It's Kind of a Long Story... about THERAPY (Part I)
Where should we begin?
Hey Drama Goblins,
A little bit of business before we get to the story.
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But, several readers had already made generous pledges. Their support has inspired me to push the payment button.
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-Lara
How are you?
Short story:
In mid-2022, I wasn’t feelin’ or dealin’ like I wanted to be, so I started therapy. In 2023 I went through six therapists. Some I fired. One fired me. Navigating the mental health care system can make you crazy.
Long story:
Before 2022 I had limited experience with therapy. John and I saw couples counselors a couple of times. When I was most stressed and over-extended as a working mom, I saw a therapist who listened to a rundown of my schedule, to-do list, and responsibilities and declared, “You need a cleaning lady!” And no, she didn’t offer to pay for it. And if you read last week’s post, you know I did grief counseling for a year after John died.
But in mid-2022, my life was at a turning point. It had been a year since the tree fell. I had to leave the apartment my insurance had secured for me, with no idea when I might be able to move back into my house. I stored or got rid of everything except two suitcases of clothes, two boxes of stuff, and a bag of shoes. I was scrambling to patch together housing. It’s not easy to find a furnished place to live for an indefinite amount of time. The options are sublet, house sit, AirB&B, couch surfing, or a hotel. I did them all.
My 5-year relationship with Cris was ending as he pursued and new one, and, the pressures at work were increasing.
It was a lot.
My health care is covered by Kaiser, which for those unfamiliar, is a California-based system that is both a health care and insurance provider. It has its pros and cons. Ask any ten people who have Kaiser, and 4 will say it’s great, 4 will say it’s terrible, and 2 will swear it killed their parents. They’re all right.
I should have known Kaiser’s mental health care system wasn’t exactly patient-centered when I was required to talk on the phone during work hours with an intake counselor. I’m fortunate that I worked in an office where I could find a private room to talk. Not everyone is so lucky. That initial and significant barrier to care will keep many people from accessing the services they need.
I was referred to Two Chairs, an online therapy service similar to Better Help.
I should have known Two Chairs wasn’t exactly patient-centered when the email I got let me know, “You have a therapy appointment coming up!” Yes, with an exclamation point.
That kicked off a very rocky road toward improved mental health in which I saw a string of shrinks with varying degrees of skill.
Most of the therapists I saw were LCSWs or MFCs, but my nickname for all of them is “Doctor.”
Dr. Middle Part (May 2022-Jan 2023)
My first therapist wore large hoop earrings and her hair pulled back with a severe middle part. She was well-dressed, had a husky voice, red lipstick, a diploma or certificate on the wall behind her, and sat up straight and at attention. I saw her for about 8 months, as she graciously made the case to extend my care beyond the 16 weeks Kaiser expects you to figure your shizz out.
She and I did some good work together. I was so impressed at how she kept track week to week of the goings-on and cast of characters in my chaotic life. I lived in 9 places while we worked together. I’m grateful she was there during the 6-8 weeks in Fall 2022 that I have described as so weird that David Lynch would say, “Naw, no one would believe it.”
During those 8 months, I didn’t make it through many days and not a single week without a major plot twist, and yet my problems remained the same: I was stressed about my housing situation, feeling like a failure because if I had more money I could get myself out of my mess, and even though I did not want to be with him, I couldn’t stop thinking about Cris.
In January 2023, when I expressed that I felt stuck, she somewhat suddenly suggested, “You may benefit from medication and a different modality.” Which was a nice way of saying, “Your problems are beyond my skills.” However you say it, she fired me.
This is how I was starting to feel in my therapy sessions like I was doing the same thing we do every time.
Dr. Side Effect (Jan 2023)
While Two Chairs was matching me with a new therapist, I somehow worked my way through the Kaiser system to find an MD who I could talk to about medication. I picked her randomly from a list as I didn’t have a regular GP.
I was nervous about taking medication. I never had before and the thought of messin’ with my brain was making me even more anxious about my anxiety. Anxiety was a self-diagnosis. I didn’t think I was depressed. I never didn’t want to get out of bed. I got up, showered, dressed, and made up every day. I was social and having fun, but fear, self-doubt, negative self-talk, and lack of hope and confidence were constant companions. I had a very, very hard time concentrating and sleeping. I was reaching for my phone like a smoker reaches for cigarettes.
