Posted by mair on February 19, 2008, at 11:32:55
In reply to Re: Please be civil, posted by Hermitian on February 18, 2008, at 21:51:24
This isn't fair, particularly since Hermitian can't respond, but these issues are so loaded for me largely because I'm constantly conflicted about the very arguments he raises.
I'm a product of long-term therapy, having seen the same therapist for about 10 years, twice per week for most of those years. She and I have been over this ground alot, but never to the pont where I've felt any sort of resolution about the continued value of so much therapy. But here's what I think my T would point out as valid reasons for long term therapy:
1) Like many on this board, my response to medication has been only partial. This is not for lack of effort - I've probably tried 20-25 different medications over the last 12 years. I'm pretty satisfied with my current combo of 4 drugs although it's by no means perfect. When I'm feeling pretty good, it's seems more than adequate, at other times, the combo seems woefully inadequate.
2) Depression for me is not curable, but hopefully mostly manageable. I've had too many major episodes, and the picture is complicated by the fact that I'm probably dysthymic too, or suffering from some sort of anxiety disorder.
3) In an attempt to better manage my depression, my T and I have tried lots of CBT stuff, mostly not very successfully. She is constantly on me about exercise, so I'll throw my hat in with others on that - all the harping in the world doesn't make it happen. When I feel up to it, I really do try to make it a more important part of my life. I don't think regular exercise is going to make the demons go away - it will make me feel a little better about myself - like I'm not a total slug.
4) The sympton which has been most resistant to medication is intrusive, always negative, sometimes self-destructive thoughts. These thoughts tend to paralyze me.
5) I'm high functioning only in the sense that I put on a really good act and only a handful of people know that I have depression and have had to deal with it for eons. People also don't realize that while my work product probably looks ok, I get about half as much done as my colleagues. Putting on a really good act also means that I'm very much a silent sufferer. Even the few people who know about my depression ever ask me about it. If I wasn't able to talk to my T about what goes on in my head, no one would know.
6) When depressive feelings get triggered, I tend to spiral downward very quickly. Therapy can be a safety net, because on some occasions I've been able to stop the spiral by quickly addressing it in therapy.
7) Because of the great difficulties I have talking about emotional things and holding onto an emotional connection with my T, once per week therapy has always felt pretty worthless to both of us.
8. At this stage in my life, most of my triggers can be found at work. I am not my T's longest-running patient, but I am the longest-running patient when it comes to the frequency of sessions. She tells me that the real difference between me and the 2 other patients that she's been seeing longer than me is that their circumstances allowed them to stop working.
Given all of this, I think I'll keep going through alot of ebbs and flows until I don't have to work anymore.
ON THE OTHER HAND, my judgmental alter ego views the facts a little differently.
1) I've made progress but it's been very incremental, and thus at a very high price ($$). So if you look at it in the way insurance companies do - strictly a cost/benefit analysis - it probably hasn't been "worth" what I've paid for it. I'm pretty sure disinterested third parties might say the same thing.
2) My years of therapy have led me to spend too much time pathologizing myself. Maybe if I didn't spend as much time thinking about myself, some of the destructive thinking would go away.
3) Maybe CBT stuff hasn't worked well with me because neither my therapist nor I really stuck with it. If I had no other choice, would it be more effective than it has been?
4) While my T always says she'll support any decision I want to make about terminating therapy or cutting back, she also points out all of the fears she has for me if I'm not in therapy, or for that matter, don't come to therapy as often as I do now. I think her litanies make me afraid of quitting. What if she's right?
5) Last year my T went through breast cancer surgeries and awful chemotherapy. I continued to see her, but on a very truncated schedule. For the most part, I fared very well. So I know that if I'm otherwise fairly stable, not seeing her is not the end of the world.
6) Nothing seems to trigger anxiety-laden depressive feelings quite like the times when I feel pretty disaffected from her and from therapy and I start thinking about quitting. I'm in that place now. It makes me wonder if i don't trigger depressive feelings to justify therapy. (She really disagrees with this, but I'm not so convinced).
7) Monitoring me over the years has led both my T and me to feel pretty secure in the knowledge that while suicide can be a real preoccupation, I'm probably never going to give it a real try. So strictly from a medical perspective, I'm not sure I need the safety net of therapy to keep me safe.
8) When you've been on long-term drug therapies, it starts to get hard to quantify the effect of each drug because you can't remember what it was like before you started taking it. I've had some bad experiences making drug changes so I'm really leery about attempting to get off a drug I take now so I can try a different one. Maybe therapy is like that - I can't quantify it any more because I can't remember how it was without it.
I think everyone has to engage in whatever type and duration of therapy which seems right for them. And if you do trust your T, you have to give some credence to what he or she says about where they can "take you" in therapy. I would never question anyone's decision to continue with long term therapy psychodynamic therapy particularly given the amount of suffering I've read about on this Board. What others struggle with makes me, with my non-traumatic childhood, feel like an imposter. So although I wish Hermitian hadn't started (and perpetuated) this discussion in quite the way he did, I'm an easy mark for questioning whether I continue to get a bang for my buck.
Mere
poster:mair
thread:813285
URL: http://www.dr-bob.org/babble/psycho/20080210/msgs/813576.html