Group therapy, for me, is sort of like travel. Sometimes the experience is worse than you’d like to admit at the time, but it’s OK, cause you’re not doing it for the immediate experience. You’re doing it to have the experience, by which I mean to possess it. And once you possess it you can use it however would be useful to you.
I don't have a lot of personal experience with mental healthcare, but pieces like these about shortages and access difficulties always remind me of teaching: for the system to achieve its stated goals (education/mental healthcare for all) we need drastically more workers, even as the infrastructure is falling apart and the profession fails to keep talent because of burnout, care fatigue, and lousy pay in the places where it's most needed. It's hard to see a way out.
For all the village explainers in the Freddiesphere: Is it easier to get mental healthcare in other developed countries? Do bus drivers and custodial staff in Finland or France have ready access to therapy, or do they also have to have to wait for months and hope they don't have an emergency? Have other places figured this out?
Oh man your national park story was a lightbulb moment for me. I often have fond memories for things that I rationally know were hellish at the time, but I couldn't quite articulate why. These days I'll go on vacation with my kids, watch them fight and whine the whole time, then talk about how great it was after we get back. It's exactly what you describe; they have very short memories for the fights and very long memories for the fun.
Inpatient vs. outpatient treatment also ties into dealing with mental illness among the homeless population. Freddie is a very smart guy with a lot of executive function and he narrowly avoided homelessness a few times. Those folks not a gifted as he is often have a terrible time as they just can't do the things that need to be done. There needs to be a more interventional alternative between inpatient and outpatient.
I'm a very introverted and private person so group therapy (in and out patient for addiction) was absolute torture for me. But looking back I mainly remember the good stuff. After the session was over most of the group went outside for a smoke. This is where the real bonding happened. We would talk shit about Dr. Dickhead but also share a lot of stuff that didn't make it into the session. So many funny stories.
I've pretty much stopped judging people after group therapy. I despised this guy named James. Everything about him made me angry. One day we walked back to the subway together and he told me about growing up in the foster system and being physically and sexually abused. Then finally escaping to the army, where he had two great years until he was raped by a very popular officer, and put through absolute hell when he reported it. Then years on the street struggling with opiate addiction. It's amazing how all your previous judgments seem incredibly petty after hearing something like that.
My wife’s been attending weekly AlAnon meetings for about 6 years now. It seems to be voluntary group therapy, but minus some of the negative baggage in your internal monologue.
In your opinion, how does the 12-step style of group therapy differ from what you’re writing about here (other than the presence of a licensed professional)?
Maybe it's because I was in what is considered to be one of the worst inpatient psychiatric hospitals in my state, but my experience with group therapy was just some nurse running through the alcoholics anonymous twelve step program with schizophrenia or bipolar or depression or whatever substituting for alcohol. My only long-term takeaway was that it made me really dislike twelve-step.
The shortage of psychiatrists willing to treat bipolar disorder around here is bad enough that the clinic I'm at has taken to group medication management to increase the number of patients that can be treated per unit time. It's actually not a bad experience. (Not talk therapy, the doctor and NPs briefly interview people about current life events and emotional irregularity, but just with an eye to adjusting medication if needed.)
Holidays are hard for many people. For different reasons. Anniversaries of traumas is a big reason. Possibly additional presence of family in one’s life.
This isn’t a competition but in my experience the groups that are peer-run and nominally about recovery - alcoholism, co-dependence, etc - are consistently rewarding.
The connection between the experience of having to deal with someone with alcoholism or addiction, and one’s own later psychosis - I think that’s a real connection and I think there’s evidence for it. It’s not at all the whole story - but in addition to the capability of being coherent, the mind/heart/person has the condition of willingness to be coherent. Capability of being coherent can be influenced by the canonically diagnosable stuff. Willingness to inhabit a coherent world in the face of incomprehensible trauma - that’s the trauma therapy side of psychosis. A human is an organism alive on multiple levels - human, animal, vegetable even. A human may shrink from trauma even at the vegetable level, the most basic life, the way a vine turns toward the light. How that manifests in thoughts, intentions, and actions - after trauma, that whole communication channel can get wrecked. Then indigestion manifests as I think I’m being attacked by demons. Etc.
