Therapy Cocktail: Cruelty with a Splash of Mr. Kind Eyes
Therapy. Whether it was a difficult decision, no-brainer, or the last-ditch effort to stop the eternal screaming inside your head, there’s one universal truth: it’s personal. Therapy is the place where you can take a deep dive into what it means to be a special snowflake.
If you’re anything like my anxiety addled brain then your journey with therapy began by Googling the parking situation and the layout of the building. Once you leap that hurdle you have several hurdles ahead before you digging into your psyche. Like, what’s the aesthetic of this place? Quirky, neutral, rustic, and oh look a Keurig, that’s fun, I’ll never use it. I mean I know how to use it and at home, I can do it even in my sleep, but here, that’s a guarantee when the therapist opens the door to invite me back the cup is overflowing with coffee-tea hybrid I somehow managed to make and I’m trying to stop this overflow by catching scalding hot beverage with my t-shirt all while yelling, "why don't my parents love me". And what about the therapist? I mean, that’s the whole shebang right there. Do you and this stranger mesh? What does that even mean? On a scale of 1-10, how fucked up do they think I am based on my clothing choices sans the Keurig incident? The answer, by the way, is 11.
Then you begin. At first, it’s like oh awesome, someone is going to listen to me. No interruptions (except for the ongoing conversation in my brain) AND they validate me! Whoah! That’s new and alluring. Ah, things are looking up.
A few weeks go by and yeah, you’ve got this rhythm and things do feel a bit lighter. Next thing you know you’re in the middle of the session and the therapist makes a random remark that hits you like a jab from Mike Tyson pre-face tattoo because you realize they have no clue how off base they are about this topic due to you not sharing the coveted information. Fuuuccckkkkk… Fine, you interrupt their train of thought and see clearly on their face that your body language and expression must have changed. Suddenly the ease of which they were speaking grows somber and they are tuning in. You don’t like it that’s for sure because someone genuinely caring about what you’ve got to say is foreign in every aspect and your wavering voice backs that up. Somehow, you awkwardly spill the deets. Trauma, secret, abuse, whatever it was that was far too risky to share at the start of therapy is now out in the wide open. Ew, gross, phew, I did it, or maybe even, relief and comfort that you have found someone you can share the scary and hard things.
Maybe now the hard work begins. Maybe the share was too big so you back off and pretend it doesn’t exist for some time. There’s no wrong choice and no timeline. Sure insurance companies love timelines and that’s assuming you are lucky enough to have mental health benefits. And this is where I begin pondering the brutality of therapy. Completely based on my opinions from what people have shared with me and my own experience. Perhaps your journey hasn’t been this rough. If it has well you’re not alone.
We do not as a collective give enough attention or resources to mental health. Benefits are often non-existent and if you are lucky enough to have them they are restrictive and come with a variety of limitations.
We are stuck in this hetero-normative, White, patriarchal space. That means 50% of our population is told to “man up” and whatnot when it comes to feelings. The other 50% are taught not to get raped, shut up, and be desirable. While some people have more privilege than others it’s still fucked up as a whole and we are terrible at doing what our human bodies are built to do which is feel our feelings. Understand why the exist and work with them versus beating them into submission and repression. ‘Merica!
The result is a lot of time in therapy just learning the fundamentals. Imagine if the fundamentals were treated like A, B, Cs in pre-school? Also, it’s cool if your kid doesn’t master their A, B, Cs in pre-school.
The lack of resources, the way our economy is structured, our views on norms, race, gender, and such also lead to therapy being cost-prohibitive mixed with lack of access to providers. On a societal level, I find it infuriating. I don’t like injustice and this is unjust and inhumane.
Time is a commodity and we’ve been programmed to use it “wisely”. So if you’ve opted to go to therapy you might be swapping that out for something else. That for me is not a big deal because fuck the patriarchy. What I find is that the actual time spent with my therapist is not enough.
The standard is a therapeutic hour once a week. Therapeutic just like approaches to therapy are varied. The “hour” lasts anywhere from 45-60 min. Also, your therapist might be Mr. Kind Eyes who won’t boot you out when you are significantly dysregulated so you might get a few extra minutes. I’m the person who is fine waiting a bit if my therapist needs to take some time for themselves or their client before me because I know there are times when I need it. Have a therapist who is super strict about this timeframe but jives elsewhere for you? Get used to it and discuss it in therapy. My actual point is that this “standard” isn’t enough time. At least not all sessions, all the time, and for all clients.
The problem with industry standards is that humans aren’t cookie-cutter versions of each other and this is the mental health field so for fuck sake why is it set up this way? Literally, the entire profession is about you and your experience with the human condition. Of course, it’s individual and case by case dependent.
