What I would like to share with you, and in turn, hear you share your thoughts about, is chronic unhappiness. Is there ever an end to depression and its shadow? Is there a way to “get over it’? My goal is to be able to live beyond depression and to actually grow from it. Sure, I hate those books where people claim to be grateful to their depression… but I hate it mainly because I resent their ability to feel that way! What do you think?

There’s no way to “get over” problems you have no control of in the first place and, no matter what form it comes in (shitty in-law, brain tumor, Hurricane Earl, etc). Chronic unhappiness is high on that “uncontrollable” list.

So now you have to ask yourself what it means to “get over” an uncontrollable problem. Usually, it means you’ve asked yourself to do the impossible and thus given yourself a chronic headache to top off your chronic unhappiness.

Know your exact strain of chronic unhappiness so you can figure out what you can and can’t do with each one. Depression is unique in being a thought-distorting illness: it’s more than a poor outlook or a bad mood caused by bad luck or a rough divorce (or both at once). It’s a bad mood that goes on and on, even when you win the lottery or hit your 50th anniversary.

As an illness, it hits you with a variety of complicated, brain-related symptoms, like messed-up sleep, appetite, focus, energy, social urges, and sexual reflexes, and that’s not counting the storms of anger and/or anxiety. It’s a bad mood on steroids.

Having an unhappy life, on the other hand, can make you depressed, but not necessarily. Some people with happy lives can get very depressed, and some people with grumpy personalities aren’t depressed, although other people may wish they were. In each case, figure out, through trial and error, what you can and can’t do. Each strain is unique.

To “get over” your “getting over,” try cognitive therapy. It protects you from negative thinking by attacking the plausible, idiot assumptions you make without thinking, the most dangerous of which is that you should be able to get over chronic unhappiness.

Once you’ve done what you can do with your particular flavor, whatever that is, give up and chill out. It’s time to go on with work and relationships, however much your chronic unhappiness hurts or slows you down. The better you do that, the more you’ll grow.

No, no one should be grateful to aging, loss, and chronic pain—I think we’d all be happier with fewer “growth opportunities”—but there’s no choice. This is the life we’ve been given, so take pride in what you do with it, with or without depression (or a brain tumor).

STATEMENT:
“I don’t know why these blues won’t leave me alone. Maybe I inherited them as part of a gene-package deal from my creative, reach-out-and-connect-with-people ancestors. In any case, I’ve done what I can to manage them and I haven’t let them make me lazy or isolated or self-absorbed, and that’s a major accomplishment (which I’d be happy to do without).”

My younger brother is four years younger than me—that makes him 26, but you’d never know it because he acts like a freaking toddler. He’s not mentally impaired, he’s responsibility impaired. He dropped out of college to “find himself,” and he’s still searching, sometimes getting crappy jobs but mostly going on “adventures” and landing our parents with the bill (and sometimes the bail). I love him, but the older we get, the more I worry, because our parents won’t be around forever and I can’t be the one to clean up his messes—I’m not rich and I have my own kids to care for. Is there anyway to get him to take life a little more seriously?

Sorry for the obvious response, but the real question is, are you serious?

I’m sure your brother would say he’s serious about experiencing joy and living in the moment and that you ruin your chance of present happiness by worrying too much about things that aren’t going to happen. In other words, he’s not going to change.

Even thinking about trying to reform him will backfire and trigger conflict. You’ll give your brother a worried look, he’ll return that with a look of tolerant condescension, and your parents will accuse you of undermining his confidence. This will all leave you stewing about good deeds, their punishment, and his bullshit.

Forget about your responsible feelings and figure out what a good sibling should do to help one not-so-good. Your parents have shown you that rescuing him does no good, so rejoice. Since they’ve proven there’s not much you or anyone can do that will actually help him, there’s nothing much that you have to do, period.

When he makes a mess, help him help only when you think it will do good and it’s not someone else’s job; that won’t be often and it won’t drain you dry. The rest of the time, give him your best wishes, condolences, and directions on what he can do if he can get it together.

Don’t expect to feel comfortable, at least not at first. Your guilty, responsible feelings will be stirred up, but if you don’t keep those feelings hidden, other people will stir the pot. If experience and logic tell you that you’re not responsible, believe them and act accordingly, regardless of how you feel or what the rest of the family has to say.

Announce, don’t communicate. Let him know what you think is best without paying much attention to his response. Yes, it would feel better if you could get him to agree, but your need for agreement opens a door you want to keep closed.

He’ll keep his carpe diem attitude, and all you have to do is keep your end of the bargain, on your terms. He can go find himself, and you can find some peace.

STATEMENT:
Here’s a statement to keep you from trying to change him or win him over. “As much as I want to protect my brother and parents from his irresponsibility, I know I can’t. He will wind up in horrible messes. I will not stop loving him, caring for him, or doing for him if there’s a real chance to help. Most times, it will hurt to watch him suffer, but I will not turn away.”

