We Keep Going to Therapy, Even if We Don't Know How It Helps

When I started this blog, the topic of mental health wasn’t everywhere as it is now; writing about it was a bit revolutionary. I loved that. I'm edgy and welcomed the chance to be a person who pushed the envelope.

For context, TikTok didn’t exist, nor did influencers, nor did people post on social media (to everyone they knew and everyone you knew) about their personal mental health.

You had to be pretty secure in your fame to be open about your experience of living with a mental illness, and day-to-day people certainly didn’t put I go to therapy on their dating profiles.

In terms of social media, we were firmly in the world of referring to ourselves in the third person on Facebook, and Twitter was just a toddler. Pop culture moments: Kanye West interrupted Taylor Swift at the VMAs, Miley Cyrus was Hannah Montana, and we stopped working to watch Michael Jackson’s funeral—on our desktop computers.

Perhaps it's an understatement to say that things have really changed.

All these years later, as a therapist, I routinely create a safe space for people to talk openly about their mental health—but behind a quite literally closed door. As an advocate, I’ve been mostly thrilled to see the expansion of people (not just the famous) talking openly about mental health. (The part of me that’s a little less excited is worried that we will either pathologize normal experiences or normalize experiences that are actually concerning.)

There was an entire issue of The New York Times Magazine devoted to therapy, and I was not surprised but also a little worried. The issue sat in my to-read pile for more than a month. I decided to start at the beginning, with Susan Dominus’ piece “Does Therapy Work?” Go big or go home. Right?

Dominus recounts her own experiences in therapy and weaves together interviews with therapists and researchers. She positions us in the here and now, this moment when it is okay, really okay, to say you’re in therapy. She writes: “Over the decades, and especially since the pandemic, the stigma of therapy has faded. It has come to be perceived as a form of important self-care, almost like a gym membership—normalized as a routine, healthful commitment, and clearly worth the many hours and sizable amounts of money invested.”

I anxiously read that “hundreds of clinical trials have now been conducted on various forms of talk therapy, and on the whole, the vast body of research is quite clear: Talk therapy works, which is to say that people who undergo therapy have a higher chance of improving their mental health than those who do not.”

But, research has also shown limited effects of talk therapy alone. As David Tolin, director of the Anxiety Disorders Center at the Institute of Living has said: “Maybe we have reached the limit of what you can do by talking to somebody. Maybe it’s only going to get so good."

Anecdotally, I recommend medication as a corollary to therapy to most of the folks I see in my office because if our brains are not working in our favor, we deserve to give them a chance to heal the same way we would another part of our bodies. Having seen people come in week after week and talk about the same challenges, and having seen those same people make significant progress by utilizing medication in addition to therapy, I really believe in the power of this combination.

But, where Dominus goes with her piece really touched me, because it got to the heart of what I believe motivates many therapists to continue to do the work, through a global pandemic, online, and often enough, without appropriate financial reimbursement: The relationship factor. She writes: “Hundreds of studies have found that the strength of the patient-therapist bond—a patient’s sense of safety and alignment with the therapist on how to reach defined goals—is a powerful predictor of how likely that patient is to experience results from therapy.”

When I am thinking of the people who sit on the couch in my office (or in their chairs at home), I am thinking of the vulnerability they have allowed, the laughs we have shared, and the heartbreak they have trusted me to hold.

Last week, every person I saw cried. To have a place where you can just sit down and cry—and have another person bear witness to your pain, your sadness, your fear, without judgment, without pushing you to “just feel better”—it seems worth something. I imagine it would be terribly hard to research: “Did you feel better after you cried in front of your therapist?” But, often enough, people actually say that, unsolicited. “I feel better.”

Copyright 2023 Elana Premack Sandler, All Rights Reserved