Lessons in Therapy

I’ve had several people reach out to me over the last couple of weeks to ask questions about therapy, so many that I thought it warranted a blog post. I think there are people out there who are really suffering from anxiety and depression right now and they don’t know who to turn to. Some people want to ask questions about mental health, but never would because of the stigma associated with it. This stigma is generations old, y’all and familial. Which is to say that it runs rampant through entire families for years and years. Both the mental health issues and the stigma surrounding help. Parents, grandparents, many who would benefit themselves from therapy and medications, talking shit, if you will, on people who get mental health help, creating a horrendous environment for family members who actually wish they could seek help, but are afraid to because of what their family members will say. This stresses out the people who are already in need of help, thus creating a cycle. Parents saying to their grown children: “Just pull yourself up by your bootstraps, I did it when I was your age and look at me!” Yeah. Look. At. Them. I know so many people who are “secretly” in therapy that it’s pure craziness. We need to talk openly about this. People need to be informed. People want to be informed. So, let me inform you the best way I can, with a story.

The day I walked into Patsy’s office I was nervous and sweaty. I was immediately wondering if she would see that I was nervous and sweaty, which made me more nervous and sweaty. I’d already done my “intake” paperwork before I showed up at the office. They emailed it to me the week before, I printed it out at home, filled it out, scanned it, then emailed it back. “Intake” is just a scary word that means they have all your information. Name, address, phone number, medical history, health insurance info, emergency contact, etc. All the normal new doctor bullshit. The problem is when people hear “intake” in relation to mental health, they think they are about to get committed to some scary psych ward that they watched a documentary on, and ghosts are going to chase them around in the haunted hospital. Or more likely, they they think they must have something REALLY wrong with them if they are doing an “intake” form. Nope. In fact, I think some offices don’t even call it that anymore. It’s all just called “Evaluation” which is what my office calls it, but some old school places still call it “intake,” so that is something to be aware of. The word here literally means, “Process of taking something in.” This situation being your therapist’s office taking in information about you as a new patient. That’s it. That’s all. Calm your tits.

So I walked into this new office, which is already scary for someone like me, and I was met with a receptionist, which is normal. She spoke in a nice, calm tone (as I’m sure they are trained to do) and told me she had all my paperwork, and that I had a $30 co-pay per my insurance. She then took my card, processed the payment while I stood there awkwardly, and told me that I would be seeing the office’s therapist Patsy for my “evaluation.”

Remember, the first visit to ANY mental health office if going to start with an “evaluation” by a mental health professional. Chances are, if the office has a therapist and a psychiatrist, the therapist will do your evaluation to decide whether you can benefit with regular, old, run-of-the-mill therapy like she can provide, or if you need to see the psychiatrist. Keep in mind here that the psychiatrist is the M.D. The therapist usually just has an M.A. in therapy or something like that, which means she can’t prescribe you medication. But the psychiatrist can. But, that doesn’t mean you HAVE to see the psychiatrist. In my office there is also a mental health nurse practitioner who can prescribe medication under the direction of the psychiatrist. Stay with me.

I was seeing both Patsy my therapist, and Suzan my MHNP. BUT, and this is a big BUT, your primary care physician (your regular old MD doctor you go to when you have a cold) can also prescribe mental health medication. Which means your therapist can recommend medications or treatment plans that you can then take to your doctor and get filled, if your doctor is willing.

So can’t I just see my PCP for all this, Missy? Great question! Absolutely you can, BUT that’s all you’re gonna get from your PCP, medication (and sometimes more of that judgement we talked about earlier, because they just aren’t mental health professionals). You won’t get the therapy that is SO important. In fact, some PCPs won’t give you medication unless you are seeing a therapist, which is smart if you ask me. Trust, I did the PCP for mental health care for a decade, and then it occurred to me one day: When I have vagina issues I see a gynecologist. When I have stomach issues I see a gastroenterologist. If I’m having mental health problems why would I not see a mental health professional? Answer: That generational, familial stigma. You gotta get past that.

