7 Signs That Online Therapy Might Be Right For You

There wasn’t anything wrong, really, with my last therapist. He was smart as a whip, caring, and thoughtful. But after more than a year of working together, I had this nagging feeling that I wasn’t getting out of this what I needed to be. Something wasn’t clicking.

As someone with agoraphobia, it was already challenging to get to another city just for therapy. The financial impact of a copay, transportation there and back, and the time taken away from work had already added up. If I was already spending that money, why couldn’t I just sign up for online therapy, and get the care I needed without leaving my apartment?

So (shrug emoji) I decided to give Talkspace a try.

I chose Talkspace in particular because I knew from talking to other folks that they are especially mindful of their queer and transgender clients (of which I am both).

They didn’t ask me to review their services, or offer me any kind of incentive to talk about them. This is not a paid advertisement, friends, so you can trust that everything here is my honest opinion!

(This was actually an article requested and funded by my patrons, who were interested in online therapy and wanted my perspective. Hi there, patrons!)

If you’re intrigued by online therapy but not sure if it’s for you, I wanted to create this no-nonsense resource to help you decide.

While Talkspace is the platform that I use, this is advice that I suspect will apply to other platforms as well.

As with any therapy experience, you ultimately get out of it what you put in. That being said, there are definitely some signs to look for when deciding if online therapy could work for you:

1. Paying out of pocket isn’t prohibitively expensive for you.

Between my $15 copay and the Lyft ride to and from the office, paying for online therapy wasn’t actually that much more expensive for me. For $39 dollars a week, I can send unlimited messages to my therapist (text, audio, or video, as lengthy as I want) and get two thoughtful responses per day.

If I need a video call for a face-to-face experience, I can pay extra for that, either as part of my plan or on an as-needed basis.

But I want to acknowledge upfront that not everyone can afford this.

If you have insurance and your therapy is already sufficiently covered, online therapy will not be cheaper. However, if you have travel expenses and copayments (like me), or you’re already paying out of pocket, online therapy might actually be cheaper or at least fairly reasonable.

I still think this is the best $39 bucks I spend every week. But for folks who are low-income, this isn’t necessarily accessible to you.

2. You find yourself wishing you could process in the moment.

One of my biggest issues with face-to-face therapy is that, by the time my appointment rolled around, a lot of the more intense situations or emotions had already passed, or I couldn’t remember them once it was time to talk about it.

I often walked away from my sessions thinking, “Jeez, I wish I could just talk to my therapist when things came up, instead of having to wait until our next appointment.”

I felt like I was wasting time, like our appointments were basically me trying to remember what was bothering me or just filling up our time.

If this sounds familiar, online therapy might actually be an awesome option for you. With Talkspace, I’m able to write to my therapist at any moment, so when situations or emotions come up for me, I can articulate those things to my therapist in real time.

I’ve noticed a difference, too — we’re actually talking about the issues that are most present and important for me, instead of what I happened to remember during a scheduled time.

It’s important to note: If you are the sort of person that needs an immediate response, online therapy might not feel as gratifying at first. It took a period of adjustment to get comfortable with spilling my guts, knowing that I would have to wait to hear back from my therapist.

But I did get used to it! And it’s a format that’s working much better for me.

3. You know or suspect that writing is a great outlet for you.

A lot of my best emotional work happens through writing (this probably doesn’t come as a shock, seeing as I’m a blogger). Online therapy has been like having a diary that actually talks back, compassionately and competently guiding me through my process.

If you know that you’re the kind of person that finds it cathartic to write everything out, online therapy can be an awesome platform for you. There aren’t time constraints or character limits, so you’re given permission to take whatever space and time that you need.

If writing isn’t your thing, you can always just monologue with an audio or video recording. Sometimes you just need five minutes to ramble uninterrupted, and online therapy is great for that, too.

4. You find it easier to be emotionally vulnerable in digital spaces.

I grew up in the age of AOL Instant Messaging. Some of my deepest and most vulnerable connections have happened digitally. For whatever the reason — maybe it’s social anxiety, I’m not sure — I find it much easier to be vulnerable online.

I think online therapy is the best possible platform for folks like me, who simply find it easier to be honest when there’s the safety of a computer or phone screen between us and our therapists.

In just a couple of weeks, I disclosed more to my Talkspace therapist than I had with my previous therapist that I’d worked with for over a year. Being online helped me access emotions that I found it difficult to tap into in a face-to-face appointment.

(I think it helps, too, that this is therapy that can happen in the safety of my apartment, whenever I’m ready, while I’m hanging out in my pajamas and hugging my cat and eating nachos…)

5. You feel like you’re texting your friends a little too often.

I’m the kind of person that, when I’m overwhelmed with my life, I find myself texting or messaging my friends, sometimes with a frequency that makes me feel a little annoying.

And to be clear: It’s absolutely okay to reach out to someone when you’re struggling, as long as those boundaries are negotiated between you!

