Is there a CBT solution for this problem?

November 19, 2008 7:54 AM

It keeps coming up, and AskMe isn't quite the place for it. Sometimes the it's the asker who doesn't want to hear it, and sometimes members just argue amongst themselves. Maybe we should all seek therapy!

Some people seem to think "seek therapy" is a good answer. Some people think therapy is never the answer. Most people fall somewhere in the middle, but it still comes up in thread after thread.

I am not sure it will happen, but wouldn't it be nice if we could sort of hash it out here and reach some amicable consensus so that we don't have to re-argue this issue every time it comes up?

For what it's worth, I am not sure "seek therapy," without other advice, is generally a good answer. But arguments about whether or not therapy is inherently useful are perhaps even less helpful.

posted by prefpara to Etiquette/Policy at 7:54 AM (40 comments total)

As far as I'm concerned you should realize that if you ask a question about an intractable emotional problem, some people are going to tell you to seek therapy. It's better if those people can give you some reasons why that might be a good idea [this example struck me today] or give you a reason why they think it's NOT a good idea. I agree, on its own it's not much better than "lawyer up!" or "doctor, now!" and sometimes when we see two word answers in a complicated thread we'll delete them because they seem unhelpful.

That said, what's really unhelpful is people wanting to get fighty in that thread with other commenters basically saying "Wtf, why suggest therapy??!" which is a one way ticket to derail town. What's also unhelpful is the "Dear AskMe, I have a serious emotional problem... (seven paragraphs about person who has fairly obvious issue that most reasonable people agree may be addressable with therapy) what supplements should I take to feel better?" questioner who then gets fighty with people who suggest that anxiety disorders can sometimes be treated with medication and/or therapy. I think people transfer some of their hatred/love of therapy on to other people in those threads who disagree with their point of view which is not at all helpful.

There is no such thing as "hashing out once and for all" in MetaFilter. While we try to minimize the hoops people have to jump through to post a question, I've often considered this one

[ ] I am aware that people will tell me to seek therapy and/or medication, and

( ) I am open to that possibility
( ) fuck those guys

if you click the second radio button you get sent to Yahoo Answers.
posted by jessamyn (staff) at 8:04 AM on November 19, 2008 [8 favorites]

For what it's worth, I am not sure "seek therapy," without other advice, is generally a good answer.

I think the bias towards suggesting therapy is good in areas where therapy is a common way to resolve the problem. I used to be a "I don't need therapy, no matter what" kind of person, but after hearing so many people around here talk about how therapy has helped them solve issues that they couldn't solve on their own, I'm much more likely to give therapy a shot if I end up in some sort of trouble down the road.

But arguments about whether or not therapy is inherently useful are perhaps even less helpful.

Agreed, although this thread can never really solve that. The mods will hopefully clean up any in-thread derails but there's always going to be some friction.
posted by burnmp3s at 8:06 AM on November 19, 2008

Some people think therapists are solid evidence for the "Golgafrincham Ark B" theory of human origins.
posted by Wolfdog at 8:09 AM on November 19, 2008 [2 favorites]

"Seek therapy" is at least a better answer to the fear question than "obtain a stereotaxic instrument and lesion your own amygdala," which is what I begrudgingly refrained from answering in the thread.

I doubt we'll arrive at a consensus here about whether therapy is the answer to the myriad emotional disturbance questions that crop up on AskMe. I think in a lot of cases, though, the asker just wants to be validated that therapy is a reasonable option. Sure, some folks are going to get argumentative because they have understandably strong feelings one way or another about therapy/medication/treatment of any kind, but I think "seek therapy" is actually a more useful answer than "lawyer up" or "see a doctor."

This is because people are unlikely to avoid getting an attorney or seeking non-psychological health care due to stigma, and a chorus of voices encouraging them to do so doesn't help promote a culture of acceptance for legal or medical issues, but it can for mental health issues. Just hearing other voices encourage therapy can be a step in the right direction.

