Apr 29, 2008

Preparing for therapy

So you found out that you have social anxiety. And you read that the best treatment is a combination of drugs and therapy, probably CBT - cognitive behavioral therapy. I'm pretty sure you heard that you probably have a bio-chemical imbalance... oh, that sounds so good: it's not in your head, it's a disease!

Here's my take: forget about drugs... ignore drug advertisements, ignore doctors that insist that you can't do it otherwise, ignore articles. Forget about them. Be strong and work through it for an year. Then you can decide that what you're doing is not enough.

Drug companies and medical insurance companies are not on your side. They are in for making profit, not for keeping/making you healthy. There's a lot of money involved and they are all thrown to convince you that you need expensive drugs. Lots of doctors are biased by the same advertisements. Forget the free samples. They will not last forever and then you'll end up with an expensive drug that you'll probably have a hard time weaning from.

A word on Complementary and alternative medicine: I think it's mostly placebo. I also think placebo is a wonderful thing that you should fully benefit from. But don't spend a fortune on it. Keep an eye on the wallet. Hey, that $2 bottle of homeopathic medicine that makes you feel so good: go ahead and use it! Omega 3s are making you more calm: go for it! But hundreds of $ a month for this stuff, forget about it!

This leaves you with one task: finding a good therapist - the right therapist. Psychologists are OK, but don't necessarily insist on a doctor. My therapist is a psychiatric nurse and she's excellent. Ask around: ask doctors, friends, family. If you can afford it, a therapist that does not accept any insurance is a good sign: probably successful enough to not need it, and less hassled by insurance companies (and more willing to give that time and attention to you, not your co-payment). Insurance companies are not your friends. Forget their referrals, they will send you to the cheapest guy in town.

Two books you need to read before starting therapy:

The first is a very down-to earth book about mental health care and will give you some food for thought. The second one is more practical, and will clarify some of the things that will happen in therapy - patterns of interaction that we all go through.

I love Yalom. His books followed me on each therapy session and I always ended up admitting that he was right about this too.

It's not easy to go through therapy. There will be rough spots. There will be challenges. You need to find someone that will be there for you all the way. And you need to have the strength to go back again and again. Each step up will be preceded by a very difficult breakthrough. Don't give up because it's hard. Always know that this will be over and it will be better soon.

I imagined that in therapy you talk and talk and then you discover one thing that caused it all and then you talk about it and you cry and that's it... it never happened to me. I had a few moments of "this is it", here's the problem, but a week after that the problem was still there. So there are no rules.

And last advice: if a therapist does not work, just move on without judgment. It just isn't the right person at the right time: it's not you, nor the therapist, just grist for the mill. Forget about it and find someone else. The CBT therapist that I kept bitching about in my blog ended up being really helpful more recently. I just wasn't ready when I saw him. But somehow what he said in those first 5 weeks of therapy stuck with me and I'm remembering and appreciating it now. I guess I am now ready for cognitive-behavior therapy. Only I don't need someone to help.

More to come... I'm enjoying writing this.

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