Addendum – Mental Health and Treatment and the Goals of Mental Health Professionals
I wanted to clarify issues brought up in a previous post or two on this blog.
The poster who calls herself Donna Hazel, if I am recalling and understanding correctly, was mistakenly assuming that I was absolutely demanding and insisting that if CBT (Cognitive Behavioral Therapy) or BA (Behavioral Activation) therapy helped me personally with depression (and my on-going anxiety) that it would and could also help an online friend of mine who has depression.
That is not so much what I was declaring, no.
I do not think it would hurt this now ex friend of mine, whom I referred to as “Emma,” to at least take a look at and consider some of the CBT and BA related links I sent her (some were articles, some were videos by therapists or psychologists on You Tube). (I will write more on this below.)
To her own detriment, I don’t think “Emma” even bothered to view any of the videos or articles I linked her to; I think she just glanced at their headlines and was infuriated I was sending her something other than non-judgmental emotional support for a change.
Some mental health professionals are very sensitive to critiques of their field. I’ve seen this before on other sites where I write.
Some mental health professionals take criticisms of their profession in stride, while others take it as a personal affront, and they will leave cranky replies to your article.
(And by the way, no, you don’t need to have a college degree in some field to criticize it and to notice flaws with it or with some of its practitioners or their approaches.)
Yet other mental health professionals love to argue over which and what therapies they think “are best.”
Some psychologists and psychotherapists may dislike or disagree with BA or CBT – which is all fine and dandy.
GOALS OF TREATMENT
One of the goals in American psychology is to get a patient functioning.
I have learned that from college level psychology courses I took, and one can find this information online now, as well.
A lot of mental health conditions, as described by American psychiatrists and psychologists, aren’t considered a problem until and unless those mental health issues impede the ability for a person inflicted with them to enjoy life, form healthy relationships with others, hold down a job, etc.
Many of the articles and books I’ve read by mental health professionals will explain that a lot of problems and behaviors exist on a continuum, such as narcissism, codependency, and OCD (obsessive compulsive disorder).
(And no, not all of these exist in the DSM V but are still recognized by some mental health professionals as existing.)
Using OCD as an example here, most literature I’ve seen will state that most everyone has some elements of OCD in their behavior – such as wanting to neatly line up items or keep things very organized and clean – and mental health professionals will tell you this is actually very normal behavior.
Wanting to keep things neat and organized only becomes a problem and gets into diagnosable OCD territory if the actions begin interfering with the ability to do things like enjoy life, get out of the house, and hold down a job.
Again, one of the main goals of a mental health professional is helping a patient to begin functioning again, so that,
for example, if a patient has severe anxiety and avoids people due to a fear of making social blunders, this may be holding this person back from dating or advancing at a job, the mental health professional will work with this person to lower or over-come these fears.
(Link ): The Major Goals of Psychology
Finally, and perhaps most importantly, psychology strives to change, influence, or control behavior to make constructive and lasting changes in people’s lives.
4. Change / Control
Psychology aims to change, influence, or control behavior to make positive, constructive, meaningful, and lasting changes in people’s lives and to influence their behavior for the better. This is the final and most important goal of psychology. …
…By using Pavlov’s theory, and by following the four goals of psychology, individuals can try to change behaviors.
….How Can You Use the Four Goals in Your Life?
If you’re trying to change something in your life or develop a healthier habit, consider using the four goals. To start, visualize your goal. What is that you want?
…Change/control in a personal setting can also come in the form of breathing techniques, meditation, or mindfulness.
It might come in the form of wanting to conquer post-traumatic stress or another anxiety disorder, a frequent goal of cognitive behavioral therapy.
In short, seeking the goal of change/control can involve anything that helps you to take charge of and modify your feelings, thoughts, or behaviors. Because changing or controlling something can be a difficult task, getting help from a trained professional can help.
— end excerpts —
There are more pages online that discuss what the goals of therapy and psychology are, and from that, and from what I recall of learning in my college days, helping a patient get back into life, achieve milestones, goals, being able to function again, all play a role.
There is nothing I can recall in all my reading that states that a primary or sole purpose of a mental health professional is to give nothing but emotional support to a patient, and at that, with no attempts of healing a patient, or getting a patient to function again (and functioning even in spite of having anxiety or depression, even if neither totally dissipates).