Truth Time! Patsy is the third therapist I have been to see. The third time I got up the nerve to talk to someone. But each time before I quit going within three months. Why, Missy? Because, and I can’t stress this enough, THERAPY IS HARD AS FUCK, Y’ALL. You think the first time you will feel better. Nah, you won’t. In fact, you feel even worse. You feel like shit and you start to wonder if the therapist is straight-up out to get you. Like they are a sick subgroup of people who just like to watch other people cry. That’s not the case. Well not usually. It’s just HARD AS FUCK the first few months. The most important thing I can say to you is to STICK WITH IT. Those first few months the therapist is trying to understand you. Trying to figure out what your main issues are. Diagnose you. And no, it isn’t all your Mom’s fault, though truth be told a lot of it is, so if you love your Mom and think she can’t do any wrong, it’s gonna be even harder to sit through this part. Because most of what we deal with as adults stems back to the environment we were raised in. And most of us had shit happen to us, that we can’t even relate to our life now, but trust, your therapist will pull it out of you and before you know it you will be all, “HOLY SHIT! That makes so much sense. This is why I react like that now.” Or “Ohhh, that’s why I hate the color purple.” Trust, you will get answers. But it will take time.

I told Patsy at my evaluation appointment, all about my other therapy experiences and what I did. At the end of the evaluation, which is just a long talk, she asked if I would be willing to work with her, and if so, would I be willing to stick with her for SIX MONTHS! Six months, you guys. I knew my track record. I knew how hard it was, but even so I said yes. And now it’s a year later and I actually fucking look forward to seeing her every few weeks. I smile when I see her (I secretly want to hug her, but I think that’s frowned up) and I already have a list of shit to talk to her about because I know she gets it and can help me. She always gets it. She always helps me. But it took awhile to get there.

The other thing I want to say is that the first therapist might not be your person. Same for the medications. We counted it up, and along with having been to three therapists, two PCPs, and a mental health nurse practitioner, I have been on 10 different medications. Not at the same time. I mean I’ve tried 10 different kinds over a decade and just now feel like I found a good fit. Some of them worked for years, don’t get me wrong, but then they’d stop working. Prozac. Wellbutrin. Zoloft. Yeah, been on them all. And they were all great, but got to the point with me that they weren’t doing their job. So it takes time. And patience. Lots of patience. (Side political note: It also takes money. Health insurance. So people who don’t have money and/or health insurance can’t do this. Is that what we want? A country where only people with money/health insurance can get help they need? Nah, I didn’t think so. Vote, assholes.) Sorry I called you assholes.

Whew. I’m tired writing this, and I’m sure you’re tired in reading it, so let’s stop here. But let me say this: If you have any questions or concerns, or just want to talk to someone about how to even start this process, I’m here for you. Yes, even my complete strangers who just Googled “Ligers” and got to this post. I’m making one of my tags “Ligers” for this reason. I will help you. You can comment on this post. We can get you into therapy. Into someone who can help you around your area. In fact, I’m going to share some links at the bottom of the page to help you if you need it.

Listen, I need you to take care of yourself, okay? It’s important. We need you. Yes you! Your family needs you. Your friends need you. Your community needs you. And if you let what you think is just “a bout of the blues” linger, I promise it won’t get better alone. Trust me. I know. I’ve been there. There are people who want to help you. No judgement. Let me help you find them.

Stay safe and sane, y’all.

M.

American Psychological Association – How to Find a Good Therapist

National Suicide Prevention Lifeline – 1-800-273-8255 (TALK)

Mental Health America – Text MHA to 741741

There are currently online support groups for dealing with Covid-19 stress and trauma. Check out this place that are offering their services 70% off (I don’t know much about them, but I did go to their website and see their offer. So it might be worth checking out if you need to.) This is just one example. Google “Online mental health support groups.”

4 thoughts on “Lessons in Therapy

  1. Good post! Just a note: some PCPs won’t prescribe you psych meds if they think you might have more than general anxiety and depression. I was having a severe depressive episode and my PCP had me go to a Psychologist for a diagnosis and Psychiatrist for meds. Turns out I have Bipolar Disorder and I continue to see the Psychiatrist periodically for meds and a therapist weekly.

    Liked by 1 person

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