All this is to say that if someone is stable on meds for psychosis, and has trauma history, a reasonable move is to locate an actual trauma therapist - perhaps certified by EMDRIA, perhaps some other way, but not the CBT merry go round- and find some guidance for mind/body trauma work. Maybe you’ll have to travel to suburban New Jersey in a ridiculous Uber once a month or something, to find someone with open appointment times.
I haven’t been here long enough to know FdB’s whole therapy history. But if you haven’t done this, move heaven & earth to do so… in my humble advice… and if the response is But why? Order up some therapist training materials on trauma, you have a more than adequate reading level. Google up some textbooks and see what the experts are telling the trainees to tell someone with your symptom profile and backstory.
Trauma treatment is frequently unavailable to people with severe symptoms. Your experience of therapists rejecting you sounds like it was very isolating. You may have a recurring impulse to get more/better help but seem unable to access it. This is a reach, but maybe the universe is protecting you from idiots, and what you need is a competent trauma therapist with experience. Also, you’re in NY, if you get a call back that would be a No, ask them questions - do they know anyone with interns, anyone with open appointments, in or out of the area. They won’t be surprised to get questions, you can do it politely, not pressuring or demanding anything from them specifically but simply trying to find resources. Call the places that train MSWs and MFTs. See what they know. University departments have a year’s worth of fresh grads but they also know which providers mentor interns; it’s a way of selecting for who is experienced or confident enough to train others. Call up the women’s crisis center, ask them about providers. Therapists might not advertise - some don’t have to - so you may have to look in unexpected places, seeking information several steps removed from what you want. Call expensive bodywork providers - everybody has friends, people their clients see, etc. Eventually you’ll get the “so and so sees somebody who’s great, I’ll get their number next time I see them” and they might come back with a number.
Call organizational skills coaches. Ask them if they know any therapists.
Institutional mental health is necessary but it’s the beginning. I used to want to be a provider but now I don’t know.
New York is full of secrets. Things hide in plain sight. The unnoticed street door goes up the stairs to the studio space. I want to believe there is something there for you to find.
"Being treated for a psychotic disorder is boring. I’ve been in a handful of programs in my life and the vibe resembled nothing so much as the DMV, or the registrar’s office at a state college."
There was a famous British columnist called AA Gill who was an alcoholic in his youth and that's almost exactly what he said. He was a topper-upper, not a binge drinker, so he was effectively drunk 24/7, and said life was a series of waiting rooms. Sitting around, head bobbing a bit, drunk, waiting to drink more. His father got him on a train one day with two bottles of champagne and a ticket to a rehab facility. He drank the two bottles, got off at rehab, and never drank again.
Anyway, yes, the lack of access to something that's proven to work and proven to be an excellent - for want of a better word - prophylactic is a huge recurring theme in American healthcare. We can spend tens of thousands on people at the emergency room but balk at the kind of preventive care that would render it needless in the first place.
I know you made some very important points about mental healthcare, but I have to tell you that your comments about the "stock photos" were terrifically funny. They made me laugh aloud.
There are plenty of articles if you look, but if you don't look too hard, you can find plenty of news articles that reinforce that preventative care saves money.
Group therapy in my city is still remote-only because of COVID hysteria. It's so stupid and infuriating I had to opt out, I don't think it was a net benefit for my mental health, just trying to control my temper at the sanctimonious irrationalism for two hours every Wed. It's too bad because the program looked like something that could really help me. I'll go back as soon as they resume in-person, question is how many more months until the hysterics concede that vaxxed in-person meetups are perfectly safe?