I don't really want to encourage people to drop two word answers into any AskMe, because they're generally unhelpful, but encouraging people to seek therapy is sometimes just what they need.
posted by solipsophistocracy at 8:16 AM on November 19, 2008

I actually think therapy is an imperfect answer to the first question ("Help me navigate my crisis of meaning") but an excellent answer to the second ("The fear of fearful things") . Therapy is for problems, or for when you're stuck in a phase in life that you know you should move beyond but can't. It's for when your thoughts or feelings are holding you back. That's the second question.

The first question is one all normal people should be asking themselves at some point in their life. In this particular poster's case, however, she's obviously been through many harrowing experiences and phases and one of which therapy would have helped her to get through, and thought the bad habits are perhaps gone, the wrong-headed thinking lingers ("Extinguishing my own flame" for example). So therapy is probably recommended for that.

But the bigger picture issue ("I want to find meaning") is not one for therapy. That's the person who's come to terms on an initial level with the finiteness of life. It's going to end, and that ending begs the question of what did it mean. Everyone should be reaching this stage at some point; it is not a problem to be fixed, or something to get over. (Though in the specific case of the post linked here, she clearly has some issues suitable for therapy.)

These questions are better suited for priests who are very old themselves and have considerable experience advising people on questions about life outside of religion. Because of their age and experience, they wise enough, and jaded enough, not to give glib answers about "finding God." Also, these priests have been by the side of more than their share of deathbeds, and they are likely to have a great deal of firsthand knowledge of what people tend to regret in those final moments. That is a kind of insight that most therapists do not have.
posted by Pastabagel at 8:19 AM on November 19, 2008 [4 favorites]

I used to get as exercised about this as you. Every time I saw one of these long-winded questions about some psychological issue or another, I thought to myself: "oh no, not another to-seek-therapy or not-to-seek-therapy" clusterfuck that has been done here ad nauseum.

Here's the thing, though: some of the people asking (and answering) those questions haven't participated in said clusterfucks before. A lot of the askers need to hear that, yes, therapy is indeed one option, but not the only option. It may be old old old news to you and me, but if in just one case it helps the asker out the hear the range of opinions on this issue - well, that's what AskMe is for.
posted by googly at 8:29 AM on November 19, 2008 [4 favorites]

cock and ball torture is not a solution.
posted by dawson at 8:33 AM on November 19, 2008 [4 favorites]

I think the other thing to note is that therapy isn't exactly free. Even under a lot of health insurance plans it's barely covered, or something like 3 sessions are covered. Not to mention the fact that if you get mental health treatment it's now part of your medical history. And yes I know all about HIPAA but there are plenty of jobs where you have to sign medical waivers to release that information. So there can be many legitimate reasons why a person would be hesitant to go to therapy that have nothing to do with the merits of therapy itself. I'm not saying therapy is always a horrible answer to a question, but the fact people are coming to AskMe instead of a Doctor in the first place generally tells me they don't want to or can't go the therapy route.
posted by whoaali at 8:41 AM on November 19, 2008 [3 favorites]

the fact people are coming to AskMe instead of a Doctor in the first place generally tells me they don't want to or can't go the therapy route.

Hmm, it doesn't say that to me at all. I presume for people who have had very little experience with therapy, they may have no idea that it might address their problems. I grew up in a therapy-happy family and have grown up to be a somewhat therapy-averse adult but one of the things I find so poignant about some of these questions is people who are clearly battling something and whatever they're battling is standing in the way of them being able to help themselves. It's a classic depressive-type cycle and anyone who has had a close relationship with someone who grapples with this sort of thing is pretty familiar with the outlines.

