Bipolar 2 From Inside and Out

Archive for the ‘mental health’ Category

Hello, Post-Traumatic Growth

I’ve had my share of trauma in my life. There was trauma in my childhood starting with relentless bullying, including children throwing rocks at me. I still remember crying into my mitten, my tears mixing with the blood. There was trauma in my young adulthood from self-harm to the gaslighting and implosion of my first serious relationship. There’s been trauma of various kinds since I’ve become an adult, when many of my traumas became lumped into the effects of my newly diagnosed bipolar disorder. When my psychiatrist said that I needed ECT, that was traumatic, too.

But I’ve recovered from all those traumas. (At least I think I have.) In fact, I may have experienced what’s called post-traumatic growth (PTG).

Post-traumatic growth is when you come out the other side of a trauma and experience positive changes in five spheres of your life. These are often listed as: appreciation of your life, relationships, personal strength, new possibilities, and spiritual change. PTG is usually discussed in connection with PTSD, sexual violence, and near-death experiences. By those measures, I guess what I experienced was really resilience, the ability to bounce back from hardship. Only one therapist has ever suggested that I had PTSD from the emotional abuse I suffered and, at the time, I dismissed it as unlikely. Now I wonder.

I do appreciate my life more now. My relationships are stronger and more stable. My personal strength is vastly improved. I have responded when new possibilities entered my life. My spirituality has evolved. I feel like a new person, a stronger feminist, a better person, better able to make and develop new relationships.

This is not to denigrate the experiences of anyone who has experienced PTSD, a near-death experience, or sexual violence. I understand that my experiences are nowhere near those traumas. But I’m not here to compare traumas. I’m here to talk about the aftermath.

Some people may experience PTG in the immediate aftermath of a life-altering experience, but I think that’s rare. It can take years or never happen at all. Therapy is likely to be a part of achieving PTG.

There are circumstances where PTG is assumed to be instantaneous, or nearly so. Cancer is a life-changing diagnosis that can take you through the five stages of grief. But, in the case of breast cancer, some people are expected to demonstrate PTG almost immediately. Barbara Ehrenreich has written about her own breast cancer diagnosis. She pointed out the number of people who, quite soon after their diagnosis say that it was the best thing that ever happened to them or that “cancer is a gift.” Ehrenreich noted all the pink ribbons and cheerful positivity that ensued. It was as if people with that diagnosis were not allowed to feel frightened, angry, or bitter.

But for most people, it takes time. The five stages of grief don’t occur according to anyone’s timeline. It’s personal. No one can tell a sufferer what they should feel or when they should feel it. In fact, those diagnosed aren’t even supposed to think of themselves as suffering from cancer. They call themselves survivors rather than victims. Acceptable reactions are strictly limited. How different is that from when people with psychiatric diagnoses are told to simply get over it?

Both resilience and post-traumatic growth are good things. I wonder if they’re related—if people who have resilience are more likely to experience PTG, or if people who demonstrate PTG then become more resilient. And I don’t know if we’ll ever find an answer to that.

But whether either explanation proves to be true, I’m just thankful they both exist. And I feel deeply for those who fight trauma without either one. They need help in any way they can get it, but likely through professional help. I know that whether I am resilient or have PTG, professionals have helped me. And so have non-experts who have supported me on my journey. I thank them all and wish the same for others.

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Our Shadow Selves

You may have heard of the “Shadow Self” or “Shadow Work.” But what does this mean? And is it related to bipolar disorder?

The Shadow Self has been described as the Mr. Hyde to a person’s ordinary Dr. Jekyll. It’s made up of all the parts of ourselves that we want to deny or keep suppressed—our baser impulses, uncivilized or unacceptable emotions, self-talk, beliefs, and antisocial traits that lurk somewhere within our psyches. We all have them. But we hardly ever try to get in touch with our Shadow Self or know what to do about it if we’re aware of those traits and impulses.

According to Carl Jung, the Shadow Self develops from unprocessed childhood events. It also arises when someone internalizes messages they get from family, friends, or society regarding what is acceptable and unacceptable. A person can project their repressed traits onto other people. For example, if you look down on someone because they express rage, there may be rage hidden within your Shadow Self. Or a person may have the belief that being assertive is actually selfish and may be pushed around because of that. They repress a feeling of resentment and feel guilty that they are resentful.