I don't have a lot of personal experience with mental healthcare, but pieces like these about shortages and access difficulties always remind me of teaching: for the system to achieve its stated goals (education/mental healthcare for all) we need drastically more workers, even as the infrastructure is falling apart and the profession fails to keep talent because of burnout, care fatigue, and lousy pay in the places where it's most needed. It's hard to see a way out.
For all the village explainers in the Freddiesphere: Is it easier to get mental healthcare in other developed countries? Do bus drivers and custodial staff in Finland or France have ready access to therapy, or do they also have to have to wait for months and hope they don't have an emergency? Have other places figured this out?
Oh man your national park story was a lightbulb moment for me. I often have fond memories for things that I rationally know were hellish at the time, but I couldn't quite articulate why. These days I'll go on vacation with my kids, watch them fight and whine the whole time, then talk about how great it was after we get back. It's exactly what you describe; they have very short memories for the fights and very long memories for the fun.
Inpatient vs. outpatient treatment also ties into dealing with mental illness among the homeless population. Freddie is a very smart guy with a lot of executive function and he narrowly avoided homelessness a few times. Those folks not a gifted as he is often have a terrible time as they just can't do the things that need to be done. There needs to be a more interventional alternative between inpatient and outpatient.
I never got anything from therapy, group or individual. But the medication completely changed my life after 3-4 months.
I'm a very introverted and private person so group therapy (in and out patient for addiction) was absolute torture for me. But looking back I mainly remember the good stuff. After the session was over most of the group went outside for a smoke. This is where the real bonding happened. We would talk shit about Dr. Dickhead but also share a lot of stuff that didn't make it into the session. So many funny stories.
I've pretty much stopped judging people after group therapy. I despised this guy named James. Everything about him made me angry. One day we walked back to the subway together and he told me about growing up in the foster system and being physically and sexually abused. Then finally escaping to the army, where he had two great years until he was raped by a very popular officer, and put through absolute hell when he reported it. Then years on the street struggling with opiate addiction. It's amazing how all your previous judgments seem incredibly petty after hearing something like that.
My wife’s been attending weekly AlAnon meetings for about 6 years now. It seems to be voluntary group therapy, but minus some of the negative baggage in your internal monologue.
In your opinion, how does the 12-step style of group therapy differ from what you’re writing about here (other than the presence of a licensed professional)?
Maybe it's because I was in what is considered to be one of the worst inpatient psychiatric hospitals in my state, but my experience with group therapy was just some nurse running through the alcoholics anonymous twelve step program with schizophrenia or bipolar or depression or whatever substituting for alcohol. My only long-term takeaway was that it made me really dislike twelve-step.
The shortage of psychiatrists willing to treat bipolar disorder around here is bad enough that the clinic I'm at has taken to group medication management to increase the number of patients that can be treated per unit time. It's actually not a bad experience. (Not talk therapy, the doctor and NPs briefly interview people about current life events and emotional irregularity, but just with an eye to adjusting medication if needed.)
Holidays are hard for many people. For different reasons. Anniversaries of traumas is a big reason. Possibly additional presence of family in one’s life.
This isn’t a competition but in my experience the groups that are peer-run and nominally about recovery - alcoholism, co-dependence, etc - are consistently rewarding.
The connection between the experience of having to deal with someone with alcoholism or addiction, and one’s own later psychosis - I think that’s a real connection and I think there’s evidence for it. It’s not at all the whole story - but in addition to the capability of being coherent, the mind/heart/person has the condition of willingness to be coherent. Capability of being coherent can be influenced by the canonically diagnosable stuff. Willingness to inhabit a coherent world in the face of incomprehensible trauma - that’s the trauma therapy side of psychosis. A human is an organism alive on multiple levels - human, animal, vegetable even. A human may shrink from trauma even at the vegetable level, the most basic life, the way a vine turns toward the light. How that manifests in thoughts, intentions, and actions - after trauma, that whole communication channel can get wrecked. Then indigestion manifests as I think I’m being attacked by demons. Etc.