The argument I suspect or made up in my head is consistency for the professional and yes in some ways consistency for the client. I say this because of my soapbox rant about society. Your therapist is a human being who has chosen a profession that is difficult so they need expectations and boundaries to avoid burnout. They also have bills to pay and lives to live. It’s hard to create a schedule when it’s carte blanche for each person week to week. So the argument seems fair and reasonable. I also feel there’s little flexibility and that can be difficult for the client. Especially a client who struggles with verbalizing needs and wants. Especially one named Lauren.
I think the one hour/week model sets the client up to fail or perhaps reinforce distorted beliefs about themselves. Example: I’m convinced I SUCK at the therapy process. No, Mr. Kind Eyes, I don’t believe you otherwise, also could you tone down the kind eyes until such time I’ve earned them.
For me, the ideal model would be a place where you just sit me in a chair like the one in the Matrix and upload new programming. I still want to consume real food and not that other shit Neo and his buddies ate. Buutttttt… that’s not going to happen or we are already living in the Matrix.
Either way, this is what would have helped me at the beginning of my journey:
Make an appointment. An intake appointment is 1.5 hours. Get a sense of this person and process. Get some options. Do I think I’m the type of client who is going to do okay with the one hour/week set-up? If not, do I think I need less? More? If more, is that more than an hour or more than once a week? Here are fee structures based on a menu of options we have found best serve our clients. Please note you are not obligated to decide today, think it over and we’ll discuss next week. We have a sliding scale (see the rant about how we currently deal with cost as a society above). Also, you can change your mind and we can readjust. There might be times when we can’t make it work and we’ll discuss that too.
Maybe this is too overwhelming to implement. How’s this then? New clients choose from attending therapy 2-3 times a week for 1-3 months and then assess with their therapist what comes next. Imagine having choices and a say in your mental health. I know it’s hard to imagine because our entire healthcare industry is a monster clusterfuck but try, just for a moment. Kinda nice, right?
Side note small business owner to small business owner. I didn’t open a theater to analyze financial reports, bookkeeping, optimize products, marketing, and sales. I loved my profession and believed I had a strong voice to share the art with other people. I wanted to connect, educate, travel, and perform. I did do those things because I also did the business part. It sucks, I get it. Chances are it’s hard enough to build a client base let alone all the other business tasks. Maybe you can hire someone to do that shit and if you can AMAZING. Here’s the thing. You’re in sales now. You need clients. The great news is clients need you. If you aren’t dealing directly with insurance companies then consider getting creative. I can tell you as private pay if my group offered packages of varied hours and sessions I would buy those mofos! Also, it’s guaranteed money instead of this piecemeal bullshit you all seem beholden to and that’s a big deal when you have fixed debits on your balance sheet. Maybe your licenses don’t allow this? I don’t know. I just think it’s dumb that I have yet to come across a private practice that doesn’t think outside of the box. Also, I exist far out of the box so maybe this is too alternative?
Here’s what I know from my experience over the past 10 + years with the Cleveland Clinic, yes, the one in Cleveland, has a different model of care. Doctors aren’t paid per patient, lab, and procedure. There is no getting extra money from the outpatient center so many doctors seem to have part ownership and double-dip as part of their income stream. There’s an agreed-upon salary. Clean. Simple. What this means for the patient is the doctor isn’t watching the clock, trying to fit in as many patients as possible, and trying to get you out the door because time is money. It also means testing is done in the interest of the patient. It’s a safety net I’ve been grateful to have. I have no idea if that model is feasible in the mental health field but I do know that we are so far away from even having a conversation about this and that’s shameful.
Going to therapy 2-3 times a week should be normal and affordable until the client feels they are ready for less or can handle the spaces in between sessions. Those spaces in between when you are dealing with complex issues are merciless. Complex issues take time. Why aren’t we setting up the client for success?
I recently went from one hour to 1.5-hour sessions. It’s helped. It’s not perfect but it’s helped. It was SO FUCKING HARD for me to even float the idea and I'm 137% full of shame for needing it. I’m agitated when my appointment rolls around. Hearing the drumbeat of time tell me to get going once I sat down was oppressive. Abuse, sexual violence, medical trauma, grief… these aren’t topics I can just jump on. Well, if my therapist let me use my sardonic wit and hide behind sarcasm and humor I could but he somehow thinks that it’s a defense mechanism for how hurt I am and the harm that’s taken place.
Ugh, therapists, amirite?
Seriously, I need some lead-in time. Trust is a big issue. The energy of the room impacts me. Wait, he got a haircut at some point between now and last time. Why is he so patient with me? Is that shirt new? This is my brain. It needs this bridge from chatty anxiety bullshit to oh, yeah, this is that safe person. Oh Great, Mr. Kind Eyes is growing on me.