My Shadow Self includes any number of unpleasant aspects. I own that I am obsessive, insecure, and unforgiving. These and other shadow traits result in perfectionism, fear of failure, and self-sabotaging behavior. No doubt there are parts of my Shadow Self that I haven’t recognized yet, or don’t want to.

Of course, some of my shadow traits are almost certainly caused by messages that I haven’t addressed yet. For example, I think my perfectionism was caused by messages I received that making mistakes equaled being bad, something I didn’t want to do. It wasn’t fear of being punished; it was because I didn’t want to be a bad person like some of my relatives who made mistakes involving sex and alcohol.

The Shadow Self isn’t universally bad. It’s a part of everyone. It’s possible to channel the Shadow Self in constructive ways. Million-selling mystery author Sue Grafton referred to hers as “She Who Writes.” Her protagonist was far from a perfect human being, being occasionally given to lying, ignoring rules, and Looking down on others’ faults. Grafton thought she was able to write the character because of her own less-than-noble impulses. It made her detective a flawed human being, but one that readers could sympathize with and, perhaps, see themselves in.

If you try to deny or repress your Shadow Self, it continues to affect you negatively without your knowledge. Identifying it through “Shadow Work” can result in self-acceptance and growth. Therapy is one way to deal with the Shadow Self, though those words may not be used. Trying to do Shadow Work by yourself is also possible, though the help of a therapist may increase your ability to work through difficult emotions like shame and fear. Therapy may include journaling, meditation, artistic expression, and inner dialogue and can help you understand and integrate your shadow traits into your conscious mind. Patience, keeping an open mind, practicing self-compassion, dedicating time to Shadow Work, and reflecting on your progress will help you with the process.

Or help me. I don’t have a therapist at the moment, so if I try to do Shadow Work, I’ll be on my own with it. I don’t know whether I’m brave enough. It’s something I need to consider, though.

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Mania, Overthinking, and Costa Rica

I’ve had a bad spell of overthinking lately. It’s related to a bad hypomanic episode that I had lately. I had it in my head that my husband and I needed to move to Costa Rica. Of that I was sure. (Why Costa Rica? Of that I wasn’t sure.) What I couldn’t decide was whether we needed to go to Costa Rica for a week or two to scope out arrangements before we took the proverbial plunge.

At first, I had been exploring whether there was any real estate for rent at a reasonable price in or near the town of Grecia, which I had somehow fixated on. (Why Grecia? Again, not a clue. That’s about the last thing I’d need to decide and arrange for if we were to move.) I was researching the cost of living, the health care system, and the cuisine. I was practicing in my head the Spanish that remained from my high school days, supplemented by “essential phrases” that were listed online. I looked up what papers were needed and how long you could stay on a temporary visa. I checked on whether we could bring our cat.

It kept me awake at night. After I take my nighttime meds, I usually read for about a half hour before I shut down my brain and try to sleep at night. But I had no such luck. The arrangements, the language, and the travel all occupied my thoughts. I would give up on sleeping, try reading for another half hour. Then the cycle would start all over. For the first time in a long time, I need sleeping pills—the 10 mg. ones. Even then, sleep didn’t come easy.

My husband pointed out that maybe it would be better if we went to Costa Rica for a week or two to see how we liked it before we made the move. Instantly, my mania switched in a different direction. I began working with a travel consultant on what cities or attractions (in addition to Grecia) we might like to see. Anticipating a chunk of money coming in (another manic fantasy), I researched flights, even selecting flight times and layovers as well as costs. I selected dates, then revised them based on seasonal prices. Again, I couldn’t sleep for running over the arrangements in my head.

At last the mania and the planning eased off. The fantasy funding fell through, as I should have realized it would. Along with it, my mania retreated and my overthinking stopped—at least for the time being. My overthinking backed off too, at least on the subject of Costa Rica. Now, what I have to overthink is my writing assignments, which seem to have multiplied while I wasn’t looking. I’ll make money, but not enough to get me to Costa Rica.

