The Bipolar Bum

Backpacking and Bipolar II. Taking Manic Depression on tour.

Managing expectations and passive therapy Pt.1

See you in two weeks then...

See you in two weeks then…

#bipolar #Manicdepression #mentalhealth #mentalillness #therapy #passivetherapy

This post is not intended to be my foray into ‘agent provocateur’ territory.  I am not lamb-basting psychologists or psychiatrists.  Rather I hope to accurately skewer with a literary fencing foil the unfortunate situation where (probably by their own actions) a patient is cemented into a state of learned helplessness.

 

This mental health stasis had very little joy with me because, thankfully, I benefitted from my housemate’s experience of it.  He had years of pouring his heart out to therapists, who would then nod their heads and set an appointment for a fortnight later.

 

He told me a story of a family friend who’s parents had been seeing a therapist for forty years as a marriage councillor, who then sent their depressed daughter to the same professional.  After years of this kind of passive therapy – she killed herself.  Consequently I feel comfortable to put forward the notion that passive therapy is NOT therapy at all.  The modus operandi of this particular therapist seemed to be: “Tell me everything as I do nothing.”

 

Voltaire said of the art of medicine that it:

 

consists of amusing the patient while nature cures the disease.

 

Certainly, a disgruntled former patient of passive therapy would see merit in this statement, even perhaps where there isn’t any.  I’d like to hear from any therapist out there that would in good conscience sit silently, occasionally affirming the stream of consciousness being delivered to them.  I would appreciate hugely an explanation of what this is designed to achieve, and the finer points of what mechanism allows it to do so.

 

I’ve had theories put to me ranging from

“They’re feathering their nests.  Psychology/Psychiatry of that ilk is just a machine for wringing money out of the sick.”

to

“They’re terrified of saying ANYTHING lest they be sued when a patient commits suicide.”

and many shades of grey between.  There appears to exist an industry of professional middle men, trading stock of ‘Wellness’ in the way that parties in the silver-rush of America traded feet in mines that were never going to be worked.

 

I dare say that a depressed person who is told to “Get therapy” and then has a few sessions where they expect to be made well, and don’t feel any better for them, would probably take the thinking bus one stop further to: “I cannot be helped.”

 

When you take your car for an oil change, there are certain things that happen.  You pay money.  They drop the oil.  They change the filter.  They fill the oil.  In this therapy transaction, there is no clear methadology.  It could be one of a variety of methods used to try and help a patient to make themselves well.  This seems to propogate the notion, however, that therapy cannot be quantatively assessed.  It can.  If you feel better, it is working, if you don’t – you need to change the approach.

 

I would love to hear from anyone, therapist or not, who has an opinion on this kind of passive therapy.  Has it helped you?  Was it a waste of time?  Do you help people by offering this service?  Do you want to blow a whistle about a consciously enabling aspect that may exist?  Is this a way of having bread and butter business to support a bulging industry populated by too many graduates?  What is happening?

 

All the best,

A curious H&J

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6 comments on “Managing expectations and passive therapy Pt.1

  1. I love your description of “passive therapy.” I have never named it, but there certainly are therapists who work this way. I worked as a therapist for many years and supervised many therapists. The reasons for this approach vary from, this is the way they were trained to work (psychoanalysis…which I think is ridiculous), to they are too burned out to put any energy into the process. The saddest thing about this pattern is that clients who have never seen a therapist who is more “active,” meaning engages in a dialogue, challenges thinking, educates, etc., do not know any different. They think all therapy is passive and don’t look for alternatives. The bottom line as a therapy client is that you have to be your own advocate. If you aren’t getting better or don’t like the approach in therapy, either talk to the therapist or find a new one! And most importantly, don’t give up on yourself and the healing process.

    Liked by 1 person

  2. Unthink
    26/03/2014

    People go to see therapists in the hope of getting better – we can all agree on that. Yet the form, format and formalities of treatment are often lost on the new patient; who cannot be sure of what to expect from the whole experience of working with a psychiatrist or psychologist.

    Note I say ‘working with’, because as H&J rightly points out, this should be the mindset of the patient, rather than a passive approach wherein there is an expectation that the therapist alone will solve one’s problems.

    In many cultures worldwide, doctors are held up by patients as beings of great status and wisdom; and the natural assumption is that to see a therapist is at the very least a strong step in the direction of wellness. The patient presents him/herself for therapy, and naturally assumes that the therapist knows best, and that there will be guidance to help point the patient in the right directions.

    This seems to be a logical and reasonable expectation, right? You would think so. Yet there is an uncomfortable reality that anyone seeking therapy ought to bear in mind – and that is that most of the work to be done to get well has to be done by the patient.

    Sadly, the scale and scope of human distress that is wrought from emotional strife, trauma and brain chemistry imbalances – often spanning decades – is some heavy-duty grief, that needs some heavy-duty treatment.

    Medication is undeniably the greatest blessing for many of us. It gives us enough relief to be able to think rationally again, and to feel much better.

    But there is an abiding power in the many underlying issues we may face that can wreck even the best treatment programme. Patients need to get to know themselves and their many assumptions and perceptions – and to constantly evaluate the worth of these ideas.

    Pre-diagnosis, many of us have rationalised and given false meaning to negative thoughts and feelings. After diagnosis, although we become aware – intellectually – that many of these thinking subroutines were erroneous; nevertheless they still have impact on our daily lives. It’s only by completely overhauling and scrapping useless modes of thinking that we can embark on a true path of repair.

    All of this is a very long-winded way of me saying that even if the therapists aren’t pointing it out, we all need to recognise when Our Thinking is Wrong.
    Whether that thinking is leading you to obsess about an old flame (when there’s absolutely no chance of a reconciliation); or ruminating over past events (that cannot be changed) – we can all at times be guilty of engaging in harmful thoughts. The sort of thoughts that destroy you, and can have the power to push you to breaking point.

