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Jumping in here.

I suspect that the number of people who could benefit from quality therapy, greatly outnumbers the amount of quality therapists that exist in the world.

To the point where, I surmise, a vast majority of the world's population simply would not have meaningful access to it, due to location, finances, availability, introversion, etc.

So for me, it's not that "get therapy" is bad advice. Good thing is good. Therapy has proven techniques and results. But that doesn't help the majority of the world's population, who do not have access to the luxury of visits to high end trained professionals that only exist in suitably affluent settlements of certain countries.



Honestly, echoing some of mancerayder's sentiment here - I actually think there's a ton of mileage one can get from a not particularly extensively trained listening partner - I think there are cases where you genuinely need a highly qualified therapist, I think there are situations where an under-qualified individual can do a great deal of harm when dealing with someone with particular types of mental issues, but I think there's also a huge amount of therapy that can be done by someone a whole lot closer to an RN or a PA than an MD.

I also suspect that the broad lack of coverage for therapy and other kinds of mental care in most medical plans, as well as a "treatment/cure"-type paradigm when it IS covered ("we expect your 40 years of accumulated neurosis to be adequately addressed within 6 months, otherwise we're not going to pay anymore") is part of why this is out of reach for many people.

(I also suspect providing the population with broad access to mental health care would almost immediately pay for itself in terms of better physical health outcomes, improvements in the crime rate, and better economic outcomes, but that's the kind of second- and third-order thinking we're pretty notoriously bad at in this country, policy-wise)


Therapy, and consequently the background and training of the therapist you see, is broadly subdivided into 2 different fields:

1) what I refer to as "psychiatric" therapy, with a specifically "medical" way of doing things. It's based on diagnosis and pathology, with a focus on treating the underlying causes of mental health problems. This typically amounts to chemical intervention. The provider will always be someone with a medical license, typically an M.D. or PsyD, although it can also be an RN or PA; someone who can prescribe drugs. While not always the case, talking with them is generally limited in scope to what is necessary to provide a diagnosis and appropriate medication management. It's normal to have appointments on a monthly basis initially, often stretching to a brief visit every 3 months as one's condition stabilizes. You will need to continue to see them for as long as you take medication (although you can sometimes convince a primary care physician to take over medication management once an effective treatment regimen is established).

2) what I refer to as "psychological" therapy, this is often in the form of talk therapy, and focuses more on cognitive understanding and behavioral modification, and can even be as simple as having someone listen to your shit, put it into a reasonable perspective, and provide emotional support or even just providing human interaction. Often the provider will have a Master's or Doctorate in psychology, which is NOT a medical degree. While some psychiatric doctors will also handle this type of therapy, it's much more often they'll refer you to someone who does this. It's quite common to see this person for an hour each week, but can be more or less often and may also include group therapy. They focus on teaching coping skills and can provide CBT and the like. Some people may continue to benefit from this therapy and go for years, others may stick around just until they establish the coping skills needed for their situation.

I'm probably over generalizing, but it's uncommon to start out not knowing what to expect at all, so if even one person reads this and benefits, it was worth me writing this long post on my phone at 2 a.m.

I also have a bit of a warning, with either type of therapy, it's not uncommon for patients to think they should see results pretty quickly, and when they don't they will assume it's not working and discontinue treatment or assume their therapist is inept and jump between several in short order. Imo, this is the worst thing someone can do, it may take a few months for medication to show results and more often than not the first few tries can fail to help, and it can literally take years to develop behavioral changes and coping skills to the point they show real benefit. People that give up on therapy too quickly can end up losing all faith in therapy for the rest of their life, and losing that kind of hope can even worsen their problems. I struggled from my late teens and all the way into my 30s before I really began to really feel like I hit an appropriate balance in daily life, and that isn't guaranteed. However now if I fall apart, I can put myself back together in a matter of days instead of wallowing for years.


> it's not uncommon for patients to think they should see results pretty quickly

For me it took a long, long time to see results. Like 2 sessions a week for 6 months... then see slight improvement... then a major regression after some difficult life events... then another year of thinking I wasn't seeing progress... then rapid improvement.

But, in retrospect, there was constant progress that I wasn't in the right frame of mind to observe. One of my issues was that I had spent decades learning to ignore my issues. It took a lot of progress on that issue before I could see most of the other progress I had made.

One thing I could observe quickly was just how bad things were. Almost every session was revealing new ways my thought patterns were making things hard when they didn't need to be. Not what to do about those thought patterns yet, but just that they were there. That convinced me to keep doing the hard work. I'm glad I did.




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