At any rate, I’m happy to say that I’m back to where I was before the mania and the overthinking—back to sleeping without sleeping pills, anyway. Now all I have to overthink, besides the writing, is our upcoming trip to Florida, which provides plenty of fodder. I’ve prearranged everything I can think of, but I’m sure there’s something that I’ve forgotten or that is completely out of my control. And I hate that feeling. It leads to other things that are out of control, like thinking and mania.

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Being There

Sometimes there’s just nothing you can do. A friend or family member is in distress—depressed, angry, disappointed, anxious, frustrated, or whatever. They may have experienced major trauma or be in the throes of some emotional upheaval. There’s no way you can solve the problem, and sometimes it’s simply better not to try. Not every problem can be fixed, and not everyone wants you to fix their problem. Sometimes it’s simply futile because there is no solution. Sometimes it’s insulting to even suggest that you might be able to fix it.

What do you do then? You sit with the person as they experience their feelings and say nothing. They don’t need advice. They don’t need conversation. They simply need the presence of another person. They just need you to be there.

Therapists sometimes recommend that when you have a strong feeling, you sit with it for a while. You don’t jump up and try to do something that will make it go away. You don’t ignore it. You don’t try to ignore it. You simply sit with the feeling and feel it. Later, there will be time to talk about it. First, you simply identify the feeling, if you can, and then be there with it.

Being there for another person is a great gift to them. In the face of strong emotion, they may not have the ability to talk about it. Having someone who will simply lend their presence in a time of turmoil gives comfort when it’s needed, unobtrusively.

You don’t have to simply sit when you’re being there for another person. You can touch them, place a hand on their shoulder. You can make them a cup of tea. You don’t ask if they want one. You just do it. The tea will be there if they need a soothing beverage. You will be there if they need a soothing presence.

Our society is so action-oriented these days. When we can’t solve a problem, we feel helpless. And that may be true. We’re helpless to change the situation, helpless to cheer up our friend, helpless to take pain away.

But being there may be the only action that is needed. The power of being there is the promise that, if your friend does need something concrete, something that you can offer, you will be there to provide it. In the meantime, there is nothing that either of you needs to do. Being there is the offering.

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Completing Therapy

In a sense, there’s no such thing as completing therapy, and in another sense, it’s necessary. Right now, I’m trying to balance between the two poles of that spectrum.

I know that, barring any unlikely miracle cures (which I don’t anticipate), my bipolar disorder is something I’ll be dealing with for the rest of my life. On the other hand, I have on occasion achieved periods of stability in which therapy was no longer a necessity.

Sometimes it’s been my therapist who has encouraged me to leave treatment because they didn’t feel that I had symptoms severe enough to require further therapy at that time. I was, if not cured, stable enough to function well without weekly or biweekly boosts of psychological or psychiatric tune-ups. (Once, when I left therapy this way, Dr. L. told me solemnly, “I hope you don’t think I’m rejecting you.” I didn’t, but I thought it was nice of him to bring up the subject.)

Once I quit therapy because it was supremely unhelpful. It was couples therapy, and it wasn’t achieving its goals. The therapist sided with my husband and shredded me. After a few sessions, I refused to go back.

Sometimes, my therapy has quit me. I had a very good relationship with Dr. R., my psychiatrist, who retired and moved across the country. I knew I still needed the services of a psychiatrist as well as a therapist, so I began the long search for another practitioner who could help me, had an opening, and would take my insurance. It’s a process much like interviewing candidates for a job. You need to find a good fit (i.e., one who won’t shred you). At the time I mostly needed someone who could supervise my meds, as I was seeing a therapist for my ongoing psychological issues.

I stayed with that therapist for years. It began to become clear that perhaps I should leave therapy when I needed therapy less often—once every other week instead of every week, then once every three weeks, and eventually every month. Even when we still had sessions, they ran short because I didn’t have immediate issues that needed to be addressed. And her advice consisted of “Look how far you’ve come” and “Keep doing what you’re doing.” When she moved to a new practice, I had one or two more sessions, then ended therapy. I kept her number, though. You never know.

