After a brief hiatus, Stopgap is back… with some sad news: I may be breaking up with my therapist.
The separation is not by choice. In America, switching jobs means switching health insurance plans, which so often leads to losing access to the medical care you once relied on. (A different rant for a different newsletter.)
I’ve been consistently seeing my therapist at least two times per month since 2017. That sounds, I’m sure, like a remarkably long amount of time — especially in the age of Talkspace, BetterHelp, and TikTok, which emphasize quick fixes for acute problems, rather than long-term therapist-client relationships. (Please read this great story from Molly Fischer.)
Even cognitive behavioral therapy (CBT) — one of the most popular, evidence-based psychotherapy approaches — typically lasts for 12 to 20 weeks. After those few weeks, the thinking goes, the patient should be armed with enough “tools in their toolbox” to successfully regulate their emotions, cope with a recent loss, or overcome a trauma.
CBT surely has its place in treating certain patients or disorders, but I worry that when it comes to mental health, quick fixes have become the norm, rather than an option.
I’m grateful for the lasting partnership that my therapist and I have built over the years. It has been one of my longest, and most cherished.
***
In 2017, my stomach started to cramp after every meal. I constantly felt nauseous, or bloated, or in pain. I cut out dairy, then sugar, then alcohol. Nothing helped. I dropped nearly 20 pounds in just a few months.
I saw three different gastroenterologists, an OB/GYN, and my primary care doctor. When every test came back normal, not one of them concluded that the root of my symptoms might be anxiety.
Had someone suggested that my pain was psychological, I likely would have scoffed. But now I know that chronic depression and anxiety are very real, very serious, and — more often than not — very physical disorders. That is to say, “mental” illness is not “all in your head.” It’s in our bodies.
***
It wasn’t until October of that year — weeks after I broke up with my boyfriend and found myself crying in Target on a Monday afternoon — that I finally decided it was time to talk to someone.
I had only seen one other therapist in my life, during my sophomore year of college: a middle-aged white woman who spent more time telling me about the successes of her adult children than asking about my own crises. So, when it came time six years later to choose someone new, my criteria was short: She had to be young and tight-lipped about her own life.
After over a month of emailing, playing phone tag, and getting ghosted by at least a dozen potential counselors, I ended up in the office of a twenty-something telling me that I seemed “a little rigid” and suggested I try yoga. She asked when I’d like to schedule my next appointment. I told her to have a nice day.
***
Then, there was Lisa.
I sat across from her in a brightly-decorated room in a Rittenhouse high-rise and felt instantly calm. I joked that she was the second therapist I had seen that week, and she asked why I had dumped the previous one. “She was really, um…prescriptive,” I said.
She nodded and proceeded to ask a long list of intake questions.
I cried, and cried, and cried.
That’s how therapy went, every other week, over many months. No sooner would I open my mouth then the tears would well in my throat and spill out of my eyes. I owe that poor woman at least a dozen tissue boxes.
Then, one day, I noticed my stomach had stopped hurting. I could go many hours without thinking about what I had or had not eaten that day. I went on a solo trip to London and happily indulged in Indian food, pasta, fish and chips, and ham sandwiches. I took a sightseeing cruise on the River Thames on an unusually warm April day and breathed a full breath of air for what felt like the first time in a year.
I realized that the persistent knot in my stomach was not Crohn's disease or stomach cancer. It was grief. Therapy had allowed me, finally, to release it.
***
Still, I didn’t feel “cured.” New problems emerged, then went away, and circled back around. I cycled through family losses, romantic relationships, friendships, managers…and one failed foreign venture that left me jobless, sleepless, and more lost than ever before. Lisa was there for all of it — listening, watching, and recording.
We did at one point make a treatment plan with goals that I have since long forgotten. I’m sure “feel less anxious” was on the list, and, for the most part, I achieved that.
But for me, therapy has never been about finding a solution to a specific problem. It’s served me instead by loosening the knot in my stomach, week by week, leaving me to feel in greater control of my mood, my mind, and my body.
***
Recently Lisa reminded me of all of this — that four years ago, I couldn’t get through a sentence without bursting into tears; that every bad day would send me spiraling into a fit of despair.
Now, this person — whose judgment I trusted whole-heartedly, after sitting across from her for somewhere close to 100 hours — was telling me that I am more regulated, more confident, a better communicator, and more willing to trust my own instincts. It was the most welcome performance review I’ve ever received.
People talk about “finding yourself” during long periods of solitude, in nature or on cross-country road trips. But the truth is that often the best way to find yourself is through someone else.
Perhaps this is the greatest utility of a long-term therapist: not as an analyst, but as a biographer — someone you trust, who shows up consistently, who reminds you that you’ve grown and are still growing in just the way you ought to be. Without someone charting that progress, you can start to feel stagnant, or lost, or inauthentic; the knot in your stomach will never unbind.
As Anais Nin once wrote: “We do not grow absolutely, chronologically. We grow sometimes in one dimension, and not in another; unevenly.”
I’m certainly still growing in all directions. I am “mature in one realm, childish in another.” And I’m not sure where being Lisa-less will leave me. Starting over with a new therapist feels daunting, but the prospect of going through life without that listening ear feels even more so.
I suppose that no matter what happens, I’m just thankful that I didn’t need to rely on self-therapy or mental health influencers to get me through my darkest days. Like with any long-term relationship, long-term therapy is hard. It takes time and work to build intimacy — but it’s the kind of work that leaves you feeling secure and stabilized in a world that is constantly going to throw you off balance. So I encourage you, too, to build that kind of connection with someone who’s rooting for you. I promise it’s worth it.