But what’s great about online therapy is that I now have a safe space to express myself at any moment, without the fear that you’re “too much” for that person.

If you’re an “external processor” like me, where nothing feels resolved until you’ve actually gotten it off your chest, online therapy is actually awesome.

I feel like there’s more balance in my relationships across the board, because every single day, I have an outlet for what I’m thinking or feeling that doesn’t rely exclusively on my friends and partners. That means I can be more thoughtful and intentional about who I reach out to and why.

6. You have other clinicians on your team that can help during a crisis.

A lot of reviews I’ve read talk about how online therapy isn’t designed for folks with severe mental illness. But I don’t actually agree with that — I just think that folks like us have to be mindful of what support systems we put in place, and when we use them.

Every person with severe mental illness should have a crisis plan. This is especially true for those of us who use online therapy, which means we won’t always get an immediate response when we’re in crisis.

I use online therapy to explore my trauma history, manage my OCD and depressive symptoms, and navigate the daily triggers and stressors in my life. However, I don’t use online therapy exclusively.

I also have a psychiatrist that I see regularly, support groups that I attend on an as-needed basis, and I can also contact my previous therapist if I’m suicidal and need to be referred to local crisis resources (like outpatient resources or hospitalization).

My Talkspace therapist knows that I have a history of suicidality and self-harm, and we’ve talked about what steps we would take if I were in crisis again.

I think online therapy can be a great option for folks with severe mental illness. (For me personally, I feel much more supported checking in with my therapist ten times a week online, as opposed to seeing them just once a week, if that.)

The key is that online therapy should never be the only option, and you and your therapist should work out a crisis plan upfront.

7. You have very specific therapeutic needs that you’re having trouble meeting.

My therapeutic needs were a bit… complicated.

I’m a queer and transgender person with a history of complex trauma, struggling with depression, OCD, and borderline disorder. I needed a therapist that can handle all of the above, but trying to find one who was up to the task was daunting, to say the least.

When I signed up for Talkspace, I first talked with a consultation therapist (kind of like a clinical matchmaker) who would help me find my ideal therapist. Upfront, I gave them as much information as I could, and they gave me three therapists to choose from.

One of them was a trauma-informed therapist who was also queer and transgender, who was well-versed in the disorders I was dealing with. We also came from a similar perspective, valuing a social justice-oriented and sex-positive approach.

Talk about a perfect match!

I think that one of the benefits of online therapy is that you have more options. Rather than searching for someone within a reasonable distance, you can connect with any therapist that’s licensed in your state. This widens the pool of available clinicians, and ideally connects you with a therapist that meets more of your needs.

(The great thing, too, is that switching therapists on apps like Talkspace is super easy — and those therapists will have access to your previous conversation logs, so you won’t feel like you’re starting all over again.)

If you’re a marginalized person that needs a therapist from your own community, your odds of finding the right therapist are much higher with online therapy. To me, this is by far the best part of the process.

There are definitely some valid criticisms to keep in mind, though.

I’ve loved my online therapy experience, but I’d be remiss if I didn’t mention these. Some of the common issues that people encounter with online therapy, summarized for quick reading:

  • You need to be 18 or older: As far as I know, for legal reasons, it’s not available to folks under the age of 18. Be sure to investigate this before signing up if this applies to you.
  • It’s a different pace: Responses are “asynchronous,” meaning your therapist responds when they’re able to — it’s a little more like email rather than instant message. For folks who like instant gratification, this will take some getting used to. If you’re in acute crisis, this shouldn’t be your primary support system.
  • There’s no body language: If you’re someone that is a little more withholding, and therefore you need a therapist to be able to “read” you, this can be an obstacle. If you’re someone that has difficulty interpreting emotion and tone through a text, this can also make things tricky. (Video calls and audio recordings are still options, though, so don’t hesitate to switch things up if you’re finding the text-only format to be tricky!)
  • You have to spell things out (literally): Your therapist won’t know if something isn’t working if you don’t tell them directly (they can’t exactly see if you’re uncomfortable, or bored, or annoyed, for example), so be ready to advocate for yourself if you aren’t getting what you need.

Alright, so what should I know before I get started?

Online therapy is really like any form of therapy, in that it only works if you show up. Here are some quick tips for the best possible online therapy experience:

  • Be as specific as possible when looking for a therapist: Better to tell your “matchmaker” too much about yourself than too little. The more you advocate for yourself, the better your matches will be.
  • Disclose, disclose, disclose: Be as open, vulnerable, invested, and honest as you can possibly be. You will only get out of the experience what you invest into it.
  • Talk about therapy in therapyTalk with your therapist about what’s working and isn’t working. If something is helpful, let them know. If something isn’t, be sure to say so. If something needs to change, it’s important that you communicate that to get the best possible experience!
  • Customize it: Online therapy has a little less structure, so be sure to talk with your therapist about how you can create accountability and a format that works for you. Whether it’s homework assignments, assigned readings (I like to share articles with my therapist on occasion), scheduled check-ins, or experimenting with formats (text, audio, video, etc), there are tons of different ways to “do” online therapy!
  • Set some goals: If you’re not sure what you want out of the experience, take some time to think about it. Creating goal posts can be helpful in guiding the process, both for you and your therapist.
  • Be safe: If you have a history of suicidality, substance abuse, or self-harm — or any kind of disordered behavior that could lead you to harm yourself or someone else — make sure your therapist knows this, so you can create a crisis plan together.
  • Anticipate an adjustment period: I felt weird about online therapy at first. It feels distinctly different, especially in the absence of body language and the delayed responses. Give yourself time to adjust, and if things feel off, be sure to let your therapist know.

