Don’t get me wrong. Therapists are a vital resource, and everyone should have affordable, easy access. From talk therapy to CBT to prescriptions and support groups, we all deserve to live in a world where whatever works for us is available and affordable. I’ve turned to therapists in the past, and they’ve been a huge help. I will certainly step into a licensed therapist’s office again.
But let’s face it. This has not been a normal year. We’ve had to get creative in order to access our healthcare, especially those of us at higher risk for severe COVID. And mental healthcare is no different. We are all living in the midst of multiple collective traumas right now, particularly the pandemic and the struggle to end police brutality against Black Americans. So many of us, especially those of us who are BIPOC and/or disabled, need extra support right now. But we also need support that’s safe and accessible. And it should be helping us cope, not piling on more stress.
For now, I’ve opted for a workbook instead of online therapy.
We’ll see, once I’m back in therapy, how this choice looks in the rearview mirror.
Here are the top five reasons why I’m going it alone, for the moment.
1. Trust is a real issue for me.
This is an issue for a lot of us with PTSD, and many other mental health disorders. As anyone who’s done therapy knows, the search for the right therapist can itself be stressful. I’ve never before worked with a therapist specializing in trauma and PTSD, so it’s going to take some shopping around. Which can feel a lot like dating. It takes time, it involves large helpings of frustration and disappointment, and it’s not nearly as fun as rom-coms lead you to believe.
Added to that, there’s the stress and anxiety of doing therapy over Zoom calls and online chats, with someone I’ve never met before.
No, thank you.
That’s why I’ve opted for a year with a workbook written by three specialists. I do need treatment, but it’s not a mental health emergency (yet). And like everybody else, my bandwidth is limited right now. I know that one or two bad interactions with the wrong therapist could push me away from treatment for years. It’s more urgent that I have some guidance from licensed professionals than that it be in-person, synchronous guidance.
2. Taking control of my own healing process helps me develop a sense of agency and empowerment.
I also don’t understand what the plan is with most therapists. Out of the three counselors I’ve seen, only one (who specialized in CBT treatment for insomnia) laid out a clear plan for me. I could track my progress. I knew where we were heading. This left me feeling that I had some control over my treatment.
Talk therapists, on the other hand, tend to be lovely people dedicated to supporting, encouraging, and nurturing everyone who steps into their office. But their plan has generally seemed to be Let her talk as long as she needs, about anything she wants, and then I’ll bill her for it.
This works great for many people. That’s wonderful. But for me, this is not a treatment plan.
Of course I’m not a therapist, so I don’t know if maybe there was a plan. As I’ve learned from earning a master’s in education, then re-entering the classroom, something that looks easy and simple on the surface can have lots of strategy and research backing it up. So I know they probably had a plan. They just didn’t communicate it to me.
And therein lies the problem.
I don’t enjoy strolling down Memory Lane with a total stranger, blubbering about my feelings and crying until my eyes are red, which triggers more migraines. I will do it. But I have to feel absolutely sure there’s a goal, an end point, that all this will move me closer to.
Trauma leaves all of us face-to-face with the fact that there’s a whole hell of a lot we have zero control over. Regaining a sense of control over specific things is beneficial to trauma survivors. And I want control over my care. I’m not someone who can just trust the pain is going to magically transform into unicorns and rainbows when I talk about it for the 53rd time. Please refer to #1.
Which also brings me to #3.
3. Therapists, despite the best of intentions, can sometimes function as gatekeepers to essential knowledge.
The current workbook I’m going through (The Cognitive Behavioral Coping Skills Workbook for PTSD) has equipped me with a much wider repertoire of tools than any therapist has yet. And it was written by three therapists. So they have the knowledge. But in sessions, they have to pick and choose what to share and when. And unfortunately, this doesn’t always align with what we need. And we can’t tell them that. After all, we can’t ask for what we don’t know exists. Even when we can, there’s no guarantee they’ll listen and actually focus on the type of therapy we prefer.
After attending the annual Migraine World Summit online and learning research has found that CBT can dramatically improve quality of life for those with chronic migraine, I signed up for a free CBT program also online, MyCompass. It worked wonders for my depression after becoming chronic and having to quit my jobs, miss my graduation from grad school, and live most of my life in a 700-square-foot apartment. I stopped wanting to kill myself. I started getting into disability studies and seeing the value in my own life, no matter how limited it was.