I decided recently to listen to my friends and family and see a psychiatrist about my depression, but I don’t know whether I’ve made the wrong decision, or whether I’ve just chosen the wrong doctor. Basically, I decided to get help because I feel helpless, but my doctor wants me to do a lot of the work myself and doesn’t really help that much. It’s not just he wants me to ask myself a lot of questions (and answer them—if I had the answers, would I really be paying him?—but also deal with my insurance company and read up on the medication he suggests (he tells me about them, sure, but he says I owe it to myself to read up on them on my own, and that doesn’t make sense to me since he’s a doctor, knows everything about the pills, and he could just tell me himself). My goal is to figure out whether therapy is worth it, or whether I’m just getting help from the wrong source.

I hate to sound like your psychiatrist, but ask yourself what you have a right to expect from treatment, given what you know about its limits and your resources for paying for it.

If you want, you can spin things positively by saying that you’ve heard about good new treatments that can really help and that you’ve got great insurance that you pay a ton of money for. Of course, you’d probably be full of shit.

You don’t need to do months of research to know that no treatment has yet been acclaimed as a cure for mental illness or any other life- or personality-related problem.

Plus nothing you’ve read (or probably haven’t bothered to read) about the effectiveness of any current treatment implies that it works 100 percent of the time or that the treatment, if medical, is safe from possible side effects.

In addition, every method of “screening” for depression that you’ve heard about involves a questionnaire, right, rather than a blood test or scanning machine, which means that the burden for enduring, measuring and tracking the results of a trial of treatment falls, inevitably, on you the patient. And those are unfortunate facts of life whether you’re rich or poor, smart or stupid, board certified or not.

That’s the next problem: you’re not rich. And while you bristle at having to deal with insurance limits, you can’t afford insurance that would give you unlimited mental health treatment because it doesn’t exist. All insurance puts a limit of some kind on the amount of treatment you get and, unless you know what that limit is, you’ll use up your resources too quickly and have no idea about what, if anything, entitles you to more.

In addition, insurance limits your doctor’s fees and the amount of time s/he can afford to spend on a visit, so don’t fall for the professional who is ultra-amiable until your money runs out. Instead, look for someone who gives you what you most need in as little time as possible. In other words, beware smiles and frills because they may drain your limited resources.

Depressed people like yourself also tend to get negative and helpless ideas, which make them act negatively and passively, which makes them yet more depressed. That’s why mental health clinicians will push you to challenge your negative assumptions, learn more positive ways of thinking about your problems, and put the breaks on the depressive cycle.

It’s a cognitive kind of psychotherapy and is very helpful, although it’s often unpleasant in the beginning because you need to clamp down on your natural instincts. It’s a mental workout to make your non-depressive muscles stronger. No pain, no gain.

So yes, therapy of all kinds can be worth it, but you’ll be the one doing much of the work, not because someone else is slacking, but because mental illness sucks and both treatment and the resources to pay for it require careful management—by you.

Now you just have to decide what’s harder—doing the work or doing nothing. It might not be what you want to hear, but there’s no psychiatrist out there with a better offer.

STATEMENT:
Here’s a statement to keep you positive about a negative treatment process. “It’s hard having an incurable illness and knowing that the treatments are iffy, take a long time, and can easily use up my insurance before helping me, but I owe it to myself to give every reasonable treatment a try and become and good resource manager because that’s what I have to do.”

I’ve been in therapy for five years, and while I like my therapist a lot, I’m moving soon (my girlfriend got into grad school on the west coast), so I’m ending my treatment with her. She asked me recently though whether I was going to continue my treatment in my new town or whether I thought I’d taken it far enough, and I realized I honestly don’t know. She had some suggestions in terms of determining when and why to end therapy, but to be honest, they didn’t really help. I’ve been in therapy long enough that I don’t really remember how I coped beforehand, and while I feel much less tormented than I did when I began therapy, I’m not sure if my state of mind will crumble once I’m no longer getting help. How do you think one can determine when therapy has run its course, or whether there’s more to be done?

There’s a simple way to figure out how much talking psychotherapy you need: imagine paying full fee for it.

Before you crunch the numbers, ask yourself why you started therapy in the first place. Forget self-improvement, introspection, or generally pondering your bellybutton. Figure out what’s so bad about the way you feel and/or handle your life that you need to continue to spend lots of time and money on changing it.

Having failed to solve your problems over the past 5 years, you should wonder whether you can realistically expect a cure in the next year (no way) or whether you need maintenance treatment to keep you from slipping backwards (which is what you’ve been wondering all along).

At the same time, go back to the original question and ask yourself how much you can afford to spend on treatment each year and whether you should hold a few sessions in reserve for use in emergencies.

Unless you’re rich, don’t waste time worrying about how stopping treatment will make you feel. Instead, try stopping and see what happens. Even if you miss your therapist’s support, lose confidence, and re-experience your nervous stammer, suck it up, give it time, and the earth will continue to turn.

Next, think of therapy as a course that’s supposed to give you a specific marketable skill in exchange for your hard-earned debt. Don’t think like a college kid; you’re not there to party, please your parents, or become cool. If the first few sessions don’t deliver what you need, drop the class.

If you do have ample insurance coverage for therapy, don’t let it make you forget basic resource management skills. For one thing, many insurance policies are stiffening the limits on outpatient psychotherapies and are about to force you to do the above.