This quote may be familiar to most anyone who is reading this post:
The definition of insanity is doing the same thing over and over again and expecting a different result.
The above is what I kept alluding to in regards to poster “Donna Hazel” and my friend “Emma.”
I think that salient point slipped right over their heads.
“Donna Hazel” struck me as a show-offy person who thinks because she teaches psychoanalysis at some university that she is the “end-all, be-all” of knowing the limits of psychology, or what will work or not with each and every depressed individual – which is a pretty arrogant view. (But she seemed to be accusing me of that.)
I’ve known this “Emma” person since around 2014 or 2015, and we’re now in the year 2021. That’s at least six or seven years.
If CBT or BA cannot work for this particular depressed person, or for any depressed person, okay then, that is not my dispute.
Resistant to Change or Even Considering It
My point is that with some troubled or depressed people I’ve known, such as “Emma” and others, they apparently expect their outlook, depression, or situations to improve by not changing a thing, or doing or trying anything different.
Some of these individuals have something else going on way beyond the normal negatively- tainted thinking caused by clinical depression, to the degree they are hostile or very resistant to even CONSIDERING the POSSIBLITY that there may be something new they can try that may decrease their depression or solve whatever problem they are having.
I used to have another online friend, a lady I knew for over ten years, who lived in another state from me, who spent about two years complaining to me continually about how lonely and friendless she was – her husband’s career kept getting him sent out of country, leaving her home alone.
This friend would regularly e-mail me to complain that she was lonely because she had no lady friends.
For the first twelve months, I offered this friend that much coveted non-judgmental emotional support that all negative, depressed, and upset people crave, but a year of that from me to her did nothing to bring her friends.
By the second year, in spite of all my emotional support, this lady was still writing me to cry and complain that she was lonely.
That is when I began offering her suggestions on how she could actually make friends.
This friend though, after about three or so weeks of me nicely offering suggestions on how she could maybe make new friends, went on to Facebook one day to complain, “When I complain about being lonely, I just want empathy, not suggestions or advice!”
See, this friend of mine was not willing to change anything.
Her habit was to stay at home all day in her den, on a cell phone or Lap Top, either playing online video games, or complaining to me on social media or e-mails about how lonely and friendless she was.
I gave her empathy, but I realized after a year of this behavior by her that her complaining to me for over a year about being friendless was not resulting in her making friends.
The odds of this person ever gaining a friend (and thus easing her loneliness) was about zero, so long as she did not actually leave her house to go out and be around new people by getting a job, volunteering at a charity, taking college courses, joining a new church, or what have you.
This holds true for many other situations and types of people, including depression.
I am not a mental health professional, but I’m well into middle-age now, and I’ve realized, thanks to life experience, and having had to deal with many friends, family, and co-workers who had depression, anxiety, marital and job problems, etc, there are limits to how beneficial it is to give nothing but emotional support to a troubled or hurting person for months on end, or for years on end.
So… while people like “Donna Hazel” may love the idea of people giving the depressed (nothing but?) emotional support,
and she may dislike CBT and BA (and have god only knows what preferred treatment strategy),
she (and some people with mental health problems and other kinds of problems)
apparently fails to acknowledge that engaging in the same behavior day in and day out is not likely to bring about desired change (ie., making new friends, decreasing depression, or whatever the individual’s goal is, etc).
For a desired outcome, the person will likely have to do something, some kind of change (change in thinking processes and/or behavior) to bring it about.
–That was my point.
If you’re an anxiety-striken person who is afraid of dogs, for example, then spending all your life in-doors on a sofa avoiding dogs is not likely going to . . . somehow cure your fear of dogs.
If you have depression, and your usual routine is to stay at home watching TV or playing on Facebook all day, and engaging in negative thinking or behaviors (such as consistently complaining to other people about how terrible your life is, or life in general is), the odds of your depression decreasing or vanishing is around zero.
That was my point.
I don’t care what a person tries to conquer their issue, whether it’s CBT, BA, or some other type of medication or therapy – but they need to do something, because if they keep doing nothing, keep the status quo going, then nothing will change.