But when I went to my next therapist and specifically requested CBT, telling her how much it had helped, I got nothing but talk therapy. Maybe she thought it was best for me. Maybe there was CBT involved, but she didn’t point it out to me. I’ll never know. I did know it wasn’t going to work out over the long term, so I ended treatment with her after a month or so.
One of the things I love about this workbook is it lays everything out in the introduction, then encourages the reader to choose for themselves where to go first. I appreciate that recognition that I know what I need. Sometimes patients really do know best.
4. I’m awesome at doing self-directed stuff consistently.
I’ve done enough online teaching and tutoring to know that not everyone is. And that’s okay. The key is to know our own strengths and use them to the fullest. Successful self-management is just a combination of temperament, intrapersonal intelligence, and skill set. Other people are incredible at off-the-cuff spoken communication and interpersonal intelligence. Talk therapy, for them, may be a godsend. What really matters in anything health-related, from brushing our teeth to getting in exercise, is consistency. We benefit most from the habits we can sustain.
For me? I’m good at planning. I’m good at scheduling. I’m amazing at long-term plans (five years or more). I stick to things. And I revise those plans as things change (hello, chronic migraines). I’m great at evaluating sources because I’ve had the privilege of a college education. I focus on workbooks and tools developed by experts, with lots of research backing them up. Then, I commit.
Every Sunday at 4 p.m., I spend 50 minutes reading the workbook, reviewing the worksheets I filled out that week, journaling about how my exposure therapy went, and taking the PTSD assessment on my PTSD Coach app. Believe it or not, this helps me. There’s no chance it would help everyone. We’re all different. But I’m an athlete by training, so it helps me to look at my mental fitness the same way I do my physical fitness. Practice, track progress, review goals, recalibrate. I’m perfectly aware this probably isn’t going to give me a full recovery from PTSD. But until I’m ready to begin the long road to the right therapist, it helps me manage my symptoms.
5. Chronic illness makes it stressful to commit to weekly appointments for which I’ll be charged if I miss them.
As my friends and in-laws know, I can’t even make Zoom calls if the migraines are really bad. My last round of in-person therapy involved a 45-minute bus ride each way, which often left me with a migraine just in time to start work. This can negatively impact my income, which also ratchets up my stress and anxiety. It’s not always a good trade-off.
Sometimes, I will simply miss therapy because I have no choice. As my fellow migraineurs know, we can’t know we’re going to have a migraine until we have one. That means same-day cancellations. Which means, in most therapy practices, a full charge for a missed appointment, which insurance won’t cover.
In a perfect world with a perfect me, I’d step into a new therapist’s office and immediately disclose my chronic illness and the inevitability that I’ll have to miss appointments, which I can’t afford charges for—but I haven’t been able to do this yet. I believe I will one day. But such an assertive declaration of my situation and my needs is way beyond where I am.
So in the meantime, I’m doing my therapy at home with a workbook and an app. And that Sunday at 4 p.m. routine? Honestly? It changes when migraines require it to. No questions asked. No advance notice needed.
Like I said, this is something of an experiment. I am by no means recommending anyone else try this or suggesting that it’s even the best way to approach mental health care during a pandemic. All I’m saying is, for now, I’ve found something that works for me. It won’t work forever. Like all therapies, one day it too will come to an end. It will be time for the next chapter. But this year, I’m so grateful for the app and the workbook that have helped me look after my mental health.
Entire teams of developers, therapists, researchers, and editors have created these tools and helped make them accessible to me and thousands of others. My gratitude for their work is infinite. I’ll never meet them, but they’re part of my journey, too. And their contribution to my recovery counts every bit as much as the therapist I’ll one day sit across from. We can all touch the lives of people we’ll never know. So whatever good you’re sending out into the world right now, when so many are suffering, thank you. Your kindness matters. Your contribution counts.
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*I am not a therapist or treatment provider and am only recounting my personal experience of PTSD and its treatment. This blog is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a physician, licensed therapist, or other qualified health provider with any questions you may have regarding PTSD or any other mental health disorder.