For this week’s interview, I get to interrogate a woman who asks other people questions all day. Score! I love interviewing therapists. Because most of them are so complex and intriguing that they went into the field of psychology to learn about themselves. Right?
Therapy Doc, a woman from Chicago with lots of degrees and 30 years of experience in the mental-health profession, writes a fascinating blog called “Everyone Needs Therapy.” Even before I read any of her posts, I knew I was going to like it based on that name.
Her mission statement:

This social work blog reflects my multi-disciplinary scholarship, academic degrees, and all kinds of letters after my name that make me feel big. Patients wanted more feedback, but it’s morphed, so you get how I cope, too.

I love it when knowledgeable, educated, professionals write in way that is entertaining … and clear. It’s not painful reading like the psych texts were back in college. Every time I read a post from Therapy Doc’s site, I come away with some practical exercises I might incorporate into my mental health program.
1) Let’s start with the name of your blog, and the post where you support your claim that everyone does, in fact, need therapy. I liked your explanation of why therapy is different than getting coffee with a friend, because I’ve been tempted so many times to spend the money I hand to my therapist on a girls’ night out or a nine dinner with my husband.
You write this:

What’s wrong with having a good friend, a shoulder to cry on, or even handling one’s problems ones self?
Frankly, when I hear the advice that caring significant others shell out for free I want to die. My patients have generally suffered from the advice of friends and family, not gained. The advice is often so off the mark, I’m sorry, so wrong, so out of touch with the client, so self-serving, so biased, so blind.
Sorry, guys, but we DO learn a lot in school.

You later say that most of the time the wrong people are in therapy. Ha! I couldn’t agree with you more. So what does that mean? Do the navel-gazers like me continue to sit my butt on the couch while ones in rage just continue getting the aggression out by cutting off as many cars as possible on the way to work?

Funny you should mention ragers. Believe it or not, they do come in for therapy, sometimes court-ordered, but they come for anger-management a lot. The Sopranos did a nice piece on it. It’s not comfortable being angry.
So much to say here, maybe too much. The idea is that the identified patient (IP), the one who seeks therapy, often does so because other people make him sick. Think about growing up with ragers, or “loving” people who neglect or abuse you. Or maybe a boss who refuses to distribute the work equally, allowing some people do it all, whereas their “colleagues” are playing Spider.
When I say, The wrong person is in therapy, I mean, not enough people are in therapy.
As crazy as it sounds, one person’s dysfunction can make another person feel healthy. Feel is the operative word. So it becomes an, If you’re not a part of the solution, you’re part of the problem kind of thing. An identified patient can make a valiant effort at change, but the change is sabotaged somehow.
It’s all about psychological systems of attachment and the idea that we’re assigned, either overtly or covertly, to roles and expectations. The patient is stuck, will comply to expectations, obligated with invisible loyalties. There’s a good book on the subject with that title.
So although docs gently push people to establish better boundaries, to make independent decisions, to be more assertive, and to leave relationships that make them unhappy, it is the family (and that may mean something different to everyone) that ultimately wields and yields power for change.
And therapydocs don’t invite nearly enough of them to visit.
2) In a second post you qualify your blog name with this statement: “Everyone really does need therapy if they have any intention at all to be in a committed, long-term relationship.”
I totally get where you are going at. I agree with your explanation here:

Oh, you want to know how intimacy issues can mess with your relationship? Those fears I mentioned interfere with our ability to talk, to express what we want and need, to say things with sensitivity, to think less about ourselves and more about our partners. They interfere with empathy, our willingness to focus on our partner, to get into his or her shoes.
So they’re huge, okay? You can’t ignore them. They don’t go away over night no matter what you do. They just make you cuter is all, and all the more interesting to get to know.

But, come on, therapy is somewhat of a new invention, and sort of “American.” No one really flinches anymore if you say you’re on your way to therapy. But in Europe, Asia, South America? No, no, no. So would you say that these long-term relationships in other cultures are exra-dysfunctional?
No idea. But much depends upon culture. Certain tribal cultures respect individual differences to the degree that they nurture every member of the community and see to it that there is no shaming or abuse. A person with schizophrenia, for example, is protected, not stressed, treated with gentle attention. In that sort of ideal culture, people don’t need therapy.
The Europeans? South Americans? Asians? I don’t know enough to offer any opinion.
I do know, however, that Americans did not invent psychotherapy and that we have no corner on psychological or social research.
It could be, by the way, that our particular society breeds the need for therapy, that we have inherent morbid stressors. The need to be very skinny comes to mind.
3) I loved the tools you list in your post called “Coping/Managing Stress and Anxiety,” many of which are part of my “12 Step Program for Mental Health,”: exercise, diet, distraction, sleep, therapy, support, and so on.