So is online therapy a good option for you?

Obviously, not knowing you personally, I can’t say for sure! But I can say with certainty that there are definitely folks out there who have benefited from it, myself being one of them.

While I was skeptical at first, it turned out to be a great decision for my mental health, though I recognize its limitations. Like with any form of therapy, it largely relies on finding the right match, disclosing as much as you’re able to, and advocating for yourself throughout.

Hopefully this guide gives you all the right information to make a decision that’s right for you. I’d also encourage you to research more on your own (I am by no means the ultimate authority on therapy!). As the saying goes, knowledge is power!

Hey, fun fact (added some time after I published, once I found this out): If you sign up with Talkspace using this link, we both get $50 dollars off. ¯\_(ツ)_/¯ If you’re on the fence, give it a whirl!

If you found this guide to be helpful, please hop on over to my Patreon and consider becoming a patron! Through donations, I’m able to create free and thorough resources like these based on your recommendations.

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5 Ways to Lovingly Support Someone With C-PTSD

I was watching Disney’s The Hunchback of Notre Dame when I felt myself starting to panic.

Right from the start, seeing Quasimodo be the recipient of so much gaslighting – being told that the world wasn’t safe, that he would never be accepted or loved, that Frollo had only his best interest at heart – struck a jarring but familiar chord with me.

Quasimodo’s isolation in the bell tower, unable to leave or connect with the outside world, eerily mirrored the control and entrapment I’d experienced years before.

“Hey,” my partner said softly, pausing the film. “Sam, you’re safe. It’s okay. But if this is too much, I’m more than happy to watch something else.”

In the midst of an emotional flashback, my fears were disrupted by my partner’s tender assurances. I could only nod. Without another word, my partner put on Steven Universe – my go-to show, having watched every episode at least three or four times, its familiarity and charm never failing to calm me down.

And I breathed (slowly and deeply) as I was lulled back into a sense of calm, my partner sitting quietly beside me. Sometimes seemingly “little things” can stir up something in survivors that becomes difficult to process in the moment.

But if I’ve learned anything over the years, it’s that sometimes our greatest healing can happen when we allow ourselves to love and be loved.

When my therapist told me that he believed I was struggling with C-PTSD, countless pieces of the puzzle rapidly clicked into place for me. The flashbacks, the fear of abandonment, the hypervigilance, the distrust, the dissociation, the deep and abiding emotional pain that I could swear I was born with – with one diagnosis, all of it seemed to make so much more sense.

Complex trauma, while not officially listed in the DSM-5, is still widely recognized by clinicians and survivors alike as a form of PTSD that occurs due to prolonged exposure to trauma – particularly interpersonal trauma, in which there was abuse and/or neglect that led to a significant imbalance of power.

Many culturally competent clinicians and survivors alike extend this framework to include the oppression that marginalized folks face, which can so often be traumatic.

My understanding of C-PTSD is largely influenced by the work of Pete Walker, a psychotherapist and survivor of complex trauma, whose words and affirmations helped bolster my own recovery (his book on complex trauma in childhood is a must-read).

While I am in a much better place with my trauma history, my loved ones – especially close partners who don’t share this kind of history – sometimes struggle to know how best to support me. I’ve had time to read, engage in trauma-informed therapy, and connect with community around these issues, but my loved ones haven’t necessarily done that work.

Friends and family of folks with C-PTSD don’t always have the same level of education and understanding that survivors do. That’s why I wanted to create this quick resource – to serve as a jumping off point to how to better support trauma survivors.

If you aren’t sure how to support a loved one with complex PTSD, here are some suggestions to start with.

1. Recognize That We Don’t Always Know Our Triggers, Either

Whenever I disclose to someone that I have C-PTSD, they often try to support me by asking, “What are the triggers I should know about?” I think this is a great question to ask if a survivor is aware of what can cause a flashback, but the reality is that many of us can be triggered on a level we aren’t even aware of.

That’s why it’s good to not only ask what triggers us but to ask what you can do if we find ourselves triggered.

What does your loved one find helpful? Is there something you can say, a kind of safe touch they want from you, or something else that’s comforting?

