselves to the hospital.

It’s really hard


It should make you feel better

Again, the truth is somewhere in the middle.  Therapy can be hard, and it shouldn’t necessarily be “easy.”  It’s not uncommon for people to leave therapy sessions (especially in the beginning) feeling a little worse than when they came in.  It makes sense when you think about it- we often spend an hour talking about things that are difficult.  Over the long-term, though, treatment should result in feeling better.  That’s why you’re going, right?  You should feel more capable and more able to manage stressors.  So, while the actual process of treatment is hard work, and sometimes it gets worse before it gets better, the end result should be an overall improvement in mood or functioning.

You’ll be told what to do


You won’t be told anything

Different types of therapy vary in how directive the therapist is.  In general, therapy is not advice, but it’s also not a blank wall. Your therapist will do more than say “interesting” and jot something down on a notepad, but they also won’t make decisions for you.  DBT therapists tend to be fairly directive in teaching coping skills, recommending strategies for getting through situations, weighing pros and cons, and helping clients to organize their thoughts, but we don’t make decisions for our clients.  Ultimately, it’s our job to help you trust your own decisions.

 Your therapist has it all together


Only nutjobs go into psychology

The bottom line is that most therapists – just like most therapy clients - are just normal people.  They probably don’t have it all figured out.  They probably have their own worries, conflicts, and mistakes.  But, they probably also practice what they preach.  For example, I’m a DBT therapist because I believe the principles of DBT work, and I see that in my own life.  This brings home one of the fundamental aspects of psychological treatment; treatment is not about getting rid of problems and creating a conflict free life.  Rather, it’s about learning how to manage the difficulties that are inherent in life and, hopefully, reducing the struggles and increasing positive experiences.

Should I Go to Therapy?

Making the decision to start therapy can be daunting.  During first sessions my clients often ask something along the lines of, “Do you think therapy can help me?”  Sometimes this is out of fear that problems are too big (they never are), but often people are concerned about just the opposite.  People are often worried that their problems aren’t bad enough to warrant treatment.  I can honestly say that this isn’t the case.  There is no such thing as a “good enough” reason to seek treatment.

Although I don’t subscribe to the notion that everyone should be in therapy all the time (I believe therapy should be targeted and goal-directed), I do believe that there are many people who could benefit from treatment who are not seeking that help. I frequently see people who have been struggling for months or even for years before they decide to ask for help.  While it is certainly true that ups and downs are normal and that life is often painful, it is not true that suffering has to be a part of it.  The longer we wait to seek treatment, the harder it can be to find relief.

People start therapy for all kinds of reasons, including mood and anxiety concerns, difficulty managing or forming relationships, coping with events from the past, or setting goals for the future.  Reasons for starting therapy can be very broad (“I want to feel better about myself”), or very specific (“I want to stop fighting with my partner”).  Problems can feel mild (“my mood has been low”) or debilitating (“I can’t think of a reason to live”).  No matter what your reason for considering treatment, it is valid.

So, when is it the right time to start treatment?  Here are some signs that now may be a good time:

1.  Your methods of coping just aren’t working.  Sometimes we tell ourselves that if we just try a little harder, just take a few more deep breaths, just wait another day, it will all get better.  Sometimes things do get better, but if those days have turned into weeks, months, or even years, it’s probably time to seek treatment. 

2.  You’re doing okay now, but feel like the “next thing” may just send you over the edge.  People often try to push through on their own and don’t seek treatment until things feel like they are falling apart.  Treatment is often more effective (and faster) if it starts before things fall apart.  That doesn’t mean all is lost if you wait to seek help, but preventing a crisis is often easier than recovering from one.

3.  You aren’t sure what the problem is, but you know there is one.  Often people don’t know exactly what needs to change.  On the surface, everything may look great.  While you may not be able to identify anything in particular that is “wrong,” you still have the feeling that things could be better.  Someone who isn’t “in it” (a treatment provider) can help to identify the problem and work toward a solution.

4.  You don’t want the same thing to happen again.  Sometimes treatment is more about prevention than anything else.  Often we make it through difficult situations in one piece but think, “There has to be a better way.”  Cycles of difficult relationships, mood swings, depression or anxiety can be broken.

 5.  You just don’t want to do it alone.  Maybe you could push through it and come out okay.  That doesn’t mean that’s what you have to do.  Treatment can simply help to lighten the load.

Here’s the bottom line: don’t fall for the myth that things need to be “really bad” before you can ask for help.  Most of the time, if you are wondering if therapy could help, it probably would.  If you are considering therapy, give a provider a call and ask, “Do you think therapy could help?”