I’ve found (and this is true for me as well) that while getting emotional support feels good in the short term, that in the long term, it does nothing to actually improve the person’s life, to heal them, or solve their problems.
With my experience of having been diagnosed with clinical depression by a psychiatrist in the 1980s, on up through seeing other psychiatrists and therapists into the 1990s to the early 2000s, and taking psychology courses in college in the 1990s, I never once read or heard a mental health professional advise me or others in my situation to do nothing.
I never once heard from a mental health professional I saw, or psychology text books I read in college, that the “treatment” for clinical depression was to stay inert, and to not even try to get out of bed, shower, etc.
Nor did I hear it was “impossible” from those sources for someone with clinical depression to hold a job, engage in hobbies, or attend classes.
I was told, and I experienced, that energy and motivation are greatly lowered with depression, but none of that prevents someone from making changes or engaging.
During the years I had really bad depression, I often did not feel like getting out of bed and leaving the house, but yes, I did so.
If you’re seeing a mental health professional who isn’t urging you on to overcome issues, and maybe giving you techniques to deal with them, to work to change and meet goals, this person is really not helping you and is wasting your time.
It doesn’t matter to me WHAT types of specific treatments or techniques this mental health professional prescribes, so long as they get you to function again – that was my point – not arguing over how effective C.B.T. is or is not, or does C.B.T. work (or should it work) for each and every person who has depression.
This page is informative…
(apparently there are some therapists who do not have goals for their patients – which means they are probably not that helpful to their patients!):
by Michael Karson Ph.D., J.D.
One of the many detriments of a medical model for approaching anxiety and depression, the two most common topics of psychotherapy, is the diminishing art of setting goals.
…Many therapists don’t set goals with patients. Some assume the goals are implicit and need not be stated overtly.
…If therapists don’t set goals, it’s often because they and their patients understand that the goal is to find love, work engagingly, enjoy life, or feel their lives have meaning.
I prefer to make these goals explicit, even if they never come up again.
Some therapists, I’m sorry to say, don’t set goals because they don’t like the idea of subjecting their work to measurable criteria. The latter can signal failure or a time to stop (when goals are achieved), which can be aversive for therapists.
Recent developments in the field of therapy have reacted to the image of the know-it-all doctor pontificating about the patient’s life and psyche.
Now you often see therapists who think they can keep from imposing their own values on patients, which leads them to doing it unconsciously.
The result is a generation of therapists who think they are not allowed to co-create the goals of the therapy with the patient.
Patients want help overcoming their fear of riding the bus, and therapists think they are not allowed to ask where the bus is going, whether to see if they want to help the patient get on it or to see if the fear may be of the destination rather than the ride.
This tendency is especially pernicious when the patient wants relief from anxiety or depression and the therapist doesn’t even wonder what the function of the problem may be.
I think it is important to ask patients what they would like to be doing with their time and energy if they weren’t anxious or depressed. This approach allows therapists to decide if they are on board with their patients’ goals, and it articulates an outcome that can inspire the patient.
It also sets the stage for psychology to enter the picture when therapists direct attention to patients’ efforts to do these things directly.
For example, patients say they would socialize more if they weren’t depressed.
Often, it is the case that not socializing is causing the depression rather than the depression causing isolation, but even if that is not the case, it is useful to wonder what step the patient would take if he or she were to socialize. Then, the therapist can focus on what keeps the patient from taking that step.
…Some barriers are not psychological. The therapist cannot arrange for the availability of rewarding work or a reciprocal lover. This is what Freud meant when he said the goal of psychoanalysis was to replace id (“it”) with ego (“I”).
He meant that patients must learn to take responsibility for themselves.
Other in-therapy goals include resolution of conflicting agendas, reconciliation with reality, acceptance or understanding of the self, and so on. These can lead to engaging work or romantic love, but they can’t guarantee it.
…Therapists who claim not to have an agenda cannot be counted on to pull their oars as energetically as their patients, and this leads to going in circles.
(Link): 10 Signs Someone’s Always Playing the Victim (6.05 long video)
(Link): The “Victim” Narcissist | How to tell who is playing the victim (17 minute long video)
Applicable to Emma (and to “Donna Hazel”):
This post has been edited after publication to add additional comments
(Link): Emma Responds – My Comments