April 6, 2010

As usual, a warning: this daylog is a purely personal musing on my own situation and issues, and deals with depression. If you don't care (and there's no reason you should), or this would annoy you, then skip this writeup immediately.

I have come to a bit of a realization about therapists. I have been to many, many therapists over the years, all across the boring vista of my life. I have had good therapists, awful therapists, and a few in-between. I've seen psychiatrists, psychologists, social workers, psychopharmacologists, psychotherapists and more. One constant has been my frustration with them and with the process they have used. The frustration has been there to a lesser or greater extent, but it has always been there. I have slowly realized a few things about this frustration and my relationship with therapy.

I'm the child of a psychiatrist. As a result, I have been exposed to the process of psychiatry and psychotherapy pretty much since before I could talk. I know that game. My mother used her training on her children unconsciously and continuously, despite her protestations that she would never do such a thing. This isn't me placing blame for that fact, it's just how life was - my mother loved being a psychiatrist, and she absorbed her training with the ferocity that all who love what they do bring to their schooling. It became something more than a tool for her; it became part of how she interacted with people on all walks of life. She was, naturally, aware when she was consciously using the tool, and she would use the tool on people outside her profession, but I believed her when she said she never used it on her children.

But whether or not she used it, it was a part of her all the time.

As a result, my brother and I have what I think is an abnormally developed sense of our internal mental and emotional processes. I am in no way saying that we can control them any better than any other schmuck out there, nor that this awareness is completely 'real time.' However, generally, we know what our heads are doing in an abstract sense. We know when we're being sullen in reaction to a slight. We know when we're illogically and without reason being excessively hard on ourselves. We know when we are trying desperately to avoid confronting some issue or person. We might not be able to describe it right at the moment it's happening, but generally, the first time we think about it in relatively calm circumstances after the event, we can give you a pretty good picture of what parts of our psyche reared up and interfered with our actions.

As I've dealt with therapy, I've noticed that many therapists place a great premium on the Explanation, capital E. The truly incompetent therapists (and the amateurs) want to Explain to you what you've done and why. They're not so concerned with your role in the therapy process; they want to be the ones with the answer, and to divulge that answer to you from on high atop the altar of Professional Competence.

They're idiots.

The better therapists, the ones who are midrange to mostly-pretty-good, seem to have as their agenda the notion that the patient should be coached to an understanding of what is happening inside their head. They will hint, guide, lead where required - but their 'endgame' seems to be that moment when the patient stops talking, thinks furiously, and then slowly a Great Realization Dawns - they understand why they did whatever they did, why they do whatever they're doing. They, too, see the reasoning that the therapist has recognized and has been trying to push them towards. And that moment of realization, in the therapist's head, serves to allow them to defeat the behavior pattern, or to lessen the impact of whatever they've been doing to themselves.

These types of therapists don't do me any good, for one simple reason. There isn't any moment of realization. I know perfectly well what I'm doing to myself, usually how, and most of the time why. I say this from experience. Because of my childhood exposure to the notion of carefully observing the mind at work, I already know this stuff. As a result, I have so often been in therapy and had a moment where the therapist beams and makes as if to hand me a Great Realization, or sits expectantly and waits for me to come to the Great Realization, and every time I look at them coldly and say "And what? I know that. I know what I'm doing. I'm doing thus-and-so, and I'm doing it in this-and-that manner, and probably because of this-or-that."

Then they look at me, and almost immediately, they start trying to explain to me why either I'm not properly engaging in the therapeutic process, or why my problem is one that conventional therapy can't ameliorate.

Once in a great while, I meet a therapist who understands what I'm doing, and tries something else. But those are few and far between, and I get the feeling that even the really bright ones start to flounder when their main toolset is taken from them like that - and as a result, therapy for me, even from those who understand that the Great Explanation is bullshit and that the Great Realization won't occur in my case, is a very hit-or-miss business, and one which very often doesn't seem to produce any progress. Sometimes it actually doesn't produce any progress, but I have no choice but to grimly stick it out for four months or eight months, because really good therapists don't give up easily - and until they have told me that they've given up, I can't assume they won't be able to help me and quit.

And in the meantime, there's nothing really left to do but survive, grim and utterly thankless though that is.