I have been through lots of therapy and lots of therapists in my life and my contention is that therapy can’t be used to actually treat uncontrolled, serious mental illnesses. Now, don’t get me wrong, therapy can be supportive to a person with an uncontrolled, serious mental illness and therapy can be useful to a person with an uncontrolled, serious mental illness (such as in the case where the therapist tracks your bipolar symptoms and report changes to your doctor) but therapy cannot be used to actually treat a serious and uncontrolled mental illness.
Everyone with a Serious Mental Illness Should Be in Therapy
I regularly recommend therapy to people for a variety of reasons. Therapy can help with relationships, coping skills, dealing with issues and traumas and more, but there are only some people that can truly treat their mental illnesses with therapy and only at the right time. This notion that psychotherapy would cure mental illness if everyone was just in it and just tried, is pure nonsense. Yes, in therapy you have to try and you have to do the work but even if you do that, it might not make your mental illness any better.
Uncontrolled, Serious Mental Illness and Therapy
And if you have a serious, uncontrolled mental illness, therapy is not going to fix it. You want to talk to someone you trust? Go ahead. You want to be supported by someone? Great. But if you want to treat your mental illness, you better be seeing a doctor, too. Therapy is simply not the cure-all that some people (usually therapists) claim it to be.
This is because therapy cannot possibly work if you have seriously uncontrolled symptoms. If, say, you’re in the trough of a severe depression and suicidal, therapy just doesn’t cut it (trust me, I’ve been there). If you’re floridly psychotic, therapy won’t help. If you really are severely ill, therapy can still be useful but it won’t actually make the mental illness better. It won’t make you stop seeing little, green men.
Why Won’t Therapy Help Serious, Uncontrolled Mental Illness?
It’s like this. If you’re at the bottom of a 20 foot pit, therapy can offer you a coping skill of a five foot ladder; too bad that’s 15 feet short. If, on the other hand, you were only in a five foot pit, that coping skill would be great. So, if, for example, your depression were not as severe, you could expect therapy to be more effective. You just can’t make that kind of progress when your brain is severely dysfunctional.
It’s like all those people who say that everyone with a serious mental illness should exercise to get better. Well, if getting out of bed and making yourself a ham sandwich is too much for a person then the idea of the person getting up, putting on clothes and leaving the apartment to do something that requires energy and that he or she doesn’t want to do is just, plain ludicrous.
People with Serious, Uncontrolled Mental Illness
I’m not saying you shouldn’t start therapy if you have a serious, uncontrolled mental illness. As I said before, you may find other benefits from therapy. What I’m saying is that you need to be seeing a doctor as well and that medical relationship is the one that’s going to lift you up enough for the therapy to start taking effect. Because I have learned a lot in years and years of therapy but none of it has been able to get me out of a 20 foot pit. Once that pit started to dissipate, however, therapy made a lot more sense.
Image by Fox Valley Institute.
Quality of life > quantity of life. Why everyone is centered on the latter is beyond me. Some people just can’t be helped and we have to face that. Those that want the “out” that suicide provides should be given humane access to it if they A) undergo treatment for a long enough period of time without a significant enough improvement so as to grant them a higher quality of life and B) can demonstrate an ability to make coherent decisions. And no, wanting to die doesn’t mean one isn’t “in their right mind.”
If terminating pregnancies is okay according to the outrage over Roe v Wade, then why is me, a grown adult, choosing of his own accord to die some terrible sin that shouldn’t be allowed?
Hi Nathan,
First off, I’ve never said that suicide is a sin. I don’t believe that it is.
However, what I do know is that suicide is an option only people who are in great pain consider. And what I say is, let’s remove their pain. That’s what people really want. That’s what needs to be done. No one want to terminate their life. They want to terminate their pain. I’ve been there. I know this.
(All that being said, medical assistance in dying (MIAD) is something people with mental illness are fighting for in Canada. It’s supposed to become law next March. It’s a very complicated issue. All I know is that as much as possible should be done for a person before that is medically considered.)
(By the way, terminating pregnancies, by the way, is a false equivalency for a million reasons. First off, a clump of cells are not a human and secondly, you don’t live inside someone else’s body — and that other person deserves bodily autonomy.)
Please try something new. Try a new doctor. Try a new psychotherapy. Try a new medication combination. Try a new neuromodulation therapy. There is a lot out there to cross out that can help.
