Periodically when I have a conversation with my father, he will ask me if I’m still in therapy. He knows what the answer will be; I think this question is his way of telling me that I’ve been in therapy too long, to hurry up and get the hell out of the therapist’s office.
All he sees is that I’m no longer suicidal and no longer depressed. He’s a recluse; what does he care about quality of life issues such as building a social life, finding a partner and reducing stress at work. He hasn’t had cause to deal with any of those issues in almost forty years.
My brother doesn’t particularly care for my current therapist, especially since this last relapse of my anorexia. He’s left critical messages on her voicemail. But he calms down when I point out the progress I’ve made during the years I’ve been seeing her. I know that he also remains incredulous at the number of years I’ve been in therapy, but he holds his tongue for my sake.
My father has never been in therapy and my brother tried, but only lasted several months — not enough time to make any difference. I keep telling myself that they just don’t understand what a gift a connection with the right therapist can be and they can’t understand the feeling I get when I finally comprehend what has been an elusive motive for a pattern of self-destructive behaviors.
I have to put blinders on and forge ahead for I know that to continue in therapy right now is the best way for me to proceed. I’m getting ready to cut down within the next couple of months — from two sessions a week to one — which will be a huge step for me. Dr. Adena, my current psychiatrist, recently remarked that I have doing more of the (therapeutic) work on my own now, in between sessions. So I guess I’m ready. I’ve been working with her for so long, that at this point, I can often imagine what she would say to me when I’m in a difficult situation.
When they first enter therapy, my patients often tell me that they haven’t told any of their family members that they are coming to the clinic. They are fearful of the reaction of their husband or wife, or of their parents’ or children. My patient whispers to me that he or she is not “crazy,” they just have this one small thing that they have to deal with right now. And then they will stop therapy.
Unfortunately, this is part of the stigma of mental illness and therapy — that one has to be “crazy” to come for treatment and this myth is perpetuated within the family. I ask the patient what "crazy" means to him or her and more often than not they have a difficult time giving me a coherent answer. "You know, cuckoo, nuts, whatever," they tell me.
"You know what one definition of crazy is?" I ask them. “Doing the same thing over and over again and expecting different results.” I let that sink in. “Does that in any way sound familiar?”
Most of the time they have to acknowledge that sounds analogous to at least one part of their life. And most of the time, the therapy extends past the “one” issue they thought they came into treatment for, and the patient stays at the clinic for enough time to work through at least the most pressing issues.
At some point they decide they want to let their family member(s) know they have been in treatment because they have become uncomfortable keeping such a big secret. Having heard about the family dynamics, we explore the best way for the patient to approach his or her family member. I typically encourage the patient to keep the initial revelation short and simple and if the family member wants to get into a prolonged discussion, to come into the clinic for a family session. In such as session I will do some education on mental illness and the course of therapy; what to expect and what not to expect, a potential time frame, and I offer to set up an appointment with the psychiatrist if the patient has been prescribed medication.
My patient is usually somewhat relieved that I am willing to take much of the burden of explaining all this to the family and they are eager to take me up on the offer. Sometimes the family is quite willing to come in and sometimes it takes some encouragement. In the end, I find that the majority of families do care enough about the patient to come in and take part in a family session to at least satisfy their curiosity and ensure for themselves that their child or spouse is receiving good treatment.
When I first entered therapy at 23, it took me six months to work up the nerve to tell my parents who at that point were divorced. I told my mother first and I don’t quite remember her response; she was probably supportive — I imagine she said something like “If that’s what you feel you need to do.”
I was terrified to tell my father who had consistently demanded perfection from me. I thought he would view my seeking professional help as a failure. I never expected his response which left me reeling.
“Dad, there’s something I need to tell you.”
“Dad, I’m in therapy.”
“What the hell took you so long?”