We see a lot of these sorts of questions where people have a laundry list of "I know that this this and this would help me but here are solid reasons why they won't help or I can't do them 1... 2... 3..." and to someone who has seen that pattern a hundred times before -- anyone who hangs out in the AskMe mental health questions -- that's a classic pattern. To the person asking the question, it may be their first time even thinking about it like that. Having someone who is not a family member or a partner or a boss say gently "this may be a thing that can help, I know you think it won't but I suggest at least trying it" may be a big deal.

I'd like to encourage people to be a little more long-winded in their answers to people who are having complex problems, certainly, but bringing our own baggage about "therapy sux/rules!" or even "therapy is expensive/complicated!" is sort of addressing a meta set of questions that we may not know enough about to answer. It's tough to not want to share your whole experience with "omg, this one time I went to the therapist and it went like this ___________" We've seen a ton of questions where people got information about sliding scale therapy or how to find a therapist that is covered under their insurance.. While it's not free, it may be affordable and it may be an improvement over whatever their current situation is.

It would be helpful if the OP addressed whatever their perspective was towards therapy, and yet at the same time, like the "How can I fix my leaking transmision myself" question, a polite addressing of the OPs presumptions may be a helpful response.
posted by jessamyn (staff) at 8:53 AM on November 19, 2008 [2 favorites]

I skip most of these threads because they are interminable and boring. I'd advise you to do the same, prefpara.
posted by ikkyu2 at 8:58 AM on November 19, 2008 [1 favorite]

but wouldn't it be nice if we could sort of hash it out here and reach some amicable consensus so that we don't have to re-argue this issue every time it comes up?

Asking for a general consensus to such a specific problem is madness.

Therapy can work, but there are some many variables, such as the ability to pay for it, finding the right therapist, understanding what therapy is and is not, different types of therapy and even the person's willingness to not only go to therapy but put in the work to make therapy successful. If any one of those things is off, the therapy won't work or might be even be harmful.

So rather than thinking "therapy will fix everything!" or "theraphy sux!" it would probably be better if people were more nuanced with their therapy answers as to why it may or may not work.

That and not taking the various answers personally, which often results in these therapy arguments spinning off into chaos.
posted by Brandon Blatcher at 9:10 AM on November 19, 2008 [1 favorite]

cock and ball torture is not a solution

My SO is going after her Master's in Counseling Psych, and is taking a class in cognitive behavioral therapy. While I'd heard the term before, I'd NEVER heard it abbreviated as CBT, which, as dawson points out, means something else entirely to a people who are into that sort of thing or spend too much time on the internet in general.

Point being, when we were over at a classmate's house, and I saw a big binder in his bookshelves labeled "CBT", I briefly considered running for the hills.
posted by SpiffyRob at 9:13 AM on November 19, 2008

note: Everyone needs a hugtherapy.
posted by allkindsoftime at 9:22 AM on November 19, 2008

For such threads, it may be useful to picture Lucy van Pelt in her "Psychiatric Help 5¢" booth.

"That'll be five cents, please."
posted by pracowity at 9:26 AM on November 19, 2008

One sentence answers in these cases seldom effective because they might seem callous. But I've read many AskMe's over the years where to me the only correct answer is a variation of "You should seek the help of a professional who has expertise in this field and can offer you more personalized and reliable advice with your problem".

This keeps coming up in MeTa and I don't think you're ever going to get a clear consensus. One of the best parts of MeFi for me is the variety of experiences, opinions, and personalities, which results in many different takes on a question that one person may think is straight forward enough to only have one correct answer. If somebody asks for advice because they're bummed they missed the bus, I doubt they'd get any "go see a therapist" type answers. But if they said that they can't get out bed and aren't eating because of a crippling anxiety about something in their life, then I hope that some people might steer that person towards seeking some professional help. Additional suggestions and guidance with some encouraging words can be helpful, but it shouldn't be at the expense of helping someone seek help that they need.
posted by Slack-a-gogo at 9:44 AM on November 19, 2008

THANK YOU, dawson. I thought I was the only one who reflexively thought of cock & ball torture whenever I saw CBT.
posted by desjardins at 9:48 AM on November 19, 2008 [1 favorite]

