Is therapy always the answer?

August 5, 2010 2:18 PM

"Looked at a certain way, the entire enterprise seems geared toward the needs of the therapist rather than the patient to a degree that can feel, after a certain amount of time, undemocratic, if not outright exploitative. With no endpoint in sight, it’s possible to stay in therapy forever without much real progress; at the same time, the weight of responsibility is borne almost entirely by the patient, whose “resistance” or lack of effort-making is often blamed for any stagnancy in treatment before the possibility of a therapist’s shortcomings is even acknowledged."

Writer Daphne Merkin's "My Life in Therapy," for the New York Times Sunday Magazine, explores these questions through an examination of her own history with therapy, just as a previous piece for the magazine mined the depths of her lifelong debilitating depression. Her previous candor has invited criticism; this time, Slate's "Double X" makes an apt comparison to dating and romance narratives. And indeed, Merkin's narrative ends with "taking a break."

posted by liketitanic (49 comments total)

OK, obligatory YouTube link!
posted by Xoebe at 2:26 PM on August 5, 2010

I was assumning that was going to be an SNL Jeopardy clip...
posted by Artw at 2:30 PM on August 5, 2010

One reason I refuse to See A Therapist is because most of them insist on keeping bankers' hours. I mean, I'm supposed to talk to this person about my deep inner misery, going through all the emotional hell that entails, and then I'm supposed to go back to work? What the fuck?
posted by Sloop John B at 2:43 PM on August 5, 2010 [9 favorites]

Looked at a certain way, my cat resembles a meatloaf.
posted by BitterOldPunk at 2:47 PM on August 5, 2010 [17 favorites]

"The entire enterprise" = "Daphne Merkin's career"
posted by koeselitz at 2:51 PM on August 5, 2010

most of them insist on keeping bankers' hours.

Not quite. A banker's hour is more than 50 minutes long.
posted by The World Famous at 2:54 PM on August 5, 2010 [8 favorites]

Therapists are good for talking you out of suicide or radically altering your whole life for no reason.

If you are considering either of these, take some time out to see a good therapist.

When my life is going better than that, I find that intoxicated conversations with friends are as helpful as therapy.
posted by poe at 2:55 PM on August 5, 2010 [4 favorites]

I thought this post was about Deanna Troi
posted by nomad at 2:57 PM on August 5, 2010 [10 favorites]

Americans have a therapy complex.
posted by pompomtom at 2:58 PM on August 5, 2010 [1 favorite]

I thought this post was about Deanna Troi

She's so vain. She probably thinks the entire Enterprise is geared toward her needs.
posted by The World Famous at 2:59 PM on August 5, 2010 [1 favorite]

It took my 6 months from starting to try to quit therapy until I got my therapist to "agree" to let me quit. Saying this is not esp. good for my self-esteem, but it's true. Since I was paying out-of-pocket, I am convinced, to this day, that the income factor was what was driving my therapist.

I also spent 3 years doing it and really can't say that it got me anything.
posted by Danf at 3:02 PM on August 5, 2010

I'm not finished with the article yet but the author seems to be talking specifically about her experience with psychoanalysis, which is quite different than other kinds of talk therapy- especially the cognitive behavior approach that a lot of Mefites seem to like. It's worth checking out before you confirm your beliefs about all therapy based on the title.
posted by Thin Lizzy at 3:04 PM on August 5, 2010 [7 favorites]

Looked at a certain way, my cat resembles a meatloaf.

Mine did, too, through the oven door
posted by Kirk Grim at 3:04 PM on August 5, 2010 [3 favorites]

Merkin of Hope(lessness)?
posted by The Bellman at 3:05 PM on August 5, 2010

From WP:Daphne Merkin

She also wrote extensively on books and became known for her frank and lyrical forays into autobiography; her personal essays tackled subjects ranging from her battle with depression, to her predilection for spanking,[2] to the unacknowledged complexities of growing up rich on Park Avenue.

Looks like another NYT trials of the super-rich (and their only-rich shrinks) article. There are good reasons why psychoanalysis is dead.
posted by psyche7 at 3:16 PM on August 5, 2010 [2 favorites]

Just to weigh in on the serious side here...you gotta have a good therapist. A good therapist is just an honest one.

I just completed a year of group therapy. Once a week, two hours. It was very eye-opening. No deep psychoanalysis, no bullshit. Just basic, simple stuff. I told the therapist that this was really simple, straightforward stuff, but I had just never thought it applied to me. He laughed and said "They all say that". He helped me a lot.