— Natasha Tracy
When I said “sin,” I was referring to society as a whole, not you specifically. I apologize if it came off that way.
And what about when that pain simply *can’t* be terminated? What then? I’m 39 and I’ve been fighting depression that’s ruined my life since I wasn’t even yet a teenager! I’ve tried medication after medication, doctor after doctor, and I just can’t find anything that will control it. It’s gotten so bad that even my family has started distancing themselves. But when the question of death comes up, I always hear the same old lip service; “Life is precious.” “Life is a gift.” “You don’t know what the future holds.” “Every life is valuable.” Ugh, especially that last one, because, in reality, *not* every life is valuable and the world won’t be any worse off if I croaked right now.
No, it is an accurate equivalency because it’s ending a life, the very thing I’m denied. I have a right to bodily autonomy, too, don’t I? Well, that autonomy includes choosing to end my life.
When you say you have to see a doctor I am assuming you mean a medication prescriber. But what if you failed meds for years and there is no other option? Untreated trauma and chronic stress can not be often fixed with medications and the psychiatrist tells you to get a therapist (heaven forbid they actually refer you to a good one, or one at all) and then the therapist cant/won’t help you because you are too mentally overwhelmed to do the work. They tell you to see a psychiatrist. That untreated limbo is leaving so many sick, stuck, and hopelessly frustrated. And suicide becomes their only option.
Even the doctors don’t help. They expect you to know what’s wrong with you.
Hi Jacob,
I’m sorry you had that experience. It sounds like you need a different doctor. A proper assessment by the doctor is critical to treatment success.
I hope you can find that.
— Natasha Tracy
Oh, you are SO right! When I get the old “Eating properly and exercising will make you better”, I want to scream! How can I exercise if I can’t even get up? I KNOW I “should” be exercising, so I feel even worse due to the guilt. When I am stable, that is when I can do the helpful things. But you are right. These things, as well as therapy, can not cure a MI. Being vegan will not cure an MI. Nothing will cure an MI, it can only be managed. Therapy, like you said, can not be cured by psychotherapy. You can not CBT yourself out of having bipolar.
@Natasha – Right on. My teen daughter is currently hospitalized for suicidality. The coping skills,, meditation classes do nothing for her because her condition needs to be treated medically first. It’s been three weeks and it’s been very frustrating to go through the psychiatry “system” where they follow ridiculously strict drug protocols when a possible quick solution could have been found in two days. Here’s why. Over the three weeks, she has been put on Lithium and Wellbutrin with an aborted attempt on Abilify. Because she is somewhat hostile/irritable, she’ll now go on Clonidine but it has to be titrated slowly. All these three drugs take time to take effect. They are treating her like she has bipolar but her parents think she’s ADHD and her mother, who has dysmythia, responds well to psychostimulants after being TRD for years. But the pdoc won’t go near stimulants even though you would know the very first day whether it worked or not. The pdoc is concerned about psychosis. Hello, she’s on Lithium, and starting her on 2.5mg of Dexedrine would have little cause for triggering psychosis. Ketamine IV infusions lift suicidal ideation for 80% of those treated. It takes only 40mins to 1 hr for the results. There is NO way the pdoc would ever consider that treatment. Current psychiatry exists to torture patients for months and years because of their narrow and rigid thinking. It’s an abomination.
My subjective experience dealing with my own lower level symptoms and several family members more serious issues is that therapy can help and medication can help, and both together are usually what is needed except for the mildest of cases. The kicker is that the more severe the illness, the harder it is to find the right medication or combination of medications, the harder it is to find a psychiatrist capable of helping you find that right combination, and the harder it is to find a therapist who is able to help you through what you are dealing with.
I really think psychiatry needs a subspecialty of treating severe chronic mental illness outside of a locked facility. Most doctors and therapists tend not to see enough SMI patients to be really good at their continuing care. Helping someone who can not experience recovery but can obtain some semblance of stability, may be the most challenging job in the field. (Drs. and therapists who see lots of SMI patients are largely in acute care hospitals where the goal is just to stabilize and street; so they, too, don’t get experience helping people with SMI manage their symptoms long term.)
With all of the above taken into account, it seems likely that most or all of the people who are bitterly opposed to medication have been turned off by the difficulty of getting the right balance of meds (in some cases this can mean a daunting number of unsuccessful medical trials) to reduce symptoms and have manageable side effects.