Right now, I am considering leaving therapy with my psychiatrist for purely practical reasons. Dr. G. only sees people on Thursdays and Saturdays till early afternoon. At the moment, my husband works both those days and hours and we have only one working car. I see Dr. G. four times a year for med check, but it’s becoming increasingly problematic for Dan to get time off work to take me to appointments. I suppose I could take a Lyft, but it’s another expense I can’t afford. Perhaps I should look around for another provider closer to me with better hours. If I can find one that doesn’t have a years-long waiting list, I mean. (I’m told that I need to get a referral from my PCP to get one in-network.) Or someone else in Dr. G.’s practice who would be willing to take me on. (I have to go to the office and fill out a form to accomplish that.) Either way, no guarantees.

There have been times in my life when I felt stable enough to go without a therapist or psychiatrist. Right now, though, I’m having issues with anxiety, hypomania, and insomnia, so I need someone at the very least to prescribe or tweak my dosages.

Most of all, though, I hate the process of finding a new psychiatrist—interviewing them to see if we’re a good fit, telling them the Reader’s Digest version of my screwed-up life, getting my records transferred, and the rest of the tap dance involved.

Wish me luck.

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Why Can’t You Just Get Over It?

That’s a question we all get—and we all hate. It implies that we can just get over it, but haven’t, for whatever reason.

The questioner may believe that we just aren’t trying. That we can pull ourselves up by our metaphorical bootstraps or choose to be cheerful. That we aren’t doing all we can to “regain our sanity.” That we haven’t tried the right diet, the right exercise, the right supplements, or the right therapy. Everyone has an answer.

Parts of their answers may be part of our answer, sort of. Diet and exercise are important, to be sure. But one food, like apple cider vinegar or acai berries, is not a secret remedy. A healthy, balanced diet of meat, veg, fruit, and grains is ideal. But many of us are simply not able to cook like that. I’ve had days when all I could manage to eat was Cocoa Puffs straight from the box or peanut butter straight from the jar.

Exercise and fresh air are good, of course, but again many of us are simply not able to accomplish it. Some can’t leave the house except for absolutely necessary errands and appointments. Then we bustle back to the safety of home. Or, if we have someone to help, they can do the errands for us. My husband can sometimes get me out of the house for a meal, but usually not a healthful one. If a friend invites me over for dinner, it’s a very special occasion and I make sure to hoard my spoons for it. Those are times I’ll even take a shower and get dressed for. As for exercise, I just can’t. I have severely arthritic knees that need to be replaced, so I can’t even do yoga or tai chi. Plus the whole getting out of the house thing.

Another common comment is, “Get some therapy.” I have and am and most of us are. What people who say this don’t realize is that therapy doesn’t work quickly, even if you can find the type that’s right for you. Personally, I can’t handle group therapy. I’ve tried. I have problems with the idea of CBT and DBT, currently two of the most favored forms. Talk therapy is the one I choose, and that helps, but I’ve had to go to the same therapist sometimes for years. A quick fix is not what I need or can get.

Also, there’s “Have you taken your meds?” which really pisses me off. First, there’s the assumption that I’m even on meds (I am, but it’s rude to assume that), plus the idea that a layperson can tell me when I need them.

No, I can’t just “get over it,” and neither can most people with depression, anxiety, phobias, bipolar, PTSD, or schizophrenia. They’re just too complicated.

Think about it. There are three causes considered likely to be the cause of brain illnesses: genetics, psychological trauma, or brain chemistry. None of those is something that can be gotten over by choosing happiness. If the origin is genetic, pulling yourself up by your bootstraps is not even a possibility. It will likely take years of therapy and medication to achieve stability, if that’s possible. If the cause is trauma, you can’t just forget about it. Imagine all your worst nightmares hitting you suddenly, asleep or awake, as though you’re experiencing the triggering event just as you did when it happened. Think about how it would feel to have grown up with repeated abuse that you couldn’t escape because you were a child. And if your brain chemicals are out of whack, there are dozens of meds that might work and dozens more that won’t. Finding the right combination is a lot more complicated than just popping a pill.