He was a really, really good therapist. Unfortunately, he had to close his doors. He moved back out to the mountains where he had built a home for himself while he had been a contractor, years before becoming a therapist. Business had dropped off and he couldn't keep his therapy practice going.

That's why I posted the link to the Dr. Finch video. He is the opposite of what I experienced. There are undoubtedly a lot of therapists out there who believe the "mumbo-jumbo". They can't help you. There's no magic, folks. Just take care of your shit. Recognize it for what it is, and take care of it.
posted by Xoebe at 3:19 PM on August 5, 2010 [3 favorites]

Therapists are good for talking you out of suicide or radically altering your whole life for no reason.

A part of me is worried that I'm about to feed a troll here, but what the hell are you talking about? The second part of that sentence is damn near incoherent. If I was a therapist, I would say you were projecting.
posted by PostIronyIsNotaMyth at 3:35 PM on August 5, 2010

At the end of the day, therapy is a tool. If it's working for you, do it; if it isn't, don't do it. There are good therapists who will encourage you to leave even if you don't realize it's time, just like there are good mechanics who will replace a $20 part and send you on your way even if you think you need a new transmission. That there are therapists (and mechanics) who are on the opposite end of the spectrum is no surprise.

I would say this, though: there's a difference between a person who is doing well, and for whom therapy has limited or no value -- and a person who is depressed or otherwise impaired and saying "this isn't doing me any good, I'm going to stop doing this" even though they really do need therapy. You have to know a person well to know which situation it might be.

In my case, I had a therapist once (my first one) who saw me for several appointments, then basically told me my feelings were completely valid given the work situation I was in, and urged me to act on that rather than keep coming to therapy. So I did, and things went back to normal, and one of these days I really should send her a card for giving me the kick in the ass I needed to realize the problem wasn't me. So YMMV.
posted by davejay at 3:39 PM on August 5, 2010 [2 favorites]

it’s possible to stay in therapy forever
It's also possible to punch at otter in the head.

undemocratic
Umm... I fail to see how consulting a medical professional can in any way be compared to a form of government.

the possibility of a therapist’s shortcomings is even acknowledged
You don't like him, go to a different one. I don't know what this commission was she got called before that assigns blame for lack of progress in therapy.
posted by drjimmy11 at 3:39 PM on August 5, 2010 [1 favorite]

Oh, and remember: even if you're completely well-adjusted and content, if you have nobody to talk to on a regular basis about things that you're feeling, you're probably going to be somewhat dissatisfied and disconnected. Having a good social circle takes care of this, but for some people who are too busy or too isolated for other reasons, a therapist is basically taking your money to be a member of your social circle who always takes the time to listen. It may or may not be worth the money it costs, but if it isn't you can always go talk to some kind, understanding friend for free.
posted by davejay at 3:41 PM on August 5, 2010 [2 favorites]

metafilter is also good for this, no?
posted by davejay at 3:43 PM on August 5, 2010 [1 favorite]

> It's also possible to punch at otter in the head.

Bluntly, that's a fairly old-fashioned technique. It's increasingly rare these days.

I recommend NLP or CBT.
posted by darth_tedious at 3:49 PM on August 5, 2010 [2 favorites]

I find it ironic that this posted while I am slamming The Sopranos, of which I had never seen a single episode before I decided to rent season 1 on DVD last month to check it out.
posted by localroger at 3:49 PM on August 5, 2010

It's also possible to punch at otter in the head.

No, it's not.
posted by Gator at 3:52 PM on August 5, 2010 [3 favorites]

Therapists are good for talking you out of suicide or radically altering your whole life for no reason.

A part of me is worried that I'm about to feed a troll here, but what the hell are you talking about? The second part of that sentence is damn near incoherent. If I was a therapist, I would say you were projecting.

I read the entire sentence as, therapists are good for talking you out of doing something drastic that you may well regret (suicide warranting special emphasis).
posted by philip-random at 4:30 PM on August 5, 2010

Therapists are good for talking you out of suicide or radically altering your whole life for no reason.

A part of me is worried that I'm about to feed a troll here, but what the hell are you talking about?

At a guess, that therapists are good for talking you out of one of two things:

A) suicide

or

B) radically altering your life for no good reason.