Natasha, I am a therapist and I could not agree more with your post. Therapy as a piece of the puzzle can be helpful for everyone. However, it sometimes is not enough. I hope more people and therapists will take this outlook in order to provide people with the best, most comprehensive treatment possible.
In the “Just for Fun” dept:
Q: How many therapists (or psychologists) does it take to change a light bulb?
A: Just one, but the light bulb has to really WANT to change. :)
I found that, by turns, hilarious and then offensive. And for some reason this damn light in my room keeps flickering. I need to see someone about that.
So If I have a severe mental illness like bipolar, whats the point of going to therapy, taking meds and poisoning my body, if it will never get to a point where I will never see a hospital again, or stop thinking of suicide; whats the point? I suppose there is none. I don’t want to live like this. I’d rather make a plan to die with compassion then make a plan to “keep myself safe” to the point where hospital staff don’t even want to take me in.
Why all this pressure to keep living like this? How can I ever control this mental illness if I can’t take the meds they treat it with, if therapy will never help because I’m always in some sort of episode? My life is so useless and pointless and I hate it.
Natasha,
I was a therapist for 25 years and have a master’s degree in clinical psychology. The therapist who tells you they can cure any mental illness is not a competent therapist. It has been proven scientifically in academic studies that therapy is effective in providing a supportive place in which people can learn coping skills to mentally ill people. Not curing any biochemical problem. Cognitive Behavior Therapy is clinically effective in treating anxiety and in helping people with PTSD. Your central theme of therapy not being effective for people with highly severe active clinical mental illness. That is true. Therapy helps with the secondary problems that some people have along with these neurchemical problems. The therapist should be able to determine whether psychotherapy will be effective. The most important part of the therapist and client is the clinical relationship one of trust and security. It is one of the most intimate relationships you can have. A helpful relationship is goal directed and one that the therapist sets strong limitations. I always pointed out to my clients what therapy could help with and what it wouldn’t help. Medications have their place as does psychotherapy. Therapy should be thought of as part of a comprehensive clinical team.
It seems very important that you define what you mean by “uncontrolled mental illness.” And are you referring just to talk therapy here? That certainly maxes out. But be wary of lumping all modalities into one and calling therapy limited. This strikes me as subjective experience stated like fact.
What IS important is case management. Here in Australia if you are admitted to a public hospital with a serious psychiatric illness you will usually be assigned a case manager on discharge. The case manager is qualified as a psychologist or social worker or occupational therapist. He or she will maintain a rapport with you when you go home. They will help you with practical matters like accomodation or meals or government paperwork. They will hep you keep up with medication and come with you to psychiatrist visits. They might provide therapy or link you to services such as an exercise group, employment services, support group etc. It is individualised to make sure that you get back on your feet again. It might be part of early psychosis intervention. I do not know how people in other countries cope without this.
I have been to private psychology as well, but have found it of limited usefulness, a waste of money, and sometimes even damaging. Medications are not perfect but they have given me periods of wellness. They do stop the nightmares.
I agree with your thinking, Natasha. For over 25 years I dealt with 5 serious episodes with Bipolar I. I was one of the first to receive Lithium in 1971 just after FDA approval. However, I was not compliant because (as most bipolars reason) it took away my creativity, energy, zest for life. So, not until a very astute Therapist, with honestly and “tough love”, changed my “reasoning”, that Lithium was needed first from a biochemical standpoint. It took hard work, but I was able to make a positive change for my life. It has been over 31 years that I have been episode free with only 300 mg of Lithium daily. Now, I give back to others, by facilitating a Group Support for “Bipolar and Anyone Else”
I’m not sure what “Jeff” above thinks is delusional — the medical research, perhaps? In my experience – which is of several decades’ length – this post is completely on the mark. Therapy is very useful, particularly if you are able to find the right match for your personality. But it cannot cure the underlying disease. Particularly when it is a partially genetic disease, as is bipolar disorder, nothing can actually *cure* the disease; the best that can be hoped for is adequate suppression of symptoms, and that takes a combination of medical and
… to finish the sentence: it takes a combination of medical and talk therapy approaches.
Exactly. As I told a friend of mine with epilepsy… Talking to someone won’t fix my brain any more that it fixes yours. It just gives you tools to deal with it. Stress reduction, recognizing triggers, etc help both of us deal with the side effects of our problems, but don’t do anhing for the underlying problem. Only difference is there are test that can pick up what’s wrong with yours but not yet mine.