For another, being an active manager protects you from unnecessary dependence and time-wasting. Give your therapy specific goals, then examine how close to those goals you’ve come.

If therapy is more about discussion, then save the insurance hassle and start a search for a fun hairdresser. You can get your hour of talk and never have a bad hair day.

STATEMENT:
Here’s a statement that keeps you focused on making the best of limited resources instead of going for all-you-can-eat and then feeling deprived and abandoned. “I like psychotherapy and feel it’s been good for me, but it’s time, before it eats up more time and/or money, to think hard about how badly I need it, how well it’s working, how much is necessary, and how much I can afford to pay for it. The more I answer these questions for myself, the less likely I am to depend on experts to tell me what I need.”

I’ve done some research, and I think my girlfriend is bipolar. She gets into these very good moods for no particular reason, and when she’s in this mood she can’t stop talking and seems high and silly (and that’s when she sometimes drinks too much). When she’s like that, she’s more obnoxious-funny than really funny, but she thinks she’s a riot. I’m not crazy about her up times, but what I really dread is the crash that follows; it’s hell for her and everyone around her. I know she sees a shrink, so I told her what I was worried about, but she acted like I was insulting her and then she said she was sorry, maybe I was right, but she likes feeling happy and doesn’t see anything wrong with it and why should it bother me. My goal isn’t to take away her joy, but I wonder if it’s bad for her to be bipolar and, if so, what she should do about it.

You’re right to worry about your girlfriend’s highs, but getting through to her may not be easy. Manic people aren’t exactly perceptive, unless by perceptive, you mean frighteningly giddy and overwhelming obnoxious.

Meanwhile, she sees her mania as the time when she’s fun and funniest, so she may resent you for criticizing her behavior when, from her point of view, she’s at her best, wittiest, and happiest.

Being manic also comes with the certainty that you can do no wrong. Between that and the ecstatic feelings, judgment is lost in a heavy, happy mist.

That’s why, if you have bipolar disorder, you should ask trusted friends to tell you if you seem over the top—it’s an “advance directive,” like the one you would use to tell them whether to authorize CPR if you pass out—because mania makes it hard for you to judge for yourself, especially when you’re too busy dancing on cars in a bikini to notice.

Of course, your girlfriend has a milder form of the problem, but it makes her focus on how she feels, rather than on what’s happening now or on consequences. That’s why she’s heard what you have to say and doesn’t appear to give a shit.

So, instead of expressing worry and doom, encourage her to consider the risks while expressing confidence in her abilities, and respect for her right to make her own choices. If she can’t or won’t understand your warning, accept that fact and do your best with it.

You want her to heed your warning and save herself and your relationship, but if she can’t, it’s better for you to know now than to spend months and years in a negative struggle, trapped in an unhappy mist that will drive you crazy yourself.

STATEMENT:
Compose a statement that makes your best case in a non-coercive way. “You’re usually very responsible and good with people, but I worry about your high moods because you seem to get carried away more than you realize, lose touch with how other people react, and drink too much, and afterwards you’re always depressed and very unhappy. Don’t trust my view if you think I’m prejudiced; ask others who know you and ask a professional whether the mood swings might get worse. Then, whatever you decide, I know you’ll be thinking about what’s good for you, rather than what feels good.

I like my brother’s girlfriend—she seems like an all-around good person—but I really worry about the two of them together. They fight constantly, and from what I can tell, the things they fight about are things that are never going to change. Like, she hates that he works so late, but she knew he was a chef when they met and that the hours are long, and he loves his work and isn’t leaving it for anyone. Then he hates how stingy she is about money when it means going without things they don’t need, even when they can actually afford it. I hate to see them fight, but they seem absolutely determined to stay together even though neither one of them wants to, or is able to, change his or her lifestyle. I see that they love one another, and my brother wants to marry her, but I worry that they’re locking themselves into a lifetime of unhappiness.

You’re right not to criticize a relationship that is obviously important and meaningful to your brother, for obvious reasons. What feels like worry to you will feel like criticism to him, with no good results to your relationship or his.

You can help him think rationally, however, (or at least satisfy yourself that you’ve done your best on that score), if you first show obvious respect for him, his girlfriend, and their effort to make things work. Keep your fear to yourself, because it always implies disrespect for his choices. Think like a hostage negotiator, with your brother’s future in bondage.

When he brings up an issue in their marriage, don’t talk about solutions; you’ve already decided there aren’t any, and trying to find one will just make you impatient. Instead, ask him about what will happen to him and her if they are who they are and life does what it does.

The key component you describe as possibly missing is acceptance—she can’t accept the hours dictated by his profession, and he can’t accept her money management–so it’s reasonable for you to wonder what’s likely to happen as their jobs become more complicated, they have kids, one of them gets sick, i.e., if life happens.

If you believe, as you do, that the things they can’t accept aren’t likely to change, then ask him whether, given the worst case scenario for his schedule and her spending, he thinks he can accept her as is and vice versa. You can share the notion that you think acceptance is a more important predictor than love of whether a relationship is likely to work.

Remember, you’re not asking him whether he thinks they’ll be happy together, because marriage is often painful and unhappy for everyone. Non-acceptance, not unhappiness, however, is what blows marriages apart.