Both things you might need a good talking-out-of.
posted by Mister Moofoo at 4:39 PM on August 5, 2010 [1 favorite]

Or what philip-random said.
posted by Mister Moofoo at 4:40 PM on August 5, 2010

It's odd that she claims therapy is undemocratic, since so many people come to therapy precisely to find a father-figure who will relieve them of responsibility for themselves by telling them what their dreams mean, what they are supposed to think and do and feel. In other words, they want something like Catholic priest: go in and confess, and be absolved and told what to do. It's true that there is potential for an unethical therapist to exploit this, but perversely, this could only happen by giving the client what they want.

The best explanation I ever heard of psychoanalysis is that it's like a detective story and the analyst is the detective. The analysand plays a double role of the clueless local policeman and, unconsciously, the murderer. S/he presents the clues discovered at the crime scene to the detective, but the truth is only unraveled by showing how all the apparent evidence is a ruse intended to put the investigators on the wrong path and avoid bringing the true criminal to justice. This is why the most suspicious thing you can say in therapy is "I know what's wrong, just tell me how to fix it." You've already caught the criminal! But actually, you have the wrong guy. Or even more radically, you have a criminal who is guilty of a different crime that you have forced a confession out of.
posted by AlsoMike at 4:44 PM on August 5, 2010 [2 favorites]

Therapist
The rapist
posted by Oyéah at 4:45 PM on August 5, 2010

The rest of the comment read, "When my life is going better than that, I find that intoxicated conversations with friends are as helpful as therapy." Which kind of read, to me, like, "Unless your life or livelihood is actually in danger, therapy is a waste of time."
posted by Gator at 4:46 PM on August 5, 2010

A good therapist is just an honest one.

I would add, who will maintain boundaries. One way I know my therapist is a good one in that way is that I had seen her for a year or so, gone back to her a few years later when I had PPD after my first son was born and stayed for several years, and recently returned because I thought I needed a little tune-up--and if I hadn't happened to meet her adult son in a completely unrelated context 10 years ago or so, I would know absolutely nothing about her life outside her office. (I should also add that I've seen her four times, and last week she told me she doesn't think I need her, that my problems are medical, not mental.)

I have had friends who ended up in this replacement-mother relationship with their therapists, stayed in therapy for years on end, and knew all this stuff about, say, the therapist's problems with her husband. Very wrong.
posted by not that girl at 4:58 PM on August 5, 2010

I know there are people who are dependent on their therapists in the way Merkin describes, but it boggles me. I started seeing a therapist at a young age for mild learning disabilities and continued to see her until I was in high school, at which point I explained to her the law of diminishing marginal returns, derived from first principles, as it applied to my study habits, and was dismissed from therapy as a (probably perpetual) underachiever. My best childhood friend, who had emotional and mental problems far more serious than I did, also saw her until he had to be institutionalized, and after leaving the institution several years later, committed suicide. I wouldn't say I blame her, and rationally I understand that even with the additional drugs we have now, he might still have killed himself, but the experience left me with a horror of therapy so deep that my jaw always wants to drop when I hear about someone who's perpetually in therapy.

(I did see a different therapist for a few months after my father's sudden death, and it was a decent experience, but it still didn't erase that gut feeling that therapy will fuck you up badly. Neither did reading my chart as an adult and learning that the therapist thought my family dynamic was screwed up and it wasn't all my problem. The lesson, true or false, was too bone-deep.)
posted by immlass at 5:09 PM on August 5, 2010

Back when high-alcohol beer became legal in my state I asked my grandfather about how the process changes to get different flavors, alcohol percentages, types of beer, etc. He'd been making beer ever since I have memories, so I figured he'd know. He gave me a steady look and said, "You know the word 'experience'? I've been brewing beer for forty years, but I don't have forty years experience. I have one year of experience forty times. Sometimes I put apples in, but really I have no idea."

Merkin has been "in therapy" for 40 years and seen how many different analysts? Not to reduce her experience to a numbers game, but if you see a dozen therapists and they are all* fatally flawed people who don't care about you, refuse to help you, and make you even more neurotic... Well, let's just say that there's one common element in all of those experiences.

To her credit, she does consider (practically in passing) the idea that you have to take responsibility for insights and problems; but if no one can ever satisfactorily meet your needs, the problem is not in the 'meeting' but in the 'needing'.

