Therapy Fail
As I have hinted in previous blog entries, I am in a bad place these days. My mental health is the worst it has been since 2006. My problems are 100% self-inflicted (as is the case for all depression/anxiety) but they are still real.
I put myself into this bad mental state deliberately. I was tired and burned out after teaching in the fall. For my entire time in KW, I had bounced between doing IT for the cult, and teaching sessionals at the University of Waterloo. I was stuck and unhappy at both of these jobs. In principle I could have resumed working at either, and it is possible I will go back to teaching. But it is also clear that both these positions are employment dead ends. I was able to live on $20k per year for two decades, but as rental costs soar and my precarious housing gets ever more precarious, I knew that cannot continue indefinitely into the future. Also I am aging, and with each passing year I become less employable. My physical health is failing, my intellect is diminishing, and my mental health had been deteriorating fast even before this year.
The problem is that as soon as I secure employment I stop looking for work. In principle I could have been looking for work while I was teaching, but work was sufficiently busy and the job hunt was sufficiently revolting that I did not even try. It was easier to put my head down, concentrate on my job, and put off trying to find something better. That has been the pattern since 2016, when I left the cult. Thus, I made a decision to break the pattern. I termed it "getting off the merry-go-round." I declined to volunteer for the cult. I declined to teach in the winter term, and expressed reservations about teaching in the future. I made an explicit decision to step back and see whether I could change things.
I did not change things. These past five months have been a waste. I knew they would be difficult, and they were. My mood crashed, as I knew it would. But to this point I have not found a different path. A lot of scenarios have been swirling around in my head. I went through a few (although not enough) mind-mapping and job-readiness exercises. But I am deeply, profoundly stuck. I am angry and resentful. I am still unclear as to what compromises I can tolerate and maintain my wellbeing, and still unclear as to what compromises I am willing to tolerate. I look at job ads and feel nauseated inside. I despise LinkedIn with a passion, but am told again and again that in this modern world that Microsoft's social network is the secret to finding a tech job. I have lost confidence that I can do any work, that I can learn anything new, that I have the social skills to fit into a workplace, that I can hold down a job. All of this is my fault -- the result of conscious choice -- but I am still stuck.
Given this context, as part of my time off I committed to seeking out therapy. Given my mental health state, the standard treatments are medications (usually SSRIs) or therapy, and I am resistant to the medication route. It is possible that my mundane mental illnesses are associated with chemical imbalances in my brain, but we don't have tests for what those imbalances are, and I reject the idea that they are caused by chemical imbalances. The picture is more complicated than that (The Noonday Demon: An Atlas of Depression by Andrew Solomon is a good book to read about this). So that leaves therapy.
I was an idiot. I knew that finding a good therapist would be expensive and time-consuming, so I took the easy way out. I qualified for eight sessions of cheap ($25/session) therapy through KW Counselling. I also participated in an eight week program on anger management held through Carizon. I suspected that these programs would not be terribly effective, but I thought they would not hurt. I was wrong. The anger management class was mostly neutral, but the cheap therapy was a disaster. I am just as stuck and more despondent about getting better as a result of that experience.
Past Experiences
I have done counselling/therapy before. Counselling Services at UW used to support sessionals, so I went through a couple of rounds of therapy there (which led to one improvement). When at the cult I went to one formal therapist (who was not that useful, but did help me resolve one aspect of family dynamics). I also had informal and possibly-inappropriate quasi-therapy elsewhere, which I feel was helpful but not sustainable. Much of my previous counselling/therapy experiences have been disappointing, but not universally so. I did not have a lot of hope that I would have success this time around, but I hoped for enough progress that I could apply for jobs.
Anger Management
The anger management class was facilitated by an experienced counsellor, but there was not much interaction. Occasionally he invited us to respond to prompts, but the format was largely lecture-based. Once in a while there were suggested exercises, but these were infrequent. As with most other skills, we get better at anger management through practice, and these sessions did not provide many opportunities for practice.
Early in the course they brought up CBT and mind traps, which poisoned my goodwill towards the course. The course did not stick to a CBT-based approach the whole way through, though.
