The Course of Treatment: Treatment Options — Talk Therapy

Understanding Talk Therapy

Talk therapy is one of the most popular treatments for mental illness. Usually you will hear talk therapy referred to as counseling or simply “therapy,” but I use the (unpopular) talk therapy to distinguish between talk therapy and other forms of therapy such as music therapy or art therapy.

There are many types of talk therapy from the psychoanalysis developed by good ol’ Freud to the currently popular cognitive behavioral therapy to new and untested talk therapies such as ********.

The basic idea behind all types of talk therapy is that mental illness can be treated through some form of discussion or learning process.

Types of Talk Therapy

“Deal with” Therapies

Obviously official terms are flying out the window here, but bear with me. Broadly, talk therapies can be divided into two groups. The most well known grouping which includes psychoanalysis is all about “dealing with” stuff. In psychoanalysis, for instance, you spend a lot of time examining your childhood to identity what caused various hang ups in the your id and ego, so you can heal and grow past them. Other forms of “dealing with” talk therapy focus on other parts of your life than just childhood, have a different understanding of the way the psyche functions, etc, etc, but they all focus on “bad shit happened in your life that caused you to have mental illness, and we’re going to deal with those bad things so you can heal.

“Learning” Talk Therapies

Unlike “dealing with” talk therapies, “learning” talk therapies aren’t concerned with why you have a mental illness. It could be something from your child, a genetic predisposition, something in your brain chemistry, and “learning” talk therapies say “who cares?” “Learn” talk therapies are the occupational therapy of mental illness. “Mental illness is fucking up your life. Let’s look at how, why, and what we can do to fix this shit so you can go back to living.” CBT is the most popular “learning” talk therapy. CBT focuses on understanding the mind, body, and emotions interact, and why we think and feel the way we do. The idea being that mental illness is a downward spiral caused by the interactions of your mind and body. Find a way to interfere with the spiral–say by recognizing what thoughts are feeding into depression and replacing them with other thoughts–and you can at least mitigate, if not stop entirely the damage the disease causes.

How Talk Therapy Works

Good fucking question. You can see above the ways both psychoanalysis and CBT explain themselves. But do they really work that way? Researchers have been trying for decades to pin down what makes talk therapy work. If they could actually figure it out, they would be a huge step closer to figuring out a form of talk therapy that is effective more than 30% of the time.

How to Access Talk Therapy

Depending on the kind of medical coverage you have, there are two ways you can access talk therapy. The first is to call up a therapist who is included in your medical coverage and make an appointment. The second is to go to your primary care provider/general practitioner and get a referral to a therapist.

If you don’t have medical coverage, or if your medical coverage is insufficient for the care you need, many local and regional municipalities offer support and services to assist people dealing with mental illness. Free forms of talk therapy are sometimes offered by community clinics, religious organizations, and other non-profits.

As usual, folks who live in places with universal health care will have an easier time getting access than those of us dependent on private insurers or paying out of pocket. Easier doesn’t necessarily mean easy–access to therapists in a universal health care system may be restricted due to availability or other issues. (Thanks to Susan for providing further info.)

Impact on Polyamory

Talk therapy will rarely impact polyamory directly. It is, of course, hoped that talk therapy will lead to improved mental health and as a result improve relationships. Talk therapy does share with psychiatric medication the issue of over optimistic partners expecting improvement in a “reasonable” time frame. Always remember two things: the most effective forms of talk therapy have a 30% success rate, and all forms of talk therapy take time. Lots of it.

The Post Session Trauma of Therapies

This issue is most common to “dealing with” therapies, but might come up in “learning” therapies. Talk therapy sessions tend to be pretty rough on people. Spending on hour confronting your worst emotions, most traumatic memories, and unhealthy behaviors can have that effect. It is not uncommon for someone to need time recovering from a therapy session. Crying, withdrawal, needing comfort, and mood swings, and other reactions are common.

It is very important to respect the privacy of someone’s therapy session. If they want to talk about it, certainly be available. But don’t ask them to talk about it. If you want to express your concern and support “Did you have a good session?” is a wonderful, neutral question that doesn’t ask your loved one to share more than they are comfortable with. They might give you a one word answer, or they might give you a blow-by-blow of the entire session. Let it be their choice.

Mental Calisthenics Are Exhausting

Talk therapies require a great deal of mental effort. This is most noticeable with “learning” talk therapies, but that may be because the emotional impact of “dealing with” therapies obscures the sheer exhaustion. However, stopping the destructive thoughts caused by mental illness is a great deal like rolling boulders up hill with your mind. In addition, someone participating in a “learning” talk therapy will often come home with reading material, mental training exercises, and homework.

Depending on the type of “homework” your poly partner may begin making changes in their habits or surroundings. They may ask you to help or support them in the changes they are making, to do mental exercises with them, or to read the papers they bring home so you can better understand what they are going through and how they are trying to address their problems.

Growth is Change

If talk therapy is at all effective, it will lead to growth. Sometimes this will be a growing understanding of mental illness and how the mind works. Sometimes it will be a growing understanding of who they are and what they want in life. Sometimes it will be a growing understanding of how experiences in the past shape their behavior now.

When people grow, they change. And it should go without saying that change can really disrupt relationships. People in therapy may find they need to step back from one or more relationships, address ways their relationships are hampering or helping them to heal, change their own behavior in a way that impacts relationships, and a great deal more.

This post is part of the Polyamory and Mental Illness blog series.



2 responses to “The Course of Treatment: Treatment Options — Talk Therapy

  1. Do not be too sanguine about availability of therapists in places with universal health care. My friend in The Netherlands was suicidally depressed and, while once referred he could go to a crisis clinic and see whoever was there, they have a shortage of therapists for long term therapy. They said it might take months and months but luckily they found someone in “only”months and the health plan did pay for it.

    • Thanks, Susan! I’m used to the main restriction on access to therapists being the ability to pay for them. I think sometimes for folks in the US it is very easy to see universal health care as an ideal system with none of the problems plaguing our private insurer system. I need to watch out for that assumptions!

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