    At some point, one has to take control of those thoughts, and to disempower them. It’s not at all easy, especially when some of these thoughts have been a source of grief for many years. But one thing is absolutely certain, and that is that someone has to be tough on you, tough like a drill instructor, in order for troublesome thoughts to be exorcised.

    Unfortunately, this tough therapy will never be found at the hands of a professional therapist. It’s a crying shame that anyone can go to a gym and find a hard taskmaster of a personal trainer – yet no such tough therapy can readily be found for the mind.

    I found that tough therapy though …. at the hands of a friend who also is a psychologist. Our friendship obviated the usual ‘professional distance’ approach I would have experienced with a clinician – and there were massive benefits that came out of this. My friend not only knew me quite well, but also was genuinely invested in helping me to get better.

    But it gets even better. My friend was – like me – dealing with OCD and depression and so she knew well of which she spoke. I was fortunate to get some tough love that left me no room to pretend anything. I was fortunate indeed to have a take-no-bullshit thought cop to tell me and to show me where and when my thinking was wrong … because when your thinking is indeed wrong,

    and you’re distraught, depressed or manic, you are the worst person on Earth to make the call about what is and what isn’t good thinking.

    Bad thinking exacerbates your condition, and no question. Better thinking alleviates your mood, your outlook, everything.

    The central kernel of my text is that very few, if any of us can expect to be as lucky as I was; to get my own personal brain-trainer – and as such, the sad truth is that you’re unlikely to get from any other living human being the sort of robust criticism or correction that is undeniably necessary to set you on the path to lasting wellness.

    You can hope to get this from a therapist (I will let any therapists explain to us how and why they exhibit such a ‘hands-off’ approach that results in them failing to challenge wrong thinking) or family or friends, but don’t hold your breath. You and you alone know the things that trouble you, and you most likely know deep down how to rectify these issues.

    But when habits such as ruminating about negative events of the past become entrenched in daily thought processes, it takes a mighty effort to get back control of your thoughts/emotions.While I don’t want to make light of suffering; nevertheless this little Bob Newhart skit is terribly funny in that it points out the absurd thoughts we collectively entertain – and it also shows how a perhaps too-firm therapist might handle this:

    Yes, “Stop It!” indeed. Of course I’m not suggesting it’s that simple. But it’s certainly true that no amount of medication, nor any number of visits to therapists, can achieve a real and lasting peace of mind. It’s essential to be utterly, brutally honest with yourself – and keep a log of troublesome thoughts – and work through these with yourself as well as your therapist; and always, always know that the buck stops with you. Nobody else can make you well. Nobody else can make you see sense. Nobody can know your innermost thoughts.

    But you know your self-talk, and you ought to listen to it – all of it – bad and good. Nobody else experiences your thoughts. Only you can qualitatively analyse your own thoughts, and assess them alongside what are known realities and truths. Other people cannot see your thoughts, so they can’t know if you’re up or down. If they could see your bad thoughts, then most likely they’d help you to see how wrong they are.

    Unfortunately, getting mentally well requires a lot of DIY. Those who don’t put in the work – just won’t get the good results. Anyone who wants to get better has to, at some point, challenge long-held ideas and assumptions, and work towards recognising and rectifying wrong thinking.

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  3. DysthymiaBree
    28/03/2014

    I’ve enjoyed great success (as a patient, not a therapist!) with psychodynamic psychotherapy. This is a mode of therapy where the therapist may not say much, but there is a clearly defined reason why – by acting as a tabula rosa, the therapist creates a space into which the patient’s issues can be brought and dealt with. This mode of therapy has really worked well for me as I confront issues of self and of my relationships with authority figures, but I have also complemented it with other, behavioural therapies.
    I’m with you regarding “passive therapies” as a general rule. Informed consent means understanding what the therapy is going to consist of and how/when most patients see results.

    Liked by 1 person

    • drheckleandmrjibe
      29/03/2014

      And this is one of the greatest problems that I see with therapy. Patients often have absolutely no idea what to expect and what demands to make when they attend a session.

      Consequently you end up with a kind of healing stalemate if the therapist isn’t particularly good, caring or engaged. I’ve read a few times where patients haven’t had any success because of therapy being passive and the end-result was that the patient made the half-logical leap to “This must mean I can’t be helped with therapy.”

      Its a real problem and I don’t have all the answers I’m afraid. I wish I did! 🙂

      All the best,
      H&J

      Liked by 1 person

      • DysthymiaBree
        29/03/2014

        Yes. Informed consent is just so, so crucial – and informed consent means full disclosure. I know this can often be hard when starting therapy with a new patient, but it’s essential. Here’s an example. I started a DBT day program a couple of months ago. At no stage was I told I’d be exposed to explicit discussion of self-harm. In fact, so much emphasis was placed on not having conversations of that ilk with other patients outside the group setting, that I was left with the impression that I would not be exposed to it. Sadly I felt ambushed and while I have to take responsibility for my own actions, it must be said that I hadn’t SH’d for nine months prior to being exposed to that content.
        In my opinion (which I’ve since shared vocally with the facilitators, believe me) I did not give informed consent. They keep telling me now that I must manage my distress because I will be exposed to such content, but post facto “consent” isn’t the same as informed consent, is it?

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  4. Samee and Bamee
    24/06/2014

    Reblogged this on Living Life On The Other Side of The Wall and commented:
    A great 3-part series on Managing expectations and passive therapy. In Part one, ‘Unthink’ makes an excellent comment that includes a ‘terribly funny’ Bob Newhart skit ‘that points out the absurd thoughts we collectively entertain…’
    Thank you ‘thebipolarbum’ and ‘unthink’ 😉

    Like

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