The main message of the course was that in order to manage anger we need space. If we let the anger take over, then we are lost. So many of the techniques are intended to give us that breathing space so we can decide how to respond to stressful situations. That is useful information but it seems difficult to follow when I am most likely to be angry -- when I am sleep-deprived, under multiple conflicting stressors, when I am defensive, etc.
The best exercise of the course was an anger log, but of course I did not keep that up.
Overall I would rate this course as mostly neutral. It did not do a lot of harm, but I did not get much out of it. Maybe if I had been more receptive I would have gotten more out of it.
Subsidized Counselling
Over the years I have received a handful of therapist recommendations. I started looking into some of them. I also looked through directories on Psychology Today. I came close to booking one of the recommended therapists at $140 per session, but chickened out. Instead I opted for the subsidized counselling offered by KW Counselling.
My presenting issue had to do with job search. It is kind of a big deal that I cannot tolerate the job search and that even looking at job postings makes me nauseated. However, I am a broken mess, and I knew that underlying this problem were a bunch of other issues relating to self-esteem, to stubbornness, to autonomy, to imposter syndrome and to a lot of other things. But at the end of the day I presented the issue of job search and career transition because (a) it is easier to discuss than some of the other stuff, and (b) if I don't work I don't get money, and if I don't get money I don't live. In retrospect I probably should not have pretended that job search was my primary issue, but it is not clear what other issue I should have presented instead.
I had a lot of apprehensions about turning to subsidized counselling. Most subsidized counsellors are perky young graduates fresh out of school, and whether justified or not I tend to harbour prejudices against perky young graduates. I am sure that wise young therapists exist, but I donot know how to find them.
I also knew I was not an easy patient. I am resistant and aversive. I have a lot of intellectual defences. I am deeply mistrustful of other people, especially people who are attempting to psychologically manipulate me (and what is therapy other than psychological manipulation?). I play distraction games and deflection games. Assigning me to some new grad might have been a good "learning experience" for the grad, but I was not interested in being a learning experience. I was interested in getting help, because I was in a dire situation.
I warned KW Counselling about these things. I explicitly said that I had apprehensions about being assigned a new grad, and I warned them that I was a difficult patient. They assured me they understood and then assigned me a "qualifying" therapist, aka a new grad. However, because this therapist was older and had previous experience as a job counsellor, they felt that this person would be a good fit for me.
Surprise! Things did not turn out well. I ended up being a "learning experience" but did not resolve any of my issues much, and lost considerable confidence that there is any help for me.
Hostile Patient
I do not know much about therapy, but I am under the impression that therapists generally try to form "therapeutic alliances" with their patients, which is fancy speak for getting patients to trust their therapists. This is why therapists refrain from speaking judgmentally to patients (at least at first) and make affirming supportive noises ("uh-huh", "mrhmmm") regardless of what ridiculous things the patient is saying. When the patient relates some story that sounds distressing they express empathy ("that must have been hard"). The idea is that the therapist fools their patient into thinking the therapist cares, and then the patient lowers their defences, and then the therapist can poke at the tender bits and fix the patient's neuroses.
My therapist made appropriate empathic noises just as she was taught, and I neither trusted nor believed her. I do not know that she realized that I did not trust her until the end of the fifth session, when I told her explicitly. She said she would talk things over with her supervisor (at the end of the fifth session??) and for the sixth session she had me do some word association exercise, as if that was going to make me trust her more.
I guess this mistrust was my fault? If I am too suspicious I cannot expect help? Maybe I was deliberately putting up barriers for her to traverse before I would let myself be helped, and then claiming a hollow victory when she fell for my traps. It is not clear to me whether a more experienced therapist would have more tools for building trust and lowering defence, or whether all of the blame is in my hands, but in either case it makes me think as if therapy is unlikely to work for me.
It is shallow of me, but the few people whom I trust tend to impress me in some way. Often they are super smart or super accomplished or super wise. They do things that impress me and then I feel I can learn something from them. This is unfair of me. I ought not to judge people so harshly. My reluctance to trust others may well be one of the barriers that is keeping me stuck. So does that mean I am too broken to be helped?
One habit which made me mistrust the therapist was her habit of declaring platitudes. The worst one was "I believe there is a perfect job for everybody," which was utterly frustrating because (a) I do not share that belief and (b) if there is a perfect job for me she was not giving me any insight on how to find it. She also expressed a positive, optimistic outlook on life, which I similarly don't share. These things increased my defensiveness and hostility, to the point where I basically gave up on the possibility of getting help by the sixth session.
