Your Friends are Not Your Therapist

    A lot of people think that therapy is just an un-interrupted hour in which people talk about their feelings, vent about their problems, and/or get advice from their therapist. Because that's the way so many people think of therapy, they also think that talking to their friends and going to therapy with a licensed mental health professional are the same thing. Those same people are also quick to point out, "Therapy costs money, and I can talk to my friends about the same stuff FOR FREE."

    Yes, it's always good to be able to talk to your friends about your life, including your mental health. Yes, your friends can be great at listening to you and helping you sort through some life-related issues.  But...YOUR FRIENDS ARE NOT YOUR THERAPIST and expecting them to be is unfair. I also feel like this needs to be said: talking to your friends about your mental health, although it can feel wonderful to unburden yourself to someone when you're dealing with a mental illness, is not the same thing as actually treating your mental illness so you can recover and heal your brain.

    On the most basic level, your friends are not qualified or trained to be able to SAFELY help you with your mental illness. Psychology (and counseling since it's part of psychology) is an actual science that takes years to study, understand, and use properly. Therapy is the actual scientific treatment plan that a licensed mental health professional uses with their client to be able to treat and manage the mental illness and the other ways that our brains can become unwell. Expecting your friends to take on the responsibility of being your (unofficial, untrained) therapist isn't only dangerous for them because they may take on your trauma as their own trauma since they aren't trained to properly set up boundaries like a therapist; it's also dangerous for you as well because your friend doesn't really understand how your brain is unwell in order to help you, which could actually create new ways for your unwell brain to become even more unwell when your friend says or does the wrong things.

    On a deeper level, treating your friends like your therapist will ruin your relationships. When you treat your friends like your therapist it can make you and your friends feel like they're responsible for your healing. That's a lot of weight to put on someone else's shoulders, especially when they weren't meant to pick it up in the first place. It's impossible to maintain a friendship when you expect things from the other person that are literally impossible things for them to give you. Your friends can't heal you from your traumas, especially when you're dealing with a mental illness that you're refusing to get actual treatment for, because your healing is your responsibility, not theirs. 

    I'll end with this: Talking about your mental health with your friends is generally a good thing. Expecting your friends to be your therapist instead of getting the real therapy that you actually need, however, is never a good thing. Your friends are not your therapist and expecting them to be is unfair and dangerous for you, your friends, and your relationship with them. 

It Takes a Team

    Friends and family will often say things to me like, "I'm going to ask my doctor for some Prozac or Paxil or Zoloft. I've been feeling depressed/anxious, and I just hate feeling that way." Then they'll go to their general practitioner family doctor, and they come back with a bottle of the psychotropic medication because the doctor wrote them a prescription for it, pretty much because they told the doctor they wanted it. When I ask them about a therapist and a psychiatrist or mention the words "mental healthcare team" they incredulously reply, "I don't need any of that stuff. I just need these pills from my doctor, and I'll be fine." (Spoiler: Most of the time, they're not fine with whatever they asked to be prescribed, and then they're angry that the medication didn't make them feel "fine". Sometimes the medication even makes them feel worse.)

    It's common practice in my state for general practice family doctors to prescribe psychotropic medications to their patients without consulting or referring to a psychiatrist or a licensed therapist for counseling. Family doctors here hand out anti-depressants, anti-anxiety medications, and some mood stabilizers like they're Advil or Tylenol. Pediatricians even prescribe ADHD medications for small children and anti-depressants and anti-anxiety medications to their teenage patients. Here, a person's general practice family doctor is usually the first and last stop for mental healthcare.

    Did you know that your general practice family doctor isn't supposed to prescribe medications to treat mental health conditions? I did not know this until I was majoring in psychology in college, and most people in my area do not know this. Let me put it like this: Getting psychotropic medications from your general practice family doctor is a bit like asking your cardiologist to prescribe the right eye drops to treat your eye infection.