You’re asking him whether they’re likely to be able to continue to do business together and, if not, what impact that will have on their lives. If he hears you out and still goes forward with marriage, then at least you can accept that you did your best.

STATEMENT:
Here’s a statement of your mission. “You’ve got three good things going for you: you love one another, you really want to make things work, and you’re actively trying to find out whether you can live together. You can’t necessarily control your own work and money habits, let alone someone else’s, so you never know whether you can make things work, no matter how much you love one another; but doing what you’re doing is the way to find out and, as long as you have the courage to accept what you find, you can’t go wrong.”

I recently started going to a doctor for my depression. She thinks I should take pills, I’ve seen lots of articles about how antidepressants don’t work and the main reason they’re prescribed is because of the huge investment that big pharmaceutical companies have made in producing and marketing them. It makes sense to me that there are better natural, holistic solutions that get played down by the medical establishment because they can’t make money for anyone and threaten the profits made by those companies. My goal is to find treatments that work best, not the treatments that server the corporate interests.

The problem with most criticism of current drug treatments is its hopefulness; it implies that there are good, effective, cheap and low-side-effect treatments for depression (that are being suppressed). If only principal clause of that statement were true.

Sure, a magic bullet, holistic or otherwise, would be great (there are lots of other unsolved and incurable problems I can work on, so I’m not worried by the hit my business will take).

The truth is, however, that current treatments are time-consuming, weak, often costly, sometimes risky, and not guaranteed to work

Please resist the temptation to change the subject to tell me why current treatments are costly and often ineffective. You’re entitled to be angry about that sad fact, as about any other of the tragic, unfair and irritating facts of life, like tailgaters, the fact they cancelled “Firefly,” and almost anything having to do with hospitals and health insurance.

As much as I agree with you, I don’t want to hear it; you’ve got a job to do, and anger is a distracting escape from facing what you need to deal with if you’re going to manage treatment decisions for depressive illness. Instead of getting mad at your hand, play the cards you’re dealt.

Your treatment choices for depression aren’t that complicated…once you accept the fact that there’s no way to tell in advance which treatments are going to work or what side effects you’ll encounter. If you’re not in a hurry (i.e., if your depression isn’t about to push you out a window or immediately end your relationship with wife and family), you begin with non-medical treatments, like cognitive behavioral therapy, exercise, and diet and life-style changes.

If the symptoms are severe or longstanding or coming back after previous bouts, then you also experiment with antidepressant medications. This isn’t because Pfizer decrees it so, but because non-medical treatments are unlikely to perform miracles and an antidepressant medication improves your chance of recovery, even though it also has possible side effects.

If you want to try holistic remedies first, by all means, go ahead, but approach those treatments with the same care you would conventional ones; do your research to see what the data show in terms of results and what the side effects might be. Most data are inconclusive, but if you believe the treatment is working, then take that placebo to the bank.

Either way, you know the major principle of risk management: the more desperate your condition, the greater risk (pain, side-effects, cost, etc.) you should be prepared to bear in your effort to manage it. Draw on your own experience of your symptoms, their severity, and their impact on your life, as well as what the experts tell you about them, to decide how desperate you are.

It’s not a big pharma conspiracy against your health; your options just aren’t that great, and you have to figure out which one will work out, if not perfectly, then best.

STATEMENT:
Include your doubts about medication in a statement that focuses on management, not resentment or silly hopes for hidden cures stashed away in a cave with Sasquatch. “If I ever decide to use medication, it will be because I’m desperate and other methods haven’t worked. At that point, I’ll try to figure out their benefits and risks by looking at scientific, controlled studies, not emotional statements based on single cases or uncontrolled, badly selected patient populations. I will consult specialists and authorities to explain why they place faith in particular data or don’t like someone else’s data; but I will then make up my own mind, shutting out my emotional response to charisma or sincerity or a desire to include everyone’s opinion. When it comes to decisions about my health, I deserve a good, objective risk manager—me.”

I know the tranquilizer I take is addictive and interferes with my memory, but it’s the only thing that works when I get really anxious, and the other drugs I’ve been given for anxiety made me sick and didn’t work. I’m anxious because I’m stressed by some unusual recent events, which I’m sure I’ll get over in time, and then I won’t need to take medication. So my goal is to get the medication that works for me and avoid the stuff I know is going to make me sick.

It’s wonderful to get relief from severe anxiety, which is a terribly painful and frightening sensation. So I hate to make you more anxious by telling you that, unfortunately, there’s no good, safe medication that provides rapid relief.

The medications that provide rapid relief pose high risks of addiction and impair memory and balance, and the medications that are safer don’t provide rapid relief. That’s not very reassuring, but if you don’t cowboy up and face that fact, you’re in for trouble.

Remember, anxiety isn’t the worst thing that can happen. Much worse is what anxiety can make you do, like avoiding whatever stirs it up, medicating with alcohol, and making it your goal to feel less anxious. Given these dangers, your real goal is to do what you can to reduce anxiety while not letting it change what matters to you.

