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Are We Over Therapy?

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Illustration: Johanna Walderdorff

In January, I quit therapy. I told people (including my therapist) that it was about the money — specifically, that I was about to have a lot less of it. I had just been laid off from a job where I was, in retrospect, wildly overpaid; without it, I could no longer justify the $300-per-session fee. (My therapist, of course, didn’t take insurance.)

And it’s true — it was about the money. But also, I … wanted to quit.

I first found my therapist after I lost a pregnancy in 2022, and for a long while, our time together was helpful. Lately, though, I was using our sessions to cycle through the same three objectively dumb topics: the way I was constantly making plans I didn’t really want to keep, my worries about whether I ever would (or even could) write a second book, and my increasing anxiety at work. I would bring up the same issues; she would give the same advice. Nothing changed. (Well, until the universe took care of my job.)

Sometime in the past decade or so, my friends started talking about going to therapy like going to the gym: as a nonnegotiable healthy habit you’re supposed to keep forever. But lately, I’ve suspected there are an increasing number of therapy quitters like me — people who have been helped by talk therapy but are in the mood for a less examined life. “It’s just déjà vu,” said Rebecca, a 46-year-old in Medford, Oregon, who recently quit therapy after four years. “I just keep saying the same shit, and they keep telling me the same thing.” I, for one, am tired of talking about myself this much.

We’re still in a post-pandemic therapy boom: Late last year, a report in JAMA Forum noted that 38 percent more people were in mental-health treatment compared with pre-pandemic levels. And even as a therapist shortage persists, the idea of therapy has firmly embedded itself in the culture. “Go to therapy” is now something to emblazon on a T-shirt or brag about on your dating-app profile. Pop stars somberly sing about their “intrusive thoughts”; in a single verse on her latest album, Ariana Grande name-checks codependency, therapy, and self-soothe.

“It feels like therapy is everywhere — it’s on subway ads, it’s every podcast ad, it’s inescapable,” said Amanda, 31, who lives in Brooklyn and recently quit therapy after four years of going regularly. Telehealth start-ups like BetterHelp emphasize in those ads that “therapy is for everyone,” a message some seem to have internalized as “therapy is for everyone — forever.” But even mental-health professionals will tell you therapy is not meant to be an indefinite self-improvement project. “I don’t think you necessarily should be — or need to be — in therapy forever,” said Emma Mahony, a licensed therapist in Philadelphia who sometimes encourages her clients to take a break or at least to reduce the frequency of their sessions.

Lately, I’ve suspected there are an increasing number of therapy quitters like me — people who have been helped by talk therapy but are in the mood for a less examined life.

It feels as though the longer you’re in therapy, the healthier you’re getting — or the more you’re healing, to borrow the language I’m often served on TikTok. But is that true? One review of the scientific literature, published last year, looked at the results of 19 studies and found no difference between shorter- and longer-term bouts of psychotherapy on a depressed or anxious person’s level of functioning. With therapy, it’s not clear that more is always more.

When I started therapy, I needed to talk through the miscarriage, but once I started feeling better, I found myself searching for reasons to feel worse. Carrie, a 29-year-old who lives near New Haven, Connecticut, had a similar experience with the therapist she saw for nearly a decade. Last fall as she prepared to get married, her therapist would bring up family issues she had shared in sessions over the years. “She would ask a lot of questions about family relationships around the wedding,” Carrie said. “It was like she was searching for a problem that wasn’t there.” Sometimes, Carrie would nod along and follow her therapist down the emotional rabbit hole — come to think of it, yes, that family member was causing drama!

“And then I would get out of a session and think, What was that?” she said. “Like, am I just talking out of my ass about this because she’s pulling it out of me?” Fifty minutes is a lot of time to fill when nothing much is bothering you. “I felt like I was searching for things to talk about,” said Carrie, “and it was bringing on negativity I didn’t feel was really there. I already do that on my own, so having someone egg me on — that’s really not good for me.” Not long after, she stopped going.

One of the bedrock assumptions of psychotherapy is that it’s important to talk about your problems. “You might imagine, based on what you hear from clinicians, that if you try to suppress something, it’ll come back to bite you,” said Michael Anderson, a professor of cognitive neuroscience at the University of Cambridge. But he has spent 20 years studying the opposite idea — that suppressing negative thoughts can in fact improve your mental health.

In a recent study published last fall in Science Advances, Anderson and his colleagues took advantage of a highly anxious moment — the pandemic — and instructed a group of volunteers to suppress their worries about the future. These instructions, by the way, were not complicated: When shown a reminder of the negative thought, the participants were to simply acknowledge it without dwelling on it. They weren’t supposed to distract themselves by substituting a happy thought in its place; they weren’t supposed to change the way they felt. They were just supposed to stop thinking about it.

It appeared to help: After undergoing the training, these volunteers reported less anxiety and depression compared with a control group — benefits that persisted when the researchers checked back in three months later.