    A general practice family doctor doesn't have the specialized training that is required to know how medications for mental illness (AKA psychotropic medications) work with the brain to treat the mental illness. Sure, they know what the pharmaceutical sales rep told them, what's on the package insert, and they know what the medication is prescribed for...but that's not enough to SAFELY prescribe them. They don't understand what these medications do as they work with a person's brain chemicals to make them feel differently or how they interact with each other if more than one medication is needed. The only medical professional that is specifically trained to understand how psychotropic medications work in the brain, with the mental illness that lives there, and what combinations of medications work well with or against each other is a psychiatrist. A psychiatrist is actually a medical doctor who specialized specifically in the study of the brain, mental health conditions, and the medications meant to treat them.

    Your general practice family doctor should definitely be involved in your mental health treatment, but your general practice family doctor should NEVER be the only person treating your mental health condition. Treating mental illness should ALWAYS involve a team of professionals. That team should include a therapist for counseling, a psychiatrist for prescribing any needed medications if medications are part of the treatment plan, and then your family doctor to help monitor the medication in your body and to consult with the psychiatrist about side effects and medication levels and your overall health.

    I'll end with this: Treatment for mental illness isn't a thing that can be accomplished by one single medical professional. Mental health treatment requires a team that includes a licensed mental health counselor for therapy sessions, a psychiatrist to prescribe medications, and your family doctor for things like monitoring the medications and side effects. Your general practice family doctor should NEVER be the only member of your mental healthcare team, and your family doctor should NEVER be the person prescribing your psychotropic medications. The only person with the proper training and knowledge to SAFELY prescribe psychotropic medications is a psychiatrist. 

Focusing on the Good

    Sometimes, feeling hopeful is hard. I feel like we've all had a period in our lives in which we hope for things, and then it feels like one gut punch after another when most or all of those things don't work out the way we had hoped or needed them to. After each gut punch, it gets a little bit harder and a little bit scarier to hope. It can feel like the next logical step is just to stop hoping and accept that things won't work out because that seems to be the pattern we're stuck in.

    Feeling hopeful has been particularly difficult for me for the last few years. More and more often over the last few years I've found myself thinking, "Yeah. There's no point in even hoping for that because I know it won't happen." Recently, I got a little worried about myself when I realized that hope-squashing thought had pretty much become my life motto.

    I addressed this concern with my therapist in my session. She told me that instead of only thinking about the times that I hoped for something that didn't work out, that I should think about the things that I had hoped for that did work out. She also told me that instead of focusing on the things that I felt like I wanted but didn't have in my life yet, to focus on the good things that I already had in my life while I wait.

    It's sort of like that saying, if you're always on the lookout for a spider, you're more likely to find a spider. If you're on the look-out for something, your brain is more likely to find it or, sometimes, even generate it for you. By thinking, "X happening is the pattern," you're programming your brain to pick out the examples that support that thought and disregard examples that don't support that thought.  Of course, if I'm thinking there's no point in hoping for something, I'm going to find more examples of when I hoped for something that ended up not working out. If I'm thinking that it might be okay to have some hope, I'm more likely to find examples of when I hoped for things that ended up working out. 

    Whenever I feel that hopelessness creeping back in, and whenever I catch myself thinking that I shouldn't hope for something because it won't work out, I try to think of a list of times when I hoped for something that did work out. Then I can shift my thinking to, "Yeah, things feel impossible right now, but X, Y, and Z also felt impossible at the time, and those things worked out. So, something has to work out eventually. The waiting is really hard, and I hate it...but right now I have X, Y, and Z that I hoped for in the past."

    My default is still to tell myself not to hope, but I made a New Year's resolution to try to be more hopeful in 2022 so I'm working on it. Some days, I literally have to list off everything over the last year or so that I hoped for that I have now so I don't get completely lost in the land of hopelessness. It's still a work in progress, but I can feel it making a small difference. 

    I'll end with this: The way we think about certain things programs our brains to cherry pick evidence from our lives that supports the way we already think and to disregard the things that don't support the way we think. So, if we think we shouldn't hope for things because it won't happen, of course, our brains are going to only pick out the instances that support that thought, which is going to feed that feeling of hopelessness. The only way we can actually fight that feeling of hopelessness so we can start feeling hopeful again is by focusing on the good instead and thinking about all the times we hoped for something that worked out.