Don’t stop trying alternatives to addictive drugs because previous trials failed—that’s anxiety whispering its lies. It tries to tell you that everything that caused you pain in the past should be avoided now and in the future.

If you find yourself listening to that shit, you desperately need some cognitive therapy to help you straighten out your thinking. You can get it from books or a therapist or hanging out with anxious people who have learned how to manage their fears. There isn’t an actual Anxiety Anonymous, but there are groups like it.

If you stay with your current plan, you’ll not only lead a restrictive life, but you’ll tend to choose immediate relief over long-term advantages, whether it’s in treatment, jobs, or relationships. At that point, your anxiety is managing you, and that’s a real cause for worry.

STATEMENT:
Here’s a statement to keep you strong. “I need to develop new methods for dealing with anxiety because, as much as I wish it weren’t true, anxiety will always come back, eventually, and the tranquilizers that give me great relief in the short run will cause problems if I take them for too long. There are lots of non-medical techniques I should learn; and, if they aren’t sufficient, there are lots of non-addictive medications I should try that have a very low risk of causing serious harm. I need the courage to do what makes most sense to me, not what my anxiety would prefer.

My wife and I liked to party when we first met (nothing too crazy, we just went out a lot), but we just had our first kid, so we now spend a lot more time at home. My wife used to be a fun, bubbly person, and she still sort of is, but ever since the baby was born she’s been really stressed out, worrying that something bad will happen and the baby will die. Not stuff she could possibly prevent, just a random act that would kill our child, and the stress is so bad she is haunted by visions of our son in a casket. I think she’s dealing with this stress by drinking a bunch of wine with dinner and getting a little more than tipsy. I’ve told her to relax about stuff she can’t prevent, but she says she can’t help it, and I don’t like that she’s drinking too much, and where that’s going to go. I want to see my wife get some treatment that will relieve her stress so she can stop drinking too much.

You might wonder how wanting to help someone could be bad, and it’s because, as goals go, it’s often one you can’t reach. If you don’t accept that fact before making your plans, you’ll make things worse.

Here, for instance, there’s a good chance she’s too busy drinking and/or avoiding her problem to heed your good advice and, at least at first, she may not be able to stop herself (and if she could stop herself, you probably wouldn’t be writing me in the first place).

If you sound frustrated, frightened or critical when you talk to her, it will make her worse. Your goal is to see if you can help her, not force her into help. You can bring a wife away from wine, but you can’t force her not to (fret and) drink.

Once people get into the habit of using alcohol to treat anxiety, they often can’t stop, particularly if they’re waiting to feel better before stopping. All the while, alcohol makes anxiety worse (as well as depression, mania…the only things it doesn’t worsen are weddings and sporting events).

So, your goal for her drinking isn’t to reduce her anxiety so she won’t feel like drinking, but to provide her with reasons for stopping drinking, now, regardless of whether it makes her anxiety worse, (which it will), while she also searches for tools to feel better. You can’t make any of that fear go away, but you can give her good reasons to find ways to ignore it and focus more calmly on your baby’s bottle than her own.

Sure, remind her about the availability of treatments; but don’t be surprised if she just wants you to leave her alone because treatment makes her think about her fears, and she’d rather not/would rather open another bottle of red.

Don’t tell her that going to treatment will be enough to make you happy, because treatment is not always effective and it’s useful only if she undertakes it for her own reasons, rather than to get you off her back. Don’t tell her treatment will definitely make her happy, either, because if it doesn’t, you’re a liar and the fault is still yours.

Encourage her to consider her options, including cognitive therapies with ideas and mental exercises to counteract negative thoughts, behavioral therapies with physical exercises to reduce anxiety, and medical treatments that might ease both anxiety and the intensity of her visions.

Her biggest danger is not the pain of anxiety, but that her fear will drive her to give up doing what matters and stop her from being a good mother and wife. The fear scares her, but it’s her fear of that fear that drives her to drink, and that’s where you need to start.

STATEMENT:
Prepare a statement that gives her positives alternative and encourages choice, not compliance. “You’re a strong woman and great mother, and I’m sorry that you’re tortured by fearful thoughts, but I’m more worried about the way your efforts to avoid those thoughts are interfering with your life. Instead of figuring out whether there’s a treatment worth trying, you’re panicking and using alcohol for relief. I know for a fact that alcohol makes anxiety symptoms worse, while it also undermines your ability to make tough decisions about treatment. You’re good at decisions. Don’t let fear make them for you.”

My daughter likes to bring her young son to our house on weekends (she’s a single mom) so he can see his grandparents and she can relax. Of course, my wife and I love to see him, but he’s getting to the age where he can walk and likes to grab everything he can get his hands on, and she doesn’t seem to notice. He’s knocked books off of shelves, broken some plates, and I recently wrenched my bottle of Lipitor out of his hands just as he was getting the lid off. I’ve told my daughter that she needs to watch him more closely, and she assures me she has a mother’s intuition and always stops him before he does anything wrong. She’s wrong, and my wife and I are too old to keep up with him. My goal is to get through to her, and protect our grandson, without getting her pissed off.

Forgive me for saying so, but I’m guessing your daughter’s obliviousness isn’t new. That and a lack of condoms is probably one of the main reasons she’s become a single mother.