* Except the ones that died before they had a chance to let you down.)
posted by mister-o at 5:11 PM on August 5, 2010 [4 favorites]

I started seeing an MFT with my wife before our (recent) divorce, and have been seeing her individually since. Personally, I find it incredibly helpful. Not going to go into a lot of detail about that since there's no way to do it without getting more personal than I'd like. Basically it's useful to have someone who is (a) more objective than my friends/family, (b) has talked with lots of other people and can give me some calibration on what "normal" relationships and interactions with people are like, and (c) gives practical advice on how to change elements of my life I'm unhappy with. She's not the "listen to you for an hour and say 1 sentence" type, though, it's more conversational than that. I'm sure it's not for everyone, but I only wish I had done this sooner.
posted by wildcrdj at 5:41 PM on August 5, 2010 [1 favorite]

Given the opening of the post, I was wondering if this article from the London Review of Books was going to make it (I don't know if it's been posted before). "Saving Masud Khan" is about an educated British chap who has a terrible relationship with a tyrannical psychoanalyst.

Personally, I have used the services of a therapeutically-minded person in the past. While in the beginning, when I still hadn't the awareness even to begin to pick up the pieces of my shattered ego, I found her a terrific boon, nevertheless as I recovered I found her making unwarranted attempts to meddle in parts of my life which weren't broken.
posted by adoarns at 6:04 PM on August 5, 2010

This article is as tedious to read as her 40 years in psychoanalysis must have been to endure. She needs a good dose of LSD or psilocybin to throw off her conscious mind for a little while. I think she used therapy to create unsatisfying, artificial relationships to compensate for her lack of genuine ones.
posted by silvicolous at 6:14 PM on August 5, 2010 [2 favorites]

I think I concur with mister-o that if every single person you saw had problems except the one who died, then.... it might just be you, Ms. Merkin.
posted by jenfullmoon at 6:52 PM on August 5, 2010 [1 favorite]

I loathe Daphne Merkin, and was self-disusted to find myself reading this article. As with watching Desperate Housewives, one ping-pongs between amused contempt and appalled contempt. I do not know what it is doing taking up 9,000 words of the NYTimes, unless she has naked pictures of a Sulzberger.

If she wanted to be whiny and self-indulgent and blather at length about how her messed up family life is her Sisyphean rock, I would have much preferred her to do use as her angle the fact that her brother was the conduit through which Bernie Madoff helped rip off Yeshiva University, among others. That might have bee interesting.
posted by Diablevert at 7:05 PM on August 5, 2010 [1 favorite]

It took me two days to slog through the NYT article. The only thing that struck me as very interesting was that she said that Woody Allen offered her the name and number of his therapist when the met. 40 years of therapy. How do you know if it is working?

The author said she went two times a week. If you use 40 years, and say 45 weeks per year allowing for vacations and whatnot and use an average cost per session of $75, she spent $270,000 on therapy. Almost $7,000 per year.
posted by JohnnyGunn at 11:40 PM on August 5, 2010

I recently actually dated a therapist. On our first date, I ended up talking about long-buried child-hood trauma. She really couldn't help herself from doing the therapy thing in pretty much every conversation we had.

Then she dumped me because I didn't ask her enough questions about her.
posted by empath at 5:17 AM on August 6, 2010 [2 favorites]

Ha, I just had this exact conversation with my therapist. And with my mental health background, it made for an interesting interaction. And don't get me wrong, I had an AWESOME therapist, not only brilliant but just a super amazing person that I had a great connection with, she just wasn't really doing anything for me. And of course she countered with the lack of effort argument, a lack of openness on my part that was slowing the process, that I haven't been engaged long enough, etc. I explained that I'm up on the literature on how long psychotherapy is supposed to take before a patient can expect to see some changes, and we were well beyond that point. Shouldn't I be allowed to have some expectation that my mood would be sustainably improved if I'm coming to sessions reliably over an extended period of time? Is that unreasonable? I explained that I liked her a lot, but felt that's what it was boiling down to; I enjoyed her company more than anything. But was that therapy, and should I be paying copays for that when my financial resources are so tight?

Maybe this is crazy coming from me, but I have been through a number of iterations of therapy over the years with different types of therapists and have never gotten any sustained benefit from it. I understand that many people do benefit from psychotherapy, but I have unfortunately found it to be more or less completely useless.
posted by The Straightener at 7:54 AM on August 6, 2010 [2 favorites]

I was wondering about something along these same lines when my husband and I recently tried marriage counseling. Outside of blatant physical abuse, I feel like the therapist would have told us we could work things out no matter what the situation. When I tried to express the depth of my doubt and concern about a long-term solution, I was simply accused of not "letting myself" want to work on things. I felt totally trapped and not listened to. Maybe I wanted someone, a professional, to validate me and say "leave him", so I wasn't getting what I needed out of it, but I found the experience very unsatisfying.