I use this guide to manage my flashbacks, and I think it’s a good point of reference for anyone who wants to help someone work through a particular episode. Give it a read, and invite your loved one to share what’s useful to them and what isn’t – assuming that this person is ready and able to have the conversation with you.

2. Encourage Us to Express Our Grief and Anger

A lot of trauma-informed therapists will say that survivors have a difficult time grieving the trauma they endured, and sometimes have difficulty expressing anger.

One of the best things a loved one can do is hold the space, then, for survivors to experience these emotions and express them in healthy ways.

Not sure how to do it? Here are some suggestions:

  • “I noticed that this conversation is bringing up a lot of anger for you. Do you want to share why?”
  • “What happened to you is absolutely unfair and unjust, and I’m open to hearing more if you want to talk about it.”
  • “If you need to cry, that’s okay. I can stay with you or I can leave if you need privacy. Just let me know.”
  • “Your feelings about this are absolutely valid. I hope you know that you’re safe now, and you’re allowed to feel those feelings.”

The key here is to (1) validate those emotions as real and understandable, and (2) open up a space in which those emotions can be felt and expressed more deeply.

Sometimes these conversations will happen when the trauma is referenced directly. Other times, a seemingly unrelated event can trigger a flashback. In both cases, it’s important to give survivors the space to navigate their feelings without judgment.

3. Let Us Vent Without Trying to Fix Things

One of the biggest mistakes that my loved ones made was that every time I tried to process aloud what I had been through, they would interrupt with advice on how to “fix” things.

In my recovery, I’ve found that coping with C-PTSD is not so much about fixing something. For me, a big part of the work has been about breaking through the denial of what I’d been through, and learning to love and protect myself in a way that I’d never believed I could.

I didn’t need to change or “fix” my relationship with the people who’d hurt me – more than anything, I needed to work through the ways I internalized that harm so I could, in turn, address the ways I’d been hurting myself.

More than anything, I’ve needed to be able to talk about what happened and feel seen when I did, so that I could begin to process what I’d been through and treat myself with more compassion.

And while every survivor’s recovery will look different, remember that when we want advice, we’ll ask for it – but what we need more than anything is your compassion.

4. Give Us Permission to Be Imperfect

For a lot of us with complex trauma, we struggle with perfectionism. Pete Walker calls this the “inner critic,” which so many survivors grapple with in recovery.

For some of us, perfectionism was a coping mechanism run amok, in which we desperately tried to better ourselves to “earn” the love or attachment that we lacked by correcting our supposed shortcomings. (Spoiler alert: No amount of perfecting ever changed this, but we continued trying anyway)

This “inner critic” can also be the voice we internalized, like when “you’re a bad child” suddenly becomes “I’m a bad child.” The external criticisms or neglect we endured suddenly became the mantras we took on as we were further and further traumatized.

Which is to say, a lot of survivors who are dealing with complex trauma really struggle with being imperfect.

For me personally, I believed for a long time that if people truly got to know me, they wouldn’t be able to love me. So I spent a good amount of time trying to make myself “better,” with the hopes that I would someday be “good enough” for the people in my life.

I think this is why it’s powerful when our loved ones give us permission to be imperfect. Some examples:

  • “You don’t have to be perfect for me or for anyone else. I’m going to be in your corner no matter what.”
  • “It’s true that you make mistakes. But you always work hard to make things right, and that’s what matters.”
  • “In my eyes, you’re already lovable and you’re already worthy.”
  • “Trust me. If something’s wrong, I’m going to tell you, and I promise we’ll work through it.”

An important thing to remember is that you’re responsible to your loved one, but not for your loved one – so their perfectionism, self-esteem issues, and unresolved trauma aren’t yours to fix.

Instead, support your loved one as they do the work to untangle those issues for themselves. That begins with simply letting them be human – creating the kind of space where you can both show up as yourselves, without the “all or nothing” expectation that the only people worthy of love are perfect people.

5. Educate Yourself About C-PTSD

Not sure where to go? A great place to start is this FAQ about complex trauma. While it’s written with survivors in mind, it’s still extremely useful for loved ones who aren’t sure what this C-PTSD stuff is all about.

I also think that this Wikipedia article on C-PTSD is one of the better online resources, along with this book that I mentioned earlier on in this piece.

Ask your loved one if there’s a particular resource that they’d like you to familiarize yourself with, or if they’re open to having a conversation about how complex trauma affects their life and relationships. If they’re interested in a conversation, make sure that you’re committed to holding the space for whatever emotions might arise, and that your approach is validating and compassionate.

Pete Walker also has a great resource on the concept of “co-counseling,” which offers a nice structure on how to have these conversations in a productive and safe way. I’d highly recommend it. You can also reach out to a therapist to facilitate this conversation between you if more guidance would be helpful.

Part of supporting a survivor is being open to learning and realizing that this learning is an ongoing process, rather than a single event. There’s no singular article or resource that will give you the expertise needed to support someone – rather, in the process of building trust between you, you’ll teach each other how to create a mutually safe and supportive space.