If you’ve been wrestling with her obliviousness for years, now is the time to stop. She’s been your daughter a long time, and if you (and having a kid!) haven’t gotten through to her by now, it’s time to raise the white flag.

It’s sad and scary to admit that her obliviousness is not going to go away and will always force you to bear an extra burden of parental worry, but if you don’t accept this fact, you’ll clash, drive her away, and reduce your chance to make things safer and hang out with your grandchildren, even after they can control their limbs.

Your goal then isn’t to get through to her, but to do what you can to improve your grandson’s safety. Do what you can afford, be it toddler-proofing your house or hiring a teen babysitter/child-chaser who can walk around for hours bent over at 90 degrees.

For your sake, hide your worry and resentment. If your negative feelings show, she’ll feel you don’t trust her (which you don’t) and then avoid you. With luck, however (and given her track record), she’ll be too oblivious to notice how you feel.

Expect problems and look for dangers, while at the same time conveying pleasure and confidence. Behind closed doors, you can share your fear and resentment with your wife, but in front of your daughter, keep a poker face.

In the long run, maybe you can teach your grandson to watch out for himself, but resist the urge to follow him with nanny cams. The hardest thing you need to do, after you’ve done what’s reasonable, is let it be. Enjoy being grandparents and lock up your Lipitor.

STATEMENT:
Here’s a statement to keep your fears in check. “We did a reasonable job teaching our daughter about safety and responsibility (as did others), but she just doesn’t get it. Now we watch out for her and our grandson, when we get a chance. Our biggest achievement, however, is not solving the problem, because we can’t. It’s bearing our worries, keeping quiet about them, and not letting them spoil our relationship with her or our ability to get on with life.”

I’ve been depressed for some time and could use some treatment, but my insurance has a big deductible, so I’ll be paying everything out of my pocket, which isn’t deep. My goal is to get treated for the least amount of money.

I’ll assume from your tone that depression isn’t making you suicidal or putting you at immediate danger of losing your job and/or family because, if it is, you need to forget about the cost of treatment and value the cost of your survival.

If depression is putting your life/work/family in danger, get a psychiatric evaluation, in an emergency room if necessary. Do not pass go, do not collect $200 (no matter how much you need it).

If that isn’t the case, there’s lots you can do to reduce the amount of money you spend on treatment…if you’re willing to spend some time, do some research, and use your common sense.

While the above question is quite short, the answer is anything but; looking for a treatment on any budget is a serious, involved process, so we have an involved, serious answer. Behold, our five step process that will help you with your depression without hurting your wallet.

Step one is telling your primary care physician (during a brief visit or even email) that A, you’re feeling low, B, you don’t have any physical symptoms (no fever, no weight loss), and C, you’d like to get some tests to rule out a physical cause of depression, like thyroid disease.

Tests will reveal if you’re feeling low because your glands, not your brain, are problematic.

Assuming your glands are good and your brain isn’t, step two is considering the options other than antidepressant medication, which, because it’s medication, always has a higher risk than non-medical therapies.

I’m guessing that medication is probably the last thing on your mind. It’s important to think about it upfront, however, because sometimes depression doesn’t wait for psychotherapy to work before causing severe pain and/or damage to your life, and medication always increases the odds for a better and faster (and sometimes cheaper) recovery.

Step two then, (postponing the issue of possible pills), is considering psychotherapies, including the how-do-you-really-feel-about-that kind. Many people assume this is the only kind since it gets lots of airtime on TV, where it uncovers exciting and unexpected changes of heart and inspires tears and plot reversals.

Despite what TV tells you, however, not everyone with depression needs psychotherapy. Psychotherapies are better at helping you manage depression than cure it, so it’s not surprising that many people with depression have had a number of psychotherapies.

Before considering a feelings-focused therapy, ask yourself and the people who know you whether there’s an issue you need to talk about. Remember, sharing your feelings with a professional is most effective if you haven’t done it before or your confidantes are unsupportive bozos and bartenders.

So, while the bad news is that psychotherapy is not a cure, the good news is that you don’t have to pay for it unless you think there’s a kind that’s worth trying. Either way, you save!

Your job is to figure out whether you (still) need one or more of them. If you want to save money, do your homework. It’s that, or pay a professional to do it for you.

If you decide that a feelings-focused psychotherapy is necessary, you may get a bargain at a state-subsidized community mental health center or a psychotherapy teaching institution. Don’t assume you should see a therapist every week, because you may get just as much bang for your buck by making the meetings less frequent.

You haven’t completed step two, however, until you consider other psychotherapies, particularly cognitive behavioral therapy or “CBT”, which is a good option if your negative thinking (caused by depression or being human) is making you more depressed.

Read books on the negative thinking caused by depression and anxiety (like The Feeling Good Handbook by David Burns) and decide whether you need to do thought exercises to stop your negative feelings from becoming negative beliefs or actions. If you find it useful, look for a therapist who “does CBT” or “DBT”, a form of CBT that focuses on thoughts of self-worthlessness and the desire to injure oneself.

Please note: we’re not recommending all kinds of self-help. In fact, if you see a self-help book about “healing the inner hurt,” run the other way as if it were on fire. If Dr. Phil recommends a book, we forbid it.