Lack of Focus
I presented a concrete problem to the therapist. I knew the problem went deeper than simple job-hunting skills, but it did not feel that we stayed focused on untangling the issues that got in the way of me getting a job. We discussed my personal hygiene and whether it was imperative that I leave my video on during sessions (which I resented), and about Maslow's hierarchy and Victor Frankl and Erikson's stages of development (she said I was in "stagnation", which was probably the most helpful thing I got out of the eight sessions). My mood was bad, so she recommended CBT books like Mind Over Mood, and tried to convince me to go on meds or try CBT.
This again was my fault. I guess the therapist was following her training and letting me direct the topics of conversation or something, but I did not feel as if I was doing a lot of directing either. If I had my act together I might have had a more concrete plan for what we would discuss at each session, but I didn't so we didn't, and we spent a lot of time discussing what I felt were irrelevant things.
Brain Chemicals vs Habits
I can believe that there are mental illness for which involuntary biochemical processes are more important (schizophrenia, bipolar disorder) but I remain stubborn, even though I know other simple interventions (sleep, sunshine) have concrete effects on my mood.
The trendy therapy these days is Cognitive Behavioral Therapy (CBT). CBT is "evidence-based", and I guess if something is evidence-based it is supposed to work for everybody. But I am highly resistant to CBT, and it makes me quite angry. (I can tell stories of being gaslit as a child to explain this resistance, but I do not have any reason to believe these stories are true.)
There are a bunch of other therapies out there. Maybe one of them would work for me, but I do not know which one. But the bigger problem is that I am resistant to change, and if there is one thing I know about getting better it is that I am supposed to put in all kinds of hard work and change. I am supposed to change my habits and my negative self-talk and my ossified identities to get out of this rut. Furthermore, I am supposed to do this myself -- nobody can do this work for me. The problem is that I am (a) resistant to change, (b) lazy, and (c) stubborn.
No Magic Insights
I already have seen what I need in order to get better. How could I have not? I listen to Buddhism podcasts and therapy podcasts. I have listened to years of The Savage Lovecast. I have read all kinds of books on depression and all kinds of self-help books. All these resources are full of good insights, and much of the advice falls into common patterns. Why do I expect that therapy is going to expose me to any information I have not seen before?
The problem, of course, is that I do not retain, internalize, or practice any of that information. I reread Dale Carnegie's How to Stop Worrying and Start Living, and not only did I remember anything from the first reading of that book, I barely remember anything from the second reading. What's the good of exposing myself to this information if I do not study it deeply and put it into practice? If I focused on studying and implementing even one good resource, I would probably be far better off than doing publicly-funded therapy with student (oops. "qualifying") therapists. But of course, I don't, so I stay broken.
At best, a therapist would force me to pay attention to the good practices that exist, and force me to put them into practice. But even this would require me to lower my hostility, which is unlikely to happen. So what is the point?
Bad Internet Influences
I go through different internet infatuations, and a recent one was Healthy Gamer, which is mostly a Twitch stream of an internet-famous psychiatrist Alok Kanojia, better known as Dr K. Mostly, I was obsessed with a series of not-therapy sessions Dr K holds with famous Twitch and YouTube content producers. There are careful disclaimers that these sessions are "not-therapy", but they are pretty therapeutic. Dr K starts out by asking open questions and getting people to relate their life stories. He zeroes in on underlying problems, and within the span of two hours he and his guest usually uncover some past undigested emotion (samskaras in Dr K's Vedic vernacular) that the client can process further.
I don't think these interviews are scripted, but as I have listened to more of them the shine is starting to wear off. I think Dr K is mostly legit, but I am noticing the tricks. Often Dr K jumps to theorizing and telling the guests what is wrong with them, as opposed to having them discover this themselves. On the other hand, Dr K has extensive experience with therapy (and with being trained as a monk in India, and other things) and so can perceive patterns quickly. Two hours is not enough time to fix anybody, but it seems to be enough time to diagnose some things and point people to solutions. Meanwhile, I muddled around for eight weeks of therapy and got nowhere.