But can’t worrying be useful? As I’m writing this, I’m pregnant again and recently learned I may need a C-section. If I were still seeing my therapist, I would have spent something like $1,800 talking about every possible terrifying outcome of having major abdominal surgery; the budget version of this has so far been Googling variations on “c-section reddit.” I’ve been telling myself it’s helpful — how else would I have learned what to bring to the hospital? But lately when I search, all the links come up purple, an embarrassing signal that I’m doing what I used to do in therapy: retreading the same old territory. What if I just … stopped?

“I think in some ways I was using therapy as a crutch, as an excuse to be able to say, ‘Oh, well, I’ll just talk about this with Jared,’ rather than dealing with it with my husband or my son in real life,” said Rebecca, the 46-year-old in Oregon. Recently, for example, she mentioned to her son that her baby grandson might need glasses. Her son rolled his eyes and brushed her off. She felt the urge to yell to make her point, and in the past, she would have — and then she’d have recounted the whole thing to her therapist, Jared, secretly hoping he would tell her she was right.

Instead, she remembered the way he would gently point out that she can’t control everything and that yelling won’t change that. She took a breath. And said nothing else.

In a recent essay, the writer P.E. Moskowitz touched on this; their therapy sessions had become lengthy bouts of self-reflection into why and how they feared ambition. “Instead of solving the issue at hand, I was concerned we were actually exacerbating it — finding more and more reasons I was scared of accomplishment and thus almost justifying them, instead of me, well, just doing the things I want to accomplish,” wrote Moskowitz, who ended up quitting therapy.

There’s a self-confessional tone in their essay, almost as if by admitting to quitting, they’re sharing something a little bit controversial. And maybe they are. My friends and I gossip about people like Jonah Hill for misusing therapyspeak, but we also use words like process and avoidant attachment without bothering with the air quotes anymore. In my lifetime — even just in my adulthood — therapy went from something shameful to admit to doing to something shameful to admit to not doing.

But it must be said: Some therapists are bad! Over nine months, my friend Heather tried to find a therapist who would take her insurance. She saw three: one who made an offhand comment about Joe Biden being replaced with a body double, another who dismissed her reasonable frustration over pricey medical bills, and a third who told her, one month after her dog died, that she should have been over it by now.

In my lifetime — even just in my adulthood — therapy went from something shameful to admit to doing to something shameful to admit to not doing.

And despite its ubiquity, it’s not even clear that talk therapy is the best mental-health treatment for everyone. I suspect many of us already know this. Earlier this year, a study published in the BMJ found that various forms of physical activity — jogging, yoga, strength training — were as or more effective than cognitive behavioral therapy or SSRIs at treating depression. That’s notable in and of itself, but perhaps more interesting is how viral it went on Twitter, suggesting that people are craving alternatives. For a while, people online said things like “Running is my therapy,” until other people online pushed back on that, insisting that only “therapy is therapy.” But is it really so outrageous to suggest that something like physical activity — something that satisfies a basic human need — can be therapeutic?

In some ways, we may be expecting too much from therapy and from therapists themselves. Mahony, the therapist from Philadelphia, recently said as much on TikTok. Too many people “are going into therapy and are like, ‘I’m putting it all on this person to change my life,’” she told me. “That’s a lot of pressure to put on a therapist!” In some cases, people may be depending on their therapists so they don’t have to risk depending on themselves — or their friends.

Perhaps one of the more insidious concepts to come out of the rise of therapy language is “trauma dumping,” which has in some circles morphed into the idea that it’s inappropriate to share your problems with your friends. “I think I’ve regretted opening up to certain people in the past. That’s definitely something I’ve internalized — ‘save it for therapy,’” said Elaine, who’s 26 and lives in North Carolina. “But I don’t want people to see me as a sealed box.”

Last fall, Elaine stopped seeing her therapist; soon after, her dad was diagnosed with ALS. For a while, she didn’t talk about it with anyone. But recently, she confided in a co-worker almost 20 years her senior, whose dad had died when she was in her 20s. It’s not like it was better, necessarily, than telling a therapist. But it might have been more meaningful.

“I shared something really vulnerable with her; she shared something really vulnerable with me. We were trading information about our lives,” Elaine said. “And therapists don’t tell you about their lives — or when they do, it’s, like, kind of weird.”

Maybe a more useful way to think of therapy, for some, is to seek a discrete solution to a discrete problem. Elaine expects she will return to therapy this year to help her prepare for the loss of her dad. Carrie, the 29-year-old from Connecticut, recently went back to her therapist while in her third trimester of pregnancy, looking for emotional support in transitioning from one kid to two.

“But I don’t plan on making it a long-term thing because I feel like I have all the tools,” Carrie said. “I know what I should be doing.” I know what I should be doing too, and I get a private thrill every time I can DIY my mental health. I can box-breathe with the best of them. I can locate an emotion within my body. I can recognize when there may be a physiological reason for, say, an increased heart rate, instead of a psychological one. And when I want to, I can shut my thoughts down and actually do something instead of talking it to death. The training wheels are off. The safety net is gone. Anxiety is a luxury I can no longer afford.

Related

  • The Therapy-App Fantasy



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Melissa Dahl , 2024-05-13 14:00:13

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