Step three is taking a break from the books and tuning up your diet and lifestyle. Exercise is a powerful antidepressant (the way you feel afterwards, not during, anyway). Vitamins and omega three fatty acids help, and, despite what most people think, drinking and drugs don’t, so learn to abstain.

Finally, read up on antidepressants while ignoring the eye-witness accounts of horrors and miracles. Consider the risks (fairly low, despite what Scientology says) and possible benefits (positive, but delayed and very iffy). Then, if you decide that the risks of staying depressed are worse than the medication risks you’ve read about, ask your primary care physician for an “antidepressant medication trial.”

Remember, you’re conducting a trial, not taking a cure. Note, quantify and record your symptoms and possible side effects over the next few weeks. (There are programs on Google that can help you do this). You’re the one who decides whether the new medication is doing more good than harm.

If a couple medication trials haven’t worked, the very last possible step, number five, is to get a referral to a psychiatrist and give him/her a list of the medications you’ve tried, the doses, how long you took them, and the good and bad things you noticed. You can find a psychiatrist on the cheap at the same clinics we sent the feelings-focused types to.

Follow these steps, and you’re on the road to dealing with/managing your depression. It’s not a cure or an easy answer, but it’s a start, and hopefully this is all the information you need to start on a good path to treatment without paying a pretty penny.

STATEMENT:
Here’s a statement of purpose that will counteract depressive helplessness and pessimism. “I don’t know why I’ve been feeling depressed and I may never know, but I know how to find any causes that are worth finding and to try the cheapest treatments first. I expect to run into a lot of dumb ideas about depression because many people want to believe they have the answer and an easy way to control it. Whether or not I can control it, I know that, by doing the research myself and using professional help whenever I think it’s necessary, I can do a good job of taking care of myself.”

My parents have decided to retire, sell the big house I grew up in and move into a smaller condo closer to my sister and me. The move makes sense—my sister and I are adults with our own families—but it’s brought up a sort of taboo issue for my parents, which is my mother’s attachment to stuff. She’s not a hoarder, but if my dad wasn’t around to put his foot down, I sometimes worry it could be, because my mother has trouble throwing anything away. She says that moving all the time as a child has given her a different appreciation of objects, and that it’s better to regret having too much stuff than to miss something you threw away and can’t get back. Problem is, there’s no room for this stuff in the new condo, they won’t have the budget for storage, and my sister and I aren’t able to put all of her old work files, souvenir spoons, and elementary school textbooks (seriously) in our basements. What I’m afraid will happen is that my father, who has always taken responsibility for managing their money, will try to get my mother to agree that they can’t afford to move and store her stuff when they move, she’ll keep complaining, and he’ll get nasty. How can we get my mother to learn to let go?

I know you and your father want to make your mother happy and have harmony, but it looks like she’s not eager to adapt a sparse, Zen lifestyle.

The problem is, trying to make someone happy when it’s just not possible usually causes more unhappiness. False hope is dangerous, no good deed goes unpunished, and stuff happens (sometimes in great quantities).

There’s no way you can spare your mother the pang of parting from her horde. Trying to do so, while well intentioned, makes your father assume responsibility for her pain and its relief. In reality, life imposes the problem, not your father or any other member of your family, and it’s your mother’s job to deal with it, because no one else can.

Ask yourself (and your father) why he takes responsibility for a problem that isn’t really his. By managing the budget, carrying out spending decisions, and insisting on making your mother happy, he assumes total responsibility, infantilizes her, and garners himself a shitload of blame.

Tell him to accept that, while he might have failed as family manager/mom’s #1 cheerleader, he can succeed in not being responsible for any unhappiness caused by the stuff-alanche.

Seriously, you can tell him he’s done a wonderful job managing the household and your mother’s angst, but there are limits to what he can do, and that he’ll do better if he presents the situation to your mother and invites her to come up with a better solution.

In other words, instead of your father telling your mother it all has to go and your mother saying she can’t bear to part with any of it until the whole dispute becomes a clusterfuck, your father should instead do some math.

After he prices storage, figures out their fixed income budget, and sees that the two don’t mix, he can present that evidence to mom, explain how he can’t make it work, and give her the chance to find a solution.

At that point, the future of mom’s stuff collection is nobody’s fault. Hopefully, she’ll find an option that works for her, but in the meantime, you, your father, and your sister have avoided a stuff-load of aggravation.

STATEMENT:
Here’s a positive statement your dad could make to protect the family from blame while requiring his wife to share responsibility for a painful but necessary decision. “I’m glad we’ve been able to retain our family memorabilia until now, but I’ve looked at the cost of moving and storage, given that our new condo has no basement, and it doesn’t fit our budget. Please review the numbers and see if you can come up with a better answer and we’ll talk about it. One way or the other, it looks like we’re facing a painful compromise.”