On the other hand, my experiences with therapy on my own have been pretty helpful.
posted by thekilgore at 8:17 AM on August 6, 2010

I explained that I'm up on the literature on how long psychotherapy is supposed to take before a patient can expect to see some changes, and we were well beyond that point.

Oooh. I would love to see some of that literature if you have any suggestions?
posted by liketitanic at 9:03 AM on August 6, 2010

Outside of blatant physical abuse, I feel like the therapist would have told us we could work things out no matter what the situation.

I think that's pretty much the marriage counselor's job.
posted by empath at 9:47 AM on August 6, 2010 [1 favorite]

One thing that's interesting as a British person reading this on the blue is that.. I don't know anyone in therapy. I've never heard a friend talk about therapy, or even talk about a friend talk about therapy. I don't think it's just my circle: therapy strikes me as much rarer over this side of the pond.

Which always makes me wonder why, culturally, America leans so much more to therapists and what it means that the UK, for example, doesn't - given that there are lots of ways in which we're culturally similar.

And I'm not driving at a particular answer here. But the UK has adopted many, many social trends that started in the US. But not this one. Or not yet.
posted by MuffinMan at 9:54 AM on August 6, 2010

Reading her other article, the one about her issues with severe depression, adds a clarity to her perspective that I find somewhat lacking in the piece about therapists, which is somewhat easily dismissed as "another NYT trials of the super-rich (and their only-rich shrinks) article," as psyche (eponysterical!) puts it. It's easier to find sympathy for her when you realize she's been through multiple instances of medication-resistant depression requiring hospitalization, as opposed to just another Park Avenue neurotic with mommy and daddy issues.

I find it interesting, though, that she doesn't really deal with that very much in the main article, and it doesn't seem like either she or her therapists are all that interested in dealing with her actual depressive symptoms as compared to all of these nebulous ideas about how she "has problems with distance" or relating to other people or whatever.
posted by infinitywaltz at 10:01 AM on August 6, 2010

Which always makes me wonder why, culturally, America leans so much more to therapists and what it means that the UK, for example, doesn't - given that there are lots of ways in which we're culturally similar.

Americans, as a rule, don't use therapy either. You hear about it a bit out of proportion to it's actual use due to it's prevalence among the affluent.
posted by empath at 1:18 PM on August 6, 2010 [3 favorites]

When my parents got divorced, they thought I should see a therapist because my behavior changed pretty dramatically, and I started (what turned out to be) a long road into self destruction and back. I realize now that I chose the path, and chose many, many times to stay on that path, and it was only when I wanted to stop that I could alter my path...but none of that self awareness came from the fruitcakes my parents made me go see.

My favorite one? I was about 11-12 and going to Catholic school, which meant I wore a uniform with the little white blouse and the little plaid skirt. The male shrink told me to lay on the floor and do leg lifts. Head away from him, panties pointing towards him. Yes, yes he did.

I've never trusted one since then, and fortunately, that was enough to get my parents to stop forcing me into sessions.
posted by SecretAgentSockpuppet at 2:12 PM on August 6, 2010

Oooh. I would love to see some of that literature if you have any suggestions?

Yeah, sure. (PDF)

It's easier to find sympathy for her when you realize she's been through multiple instances of medication-resistant depression requiring hospitalization, as opposed to just another Park Avenue neurotic with mommy and daddy issues.

Absolutely, establishing objective standards for psychic pain in order to determine whose qualifies as real pain is silly and fruitless, and I don't think psychotherapy is a bad thing in any way, shape or form. Regardless, psychotherapy is a bourgeois luxury, plain and simple. There is no other way to realistically describe it in terms of who can access it. Those without health coverage in America are without access, those with access to publicly funded psychiatric resources in the community mental health system have access to some services but nothing that resembles the kind of intensive one-on-one contact with a doctoral level clinician most people identify psychotherapy as (basically no clinical psychologists in private practice take Medicaid), and even those in the working classes with medical insurance have copays that over time comprise too much of their post tax income for psychotherapy to be feasible. This was a big part of my gripe with my therapist. At my social worker's salary I am not afforded the luxury of puttering around in therapy for another year before having a "breakthrough." Yes, even a $30 weekly copay is too much for me to afford, and my budget is always stretched to the breaking point, so, sorry. I expect and want to see results, on a timeline that I feel is reasonable, and I want the process to have a logic point of termination.
posted by The Straightener at 2:19 PM on August 6, 2010