Bipolar Thoughts

Ditch the Couch

Today I want to talk about therapy.

It is one of the most common joke topics in sitcoms and movies (especially from the 90’s). There are tons of depictions of it, from Office Space, The Departed, Good Will Hunting, 50/50, the list goes on and on. If I were to say one thing that is extremely common about the depictions of psychotherapy is that most of the therapy methods are extremely outdated Freudian or Jungian methods that no one uses anymore. And more strikingly, all of these therapists have boundary issues. I have been going to my therapist since I was 17, I have hugged her exactly once, we certainly don’t go grab a beer together, and she would never have my back in a parking lot brawl during an Eagle’s game.

Most therapy for Bipolar Disorder is Cognitive Behavioral Therapy. I have an entire essay dedicated to this, so I won’t get into it too much. But basically, you talk about a behavior, you figure out the cognitive trigger for that behavior, you work on that trigger no longer being a trigger. It can take a matter of sessions or years; that is what you do. Most of the time though, it is simply a conversation. It is a directed conversation, with pointed questions asked at specific moments, but it is just a conversation. And when you have been with someone for 13 years, like I have, it feels friendly, which feels good. My therapist knows me better than any other person on the planet.

The couch is what always gets me in on-screen depictions. Every therapist I have ever seen has a couch, and even my psychiatrist (more on this in a minute) has a couch, but none of them have ever been these big leather covered things where you can lay down easily and drift into therapy land. They just have a normal couch. I don’t lie down; I don’t think I could even if I wanted to. I usually sit in the chair, if there is one. The idea of laying down on a big couch while a therapist asks you questions and writes things down on a legal pad is an image from a century ago, and I suppose it might still work that way in hypnosis, I have no idea, as far as I can tell hypnosis is a medical lie. For the record I will say that I have had three people attempt to hypnotize me to no avail.

The notebook too, like I just mentioned, that is sometimes used, but in my experience most therapists take notes after your session is over. They want to converse with you, not have you lecture them. My psychiatrist is interesting because he spends almost the entire session typing into his computer. I found it odd at first, but that is his thing. If he has something important to say he will turn towards me and look me right in the eye and say it, which is even more off-putting.

And let’s talk about the difference in therapists and psychiatrists, since there is a ton of confusion about that as well. It is simple, but the line can blur. A psychiatrist is a doctor, an MD. They specialize in psychotropic medications and therapies, especially medically advanced therapies like ECT. They often consult with sleep doctors and all your other doctors to make sure that the myriad bad side effects of these drugs and therapies are not destroying you. They also tend to have good advice and understand the therapy side of things. They want you to be in therapy, they often consult your therapist, and they can even work in concert to direct the therapy.

A therapist can mean a lot of things. It can mean a LPT (licensed Professional Therapist), or a social worker, or a licensed counselor, or it can mean a psychologist. A psychologist is someone who generally has a PhD.

Now all of them work in their own ways that don’t necessarily have anything to do with their education. So why see whom? I just want to go to whoever I am most comfortable talking to. There are a ton of books out there to help you with exercises and changing your thinking and all that, but you cannot replace comfort.

There are some real differences. LPCs or social workers probably do or have spent a lot of time in hospitals or addiction centers. They know the system a little bit more, they have dealt with a wider range of patients. They might be a bit more savvy. A PhD probably did a lot of that in school and then went immediately into private practice. But they have a deeper knowledge base. They can often specialize in just treating one disease, and therefore get very good at it.

But there are more reasons than just that, and a big one is money! Most insurance does not cover seeing anyone except a PhD or an MD/DO. And even when they do allow you to see a social worker or LPC, sometimes insurance will limit you to 12 visits a year.

Normal therapy is weekly, and if you are doing well, then bi-weekly. Normal psychiatry visits are monthly, if you are doing well bi-monthly. And if you are doing really well, 6 month visits is not impossible. So 12 a year is just silly.

My insurance happens to cover anyone I want to see whenever I want to see them! It is amazing! Everything is just billed as a preventative health screening, and I pay a co-pay.

I think one of the most important things to know about therapy is that your time with a therapist can end naturally. At some point he or she might not be able to help you anymore, everything available to learn has been passed on. It is it difficult to come to that conclusion, but necessary to continue growing.

If you are thinking about therapy, or if you might have a mental health issue, the proper place to start is probably a psychologist. They know the most and have the most resources and will actually do therapy with you. You might be directed to see a psychiatrist at some point. You might feel like you can move on to a social worker or a counselor for whatever reason, and especially if you have an addiction problem.

It is an odd thing to me that therapy is still seen as a joke. I am not the type of person who would say something is off-limits in comedy, but clearly someone decided that dialysis or radiation therapy or chemo isn’t available for network sitcoms. So why still with the couch jokes?

It is part of the stigma. The best way we have to treat mental illness is viewed as a joke. It feeds the perception that we don’t have a real illness, you can’t therapize your way through heart disease. But we have also come a long way, just 20 years ago a beloved children’s Christmas movie, The Santa Clause, played waaaay too hard on the joke that the stepfather was a psychiatrist (which has always been a doctor, like gone through medical school and residency) and therefore didn’t have a real job. Of course, compared to Tim Allen’s character who had the very real job of selling dolls.

It seems silly even as I type this out. I am not the type of person who buys into media induced anxiety about anything. And I wouldn’t be saying this if I hadn’t literally talked to a handful of people about how they delayed getting treatment because their opinion of therapy was so deeply enforced by not all the funny comedy.

I know a lot of diseases are ill-represented and we are all misinformed about them, mental illness is not the only one. But I have to wonder why it is that way for any of them? Is it really that difficult to accurately depict disease in art? Is it too much to ask that a writer makes a better joke because he or she understands the material they are teasing?

Is it really that difficult to not put everything in a box, put a label on it, and move on?

One comment

  • This is kind of silly, but I remember in 6th grade going to the counselor’s office at school. I laid on the couch to talk to her because I thought that’s what you did in counseling. Even though I was not in the office for “counseling” that is how media portrayed it so that’s what I thought I should do.

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