If it hurts, it works
A lifetime ago, after a particularly interesting therapy session, I called my dad to have and give some news. He asked how therapy was going, to which I answered I was a bit shaken. He said "good, it means it's working".
Today I'm thinking about this conversation as I lay on my bed, in physical pain in the intimate area, my legs unresponding. I had a hard therapy session. It's working. But man does it hurt.
I've been in and out of therapy for most of my life. In a psychiatric hospital a couple times in my early teens. Currently seeing the same therapist for the last 3 or so years, the longest lasting relationship with a shrink I ever had. So I know a thing or two about therapy. Psychology, psychiatry, psychotherapy, psychoanalysis, EMDR, trauma therapy, family therapy, even an attempt at hypnosis. It's been a ride.
For some background I was diagnosed with depression at 7, sent to hospital at 13 then 14 for suicidal tendencies and depression, diagnosed with general anxiety disorder and social anxiety at 22, with PTSD at 26, and still trying to get an official diagnosis for OCD at 29.
And all of this could have been a simple PTSD diagnosis if the psychoanalyst I saw as a kid had bothered to listen and see the signs. They were all there.
Therapy doesn't always hurt, but usually when it doesn't it means it's not working. You have to try different people, different methods, sometimes different lengths or moments or times of day. It's tricky to get it right. For me, conversational therapy in the afternoon works best, with 30 minutes to an hour long sessions. I can work with 2 or 3 persons at the same time but prefer if the one delivering the medication prescriptions is the same as one of the one I tell my life story to. Having a separate psychiatrist and psychologist doesn't work for me. It's a matter of trust. But it can work for others.
I have known some friends who worked with a psychiatrist, a psychologist, and a psychotherapist as they have different skill sets and it helped. I found a person who does a lot of different things and it helps me more. We're all different, there isn't a miracle formula that fits everyone.
The one thing that all of us have in common is that if it hurts, it works. And it will hurt differently for everyone, too.
For starters, each illness or issue hurts differently. The pain experienced by someone with schizophrenia is not the same as the one experienced by someone with OCD, despite both being a big obstacle to having a social and professional life. And then each person experiences pain in their own way too.
One thing people without mental health issues fail to understand is the physical aspect of it. The physical pain that derives from it, as well as the physical health issues that can develop as a direct result of it, and how it all impacts the healing process.
I see I've lost you so I'll give examples.
I had a friend with OCD so severe you couldn't shake her hand to say hello without starting a 15 minutes loop of shaking one hand a number of times, then the other one, until the feeling in both hands was even. She couldn't leave her room without closing the door several times. She couldn't eat without repeating the same movement with her fork/knife/spoon a number of times. Result? She was constantly exhausted. Because fighting the OCD is exhausting, the routines are exhausting, avoiding triggers means 24/7 vigilance of not just your own movements but also everyone around you. How would it impact you physically if you were going for a walk and had to stop and step 100 times on the same spot before being able to move forward?
Depression means 80% of your energy is dedicated to fighting your own brain to stay alive. That leaves 20% for brushing your teeth, putting clothes on, eating, going from the bed to the kitchen to the toilet to the chair to the bed again, working (for those who manage to keep a job), driving (for those who drive), all those little things one wouldn't even think about but that take more than 80% of one's energy. People with depression have to make choices like "brush my hair or cook?" every single day and some can't afford to show it. Those who don't work risk losing or gaining a lot of weight due to lack of movement. Muscular pain, articular pain, headaches, difficulties concentrating, some movements become almost impossible.
Anxiety can cause heart issues. Social anxiety can lead to selective mutism. Eating disorders affect hormone levels, fertility, bone solidity, muscle mass, articulations flexibility, teeth health… You get the picture. And therapy has to take all of this into account.
If you see a therapist for an eating disorder and they never ask about exercise it’s not good. Because physical movements impact mental health, and mental health impacts your ability to move. All the good shrinks I’ve seen, and there weren’t that many, have inquired about my ability to leave the bed and move around. They asked if it hurt, what was harder and why, and how we could maybe make it easier.
I was given ridiculous exercises that helped tremendously. Live on the 3rd floor? Go down to second then back home, twice a day. It forced me to not only move but also reaccustom myself with going out the front door and towards the Outside, while remaining in a safe environment. I progressively went further down until I was able to walk around the block by myself. It took months. Literal months. But thanks to that exercise I can now go to the grocery store and to buy smokes and to just grab a smoke in my street comfortably.
For social anxiety, I was also made to simply look strangers in the eye while passing them by, then after a while I was made to smile at them, then to say hi, and now I can strike a conversation with people I don’t know in an Outside setting. It’s still awkward but it works. And again, it took literal months. And it was worth it.
Therapy has to be specific to one’s situation,because not two individuals are alike and not two mental health issues are alike. Depression doesn’t look the same in me as it does in my best friends. PTSD makes one of my friends aggressive while it makes me fearful. Everyone reacts differently to their own pain, and a therapist has to be able to adapt to that and devise a method and exercises that work for each individual patient.
It takes time to figure out how to do that, and it takes trust. Sometimes it also takes a support network willing to help.
I have a friend who reminds me every single day to take my medication because otherwise I forget or can’t be bothered. And she makes it exciting. Every day now I’m looking forward to Pills Time, to chat with her and to get a heart emoji. I don’t care how silly it seems,I haven't forgotten my meds since she agreed to help with this.
I have another friend who will regularly ask if I’m drinking enough water. The answer is always no, because I forget. She reminds me to eat, too. That helps a lot in keeping me alive, and I’m grateful to all the friends who take the time to check on the most basic of things for me. Are you up? Have you had lunch? Did you drink water? How is your back today? Did you walk around a bit yet? What are your plans this week? These are questions that literally keep me alive and functional. It costs them nothing. It takes a minute at most, every few days. Yet without these people and these questions I probably wouldn’t be writing this, or writing at all, or even alive.
Therapy is also this. It’s a shrink or three, yes. It’s medication sometimes. It’s family and friends willing to take a few seconds of their day to remind you that you matter. Even if it’s just sending a funny meme.
Especially when dealing with PTSD, therapy is based on memories. The old ones that hurt so much they render you paralyzed one way or another, and the new ones you make everyday that tell you how much you matter. If you don’t have people, maybe you can have a pet. A cat will tell you how important you are everyday, a dog will adore your presence, a rat will play with you, a bunny will teach you that patience is rewarding, a fish might not be the best support animal but at least they’re pretty and you have to feed them. Pets help. People help. Anything that forces you to get out of bed helps.
If you want to heal, know that it will take time and effort but it’s worth it. Mental health issues shape you in a way that isn’t necessarily the one you wanted, therapy helps you reshape yourself. You will be different in the end. You will realise how strong, how brave, how incredible you are as a person, to overcome all these odds and fighting and staying alive. You won’t see it right away but sometimes during the therapy process you will look back and think “damn I was a mess”. And you’ll be proud of how far you’ve come, and ready for the road ahead.
Therapy gives you walking sticks and directions and ropes until you don’t need them anymore and can climb that damned mountain by yourself.
That mountain is life. For some, it’s steeper or bumpier or more slippery than for others. And that’s okay. It doesn’t mean your mountain isn’t good. It just means it takes more effort to climb. But once you reach the top, you will enjoy the view a hundred times more than those whose mountain was easy to climb. Therapy is here to help you get there. And it works.