Dr. Side Effect was 8 minutes late for our video appointment without apology. I told her that my therapist had suggested medication. She blurted brusquely, “So you want medication? For your depression?”
I said, “Well I don’t necessarily want medication. I don’t feel qualified to make that determination. I want to feel better, and it’s more anxiety than depression.”
She launched into suggesting a low dose of Zoloft and rattled off the side effects, which included weight gain. I said with a laugh, but I was serious, “Are there other drugs that don’t have weight gain as a side effect?”
She responded in a harsh and condescending tone, “Well, all medications have side effects. The ads for drugs on TV all list side effects. Have you ever read the label on a bottle of Tylenol? There are side effects in the fine print.”
I couldn’t believe she was responding to my concerns with this nonsense about fine print and side effects. She didn’t ask about my life, symptoms, or concerns about medication. I felt like I was being prescribed drugs to shut me up and send me away and I told her so.
I can’t recall all of the back and forth of the conversation, but remember how I felt. Dismissed, disrespected, and unheard. I felt much, much worse than I did before the call. I was frustrated and demoralized. I really wish I had a recording of the appointment. It was almost a parody of an obtuse, disengaged, asshat of a doctor. Except it wasn’t a parody. It was real life. My real life and my brain and I was scared and needed guidance, compassion, and care.
She ended the appointment with, “Do you have any questions?”
I replied, “Not any I think you can answer. Thank you for your time.” And I hung up.
I still don’t know if I had anxiety, depression, or both. Other than a brief self-evaluation survey, I wasn’t given any other screening, exams, or tests. I do know that if I wasn’t already on shaky ground, my experience with Dr. Side Effect would have been enough to put me there. I’m angry all over again just thinking about it.
Her name is Elif Tokan -Talegon. If you’re a Kaiser member, I recommend you avoid her.
Dr. Don’t Remember (March 2023)
In March 2023 Two Chairs matched me with a therapist I saw for two or three weeks and then I had to switch again because of a scheduling conflict.
Dr. Home Goods (April-May 2023)
She opened the first session with, “How are you?”
I hate that question.
Of course, I ask it and answer it in casual exchanges. I can follow social norms.
But, it is an impossible question to answer. How am I? I’m so many things. How am I supposed to distill all of the many things I am into a neat, tied-with-a-bow answer? And if I’m in a therapy session, I’m obviously not doing great.
It lands for me as lazy. Unskilled. It does not instill confidence.
But, I was there and I needed help so I said something and gave her my story about the tree and moving and all the other stuff. It took most of the session.
She ended by suggesting that I make a list of everything I’ve overcome.
What the hell kind of discount paperback self-help nonsense was that? I could spend the entire week making a list of everything I’ve overcome. I know what I’ve overcome. I know that I’ve “survived” if you measure survival by being alive and not in a straightjacket, but I did not survive with my mental health. I emerged with anxiety, depression, poor eating habits, poor sleep, and a nervous system that was on the verge of collapse. Evaluating what I had been through did not give me confidence in my ability to navigate my future. It had gotten me to where I was, and that wasn’t a good place.
It felt like I was being assigned a gimmick she had read about in a magazine without any real consideration of who I was and what I needed.
She began our second session with, “How are you?” again, and I specifically asked her not to do that, and explained why.
As we got into the session, I said that I was concerned about the weight I had gained. I had lost 150lbs on my own ten years before. I knew what to do, but I wasn’t doing it. I said that was going to be back in my house soon, and that I would be reunited with a lot of clothes that meant a lot to me that wouldn’t fit.
“Well, how much weight do to want to lose?”
I was speechless. She wasn’t my personal trainer or even a medical doctor. She was my (supposed) therapist. I needed her to help me with the feelings of shame and loss and identity and grief, not to count calories.
At our third and what would be final session, she again opened with “How are you?” after I had specifically asked her not to. Twice.
I brought up last week’s exchange about my weight, and that it had bothered me, and she said, "I'm sorry if I made you feel bad."
My heart sank and my teeth clenched. I said, “I’m going to stop you right there. There is no ‘if"‘ about it. I just told you I found it upsetting.”
