Shirah Vollmer MD

The Musings of Dr. Vollmer

Therapy Fear

Posted by Dr. Vollmer on June 28, 2012

“I am afraid to go to therapy. I am afraid you are going to make me feel so bad about myself. I am afraid I will lose all of my confidence if I start seeing you on a regular basis,” Zoey, thirty-three says as we discuss that psychotherapy may be an important addition to her psychopharmacology for her treatment of her mood disorder. “It is that fear that makes me think that psychotherapy makes sense. Confidence, that quality in which you feel good about yourself, is what is missing from your life. Your fear that psychotherapy could diminish your sense of yourself speaks to the fragility of your self-esteem.” I say, knowing that Zoey will click in to what I am saying. “Yes, that’s true. I see that.” Zoey says with her typical candor and openness. “Still, I don’t want to think I need that.” She says, implying that she is able to accept that she needs medication, but that her associations to psychotherapy are negative and scary. “Sometimes things have to get worse, before they get better,” I say, knowing that I am stating the obvious, but also knowing that the obvious helps us lay out the psychological barriers to treatment. Zoey changes the subject, or so it seems. She talks about how she is getting involved with a new political passion. “Maybe you have transitioned to talking about your new politics as a way of reassuring me that you are engaged with life and thereby not needing psychotherapy.” I say, thinking about how our conversation shifted. “Yea, you are right,” Zoey readily agrees. “I do need therapy. I just don’t want to think about that right now.” “I love your candor,” I respond, feeling a fresh breeze in the air.

6 Responses to “Therapy Fear”

  1. Jon said

    Zoey’s situation offers an interesting dichotomy. She has a willingness to accept psychopharmacology but a fear to accept psychotherapy. The former can be oversimplified to be understood as a direct chemical intervention of the mind and brain. The later can again be oversimplified to be understood as the mind and brain altering itself through a guided process. I would think that the psychotherapy approach to be a more long-lasting than the psychopharmacology approach; however, a combination of the two is probably necessary in this fictional case. The goal of self-sustainability would imply a drug free future, if possible.

  2. Shirah said

    In my experience, this is a frequent dichotomy. Associations to medications are often seen as a “fix” without much effort, whereas the energy of psychotherapy is a journey to unknown places. Of course, both medication and psychotherapy are journeys to unknown places, but the difference is in the energy necessary to start this endeavor. As with a physical exercise regime, getting started can be a daunting thought, but then the benefits come later. The goals, I would say, are variable. Being drug-free might be a goal, but the ultimate goal is a more fulfilling life. Thanks.

  3. Melanie said

    My experience 5 years ago was the complete opposite. My friends in the office basically forced me to go to a psychiatrist because in their words, “I was wearing them out.” I went kicking and screaming because there was nothing “wrong with me,” and I had it already made it 25.5 years without any help (which included 3 years of law school and passing my first of 2 Bar exams the summer before). The doctor gave me a “diagnosis,” which I refuted. She asked me if I would come to therapy once a week, and I said ok (and I went every week). She also suggested medication. I fought that for 4 months and finally begrudingly agreed. I moved to away the next month and have been seeing a psychiatrist 2 or 3 times a year for the “drugs” and a psychologist regularly for therapy/psychoanalysis ever since. I would like to believe that the drugs are a “placebo,” and I don’t need them, and maybe one day, I will find out whether I need them or not. They don’t help me learn about myself…while psychoanalysis allows me to learn something new every day.

    • Hi Melanie,
      Thanks for sharing your process. As you say, your associations to psychoanalysis lead you to be grateful for the opportunity for personal growth, whereas your association to the medication is that it is likely to be a placebo. I understand that you have much more confidence in looking at the way your mind works, rather than being a passive recipient of medication. This brings up another dimension of active versus passive. It sounds like you take action when confronted with personal issues, whereas others are more inclined to inaction under those circumstances. Thanks again.

  4. Shelly said

    Going into therapy and psychoanalysis, I’ve learned from this blog, can be a very long and intensive process, involving commitment and staying power. It can involve sessions several times a week for several months or even years. The outcome? Better understanding of one’s motivations, actions, and fears so that one can make better choices in life and live life to one’s fullest potential and happiness and reach one’s goals in a less painful manner. The benefit of medications, I’ve also learned through this blog, is to affect one’s moods while the above-mentioned work is being done. As one therapist mentioned to me, “Therapy is a gift one gives to oneself.” A therapist should never ever make a patient feel badly about oneself. If a therapist does, then the therapy should be stopped. That is tantamount to self-bullying, which patients do to themselves constantly (or why would they be in therapy in the first place? Don’t they have self-esteem problems in the first place?).

    • Shirah said

      I was following your prose with total agreement until the very end. The issue of a therapist making a patient feel bad about himself is, as you can imagine I might say, very complicated. Clearly sadistic behavior is not compassionate, but feeling bad about oneself may be a first step to forgiveness, or it could be the first step towards internal growth, or both. Sometimes patients do feel worse in psychotherapy, as part of their journey of self-reflection. This may, at times, seem like the therapist is causing the pain, but the therapist is facilitating an exploration, which sometimes leads to unsavory material. Thanks.

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