mental health

Therapy and The Holes

One of the goals of therapy is to help a person stop repeating and reenacting destructive patterns and to start looking for better solutions to difficult situations. This goal is reflected in the following poem:

Autobiography in Five Short Chapters by Portia Nelson (1993)

Chapter One
I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost. . . . I am helpless.
It isn’t my fault.
It takes forever to find a way out.

Chapter Two
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again. I can’t believe I am in this same place.
But, it isn’t my fault.
It still takes a long time to get out.

Chapter Three
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in . . . it’s a habit . . . but,
my eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Chapter Four
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter Five
I walk down another street.

The above excerpt is from my psychology textbook (very aptly named “Psychology”, produced for free online by OpenStax. If you’re the “reading textbooks for fun” kinda person, you can find it here). I was immediately struck by this poem because it is almost exactly like a metaphor my mother used to always make when I was a kid. She used to say, “I don’t want you to fall in the same holes I did. I want to show you the holes so you can walk around them. Maybe you’ll jump over them and sometimes you’ll fall in but I’ll try my best to show you where they are.” As Forrest would say, Mama always had a way of explainin’ things so I could understand them. Mama was a real smart lady.

I had entirely forgotten about this thing my mother used to say to me all the time until I read this poem. Which blows my mind because, seriously, she used to say it a lot. My long term memory is absolutely piss poor. Anyway. I wanted to share this with you guys not just because it’s a good metaphor for life in general but as the text mentions, it’s relevant to therapy.

Over the course of my life, I’ve had four therapists. Two not so great, two pretty solid ones that helped me learn to take different streets. The first great one was in junior high – and while I was still a BIG OL’ MESS after I stopped seeing her, she was the one who first taught me how to take responsibility for my part in my problems and stop playing the victim. The second great one was around age 22 – his downfall is he ended up NOT accepting me as the victim when I told him about how I was raped but he is the one who gave me my Borderline Personality Disorder (BPD) diagnosis and a really solid understanding of Cognitive Behavioral Therapy tools.

I should have seen five probably – memories of my mental state this time last year have been coming back to me and whew they are not pretty. I can’t tell you why I didn’t – maybe because I was working so much or I thought that I could handle it. Of course, I figured it out eventually and got in touch with a counselor last summer who ended up falling in my category of “not great therapists” but at least gave me someone to let it all out to if nothing else. She kept me from totally losing my shit, and even the other not so great one filled a similar role. A woman I saw during high school who was fresh out of college and easily manipulated by her yet undiagnosed BPD patient still provided unconditional positive regard and a safe space to unleash my anguish.

So why tell you all this? As we greet 2019 and think of ways we want to improve ourselves, I want to strongly recommend considering outpatient therapy. Most health insurance policies will cover something like 12 sessions without a diagnosis. There’s quite a lot you can unpack in 12 hours. Even if you’re feeling super healthy and good, I still think that literally everyone on earth should see a therapist at least once in their lives. Once as in one therapist for a little while, not just one session. You can’t do much in one session other than determine if you feel like you can jive with that person. Think of your brain like a car – if you do preventative maintenance on it, then it won’t break down if you put it through stress like taking it on a road trip. Except in this metaphor, the road trip is like the death of a relative or other traumatic life experience. An actually good therapist will still find cognitive distortions in your thinking and help you with them even if you’re not depressed or anxious or anything else.

And if you are depressed, anxious, etc, what about medicine? Just take an anti-depressant or anti-anxiety pill and there’s no need for therapy, right? Well, not exactly. Combination therapy on average has a 10% higher rate of effectiveness compared to just antidepressants alone for depression.(1) Of course, this is just depression. Assuming you have a personality disorder or other mood disorder you’re not aware of, you may find that medicine isn’t as effective for you as it would be if you had only a depression-based mood disorder. BPD, for example, is only moderately helped by SSRIs(2). I would imagine other personality disorders like Narcissistic Personality Disorder and Obsessive-Compulsive Personality Disorder would be similar in their need for psychotherapy in conjunction with pharmacological treatment (I would Google these for you too but I think you get the idea). Of course, pretty much all mental health disorders are best served by a combination therapy of drugs and psychotherapy so please don’t take this as me saying “flush them Lexapros, you don’t need ‘em!”

As for me? I’ve done my time c: I’m kidding. I have a meditation retreat coming up next month. Depending on how that goes, I might need more therapy! I’m only sort of kidding now. I think it’ll go well but if I still have lingering anxiety then I’ll likely find a therapist once we’re in one place long enough for me to see them for longer than a single month. Fortunately, I’ve just about cracked the nut and honestly 90% of the time I’m anxiety free but if someone could help me get that to 100% anxiety free, I would be overjoyed.

If you have any questions, you know how to get a hold of me. Oh, and happy eclipse! Let’s initiate some change, shall we?

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