On the one hand, listening to the Healthy Gamer interviews was probably a factor in pushing me to give therapy a chance. On the other hand, any expectations I had that I would get a therapist remotely like Dr K were utterly stupid. Dr K mostly interviews famous streamers, and even those interviews have slowed to a trickle. If you pay money to Healthy Gamer you can get life coaching, but it will be with an unlicenced coach, not Dr K and not a trained therapist. If I was expecting this round of therapy to be anything like the Healthy Gamer streams I was in for a big disappointment. And disappointed I was, because I felt I got almost nothing from this experience.
Stupid Problems
All my problems are dumb. I am too picky to get a job, and too slovenly and lazy to hold down one even if I find one. Boo hoo hoo. If I stop wallowing and get to work, then maybe I can work well enough to remain housed. It is not that difficult. When I have been in deep depressions before, simple things got me out of them. I am not happy with my nose to the grindstone, but I am not happy now.
Similarly, all this nonsense about anxiety and depression is nonsense. All this obsession over bad experiences in the past are just obsessions. Depression and anxiety are the most mundane mental health issues, and they are easy to treat. In some real sense, I fundamentally believe that my depression is a moral failing. I claim to be depressed, but I am just wallowing.
As for the existential dread, boo hoo hoo. Few of us have reasons to exist, but people exist anyways, and they are content with their lot. When I am busy I think about the bigger picture less, and that is probably the answer to existential angst.
As for my hesitation to work for unethical organizations, boo hoo hoo. This has not stopped me from working before. It does not stop me from shopping at unethical stores, for unethical products (hello, junk food store).
My problems feel real and they feel paralyzing. But I am a hypochondriac. By now I should have learned that feelings are not real, and they are not to be trusted.
It is true that I am aging, and my abilities are diminishing. It is true that I have been unwise in my career trajectory. It is true that I have a number of bad habits and triggers that make it tough for me to be successful at work or at life. Boo hoo hoo. To claim that I am less able to work than people who face much greater challenges and setbacks is stupid. But I am not desperate enough to move, and I am picky, so I wallow.
All Alone
If there is one lesson I have learned from my therapy experiences it is that I am unlikely to find help in solving my problems. If I want to fix things I am on my own.
I hinted at this above, but I want to make this explicit: I have no idea how to filter for an appropriate therapist. there are lots of people offering therapy, but I have no good way to distinguish the good therapists from the bad ones, and no good way to filter for therapists whose approaches are more likely to be compatible with mine.
There are listings like the Psychology Today ones, but most therapists offer generic writeups, and claim to be experienced in a huge range of concerns. How am I supposed to choose between them?
Even if I found some kind of therapy or coaching problem, I am not going to find anybody who cares whether I am successful or not. A therapist or a coach is a professional relationship, not an authentic one. Just as I move on even when students I like fail my classes, my therapist will move on if I flame out in a therapeutic experience. I have no doubt in my mind that the KW Counselling therapist I was assigned has no compunctions about the fallout of my bad experiences on me. If I am looking for somebody to care about me, I am looking in the wrong place.
Expecting somebody to fix me was always unrealistic, and I do not know that this was my expectation. I also do not think I had expectations that anybody would care for me in any non-transactional way. That still left the option that somebody might be able to serve as a guide or coach, helping me work through my self-imposed barriers. But I do not have much confidence that this will happen, especially given my poor therapy experiences thus far.
Deficiency vs Ability
I hate the mental health industry, because it focuses on deficiencies. I frame myself in terms of how I am broken. And I am broken, but I am other things too.
Yes, I have bad anxiety and bad habits. Yes, I am weird. But I also have assets. I feel (perhaps wrongly) that I can contribute something to somebody. But when I am looking for mental health supports, I have to frame my situation in terms of problems I am looking to fix, not strengths I have to offer.
Meanwhile, when applying to jobs I am supposed to pretend that I only have strengths and no deficiencies. That is not right either. If I ignore my deficiencies in the workplace, then I crash and everybody is worse off. It seems that there can be no balance either way.
Conclusions
There are no good conclusions. I am despondent. I acknowledge that my barriers are self-inflicted and stupid. I acknowledge that all of the answers are already out there, and that my expectations are unrealistic.
I still feel broken and hopeless that anything will get better. At some point I have to pull myself together and get some work, or I have to give up.