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Comment by wdewind | Hacker News Reader

> It’s taken me a few weeks to write this post. Not that I was really afraid of putting myself out there, but that I needed to write it in such a way that it wouldn't scare people or make them worried.

This really is a major part, if not the biggest part, of the stigma associated with therapy now. It's hard to get mental help without it being a Big Deal. Which is stupid because everyone should go to therapy.

Therapy is great. It's like strength training for the mind. You don't have to have some kind of specific reason to go, you don't need to talk about that remark your parents made when you were 11, you don't need to be crazy. It just gives you a toolkit for understanding and dealing with every day emotions. It is expensive, but if you are an engineer you likely have a medical plan that covers some kind of mental health. Do yourself a favor and check, seriously the best decision I've ever made was going to therapy.

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Unfortunately, I've seen various family members seek out therapy, only to realize 6 months or a year down the road that the process was useless for them.

They still believe therapy would help them, but the impression is that there are a "zillion" useless therapists out there, and it's needle-in-a-haystack to find a truly good one. And of course, it's going to cost you a significant financial and time investment to find out whether you've found a good one or not.

Here is my impression of a lot of the problem, but I am certainly not an expert:

In the 80s and 90s the kind of therapy you see in movies where you lie on a couch and talk about your childhood became very popular. That is called pyschodynamic therapy. A lot of it is based on building certain dynamics between the patient and therapist, and so in a lot of ways it builds a dependence on the therapist. A lot of therapists feel pretty strongly against it, and that there are a lot of bad incentives at play. I agree with them. I also think this kind of therapy can even be regressive: it tends to focus on making the ego strong rather than flexible. I'd be willing to bet that was the kind of therapy your family members received.

Those who are doing the kind of therapy I'm talking about (some CBT, mindfulness & meditation, acceptance practice etc.) tend to be focused much more on skills than history. The point is not to figure out that you react to situations in a specific way because of some off hand comment your mother made when you were 5. The point is learning to recognize those situations, and to learn to have a goto way to deal with them. If you stay in this kind of therapy for more than 2 years it's probably a mistake. From day one my therapist talked about getting me out the door.

So my advice would to make sure you go in with a plan, focus on skillset building, not personal exploration (which can be useful in small doses, but also is extremely egocentric and can easily exacerbate issues imo). Have a timeline in mind (doesn't have to be strict, but like your family my parents were in therapy for decades - that's ridiculous and exploitative). Keep it goal oriented. Look for people with a lot of CBT experience.

And of course, the major caveat: I didn't go in with anything but general depression and anxiety. If you have major depression, PTSD, etc. I think the rules are probably pretty different (although my impression is that generally pyschodynamic therapy is not appropriate for that either).

I'll second that. I first went to a therapist years ago for a visit precipitated by a professional "crisis" (not that crisis-y in retrospect). I found therapy to be so helpful I resolved to continue going after that was worked out. I was very into body and life hacking, and found so many unexpexted benefits. I explain it to people as "maintenance mode", which is the only way I've been able to word it which garners consistently positive responses. Think check-up versus emergency care. Few people would advocate relying solely on emergency care. That makes sense to people, that I go when I'm "normal" so that when I really "need" to go I already have that support system in place and a great relationship with my doctor. That is not a process you want to deal with in the middle of dealing with real issues; it can be difficult finding a good doctor who is a good match for you, and a bad match can do more harm than good. I believe I benefit every visit, not just visits dealing with drama, but that explanation seems to click with people. I just know it is healthy to have an external bull-sh-t meter to run things by. Forgot who said it, but, "Trying to define one's self is like trying to bite your your own teeth."

I don't think that everyone should go to therapy. There's just not enough money. And not everyone needs to go to therapy. That strength training for the mind, a lot of people get that through everyday living. There are just some who are not quite as resilient and do need that extra help, in which case therapy is a very good idea.