She said she was sorry, that wasn't what she intended.
I said, "Well it would be pretty weird if it were your intent. Of course, a therapist doesn't intend to make their clients feel bad. I'm not questioning your intent, I'm informing you of the impact."
I could not believe I was coaching a supposed therapist on the difference between intent and impact, and that "if" has no place in an apology. Very, very basic communication skills.
Speaking of basic, she got the nickname Dr. Home Goods because she had all the depth of a Live, Laugh, Love poster.
I didn’t see her again.
As I started talking about my frustration with finding a therapist, I heard, “No good therapists take insurance” and “You have to find the right one. It takes time.”
Time? I didn’t have time. I wasn’t healthy. I wasn’t getting better. No one tells a cancer patient, “You just have to find the right chemo therapist.”
Can you imagine if they did?
This is a Facebook post I made at the time:
There are a million kinds of (chemo) therapy. You have to do a lot of research about your disease and the kinds of (chemo) therapy first. You don't have the skills or expertise to do that. They all seem to have pros and cons. You have friends who have had successes and failures with all of them.
Your insurance may only cover one kind, and only a few sessions. And there's a long waiting list to access the care.
If you can afford to pay out of pocket, it will take a lot of time, usually daytime hours when many people are working, to make difficult phone calls to find a (chemo) therapist who is taking new patients, and has appointments that work with your commitments to your job and family.
This also supposes you speak English, are documented, have ease navigating complicated systems, and have a job/life that allows you the time, privacy, and space for intimate phone calls.
If you have navigated all of that - while also navigating a disease that is killing you and getting worse by the day - it might take many weeks or months of draining, intense, and unproductive treatment to determine if the (chemo) therapy is working.
If it isn't? Return to square one and start over, this time more exhausted, depleted, cynical, and sicker than you were the first time.
That’s how I felt when I was trying to access competent therapy. And, I didn’t give up.
To be continued….
Know someone who would get something out of that story? Please share.
Lara sez…
Listen!
80s Deep Cut of the Week! My Bumble profile answers the prompt, “You should swipe right if…”
“All you wanted was a Pepsi” Only one guy got it. It got him a date.
Bonus Trivia: I went to junior high and high school with one of the skaters at the beginning of the video. When people ask what it was like growing up in LA, it’s stuff like that.
Read!
It was very gratifying to read how a very smart, very educated, very accomplished therapist lost her shizz over a breakup in Maybe You Should Talk to Someone. It happens to the best of us.
Follow!
So many people I know get therapy from Instagram. If you follow the right people, it’s effective. I’ve learned more about narcissism and trauma from creators like @elwingbling than I have from any counselor.
Listen!
I’m so impressed by the couples who come on Ester Perel’s podcast to find solutions, not to be right, and Ester’s ability to get to the heart of the matter within minutes. These real couples counseling sessions are a master class in communication skills.
Watch!
Mad Men is great for a lot of reasons, one that isn’t discussed as much is how it so accurately and beautifully and heartbreakingly depicts how childhood trauma can be a constant companion. Dick Whitman was always standing right behind Don Draper, whispering in his ear, reminding him he didn’t belong, driving him to drink and treat others as badly as he felt about himself.
Before I let you go…
I gave away the last of the Drama Goblin notebooks with Micah Player’s illustration, but I goofed and ordered some with the entry in the Urban Dictionary:
“Someone who gleefully and unashamedly welcomes and shares (relatively) harmless gossip.”
My goof can be your gain!
Two ways to win!
Comment below or reply to the email with a thought, suggestion, or words of encouragement.
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This post really highlights one of the scariest problems we have. I had such similar experiences with therapists. I too get so angry thinking about it. My child needed therapy and we were told multiple times there were year long wait lists. Just unacceptable when someone needs help at that time. I was also told the best therapist are those that don’t take insurance. So glad you are writing this.
What a beautifully vulnerable sharing of your experience moving through our very challenging mental health system (or lack thereof) in this country. You know I’ve been through this system first hand and am now watching as Jordan is trained to be a therapist. I’ve so intrigued by this process because I’ve seen the good, the bad, the ugly and wonder how there can be such a chasm between them. Thank you for sharing so transparently as imho this is where our system starts to heal.