SpiffyRob, too. I guess we're the resident freaks.
posted by desjardins at 9:51 AM on November 19, 2008

Obligatory SLYT post for therapy....
posted by Lynsey at 9:59 AM on November 19, 2008

This is merely an example of a larger issue: Don't give answers that don't explain where the answer came from or what it means. "Seek therapy" isn't an answer, it's a command.
posted by DU at 10:00 AM on November 19, 2008 [1 favorite]

I thought I was the only one who reflexively thought of cock & ball torture whenever I saw CBT.

OMG, me too. Do you guys feel awkward while using an ATM, too?
posted by Alvy Ampersand at 10:14 AM on November 19, 2008 [1 favorite]

Point being, when we were over at a classmate's house, and I saw a big binder in his bookshelves labeled "CBT", I briefly considered running for the hills.

Try this one on:

I worked as a research assistant in the lab of a prof who specialized mostly in child/adolescent psych and depression. He was toying with the idea of giving all the lab workers a crash course in the principles of cognitive-behavioural therapy, in case there was ever a need for an immediate intervention during the research sessions.

I mentioned it to a friend, along the lines of "Hey, neat! I might be going to some intensive seminars on how to do CBT with kids!"

His eyes bugged out in horror.
posted by CKmtl at 10:23 AM on November 19, 2008 [3 favorites]

Perhaps we could recommend everyone go and get their Thetans tested?
posted by blue_beetle at 10:30 AM on November 19, 2008 [1 favorite]

I think of Collies and Belgian Tervurens.
posted by Wolfdog at 10:33 AM on November 19, 2008

OMG, me too. Do you guys feel awkward while using an ATM, too?

No, that's just you. I'm not THAT freaky.
posted by desjardins at 10:40 AM on November 19, 2008 [2 favorites]

If someone writes in saying "I have spilled dirt on my rug, what should I do?" people should not get upset when they get "use a vacuum" as the answer.
posted by Astro Zombie at 11:11 AM on November 19, 2008 [1 favorite]

Where I work, we do a lot of CBT.

All the time.

Computer Based Training, that is.

"Hey Tomorrowful, we're gonna grab a conference room and run through that new batch of CBT, want to join?"
posted by Tomorrowful at 11:25 AM on November 19, 2008

Astro Zombie, are you joking? CLEARLY the solution is to find someone with pica.
posted by desjardins at 11:42 AM on November 19, 2008

Can we all just agree that Ask.MiFi need more snark?
posted by jeffburdges at 11:57 AM on November 19, 2008

Suggesting "counseling" instead of "therapy" might be a idea. Sometimes all people need is a listening ear, not a psychiatrist and medication.
posted by Carol Anne at 12:00 PM on November 19, 2008

OMG, me too. Do you guys feel awkward while using an ATM, too?

...

NOW I do. Thanks Alvy.
posted by SpiffyRob at 12:02 PM on November 19, 2008

"Seek a Psychologist" is exactly the wrong answer for the second linked question, IMO. It's like:

Q: "How do I overcome my fear of new and unfamiliar situations?"
A: "Try entering a new and unfamiliar situation!"

Seriously folks, what the fuck is that?

Seeking a good therapist can be grueling, to say the least. Getting actual, usable solutions to lifelong problems--even ones as simple as that asker's--can take an absolute eternity to drag out of a psychologist.

CBT is the answer, of course. But it is absolutely, positively, completely unnecessary for anyone to seek a doctor to get cognitive behavioral therapy, and if the asker did manage to muster the courage to embark on such a quest, (s)he would probably be put off it in no time, surrendering to a life of fear.

The only appropriate answer in a thread like that is one that explains, in detail, how you overcame your own similar problems. Everything else is noise.
posted by Sys Rq at 12:16 PM on November 19, 2008 [1 favorite]

cock and ball torture is not a solution.