A lot can happen in one week. I’m sure some clients love to roll in and leave that shit behind and talk about the sex dreams they used to have about their bandmates but there’s also those of us (okay fine, me) who’s present life is a shitshow and who’s past is a shitshow and often they collide. It’s all a web and figuring out which one strand to choose to focus on is both impossible and unfair. But no choice is a choice and ultimately I end up somewhere but now I’m fucking frustrated because I don’t even feel like I have agency in my therapy. The time for recap and decompression helps to see how the past is informing the present. Also, sometimes it’s nice to just have space to bitch and moan without expectations. Small moments untangled can have large impacts.
If you struggle to ask for help and you are hyper-independent you sure as hell aren’t going to ask for more time (IT WAS HARD OKAY?). Add to that you feel like you are once again othered because clearly, every other client seems to step in line and understand the rules in place. It gets ugly in one’s head when you already feel like a worthless piece of shit who deserved what you’ve endured to now also feel like the one client who has to be exhausting to work with and can’t even be grateful for the time she pays for. It’s as if I’m speaking from experience, weird.
Trust and Practice
How do you learn a new skill? Practice. 10,000 hours kind of thing. We have practice…. In avoiding our feelings and emotions. Probably repressing them. So now there’s a lot of reeducation taking place. Except it’s not like math where there’s a formula. It’s messy and frankly more times than not painful. Now you only practice this once a week for an hour. I mean, yeah, sure, you can take those tools and utilize them in the real world with other relationships, HA HA HA HA HA HA HA. Who lives that life?
I mean at some point yes this can happen but if you’ve lived without safety, security, attunement, repair, or even others showing up then you are in for the slowest ride of your life. Slower then the People Mover or worse It’s a Small World. It’s like the ride went down and you’re stuck in the boat and the music just keeps looping over and over, “It’s a world of laughter, a world of tears”. Please. Make. It. Stop.
You keep showing up. Often starting from zero every week. Maybe some trust is built and you share some shitty details FINALLY and ugh now you just want to throw up and OMG we are never making eye contact again but I know you’ll make me and I’m going to dissociate now, oh c’mon, you won’t even let me do that. WHY DO YOU INSIST ON DOING YOUR JOB, MR. KIND EYES?
Also, hooray for taking a huge leap and getting to some really ugly shit. Yeah, it didn’t undo the past, and good luck to your therapist for what comes next but you had courage. Also, I mean this when I say it to “you”, it’s saying it to myself that doesn’t happen. Geez, maybe some time in therapy would help? I get it. It’s expensive as fuck and more often than not unrealistic but also can we as a society work on this shit?
If your issue is trust and somehow you’ve built a bit of trust and you’re in a session where you share the hard things and were super-vulnerable you can feel pretty awful after. You question whether you’ve done the right thing in sharing and one of the things about therapy is that you share and then you show up again and that other person has shown up for you. Your brain needs that as part of the healing and relearning process. So asking people who need to know someone is going to show up to wait an entire week and often with no contact is unfair and frankly cruel. The amount of damage their internal world can do to them in between sessions is significant.
Going back to my options menu why isn’t there at the very least: it was a big week so let’s do a 15 or 30 min text or phone chat to reinforce not all humans are monsters and make sure you haven’t spent your time in the fetal position crying and when you can finally peel yourself up off the floor you just numb out and do whatever you need to do but there you are making pumpkin fluff because it’s pumpkin season so fuck off you’re 100% embracing your inner basic bitch. Your kid didn’t make much noise when they asked if they could help but because they came up behind you and your startle response is on fire you jump, shriek, drop all the pumpkin on the floor, and weep because there is no backup pumpkin puree. Your kid now thinks they are some monster or if you’re lucky enough they get your having a rough go because of your “trauma” which they are piecing together as something terrible and it’s internally fucking them up because they don’t know what to do.
Just a random example of why follow-up care and options would be ideal in the mental health industry.
Instead, wait, wait, wait. Show up and repeat. So what you are learning then? That life is pain because I guarantee your client already knows that? That they can handle hard things? Um, think about what they’ve survived. They can handle hard things. Maybe for once, something should be soft. But these are not options and society has yet to reach a better way. You could quit but there are enough tiny moments to know forward is the path so you keep showing up.
Maybe one-week things will finally shift. Maybe they won’t and instead, you start building tougher skin which isn’t exactly the goal but if you do that then other parts might have a fighting chance to heal even just a tiny bit. You gave up on hope long ago yet you have a secret place in your heart that you meticulously guard. Inside there’s a wish that what you became was a response to malevolence and there is still a future where you no longer just survive but thrive. It’s too big of an ask to open this chest let alone talk about this. For now, it’s resignation to the cruelty of therapy with a splash of Mr. Kind Eyes.