A note before we begin: I’ve taken a couple of weeks off Substack trying to wrangle the following essay into a cohesive format. I’ve discovered that when you are trying to publish something once a week you will sometimes have an experience where the writing does not want to materialize. Thank you for your patience as I pulled this essay together.
Therapy has been especially important to me lately, what with the “desperately trying to find a job after grad school” theme of my life and the anxiety that goes along with it. I have spent many a session with my therapist talking about worst-case scenarios, most of which are not in fact as bad as I am imagining them to be. “If you end up at the point where you need to pass around your resume at the mall, I’m sure you could get a job” she assures me, and although I’m hoping to find employment in my field of study, I know she’s also probably right. But I’ve been thinking about therapy a lot these days, as well as my long history with it, so I decided to sit down and write my thoughts on it.
My first taste of therapy came at age eleven, when my brain chemistry was beset by puberty and I developed obsessive-compulsive disorder (OCD). The way the illness manifested itself was this: I stopped sleeping and I’d have panic attacks over the idea of death, haunted by the thought that there either wasn’t a heaven at all, or that there was but that I was going to hell. The intrusive thoughts were relentless, and the only things that would help were these weird little rituals that I curated for myself, like praying repeatedly or making hand gestures in just a certain way. They would stave off my demons for an hour, a half hour, a second- but they’d be back, whispering into my ear all the ways I and everyone I loved was going to die and suffer thereafter. As a nurse, mom took charge of the situation and did all she could to help. First, there was the visit to a community counsellor who said, “You’re a bit of a worry wart, aren’t you, dear?” Understatement of the century. Her recommendation was that I write a letter to my newly deceased grandmother. This did not help.
After that, mom took me to see my then-minister. As a little kid, I was in awe of religious figures because I assumed that they must be directly connected to God – like they had a Batman hotline to someone upstairs. However, my meeting with our minister dispelled me of that notion because when I walked into his office for our meeting, he was playing Doom on the computer. I recognized it immediately because it was one of my dad’s favourite games. The minister told me that all I needed was a mustard seed of faith in God, and he demonstrated how small said seed was. This became part of my ritual. Whenever I would worry about the afterlife, I would curl my forefinger into the smallest circle possible and whisper reassurances to myself. Unfortunately, this didn’t help for long either; the intrusive thoughts and maintenance rituals continued. Eventually, I was taken to the children’s hospital and formally assessed, and a diagnosis of OCD was the result.
My first therapist after diagnosis was a child psychologist named Dr. P, who explained OCD to me using the record analogy. “You know how your mom and dad have music records at home?” she asked me, prompting a sage nod from me because I wanted, even then, to be taken seriously by mental health professionals. “Well, your brain is like one of those records, except instead of playing all the way through, it skips back to the same point in a song over and over again. You keep rethinking that same worry and get stuck in that record groove.” Dr. P. said that I needed to focus on relaxing exercises and gave me a cassette tape to listen to when I was suffering from my nightly insomnia. I saw her for years, and with the combination of medication and therapy I eventually got past my OCD, became agnostic (sorry, minister), and stopped worrying about death so much.
OCD wasn’t the end point in my therapy journey though, as my brain chemistry had other plans for me. When I was sixteen or seventeen, I developed severe depression that went undiagnosed long enough for me to lose 99% of my friends in school. From that point until now, I have had six therapists since Dr. P with varying degrees of success.
I’m so sorry to have to tell you this, but finding a therapist is a lot like dating. You must look through a lot of people to find someone who is both affordable for your budget and compatible to your problems, and that can be a real challenge. Currently, I have an amazing therapist named Dr. A. She specializes in the area I most wanted to focus on when I started therapy again a few years ago, and she is thoughtful, kind, and very good at her job. She even laughs at my jokes sometimes, which let me know that I am winning at therapy (this is a joke). But I have also had a lot of incompatible therapists. For example, after I was fired by my psychiatrist in my late teems for not wanting to help myself and the apparently unpardonable sin of bringing my knitting to our sessions, I started seeing Dr. S. This was a middle-aged man whom in hindsight was probably the worst demographic to help heal a bitter, twenty-something woman. Dr. S insisted that I read the Life of Pi, telling me that it would “absolutely change” my life. To this day I refuse to read it, partly because I am still mad that this person’s best suggestion for lifting me out of debilitating depression was to read a fictional book about a young man shipwrecked with a tiger. Sometimes I wonder if Dr. S. took my problems seriously, or if he was just keeping time, waiting for retirement.
Returning to Dr. A, she is also a great therapist because she has perfected the art of very gently telling me when I’m rambling or going way off-base with my thoughts. I’ll say something unhinged, there will be a moment of silence, and then Dr. A will start her sentence with the words, “I wonder…” And that’s when I know I’m in trouble.
Me: … and that’s why I’ll never find a job in my field, lose all my savings and become destitute.
Dr A: I wonder if maybe this is your thought distortions coming into play – perhaps fortune-telling or catastrophizing?
Me: You are correct. *insert carefully constructed reframe here*
Since I’ve been in therapy for so long, I have learned to be strategic with my choice of topic due to its cost. Whenever I have a session coming up, I try to sit down beforehand and ask myself, “Okay, which of my problems is worth $180?” Because I can’t afford to go to therapy as often as I’d like, I must carefully consider which problem is most worth the cost of a therapy session. And don’t get me wrong, my psychologist has a Ph. D. and has earns every dollar I pay her, but trying to decide what to talk about amongst my myriad of issues can be really challenging. Do I want to whine about a man for fifty minutes at a premium cost? Absolutely not. But would it be helpful to examine how I potentially sabotage myself in my relationships? Probably definitely yes.