Not so fast. Crippling pain followed by an endorphin release; how is that not a legitimate anxiety treatment?

Or so I've been told...
posted by hwyengr at 12:58 PM on November 19, 2008

Er, Sys Rq, had a bad experience with a psychologist? You seem rather vehement.
posted by HopperFan at 1:01 PM on November 19, 2008

Suggesting "counseling" instead of "therapy" might be a idea. Sometimes all people need is a listening ear, not a psychiatrist and medication.

I think you've got your labels mixed up. Most therapists doing, say, CBT have no medical degree and cannot write prescriptions. A listening ear (plus occasional questions and comments) is precisely what they provide.
posted by nebulawindphone at 1:43 PM on November 19, 2008

I realize MeTa is not a panacea; nevertheless, I found a lot of the comments here very helpful. Therefore, I will choose optimism and believe that others derived some benefit as well.

This thread is timely, by the way.
posted by prefpara at 2:48 PM on November 19, 2008

Er, Sys Rq, had a bad experience with a psychologist? You seem rather vehement.

Yes, plenty, but, meh.

My point was just that for a lot of people, for a lot of reasons, seeking a therapist isn't exactly simple. Just the logistical hoop-jumping is enough to put many off of it; for others it's the cost or the stigma.

Whenever I discover "See a therapist," full stop, dropped in an AskMe thread, it tends to get my dander up. You might as well say to someone stranded on a deserted highway in the middle of nowhere with no phone reception and two flat tires, "See a mechanic."
posted by Sys Rq at 5:39 PM on November 19, 2008

It's like someone breaks down on a city street, and they're running around the car, frantically flipping through the owner's manual, and calling friends for advice on the cell phone, when a friend says, "dude, you're wasting your anytime minutes. don't call me, call a mechanic"
posted by found missing at 6:06 PM on November 19, 2008

Okay, yeah, maybe.

But there's still the matter of how to go about finding a decent doc, what to expect of them, how to pay for it, and -- best of all -- some helpful hints they might suggest twelve sessions in. Which isn't to say that AskMe should become AskDoctorMefi or anything (obviously, actual doctoring is best left to actual doctors); it's just that "Get thee to a therapist," even without the implied Duh!, is just not as helpful as it could be.
posted by Sys Rq at 7:25 PM on November 19, 2008 [1 favorite]

Leave poor old Cool Bapa Tell outta this.
posted by cortex (staff) at 9:42 PM on November 19, 2008

it's just that "Get thee to a therapist," even without the implied Duh!, is just not as helpful as it could be.

I've always seen it as a specifically American reaction. From the very first, it struck me very strongly, and the feeling has hardly diminished, how nearly Pavlovian it is.

Marital problems? Therapy. Sexual issues? Therapy. Family troubles? Therapy. Traumatic event? Therapy. Existential crisis? Therapy. Workplace tension? Therapy. Cat ran away? Therapy.

Now it's possible that it would actually be a great benefit in a few cases, and at least marginally better than nothing in many, so there's no great harm, other than to the person's free time and wallet.

But the wide-eyed credulity with which Americans seem to want to believe that these therapists hold the golden keys to the soul is really quite amazing, because they're just people like anybody else, and probably on average not half as wise or educated as your typical Hive Mind busybee.

In fact, if I didn't know that it's not actually possible for most, I'd be suggesting something else as my default answer to all these crises:

Go for a surf.

If you still feel attached to your pointless crisis tomorrow, go for another surf.

Continue until you're better.

Because there's nothing like sitting out beyond the furthest breaker, out in the fresh air & the water, looking back at the busy life of the city for spontaneously & effortlessly entering a zen-like transcendence of all that silliness, and you return to shore relaxed, refreshed, calm, and free of worries.

Other than wondering when you'll be free to return, and if the swell will be any good.
posted by UbuRoivas at 6:51 PM on November 20, 2008 [3 favorites]