When you get hit with the question of why you can’t just get over it, you might be able to take ideas from this discussion and try to educate the person who asked it. Or you can print out the whole post and give it to them. (I give you permission.) They probably won’t realize they’ve just insulted you. At the least, you can tell them that they have. Maybe that will stop that one person from coming at you with the same question over and over.

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Where to Go First

Most of the advice about depression that’s out there says that the first place to go for help is your primary care physician. That may seem counterintuitive. After all, doctors are notorious for being oblivious to psychiatric problems. Either they dismiss them, assuming that all their complaints (especially those of women) are “all in their head,” or they over-diagnose mental illnesses and pass out pills indiscriminately. At least, those are the stereotypes.

The reality can be far different. Family doctors can absolutely have a positive role to play in diagnosing and treating mental illness.

The last time I went to my primary care physician (for a nail fungus), the nurse practitioner, after taking my vitals, proceeded to ask me the questions collectively known as the Depression Screener. “Do you feel like a burden to your family/do you no longer enjoy things you used to All the time/Most days/Sometimes/Once in a while/All the time” and so on.

My blood pressure was high that day and I see a psychiatrist and take all kinds of psychotropics. I’m sure all that is in my file. “Can’t you just put down that I’m anxious and depressed and leave it at that?” I asked.

“Let’s go through it anyway,” she said. And so we did. No surprises. I was anxious and depressed.

The depression screener may not have been useful for me, but it is for lots of people. There are a lot of seniors, for example, who are living with depression without realizing it. Children, too. Teens. People of all ages. Finding them and getting them help when it’s in the early stages can help them avoid a life of misery and despair.

Not every person gets to find out through the screener. My mother, who was in a nursing home, made some remarks that suggested to me that she was depressed—extremely depressed, including suicidal ideation. I excused myself, found her doctor, and told him what she said, and that I believed she needed antidepressants. Rather than pushing back, he believed me and prescribed them.

Of course, it’s easy enough to beat the screener. The answers are fairly obvious. In fact, I know one person who gave all the answers that would keep him out of the psych ward. But fortunately, most people answer the questions truthfully and get the help they need.

But back to primary care physicians. They’re also helpful in cases of depression, anxiety, and other mental disorders. They know about the most common antidepressants and other psychotropics and can prescribe them to get you through until you can see a psychiatrist. They can give you a referral to a psychiatrist. And, difficult as it is for a first-timer to get a prompt appointment, they can keep monitoring your condition, prescribing as needed, until there’s finally someone who’s taking new patients. My own family doctor was willing to keep prescribing all my medications when one psychiatrist retired and I had to find a new one and wait for an appointment.

My primary care physician is part of my treatment team.

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Finding Intimacy

What do you think of when you hear the word “intimacy”? Sex, right?

That’s a part of intimacy, but it appears nowhere in the American Psychological Association’s definition. There, it says, intimacy is “an interpersonal state of extreme emotional closeness such that each party’s personal space can be entered by any of the other parties without causing discomfort to that person. Intimacy characterizes close, familiar, and usually affectionate or loving personal relationships and requires the parties to have a detailed knowledge or deep understanding of each other.”

Let’s take a look at that definition. “Extreme emotional closeness” is pretty understandable. But note the word “extreme.” It implies that intimacy is more than ordinary closeness. We have friends whom we are close to, but not intimately close to. They may be friends we can talk to about our troubles, share our stories with, be close to, but still not share that extreme emotional closeness. You’re not necessarily intimate with a best friend, though of course it’s possible.

The next part of the definition is more troubling to some. That part about “personal space” being entered by “any of the other parties.” It implies that there can be intimacy among more than two parties. To some people, that sounds like cheating or polyamory. But that’s when intimacy implies only sex.

Personally, I have a number of intimate friends, both male and female. That’s not to say that I’m promiscuous, bisexual, polygamous, or polyandrous. What I mean is that, as the APA definition states, we “have a detailed knowledge or deep understanding of each other.”

What does it take to get that detailed knowledge and deep understanding?

What are the qualities that foster intimacy?