All this is to say that if someone is stable on meds for psychosis, and has trauma history, a reasonable move is to locate an actual trauma therapist - perhaps certified by EMDRIA, perhaps some other way, but not the CBT merry go round- and find some guidance for mind/body trauma work. Maybe you’ll have to travel to suburban New Jersey in a ridiculous Uber once a month or something, to find someone with open appointment times.
I haven’t been here long enough to know FdB’s whole therapy history. But if you haven’t done this, move heaven & earth to do so… in my humble advice… and if the response is But why? Order up some therapist training materials on trauma, you have a more than adequate reading level. Google up some textbooks and see what the experts are telling the trainees to tell someone with your symptom profile and backstory.
Trauma treatment is frequently unavailable to people with severe symptoms. Your experience of therapists rejecting you sounds like it was very isolating. You may have a recurring impulse to get more/better help but seem unable to access it. This is a reach, but maybe the universe is protecting you from idiots, and what you need is a competent trauma therapist with experience. Also, you’re in NY, if you get a call back that would be a No, ask them questions - do they know anyone with interns, anyone with open appointments, in or out of the area. They won’t be surprised to get questions, you can do it politely, not pressuring or demanding anything from them specifically but simply trying to find resources. Call the places that train MSWs and MFTs. See what they know. University departments have a year’s worth of fresh grads but they also know which providers mentor interns; it’s a way of selecting for who is experienced or confident enough to train others. Call up the women’s crisis center, ask them about providers. Therapists might not advertise - some don’t have to - so you may have to look in unexpected places, seeking information several steps removed from what you want. Call expensive bodywork providers - everybody has friends, people their clients see, etc. Eventually you’ll get the “so and so sees somebody who’s great, I’ll get their number next time I see them” and they might come back with a number.
Call organizational skills coaches. Ask them if they know any therapists.
Institutional mental health is necessary but it’s the beginning. I used to want to be a provider but now I don’t know.
New York is full of secrets. Things hide in plain sight. The unnoticed street door goes up the stairs to the studio space. I want to believe there is something there for you to find.
"Being treated for a psychotic disorder is boring. I’ve been in a handful of programs in my life and the vibe resembled nothing so much as the DMV, or the registrar’s office at a state college."
There was a famous British columnist called AA Gill who was an alcoholic in his youth and that's almost exactly what he said. He was a topper-upper, not a binge drinker, so he was effectively drunk 24/7, and said life was a series of waiting rooms. Sitting around, head bobbing a bit, drunk, waiting to drink more. His father got him on a train one day with two bottles of champagne and a ticket to a rehab facility. He drank the two bottles, got off at rehab, and never drank again.
Anyway, yes, the lack of access to something that's proven to work and proven to be an excellent - for want of a better word - prophylactic is a huge recurring theme in American healthcare. We can spend tens of thousands on people at the emergency room but balk at the kind of preventive care that would render it needless in the first place.
I know you made some very important points about mental healthcare, but I have to tell you that your comments about the "stock photos" were terrifically funny. They made me laugh aloud.
I esp enjoyed the interior monologue in this one
I went on an internet deep dive once and found that preventative care doesn't pay for itself. Its just more costly. for example: https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html
There are plenty of articles if you look, but if you don't look too hard, you can find plenty of news articles that reinforce that preventative care saves money.
Is any of it like the group therapy I see on the Bob Newhart show (the original 70s one)?
Group therapy in my city is still remote-only because of COVID hysteria. It's so stupid and infuriating I had to opt out, I don't think it was a net benefit for my mental health, just trying to control my temper at the sanctimonious irrationalism for two hours every Wed. It's too bad because the program looked like something that could really help me. I'll go back as soon as they resume in-person, question is how many more months until the hysterics concede that vaxxed in-person meetups are perfectly safe?
Thanks. Very informative for those of us with no experience. Also great job keeping it entertaining with the stock picture analysis lol.