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When my partner paused The Hunchback of Notre Dame, it was a simple but important gesture that said to me, “Your trauma is not a burden. I’m here to support you.”

More than anything, I think survivors withhold a lot of what they’re going through for fear of being “too much” – but when invited, we can find the kind of safety necessary to open up and allow our relationships to truly grow.

If you’re looking to support a survivor, it can be as simple as noticing. As simple as validating us. As simple as saying, “I believe you.”

All I really wanted was someone to believe me. And every time someone does, I can feel a part of me learning to trust again, learning to love with abandon and without fear.

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This piece that I wrote originally appeared at Everyday Feminism.

7 Signs Your Psychiatrist Is a Keeper

“I’ll defer to your judgment on this one,” I said to my psychiatrist, shrugging.

“You defer to me a lot,” he pointed out, laughing. “You’re allowed to have an opinion.”

I was?

As a mentally ill person, I was so accustomed to having decisions made for me that I was baffled when my new psychiatrist was giving me the final say on my treatment – not just once but consistently.

That’s when I realized: No one ever told me what a good psychiatrist looked like, let alone the kind of treatment I deserve.

And this is nothing short of tragic because the relationship that we have with our psychiatrist can make or break us. When our mental health impacts every aspect of our lives, having a positive and trusting relationship can be the difference between surviving and thriving.

It took seven years of navigating psychiatry to finally find a clinician that I felt safe with. Seven. Years.

This is due, in large part, to the fact that I simply accepted whatever treatment I was given, rather than advocating for myself.

I didn’t know how to recognize when a clinical relationship was working for me, and when it wasn’t – and I was convinced that it didn’t matter as long as I could fill my prescriptions at the end of the day.

But it does matter. And as both a mental health advocate and a patient, I know now that a caring and competent psychiatrist can make a huge difference.

My current psychiatrist is the-bomb-dot-com. And I’ve been reflecting lately on why that’s the case: What exactly does he do differently? And what should we, as mentally ill folks, start to expect from our clinicians?

There are positive signs that I think we should all look out for in our clinical relationships – not just to help us find a good fit, but to give us the language to advocate for ourselves with every psychiatrist that we meet.

Here are seven signs to get you started.

1. They Look at You

When my psychiatrist came out from behind his desk, pulled up a chair across from me, and grabbed his laptop instead of hiding behind his desktop computer, my first thought was, “What the hell is he doing?”

He had a desk and a computer – why did he need to relocate right across from me?

But there was something about his relaxed posture, his complete attention, and most importantly, his consistent eye contact that totally disarmed me.

I immediately felt more trusting of him – something I hadn’t experienced with previous psychiatrists.

My last psychiatrist back in Michigan seldom looked at me, only to greet me and say goodbye. She stared at her computer, rapidly typing as I spoke, saying very little to acknowledge what I had said.

In hindsight, I realize this is why I always found our interactions to be cold and why I always held back on the details when speaking to her.

Something as simple as direct eye contact can change the entire temperature of a room. I went from feeling invisible to being seen.

I can’t emphasize enough what a difference this has made.

2. You Don’t Feel Rushed

In my work as an advocate, the most common complaint I come across is that folks feel their appointments are always cut short, or that they never have enough time to say what they need to.

The pace of the conversation and allotted time ultimately makes them feel like a burden, and they ask fewer questions, share less information, experience significant anxiety, and ultimately receive subpar treatment because they feel rushed.

I realize this varies widely depending on the clinic and clinicians you have access to, but I encourage folks to explore their options as much as possible.

It’s critical that you don’t feel like you’re always running out of time – this can absolutely impact your interactions and treatment.

I’m always blown away by how long my psychiatry appointments are now, and the fact that my psychiatrist always asks at the end if there’s anything else I’d like to talk about, no matter how long the appointment has already been.

We decide together when everything has been said – I’m never pushed out the door.

And if I open a (non-urgent) can of worms right at the end of an appointment, we make another appointment to discuss it, so I’m assured that it will be addressed and I know exactly when it will be.

Check in with yourself during your appointments. Do you feel rushed? Do you feel like you’re always running out of time? If you do, don’t be afraid to mention this.

3. They Respect Your Agency and Give You Choices

When I was struggling with binge drinking, my psychiatrist didn’t tell me what I should and shouldn’t do.

He made a few recommendations about resources that I could choose from, but then went on to tell me he trusted that I knew what I needed.

He believed in my self-determination, and affirmed that I was in charge. He didn’t criticize me for relapsing, or tell me that he knew what was best for me. He gave me choices.

Not once has my psychiatrist made a recommendation for me without giving me other options, and asking me how I felt about the options I was given.

My psychiatrist told me that he strongly believes in collaboration and self-education. In other words, he believes in my agency. I can’t emphasize enough how critical this is for mentally ill folks who – far too often – aren’t trusted to make competent decisions and are talked at rather than talked with.