Time. I’d say that, for non-sexual intimacy anyway, time is required. I can’t say how long that is exactly, but I do know that it isn’t instantaneous. You may feel an instant connection with someone you meet, but that’s not intimacy. I felt an instant connection with someone I helped through a public breakdown, but our intimacy had to grow over the years. Now I do count him as an intimate friend.

Sharing. You don’t have to share everything, but some sharing is essential. It may be seemingly superficial things like a love of country songs or a television show, but that’s only part of it. The intimacy kind of sharing involves actual sharing of thoughts, ideas, and experiences. You don’t have to agree on everything, though there are usually some non-negotiables. But for intimacy, you shouldn’t be afraid or embarrassed to share the truths about and inside you.

Laughter. Nothing bonds two (or more) people like laughter. Intimacy can be enhanced by laughing at the same things. A good belly laugh, the kind where you can’t stop and can’t breathe, is what I’m talking about. Or the snickers that you both have to suppress because you know you’re in a place where you can’t express it until you’re alone.

Help. For true intimacy, this is probably the most important quality of all. Someone you feel intimacy with is someone you can turn to when you’re at your lowest. Someone who understands or even if they don’t, will hold you closely in their heart or spirit. Physical help or financial help is good, but it isn’t required.

For those of us with SMI, it can be hard to feel intimacy. We may even fear intimacy because we’ve been betrayed by someone we’ve felt intimacy for. It’s difficult—or sometimes impossible—to get past that, but if you can, and you can open yourself to that extreme emotional closeness once again, intimacy with someone new is possible. Looking for someone to share intimacy with may not work. Sometimes intimacy has to find you.

Be open to it if it does.

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Overthinking Night and Day

Like many people with SMI, my superpower is overthinking. In fact, even as I write this, it’s 2:30 a.m. I can’t sleep because I have hamster brain, a phenomenon I’m sure will be familiar to most of you.

I’ve got plenty to overthink about. I’m starting a new writing assignment and am confronted with a big, messy outline that I didn’t write and have to make into a coherent book. We don’t have the money to get a plumber, only the downstairs toilet works, and there’s only a trickle in the showers. Between the two of us, over the next six weeks, we have a total of six assorted doctor appointments coming up, for everything from nail fungus to heart meds to psych meds to test results to steroid shots. There’s the trip we have booked in January to see Dan’s 96-year-old mother. There’s our senior cat whose health is holding for now, but who knows? Pick any one. Or two. Or more.

If only overthinking were productive. Wouldn’t it be great if all that thinking led to creative problem-solving? But no. The problems remain and continue rolling over and over.

Overthinking is tied to anxiety, at least in my case. I do have an anxiety disorder, so my overthinking is something prodigious. And, as exemplified by the hamster brain analogy, it’s cyclical. Anxiety causes overthinking causes anxiety and so on and on. The more out-of-control your problems are, the more out-of-control your thoughts become.

Overthinking is also a symptom of other mental disorders, such as PTSD, OCD, and depression. Another perhaps related phenomenon is intrusive thoughts, the ones that seem to appear spontaneously in your mind for no apparent reason. Perfectionism can be involved, too, if you obsess about doing everything just right. Catastrophizing and all-or-nothing thinking can also contribute to overthinking.

But those are facts. And overthinking has little to do with facts. Take that upcoming trip, for example. The flights are booked, the accommodations are arranged, the rental car is reserved. All three are already paid for. All this was taken care of months ago. But I still overthink. I check the airline reservations to make sure they haven’t changed (they did at least once, with a layover in a different city). I hope we can get an accessible condo. I worry about paying for gas and food. I feel panicky about getting to the next gate during layovers. I have done everything I can think of to make sure the trip runs smoothly, but still…

It’s exhausting, so it’s ironic that I can’t sleep.

How to stop overthinking? Mindfulness and meditation are often recommended, but those don’t work for me. I just can’t shut off the over-thoughts long enough to accomplish them. Distractions are another recommendation, and I try that, but they only provide temporary relief. Reframing negative thoughts is yet another suggestion, but I don’t know how to reframe having to go downstairs to pee in the middle of the night. Self-acceptance or self-compassion, forgiveness, and gratitude—nothing seems to work.