I think my main point is that therapy can be thought of as a performance enhancement, not just a repair. I know a ton of people who get along just fine without it, but could be a lot more effective both in their relationships and their work, if they had the same basic toolkit that I do to deal with emotions. Even in a highly functioning adult, if you haven't been to therapy I bet there is a fair amount of low hanging fruit.

I think I was lucky in that being from the UK I was able to get it on the National Health Service but before I was referred by the doctor I didn't realise this type of thing existed or was available.

Would you mind elaborating a bit? I've heard the same sentiments as yours, but without any more elaboration.

What kind of tools does it provide you, for example?

I did therapy for around a year. Six moths with a Ph.D and another six months with a MFCC. The PH.D was charging a lot, but I really thought she would help me. I had a horrid case of anxiety, and panic attacks that came on during a holiday, and would go away.

I believed in Therapy, and really wanted it to work. It didn't work in the slightest. It actually made things worse. I didn't learn any fancy tools. I didn't find any out anything about myself, that I didn't already know.

I will say this though, if I didn't go through therapy; I would always wonder if I could have changed my destiny. In my case, I needed medication.

I found no difference between the PhD, and the MFCC. I did talk to a psychiatrist about my unsuccess in therapy, he said I didn't do it long enough. I will never know if he was right?

Because I was feeling so bad, for so long, and those Therapy sessions were expensive, I was completely honest in therapy. I devulged my innermost secrets, thoughts, warts, everything. In my case, it just didn't help my condition.

Drugs, time, and exercise helped my condition. I'm still not the person I used to be before the breakdown though. (I was told not to use word breakdown, but my brain just decided to breakdown. If I said anything different, I would be lying.)

I don't want to discourage anyone from seeking the help of a Therapist, but if you are a well adjusted individual, happy, going to school, or working, and don't have any real complaints, but one day your brain decides to bust a gasket--I would try to see a Psychiatrist. But even then a lot of them want you to go through therapy before they medicate you.

And if you decide to go through the medication route, realize you might be on the drugs a long time? Especially the benzodiazepines. I'm not sure if what I know now about addiction, I would have ever used them, but then again they are better than self medicating with booze?

It's a shame we still know so little about mental illness, or even how the brain works. I really thought we would have made huge strides in treating the mentally ill by now, but they haven't.

I think therapy works. I don't think most people should do it. I think most people should find a mentor, but a mentor is not a therapist. Most people need someone to chat to, but that person is also probably not a therapist. It's sub-optimal to spend that much money for chat.

I'll tell you one of many, this one is a bit of mindfulness/meditation: one of the best ways I learned to deal with anxiety or depression is to commit wholeheartedly to feeling that feeling. I use the analogy to strength training a lot because once you start looking at anxiety as a form of stress you can adapt to (like weight training) rather than as an uncontrollable thing that just happens to you, your relationship to it changes dramatically. It was difficult to do this: one of the key exercises I did was when I wasn't feeling the anxiety, was mentally committing to the idea that physically it really wouldn't hurt me. Then when it happened I was able to say "ok we've already decided this wont kill you, so what happens if you try your best to feel it, rather than run from it?" Then you start building a tolerance to it. Do I still feel anxiety and depression sometimes? Absolutely. But I've learned to change my expectations around those emotions: I don't look at them as signs that something is broken, they are just regular emotions to go through like any other. In a weird way, I almost look forward to them because they are an opportunity to train again, and to test myself.

In general mindfulness and meditation are great, and if you can't afford therapy as well, they can be great on their own (and are free!).

Totally disagree. I have no stigma about therapy and would tell almost anybody that I've done it. It's not a Big Deal.

The problem is that i've found therapy to be of little practical value, and its rituals often absurd. My hope is that as much good science as possible is introduced to this shadowy freudian realm.

So check out this comment: https://news.ycombinator.com/item?id=10384020

Freudian theory is the basis of pyschodynamic therapy. I'd encourage you to try a different type, as I don't think all are equal.

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