There is no consistent therapeutic methodology for bipolar that successfully works with the use of drugs or an empathetic ear. You simply move from one state of being to another and ask, “Am I better yet?” If you are good at fooling yourself some relief is in sight. Otherwise get used to the feeling of a distorted reality, and a constant disorientation amongst your fellow man. Since mankind is always at odds with itself you become transparent, or evolve into a state of esoterica the a few find useful – success, you are accepted but still isolated.
Comment is opinion based on experience.
As a person with Bipolar I have experienced long periods of deep, debilitating depressions. I’ve used both therapy and meds to climb out of that dark hole. There were times when only meds seemed to help. Therapy gave me more insight into the triggers and early symptoms of bipolar hypomania and depression. With new knowledge and better impulse control I’ve been able to level out the mood swings that always end in depression with minimal medications. I am always aware that another hypomanic or depressed state could be just around the corner and I work to keep myself as aware as possible to catch it before it moves into the debilitating states.
When your not in an active episode, therapy does help. Especially in identifying triggers to help stop or lessen future episodes. But in the middle of an episode? Its like trying to stop a cut artery with a band aid
Seriously delusional, but that’s good for the industry, which is already making money hand over fist from such thinking. Let the sheeple submit themselves to a bullshit industry with such thinking. Never promote any critical thinking–because that would actually be using the brain–and the industry certainly relies upon folks to not do that.
Let’s face it: If you have a serious uncontrolled mental illness then no amount of therapy OR medical intervention is truly going to “fix it” because mental illness – severe uncontrolled mental illness – cannot be fixed. That would mean, it can “be cured” and well, as you say quite often, severe uncontrolled mental illness can never be “cured”.. so, it can never be fixed. What it can be is zonked by pills.
Ok. So, now that you are being chemically zonked (which by the way does not elevate your symptoms entirely and often creates new ones as adverse reactions or worsen underlying ones as adverse reactions)… what to do with yourself? Hmmm?
Therapy helps to understand the way your illness manifests. If you do the work, it helps you recognize triggers and stressers and how to cope and/or handle them so that hopefully you can minimize the trigger and stresser BEFORE you need to run to the doctor to get more meds or up all the meds. It also helps to recognize your responsibility IN your treatment and quite often psychiatrists will ask – or they have me – “are you with a therapist?” since so many psych docs no longer do therapy in addition to the scripting of meds.
So no… therapy doesn’t fix severe mental illness nor does it cure severe mental illness. It’s not meant to.
It’s a supportive measure, that is what it is.. like meds, it’s a supportive measure. It is meant to be a lifeline.. someone to get a hold of when things get dicey until medical intervention can be obtained (be it ambulance, law enforcement, a appointment with the doc sooner than the doc had you originally scheduled, etc.). Quite a few psych docs have asked me, in the midst of a crisis “have you contacted your therapist?”.
If you go to the therapist with hopes to be cured or fixed; then you will be sadly disappointed. If you went with those hopes… no wonder you didn’t receive help you thought you’d be given.
Nothing can “fix” or “cure” severe mental illness… but many things can support and help. Even meds are not the end all be all. Otherwise; you’d be “fixed” and never need another pill.
I am so done with western medical (I use that term, doctor, lightly) doctors. Maybe T didn’t fully work for you, but it can and DOES work for others (without meds), just as some anti-d meds do not work for a lot of folks. Sometimes T is the only thing that works.
Trusting doctors is dangerous; I have been misdiagnosed too many times to trust any one of them ever again with my mental health/illness. I pay out of pocket to use a naturalopath; if I get a broken bone, I will go to the western doctor, that is the only time I will trust them.
I am glad meds help you, but I think you give way too much homage to doctors. They are wrong at LEAST 75% of the time. It is not all black or white.
Of course, you’re right, Natasha. That is not to say that mistakes aren’t made with medications – I’ve experienced a few of those. That can be very bad. But the whole “mind over matter” thing doesn’t heal a broken leg at the snap of a finger, so why would anyone think the brain is any different? Profound stupidity, I guess.
Totally. Meds etc. can help get people to the point that they can think straight enough, be motivated enough, and concentrate enough to do the hard work that therapy requires.
I recently told my friend something similar. You are not going to get better without medical intervention. Period.