I used to think that it was ridiculous that not everyone was in therapy, but with age I see two glaring issues that I previously overlooked. One, therapy is outrageously expensive and that is a huge barrier to a lot of people. I’ve been extremely privileged that my family has always been able to afford to prioritize my mental health care and pay for therapy when I couldn’t, but most people don’t have that luxury. I’m not sure why our society doesn’t invest in mental health as a preventative measure since it would ultimately save so much money and stress on our healthcare system. Instead, our system waits until people are in crisis, and then asks them to “just hold on” another eight-to-twelve months on a waiting list for professional help. I have often wondered how many people we’ve lost as a society by asking people who have already hit rock bottom to wait months for actual, tangible assistance.
Two, therapy is incredibly challenging. Contrary to popular belief, you don’t just waltz into a therapist’s office, word-vomit your troubles into the room, and then waltz out of a session feeling light as air. It forces you to face your worst thoughts and memories repeatedly until you find a path through them. And for me, simply talking about my problems does nothing to fix them. Rather, I need to take tangible actions like completing therapy homework every week if I want to feel better, and that takes a lot of effort and thought. My homework is usually not pleasant or fun. And if you’re like me, you’re going to cry a lot. But regardless of these things, therapy and medication have together gotten me out of both depression and OCD. Anxiety is my current issue, and so far, I can’t seem to shake the most acute aspects of it that I currently experience. My smart watch will often congratulate me for hitting my goal of intense activity minutes for the week when I haven’t moved from the couch for hours. My elevated heartbeat caused by anxiety tricks my smart watch into thinking that I’m working out when really, I’ve just been panicking about not having a job.
At the end of the day, I also must remember that therapists bring their own biases and experiences to the table. One psychiatrist I had once got angry with me to when I told her that I felt that I’d lost sixteen years of my life to depression. She told me that it was a negative attitude to take, and although she may have been right, that is truly how it feels to me. During my depression years I didn’t progress in a career, maintain any long-term romantic relationships, or do anything much except survive. Instead, it feels like I spent those years hopelessly treading water, trying to keep my head above waves that were threatening to pull me under. Also, I thought about Dr. F’s life and how it was unlikely that she’d have achieved a medical degree with a similar experience. From an outside perspective, I could see how pessimistic my view sounded. And while I’ve tried to reframe those years as simply a collection of experiences both good and bad rather than a total waste of time, it is difficult to step out of that frame of mind and view it more sympathetically.
Ultimately, therapy is full of contradictions. It can be such an important part of healing but has many barriers to access. It should be affordable and covered by insurance companies, or subsidized by the government, but it rarely is. And when it is provided free of charge, you only have so many sessions to get your shit together, and then you are kicked out of the system again. I feel like the only way to make the government care about this issue is to present facts about the costs to business, so I found some information that does just that. According to mercer.com, “Canadian companies lose an estimated $16.6 billion in productivity per year due to workers calling in sick, as a result of mental health issues.”1 If we treated mental illness at its source instead of letting it fester into an even bigger problem, I imagine that we’d save billions of dollars in the long run. But until we can get the government to take the issue seriously, I fear that we are stuck in a crisis of epic proportions.
In the meantime, I will continue to battle my demons in therapy as long as I am able to. I don’t know if there is ever an end point where I will feel so confident about my life that I won’t need therapy anymore. In fact, I believe that I will try to get mental health support throughout my entire life in one form or another, because there is something about having an outside opinion that is especially beneficial in any situation that life might choose to throw at me. Therapy should be for anyone who wants it, and I hope that one day it is recognized for its importance to society.
If you are looking for a therapist but don’t know where to start, here is what I did to find a professional that was right for me:
1. I specifically looked for a therapist who specialized in my area of interest by googling “therapists specializing in *area of interest* in *my location*”. You can also use the directory for mental health professionals in Canada at https://www.psychologytoday.com/ca/therapists
2. I emailed potential therapists and asked them about cost and whether they took insurance. I also asked what their treatment style was like to see if we might be a good match, though these days I believe that a lot of mental health professionals will tailor their treatment to the patient’s needs.
3. I set up an appointment to see if my chosen professional would be a good fit. This is where the dating aspect comes in – sometimes it will take a while to find a good match. In talking to them, see if you have good rapport. Are they sensitive to your needs and identity? What is their overall energy during the session? Most importantly, do you feel heard and do you want to come back?
As a final note, when I was on a tight budget, I went to a counselling organization that offered appointments with fees on a sliding scale. Be aware that these organizations may often use psychology students who are completing a practicum. In this case, be prepared to rehash your entire history every six months or so when the practicum is up and your service provider changes. It was worth it at the time, but when I started therapy at that organization I did not realize I would have to spend one or two sessions every six months explaining my history to someone new. So be aware that this might be a possibility ahead of time and prepare accordingly.
How much are you losing to absenteeism? (n.d.) In Mercer. https://www.mercer.com/en-ca/insights/total-rewards/employee-wellbeing/how-much-are-you-losing-to-absenteeism/#:~:text=Canadian%20companies%20lose%20an%20estimated,Canada%27s%20Mental%20Health%20Concerns%20below