I do take antianxiety meds, and I do have permission to take an extra one if I have more than usual anxiety. I have a prescription for a sleeping aid, but I don’t like to take it very often. More often I just say the hell with it and get up, read or write or watch TV. My sleep-wake schedule is off for days, along with my meals, but if I can just stop the thoughts for a while, I’ll take it.

For me, overthinking happens mostly at night, but it doesn’t have to. There’s plenty of fodder for overthinking during my waking hours. Perhaps I just don’t notice it as much because during the daytime I’m usually doing something that distracts me from my thoughts. Today I was overthinking how to get an accessible room at the condo where we’re staying in January. I made phone calls and stayed on hold, but I got put off until four weeks before the trip. That started me overthinking about what to do if we can’t get an accessible room. I’d have to get one of those shower substitute wipes they use for people who are bedridden. Then I started looking those up online. Maybe I should order some, just in case. Or, I thought, I could wash up in the sink every day. Or some combination of the above. It’s ridiculous how long I spent contemplating the possibilities. All I really have to do is request an accessible unit when I show up, and they’ll tell me whether one is available that day. But do you think I’ll be able to wait until we show up? No, I’ll keep overthinking it. And get the wipes just in case.

Because that’s just what I do.

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When Couples Therapy Works

Couples counseling is never easy. It’s hard enough to have one person discussing their problems with a therapist, much less two. Two opinions. Two versions of reality. Two sets of problems. Two emotional whirlpools. Two perspectives. Two of everything.

And one therapist. One person trying to understand the dynamics. One person listening to two stories. One person trying to help two individuals and to help a couple.

It’s a wonder it ever works.

But it can. It does. Not always, but sometimes.

My husband and I have been to couples counseling three different times. Two of them helped. One didn’t.

One was a long-term round of therapy when we were much younger, trying to work out some of the typical problems that young couples face. We weren’t fighting, but we didn’t know how to live and work together well.

Our therapist was an older lady, very dignified and comforting. A good listener, she gave us as long as we needed to talk before she did. It was a productive relationship and helped a lot.

The second time didn’t go so well. It was short-term therapy, under the auspices of an Employee Assistance Program, so we had six weeks to work things out.

Except it didn’t work. The therapist took sides, and sided with my husband. She ignored my bipolar disorder (or depression, as it was diagnosed at the time) and suddenly, he was the sane one and I was damaged. She expected me to accommodate him. After every session, I felt shredded. I didn’t make it through the six weeks. At some point before that, I refused to go.

The third time was after we had a major blow-up, one that threatened to ruin us. My therapist recommended a counselor who could work with both of us. We had opposing views that were incompatible. There was bitterness and anger on both sides. The therapist gave us a safe space to say what we needed to, question each other’s perceptions, and work out a way to go on from there. Mostly, she listened. After only a few sessions, we achieved a detente and were calm enough to continue without outside help.

Three examples—uniquely ours and not representative of anyone else’s experience. Three dynamics. Three outcomes.

What made them different? Two were safe spaces for both of us, and one wasn’t, for me at least. One was long-term and might have been even longer if the therapist hadn’t retired. One was short-term and even shorter because I couldn’t continue with the process. One was positively episodic, three sessions only.

Of course, I don’t know what couples therapy is like from the therapist’s side. From my own perspective, it seemed that the process only worked when there was space—space in time, as long or as short as needed, neither cut off artificially or drawn out more than necessary. And when there was someone who listened to both of us. Comfortable physical spaces, too, not impersonal offices but welcoming rooms that looked like someone could relax in them.

Two people with multiple problems. Two processes that worked for both of us and one that didn’t.

I can’t pontificate about the process. All I can say is that couples therapy can work, and does work, and did work for us—at least two times out of three. What made the difference? I think it was the ability of the therapists to step back, listen to both of us, and not tell us what to do. They talked too, of course. They recommended books for us to read. They suggested new ways to think about things and talk about them. They absorbed the bad feelings in the air and didn’t deny them. But in their presence, it was possible to think, to listen, and to talk. To disagree, to argue, to come back together. To heal and discover. To grow.

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mental health

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