This approach is both humanizing and, yes, anti-oppressive, as it upholds the belief that mentally ill people are truly the experts on their own lived experience. And we are.

So ask your psychiatrist what the word collaboration means to them in a clinical setting. This is far and away one of the most important signs about what kind of relationship you can expect, and what your treatment might look like.

4. Your Input Is Valued, Not Discouraged

My psychiatrist is always asking me for my opinions and for feedback, encouraging me to be an active participant in my treatment.

And I’m baffled that this isn’t the status quo.

As an advocate, I hear time and time again, “My psychiatrist was annoyed by how many questions I was asking” or “My psychiatrist was bothered by how much I was pushing back.”

Just recently, someone told me that their psychiatrist actually said to them, “You don’t get to call the shots. I do.”

This is a big, ol’ red flag, and you should head for the hills if a psychiatrist ever discourages you from being invested in your own treatment and wellbeing.

A good psychiatrist wants you to stay engaged. A lousy psychiatrist wants you to be seen, not heard, and to swallow your pills dutifully.

Don’t be afraid to seek out a different doctor if you feel that your psychiatrist isn’t listening. Newsflash: A big part of their job is listening – and if they aren’t, they’re failing you as a clinician.

5. There’s Mutual Trust Between You

During my last bout of depression, I sent an online message to my psychiatrist describing how suicidal I was and what plans I had.

I was truly at the end of my rope, and I didn’t know what else to do.

My psychiatrist didn’t call 911, though. He called me.

He calmly checked in with me, convinced me to go to the emergency room, and when I said I was on my way and that my partner was with me, he believed me. He then called the ER, filled them in on my situation, and told them to expect me.

This completely shocked me. But because I had trusted him and shared my suicidal thoughts, he trusted me to do the right thing. And you know what? I did.

admitted myself voluntarily – which anyone will tell you is preferable to being involuntarily committed and traumatized.

That kind of trust has been critical in my treatment. I feel respected and believed – and in return, I feel that I can open up and be honest about what I’m struggling with.

If you can’t trust your psychiatrist and the treatment they are recommending, how can you sustain the hope that things can and will get better? And how can you confide in them if you’re closing yourself off?

Trust is foundational in any clinical relationship. Do you trust your psychiatrist? If the answer isn’t “yes” or “we’re working on it,” then it may be time to find someone else.

6. They Acknowledge Your Identity and Trauma History

I’m transgender. And I’ve had so many psychiatrists who have pretended this isn’t the case.

Many psychiatrists have ignored the fact that my hormones do impact my mood. And almost every clinician has misgendered me, referred to me as “female,” or asked me questions that were completely inappropriate.

This is shit that I don’t put up with.

Weirdly, my current psychiatrist is the most trans competent psychiatrist I’ve ever had, despite never advertising himself as such.

I also have a significant trauma history, something that I’ve noticed many psychiatrists feel that therapists are exclusively responsible for knowing about in any detail.

But my psychiatrist has been very open to hearing about that history, and taking it into account when diagnosing and making treatment recommendations.

Which is all just to say, if your psychiatrist isn’t interested in the big picture – the aspects of your identity and history that have contributed to your mental health – they may not be a good fit.

If these things are important to you, they should be important to your psychiatrist as well, at least to some extent.

7. They Are Open to Alternative Diagnoses

When I was eighteen, I met with a psychiatrist who accused me of looking for an “easy way out,” being too young for medication, being too dramatic, and who – after all this – shrugged and said to me, “Which pills did you want?”

(I picked Prozac because I saw it on TV. She prescribed it without question or concern.)

She diagnosed me as bipolar after about ten minutes of yelling at me. And that label has followed me around since then, not being challenged or questioned by any of my clinicians until my most recent psychiatrist revisited it.

And guess what. I may not be bipolar after all. Borderline, ADHD, complex PTSD, OCD – these are labels that I only considered after my most recent psychiatrist had a real conversation with me, and these are labels we continue to revisit and explore.

Diagnoses are markers that can determine the entire course of treatment. Which therapies and medications are recommended can rely on these labels, and how we come to understand our struggles can be framed around these labels as well.

For the last seven years, it’s possible that I was receiving treatment for a disorder I might not even have. This is a huge deal.

This is why it is so incredibly important that we have psychiatrists that don’t take these diagnoses for granted. If something doesn’t feel quite right, don’t be afraid to ask for a reassessment.

If there’s a label that might fit better, don’t be afraid to introduce it to the conversation (because yes, there’s a place for self-diagnosis in psychiatry).

A good psychiatrist is open to new possibilities, and those possibilities can ultimately impact your mental health in big ways.

I don’t know at what point I started accepting whatever treatment I got. But I can tell you that now that I’ve had positive psychiatric experiences, I’m unwilling to go back to the days where I was a passive and jaded patient.

I can see the difference a good psychiatrist can make.

The sense of agency, trust, and validation I feel is absolutely priceless – and with each new success, I’m grateful for the amazing clinicians out there who make it a point to respect and uplift us, not perpetuating the harm and abuse that psychiatry can so often enact on mentally ill people.

