I am sipping my coffee and contemplating all the many times I started in therapy or began some sort of new treatment modality intending to ease my symptoms in some significant way, or to explain (or excuse) my behavior without really having to work to change it (or myself). It was both frustrating and pointless, and I didn’t get very far at all. Was it because all those different sorts of things, and all those many professionals, just weren’t effective or appropriate? Doesn’t that seem just a bit unlikely? It’s so common, though… So… What might account for how common it is for ‘therapy’ not working out, not working very effectively, or being ‘a bad fit’? I think it over and find my way to one fairly obvious conclusion; it’s the relationship.

Therapy – any sort of mental health treatment focused on interaction between professional care-giver and patient seeking treatment – is pretty intimate stuff. If I am not entirely comfortable, emotionally, with the therapist, why would I expect to get much out of it? I won’t be very likely to be open with a therapist I am uncomfortable with, would I? In such a scenario, I find myself feeling that the therapy ‘isn’t working’, when it is more properly stated that the relationship isn’t working – very understandable. So, there’s that – it’s a relationship, and requires commitment, investment, openness, trust – all the qualities any relationship must have to thrive.

There’s another characteristic, lacking which therapy is a mockery, and that is openness characterized by absolute frank forthright revealing honesty. Approaching treatment dishonestly absolutely ensures no progress is ever made, at all. Seeking a therapist who will be satisfied to take a paycheck, push some pills my way, write some notes I will never see, say nice things to me, and reassure me that I’m ‘not crazy’, allowing me to hear that as ‘it’s someone else’s fault’ (although that’s not what’s actually being said) isn’t ‘therapy’, and progress is not an outcome to be expected. It’s just more bullshit and game-playing. It’s just more drama. It is also a serious waste of limited precious life time and resources for no point; the world is generally not deceived when we play at deceiving ourselves. Certainly our loved ones are not deceived when we come home from therapy with excuses instead of progress; they are already living with our crazy, well-acquainted with our chaos and damage. It is not possible to bullshit the people we hurt with our madness for very long.

I find myself wondering if therapists and clinical professionals of all sorts find it frustrating to be aware when a client isn’t going to ‘do the work’, or when they observe that a client isn’t committed to recovering, to healing, but only to justifying their position, or excusing bad behavior? Do they experience a sense of precious time being wasted? Is the money still worth it? Is it ‘just a job’? Are they ever tempted to say out loud “I really don’t want to see you anymore, because you just aren’t making any effort”? It wouldn’t seem a fiscally good practice, if one were employed delivering therapy to people to earn a living…but… it would seem more honest, perhaps. I’ve ended treatment with a lot of practitioners of a variety of sorts (I count 14 therapists over 34 years of seeking help) – I haven’t had one end treatment with me, even when I was clearly not engaged, and getting no benefit (although two retired while treating me).

I find it, looking back, a rather sad waste of time to have paid so much money to spend time carefully crafting a narrative that resulted in hearing what I wanted so badly to hear in the moment – that I’m fine, it’s the world that’s broken, or my relationship, or my job, or… anything but having to choke on the truth that my own choices and my own behavior might have something to do with my experience, and that I might have to be accountable for the results – and responsible for making the needed changes. That may well have been the most singularly difficult step on this journey, just acknowledging that I have choices, that I am an active participant, that I am ultimately the architect of my own experience – and that I have moments when I am one fucked-up not-at-all-rational really-not-right-in-the-head fancy monkey that owes someone dear a very sincere apology, and a commitment to the real work involved in treating myself and others considerably better. It is, however, a step that had to be taken – because all the steps leading me somewhere different (and better) followed that one, and could not ever precede it.

We are each having our own experience. It’s not easy finding ‘a therapy that works’ or ‘a treatment that helps’. I find myself thinking that at least in my own case that was because it took me so long to understand that therapy involves relationships – one with the therapist, and one with the person in the mirror. Being dishonest with either definitely slows things down.

I smile and sip my coffee. I’ve been in therapy with my current therapist now since very shortly after I started this blog… February, 2013? It is the first time I’ve had the experience of mental health treatment being effective for anything beyond crisis intervention. I’m in a very different place than I once was. I’m still ‘myself’, too. My therapist is unquestionably very knowledgeable and skilled, and it is clear that the treatment modality is well-selected for my needs – both very important things, and I value those characteristics of our work together. This morning, I make time to appreciate ‘the other thing’ that seems so very much at the heart of ‘making it work’; I showed up. Seriously, I am engaged, present, open, fearlessly intimate even when completely uncomfortable, and most importantly – willing to do the actual work, the practicing of practices, the corrections in behavior, the repetition, the accountability, the utter frankness with myself and with my therapist, the willingness to embrace change; there are verbs involved. Turns out that matters a lot. “Easy” just doesn’t enter into it.

Enjoying this moment.

My coffee is cold now. I smile thinking about progress made, and progress to come. I think about the work day ahead, and the evening beyond it. I recall my therapist wrapping up our most recent session asking me to think about my goal for this next bit of work together and realize that what I heard was acknowledgement that at least in part, we’ve successfully completed a portion of the work we had begun so many months ago. Wow. I take a few minutes to enjoy that awareness, and to simply enjoy this woman I am, so much closer to being the woman I most want to be in my life. It’s a nice start to the day.