I was especially intrigued by the imaging techniques you describe—and why you suggest a person to “go directly to the catastrophic expectation, the very worst scenario, and work it how you’d handle that.” Couldn’t that backfire? I mean, I tried to do that two years ago when I was so scared that Eric was going to leave me (because I was so depressed)—I imagined myself as a single mother working downtown as a waitress (because I had dropped all writing … I couldn’t concentrate), and sometimes that would make me shake even more with anxiety. Can you describe the difference between healthy imaging, and the type of catastrophizing that can be harmful?
Taking fear to a higher level by catastrophizing, will only work if the process de-catastrophizes, of course. Talking it out has the potential to take the terrifying zip out of an imagined event, but that depends upon who you’re talking it out to. Doing it alone might not cut it, you’re right. Doing it with a therapist or a friend who gets it, might.
Here’s how it works. Take a hypothetical situation, a woman thinks she can’t make it alone, is terrified by the thought of abandonment by a significant other. I’ll use your example with Eric, although I’m admitting at the top that I don’t know your history or your history with him and am not giving you advice, just using your name and the idea that you could be upset by his leaving and might obsess about it.

if Eric left, life would go on. Each day would pass, just as it did when he had been there, and yes, you would be unhappy and heart-sick, and your quality of life not as good, but you would not be dead. And where there’s a pulse, there’s hope.
And as time goes on, as the grieving process plays itself out, if you allow yourself to properly detach by not talking to him or seeing him, you would emerge with a greater sense of independence, always a good thing, which would replace the sense of emptiness, a bad thing, and the self would grow, which is a very, very good thing, and the feeling of dependency would fade, which is a very, very, very good thing.
So that’s how you’re supposed to think.
Even though people can and do think this way, it doesn’t make the pain just go away, not right away. You can’t control that. It’s the light at the end of the tunnel, however, that mitigates the anxiety, and the emphasis upon staying rational. The idea is to find the light.
If a person knows that taking thoughts that make them fearful and magnifying them will increase anxiety to unmanageable proportions, then for sure, for sure, this wouldn’t be an effective technique to do alone. I always recommend community mental health centers for excellent treatment at relatively low cost.
4) Your post about the holiday blues was also enlightening. You mention how money is a big player here – all the commercialization surrounding the holidays can get you down. I completely agree. And I’ve had this conversation already twenty times this year: “Hey, guys, can we not do gifts this year?” What do you do if you’re in a family where the other members actually LIKE to shop and give gifts. Do you graciously accept the presents, but not reciprocate—risking harsh judgments that you are cheap and rude? Or do you get online at the last minute (because I’m not going near the mall) and ship a bunch of stupid stuff that no one is going to use across the country to accommodate expectations?
I don’t know. Honest. The guilt kills everyone. The guilt and the shame are merciless. Say someone gives me a Waterford salt and pepper. I gave that person a scarf. I’m a loser. But not accepting the s & p is probably taboo. But not always, depends upon the giver, who might want the gift back if all she got was a crummy scarf. Who knows?
But let’s look at the catastrophic expectation in such a case.
Say I wrote a poem, instead of buying a scarf, and used the poem as a gift, and within the poem I expressed regret that this year there wasn’t a way to DO Xmas and still pay rent or the IRS. What’s the worst thing that can happen?
The family/friend says, She’s broke. Or, She doesn’t manage money well. Or, She’s cheap. If this is the worst thing people can say about me, perhaps it’s for the best.
And if you follow what I said in question two, time passes, the days roll by, and nobody remembers or cares about what they got for the holidays anymore. Maybe next year all I’ll get is a poem, which would be fine.
The whole thing is insane, seriously.
5) I’m just curious: does the input you get from your blog contribute to your psychotherapy sessions and vice versa?
Nah.
Although the input I get from other bloggers makes me think a little, it’s not going to have any overall impact upon the work that I do. I’ll read links, and stay abreast of research, but for the most part, being a therapist is an art and a skill.
My work is based upon a way of looking at illness and health that has evolved over many years. Assessing and treating is based upon many, many variables, all having to do with the patient and his or her particular situation.
Any one comment about a post, albeit interesting, is not going to affect the way a therapydoc does the job. At least not this therapydoc.