I expect and demand much more now. And I believe we all should.

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This piece that I wrote originally appeared at Everyday Feminism.

Crazy Talk: Why Do I Keep Making Myself Sad On Purpose?

Crazy Talk is an advice column powered by your donations on Patreon, written by Sam Dylan Finch (that’s me!), and hosted by your fave queer blog, Let’s Queer Things Up! While I’m not medical doctor, I am a card-carrying member of Club Crazy, living the good life with a mood disorder, anxiety, and complex PTSD (gotta catch ’em all!). We’re talking all things mental health — trauma, happy pills, mood episodes, and whatever else you tweet me about. I’m kicking the stigma where it hurts, one question at a time. Check out last week’s column here.

Hi Sam, 

I struggle with anxiety and depression and I have for years. I’ve noticed that sometimes, when I’m at a low point, I’ll get sucked into listening to sad music, revisiting sad memories, watching sad movies, and basically making myself worse. I know that it doesn’t help, but it’s almost like a compulsion. What’s wrong with me?

Let’s start with what I think is a pretty important disclaimer: Not knowing your particular history, I can’t say with any certainty what drives you to make particular choices. I’m crazy… but I’m not a mind reader! I can, however, remark on my own experiences and observations. Hopefully that will give you some food for thought. Bonus points if those thoughts are then shared with a therapist!

I want to validate this for you upfront: Emotional self-harm? It’s a thing.

I find this question to be really relevant, as I used to do this a lot myself. At my worst, you could find me listening to angsty music; reading old, despairing blog entries; or camped out on my couch watching really triggering shows on an endless loop. No matter how many times my friends told me to give it a rest, it kept pulling me back in.

But as you’ve noticed, it never helps. It only sustained the depression that I was already feeling, often making it worse than when I started. So why did I do it? I have some theories:

Depression is predictable. While depression isn’t an ideal state to be in, it’s not necessarily full of surprises, either. I had a therapist once tell me that people who are dealing with depression can sometimes feel drawn to it, even unconsciously, because its familiarity and predictability feels safe. It makes sense, then, that we might engage in activities that sustain our sadness or keep us numb; we might feel afraid of the unpredictability that comes with doing something differently (I touch on this in my article about self-sabotage as well!).

I had unresolved trauma. Sometimes we force ourselves to relive the pain we’ve experienced because it’s unresolved. For me, I found myself purposefully triggering myself because I hadn’t yet found a way to accept and release the trauma I’d been through. This is what eventually led to my diagnosis of complex PTSD (which I wrote about here and here).

We might make ourselves feel pain because we’re hoping that, by re-experiencing it, there might be a different outcome. We’re usually looking for some kind of epiphany or realization to help things feel more conclusive, but we’re seldom able to do this effectively without guidance. Our brains are saying, “Hey! We have unfinished business here!” And in a way, they’re pushing us to relive something, hoping we’ll actually resolve it this time — but we aren’t always equipped to do so.

If your strolls down memory lane have become compulsive, triggering, and intrusive, it might be best to seek out a therapist that can help you process your pain in a more productive way.

I needed to feel understood/seen. Everyone wants their pain to be recognized and affirmed. We might seek this out by looking for representation in music, television shows, movies. I used to watch every TV show that featured a PTSD survivor, because I wanted to know I wasn’t alone; I especially wanted to see someone “overcome” that struggle so I could live vicariously through them.

I mean, you’re reading this article now. And you might have had a moment already of, “Wow, this is so me.” It’s a validating feeling, right? It makes a lot of sense, then, that we might subject ourselves to content that’s triggering with the hopes that it’ll make us feel validated, even if that validation is accompanied by pain.

I didn’t have the tools that I needed. When we gravitate towards unhealthy coping mechanisms, we’re often doing this because we don’t have healthy alternatives in place. I was most likely to seek out my triggers when I was already vulnerable — when I didn’t have a team of clinicians in place, when I was isolated from my support systems, when my meds were out of whack, and when I didn’t have a real treatment plan in place.

So where do you start? I have a list of free mental health apps that have personally helped me pivot away from emotional self-harming, and it can offer pretty immediate relief. If you don’t have a clinical team already (a therapist or psychiatrist), consider looking for those as well.

Remember: Be gentle with yourself. In all likelihood, you’re not engaging in these behaviors because you enjoy being depressed (I have yet to meet someone who does). This behavior is indicative of a lack of effective coping skills and unresolved pain. Rather than treating it as something that’s “wrong” with you personally, look at it as a red flag. This is your brain’s weird way of letting you know that you need additional support.

I know it’s easy to slip into the whole, “What the hell is wrong with me?” mentality. But what I’ve found to be true is that there’s always some form of method to our madness — or in this case, sadness.

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Let’s Talk About Self-Sabotage.

Confession: When I’m happy, I freak out.

