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Comment by roflc0ptic | Hacker News Reader

Dated a therapist who was adamant she could only see 15-20 people a week and still give quality care; built her schedule around making sure she had adequate breaks because it felt irresponsible to her, otherwise. Anything past that it was a plaster-on empathetic smile and “that sounds hard, tell me more.”

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My therapist is also married to a therapist, and although this isn't quite relevant, it was really cute hearing that they "therapy each other to death" when they have marital problems.

For what it's worth, my therapist felt pretty genuine. One thing that helped is to actually ask about his day, and how he's been. I think he was surprised I cared.

Another thing that helps is that BetterHelp makes it effortless to try out someone new. Maybe we've been lucky, but me and two other people haven't needed this feature; we all stuck with the first one we matched with. But it's there if you need it.

Yeah dating novice therapists is bad because they are still trying on the tools and they’ve got a neophytes zeal, dating experienced therapists is bad because they’ve integrated the tools so much that it’s hard recognize when they’re pulling them out. Being wrong and very skillful at pushing your viewpoint can feel pretty isomorphic to gaslighting in the right circumstances.

Tho upside is they sometimes have good self knowledge and insight into other people. Naturally YMMV on all points

I learned of a therapist in my area that apparently doesn’t allow patients to use insurance, you have to pay out of pocket for everything. Apparently, this allows them to have longer sessions with individuals. I’m not sure how often they will typically see a patient, but if it’s anything more that once a month it would be expensive as hell at the rates they listed.

I've surveyed many therapists recently and I've found many who are like this. And it's a good thing; if you don't accept insurance then you aren't beholden to their terms and diagnostic criteria and policies which can all be very troublesome and present obstacles to healing.

I am a member of a Christian Health Sharing ministry which is not insurance, so they work with my therapists to share the costs. My mental and medical health costs are shared by other Christians in a community of mutual support, rather than being bankrolled by insurance company premiums. And all I need to do is arrange "self-pay" terms with the provider and have the bills sent to the ministry!

Even though it is not insurance, health sharing ministry members are exempted from the tax on Americans who do not carry health insurance. It's a pretty sweet deal; my monthly shared amount is about half of the premiums for a "catastrophic" Obamacare plan found on the market.

What if you destroy your therapist by asking unsolvable but grave questions you entertain? Are there any meta-therapists for therapists?

There are, but the idea that a therapist will be destroyed by your super duper nihilistic puzzle questions is not very realistic. The position of "client thinks their problems are so big and so unique that I won't be able to understand them" is one that is studied by mental health professionals and is actually pretty easy to deal with (although hard to resolve). Therapists get burnt out by listening helplessly to people with real problems in their life like abuse and addiction and poverty. Being able to navel gaze about the meaninglessness of the universe means you're in a pretty cushy spot.

An "unsolvable and grave question" doesn't have to be philosophical. "I'm unhappy with my life and I feel trapped by my responsibility to my family, and I wish I could fall asleep and wake up in a different life" is quite tricky, and I doubt anyone would say such a person is in a "cushy spot".

I meant existential stuff like this: "I am frustrated by the ongoing war that could have been easily prevented and seeing friends dying every day, including your family, just to increase amount of green paper in somebody's pockets; this doesn't cheer me up. The thought how helpless I am in the face of this is crushing me. I won't even be able to understand my own life, nobody around me will reach their true potential and will be just left to slowly die. All you can give me is just a short-term band-aid we both understand won't change anything." You can go arbitrarily deep to make the therapist question their standing in life depending on their sensitivity.

Not to diminish the concerns, but that is not particularly tough material as therapeutic conversations go.

An example would be helpful.

If you are indeed in a war zone seeing friends and family die, my comment is completely off base and I apologize.

The therapists I know do certainly work with every day people struggling with (perhaps existential) anxiety/fear/depression. Where those concerns are negatively impacting someone's life, they are real and pressing concerns - if common.

These therapists also regularly work with clients that are dealing with the effects of being victims (or perpetrators) of various forms of physical, sexual, and physiological violence. Even in wealthy areas, people do terrible things - particularly to the weak and the young.

That job can be very intense.

Therapists do indeed experience “vicarious traumatization”, which is exactly what it sounds like. But this comes more from descriptions of traumatic experience than difficult existential questions. As others have said, existential questions are softballs. The rough stuff is staying present and emotionally open while someone describes a personally horrific experience.

I think the unvarnished therapist response to existential questions is something like: that’s fine, those are valid, but they do in fact have no answer; the only way out is to turn our attention to the day to day problems of living.

If you keep harping on unsolvable problems, I think they’ll mostly feel annoyed.

I know a therapist that works with a demographic that very few people can muster even an ounce of empathy towards. These people struggle with deeply disturbing and intrusive thoughts, and I'm amazed how this therapist can help make their lives more livable and avoid acting on their impulses.

That said, if your therapist was "destroyed" by your unsolvable but grave questions - you should just move onto someone else. That isn't likely to be a common occurrence.

That's their job that they are trained to do, so I doubt it will destroy them, but in general many therapists believe that all therapists should have therapists, yes.

Most therapists I know agree that there are many grave questions which are not "solvable" in therapy.

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