Sometimes the problem is…ME?

by Thomas Ellis, PsyD, ABPP on March 9, 2010 · 5 comments

in stigma,therapy

The good news and bad news about the fight against stigma is that we’ve come a long way but have a long way yet to go. The dark days of the Salem witch trails and huge, prison-like institutions for the “insane” are thankfully behind us, yet we continue to struggle with marginal insurance coverage for psychiatric disorders and soldiers who avoid seeking mental health services because they fear (not without some justification) that their military careers might be jeopardized if they do.

Where to start?

Such social forces often can seem beyond the reach of the average individual. Yet, as Roger Verdon humorously showed us in a prior post, there is a place where we all can make a difference, starting today:  ourselves. A renowned psychologist, the late Albert Ellis (no relation to me, but an esteemed mentor), authored an article years ago called “How to Deal with Your Most Difficult Patient: You.” Written for fellow therapists, it revolved around one of Ellis’ consistent messages:  that none of us—no human being—is without irrational beliefs, unrealistic demands and maladaptive behaviors.

To this, Ellis added a profound observation. As if these difficulties were not enough, we often compound the problem—two problems for the price of one!—by putting ourselves down for having them:  “You idiot. What’s the matter with you? Can’t you do anything right?”

Talk about stigma! And then we take it a step further and insist that it’s not OK to get help for these problems. “It’s a sign of weakness. I should be able to solve my own problems. Only crazy people go to therapists and counselors.”

Who says stigma is only about society?

As it turns out, stigma is not only something that’s inflicted on people by someone else or by impersonal social forces; it’s also about what we do to ourselves, day to day, moment to moment.

Ellis referred to this process as “symptom stress”:  being depressed about being depressed, anxious about being anxious, ashamed of being angry, even fearful of being happy. I recall, during my first days in training at his institute, being advised to always consider dealing with this issue first with a new therapy patient; failing to address (for example) the patient’s shame about needing therapy would leave in place a significant obstacle to working openly and effectively in that therapy. I find this to be sound advice to this day.

Ambivalence about therapy

It is interesting that we mental health professionals, while believing in the benefits of psychotherapy, remain ambivalent about our own relationship to it. Studies show that most therapists have at some point pursued their own therapy (one would hope so!), yet this is seldom a topic of discussion, either at professional gatherings or in less formal settings. One senses a lingering fear that fellow professionals might look askance, perhaps silently revising estimates of one’s competence, personal or professional.

On the other hand, in my experience, students and trainees are less likely to share this unease (might this be a generational difference that they will carry with them into later years?). My own graduate training program years ago actually required all doctoral psychology students to seek therapy (a rare scenario anymore), and I remember being pleased that I had an excuse to do so (hey, it’s a requirement—not that I actually need it).

Therapy as an educational prerequisite?

I have often wondered what it would be like if there were an expectation, if not a requirement, that everyone, whether in primary, secondary or post-secondary education, were asked to experience the process of talking with an objective and caring person, reflecting on thoughts and feelings and candidly exploring problem areas for healthy solutions. We all had health and p.e. classes, so why not p.e. for the mind?

Short of this utopian vision, are we as individuals willing to reconsider our own attitudes, if not to seek formal therapy, then at least reduce our self-stigmatization? Can we do away with expectations that we ought not to have problems or ever need to seek someone else’s help or support?

In a future post, we will explore strategies for shifting self-judgment and condemnation to attitudes that embody greater acceptance of imperfections and needs. Perhaps—just perhaps—if we can start treating ourselves better, we might begin to treat others better and thereby influence society after all.

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