A blog-reader-turned-bestie (yes, sometimes I befriend y’all in real life because you are lovely human beings) and I were recently talking about this over milkshakes. Being happy is terrifying when you aren’t quite used to it.

You know, that dreaded sense that the other shoe will fall? Yeah. That. It’s the worst.

The pressure of trying to sustain something that we’re not used to can create a lot of stress for us. And we might feel the impulse to self-sabotage, especially when we don’t have the support we need to cope.

Sometimes I even have suicidal thoughts when I’m happy. Do you?

The idea that I’ve peaked, and that I might as well die now while things are still good. It seems like the perfect time. Then I fall down the rabbit hole of, “Am I actually happy if I’m having thoughts like these?” (Save yourself the time: Yes. Suicidal thoughts aren’t exclusively the domain of depression.)

And of course, I don’t know how to explain this to the folks I love – that joy is triggering, because I am so used to that joy being taken away from me.

Mental illness has taught me that happiness is inherently unstable and temporary, that I shouldn’t trust it. That mistrust is the product of repeated trauma. It can make me impulsive, hypersensitive, and fearful. It makes it difficult to be grounded.

And worst of all? It becomes a self-fulfilling prophecy. I start to act out because of that fear, which reinforces the fear itself.

I thought it was just me, until I started talking about it. I actually found that lots of people with mental illness or experiences of trauma have this same mistrust of joy. It can lead us to making some lousy choices – in an attempt to regain control and cope with the fear, we make some misguided decisions and push away the very happiness we’ve so desperately wanted for ourselves.

Sound familiar?

Being happy makes me a little crazy. And if you’ve ever thought you were the only one, I assure you – it’s actually a really common thing.

When you’ve spent years associating happiness with the calm before the storm, it’s no surprise that you might associate joy with a lack of safety. In fact, maybe you find depression or anxiety to be a little safer – because it’s more predictable, something more known to you.

I’m here to tell you, friend, that this is totally understandable. Brains are very malleable things – and trauma can lead us to develop some pretty maladaptive impulses, including the impulse to self-sabotage.

I am the Prince of Self-Sabotage. Happiness absolutely terrifies me. It terrifies me because  it feels like it’s only ever betrayed me. Just when I think that I’ve gotten into a good rhythm, life throws me a curveball and I’m not only depressed again, but also grieving the loss of the stability I thought I’d finally had.

Has happiness betrayed you? If so, it’s no surprise that your first instinct is to push it away.

Recently, I’ve gotten to a good place again. Courtesy of Wellbutrin (quickly becoming a favorite of mine), the most sarcastic/excellent psychiatrist on the planet, the love and support of community, new job prospects that leave me totally ecstatic about what’s to come, and personal growth that surprises and delights me every day.

And of course, cue the terrible thoughts like, “Okay, what gives? When does the other shoe drop?” and even, “I kind of feel like taking a chainsaw and splitting myself in half” (to which my psychiatrist asks me, “Um, do you have access to a chainsaw?” Fear not, Doc. No, I do not).

What’s a kid to do? Well, in my opinion, it starts with just acknowledging that happiness is scary, and that’s 100% okay.

Sounds deceptively simple. But you and I both know this is easier said than done. I have to remind myself of this fifty times a day – that there isn’t a disaster waiting for me around every corner. I have to remind myself that I’ve been conditioned overtime to believe that happiness isn’t safe, but that doesn’t make it true.

It’s also good to check in with myself about how I’m dealing with that stress. Am I reaching out for support from a therapist and/or friend? Am I talking about my fears or ignoring them? Am I staying busy? Am I taking care of myself?

I’m a big fan lately of guided meditation when I’m not feeling so grounded. More specifically, there’s this app that I can’t shut up about called Stop, Breathe & Think, which recommends a few meditations (and even yoga videos!) based on your emotions (imagine, like, a self-care mood ring).

You tell it how you’re feeling, and it makes custom recommendations for you. When I find myself freaking out – like my skin is crawling or I’m claustrophobic in my own body – it’s the perfect thing. (Nope, they didn’t ask for the plug – I just love and appreciate them that much.)

A lot of people believe that self-care is only crucial when you’re in a bad place. But I’ve found that self-care is absolutely critical when I’m happy – because the moment I’ve stopped prioritizing my mental health is when I’m actually most vulnerable.

Let me repeat that, because it’s super important: The moment I’ve stopped prioritizing my mental health is when I’m most vulnerable.

Got it?

I know it might seem counterintuitive to reach out for help when you’re happy, of all things, but it can be very necessary if your happiness is a stressor.

And this is a process, of course, one that I know will be ongoing throughout my life. But it helps to know that I’m not alone. And I hope that this reminder can be helpful to you, too.

When we start seeing happiness as a completely understandable trigger and learn to be gentle with ourselves, instead of letting trauma dictate how we should respond, we can start to do the really important work of recovery and healing – which is absolutely something each and every one of us deserves. Yourself included.

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