I don’t know why my 10-year-old kid is so selfish and materialistic, because her mother and I aren’t. I can’t take her past a toy store without her having a tantrum if I don’t get her what she wants, and by tantrum, I mean she just keeps yelling and crying, even after I’ve dragged her out of the store and put her in the car. It’s not like we deprive her, either, because we do buy her toys occasionally for no reason, but she’s furious when she can’t get them on demand, which is all the time. She sees a shrink because she throws tantrums in school whenever the teacher wants her to stop doing what she’s doing and start something else. I’m afraid she’s spoiled and I don’t know how to undo the harm.

If the main cause of tantrums and other bad behavior in children was poor moral values like selfishness and materialism, then we’d know how to correct it by teaching better values, as forcefully and loudly as necessary.

All we’d need to rectify bad behavior is a Sunday school nun with a metal ruler.

You’ve got evidence, however, that whatever triggers your daughter’s tantrums is not simply a matter of her being spoiled, because she also has tantrums in school over the non-materialistic issue of being asked to stop what she’s doing and transition from one activity to another, sans toys of any kind.

What you’ve got here isn’t a bad set of values, but a problem in her nervous system that you don’t know how to correct. It’s understandable that you’d focus on the toys instead; you’d rather blame her and yourselves rather than face something you can’t control.

Once you face the sad fact that you’re helpless (but good) parents, you’re free to consider ways to help an unavoidably irritable kid improve her self-control.

At first, of course, try behavioral tricks you learn from teachers and therapists, because they’re less risky than medications. You learn to give her more “structure,” which means keeping her busy, providing her with clear rules, and imposing immediate time-outs when she starts to tantrum. It also means avoiding toy stores.

Therapy seldom helps if it focuses on your faults, but can be very helpful if it teaches you new child management techniques, and protects you from feeling responsible for your child’s (bad) behavior.

If non-medical treatment isn’t enough, and you think her behavior is seriously interfering with her schoolwork, friendship, and self-esteem, find out whether medications are safe enough to be worth a try.

As I’ve said many times, meds are never a cure, they sometimes don’t work, and they can often come with less-than-desirable side-effects. They’re worth a try, however, if you think the risk of her behavior is worse than the risk of the medication.

You and your daughter are in this together, and you have a lot of options for ways to manage and cope. One day, she might have a peaceful relationship with the toy store, but in the meantime, do your research, stay calm, and avoid women in habits.

STATEMENT:
Prepare a way to announce your new policy that conveys acceptance and hope. “I know that seeing new toys gives you very strong feelings that make it hard to walk away without them. We’ll help you by staying away from toy stores until you’re old enough and strong enough to manage those feelings. If you get those feelings anyway, we’ll try to find you a quiet place where you can be alone until you no longer want to scream or hit people. You’re not the only kid who’s had this problem, and we’ll get through it until you grow out of it.”

My ex and I had a drama-filled relationship and a rough break-up. Drama because I was drinking, which meant I was sometimes out of my mind, and rough because I got my shit together and tried to make it right with her but she dumped me anyway. The problem is that we work for the same boss, and now that we’re not together anymore, but I’m sober and sane, I’m wondering how to act towards her. Be friendly and normal? Are hugs in bounds? I can’t just ignore her, and I don’t want to, but things are strange. I want to show her that I’m cool, not nuts, and want things between us to be normal (whatever that means).

Be you an alcoholic or a Mormon, you have zero chance of instantly re-establishing friendship with someone you’ve just broken up with. Like cold fusion or a 2010 World Cup game without vuvuzelas, it’s never going to happen.

Since you are an ex-drinker, however, you should know that self-control is something you can never count on, particularly when your feelings for an ex-love are intense and her actions unpredictable.

Yes, you’d love to have a normal friendship; but ask yourself what your actual feelings are, and what they’ll push you to do, and what she’s likely to do in response, and, before you know it, you’ve got an answer that does not include the words “friendship” or “sobriety,” and may well include flying chairs.

Rather than holding yourself responsible for something you don’t control (always a no-no, unless you’re the President or a weatherman), your goal is to do what you can to promote mutual self-control and minimize pain. If that doesn’t meet your definition of “normal friendship,” I repeat, there is no such thing as normal friendship with someone you just ended a relationship with.

Maybe after some time passes and you both forget the hurt and bad behavior, you can get coffee together without excruciating awkwardness. For now, it’s more important that you salvage a working relationship and your job.

It doesn’t matter that you’d like to show her you don’t or do care, or that you’re happy without her, or dying because of her or that wish to re-unite/be friends/have some of that old crazy monkey sex, whatever. You’re entitled to have all those feelings and more, but keep them to yourself if you want to work and avoid a rapid re-enactment of your recent pain.

The standard operating procedure for limiting pain in these situations is labeled “polite detachment,” and blocks you from sharing or responding to feelings that fan the embers. She should get the same treatment as any other co-worker; polite hellos at the water cooler, appropriate eye contact, no flying furniture, and no hugs.

STATEMENT:
Stifle your romantic yearnings with the following directive. “My heart may want to share, but my job is to keep my job and protect my heart from receiving or delivering more hurt. So, if I seem stiff or cold, it’s not to wound, but to create a boundary that will help us both return to making a living.”

I had a tough childhood and spent lots of time in therapy learning how to take my feelings seriously and not let people step on me, so I think I did a pretty good job the other night, during a meeting of our coop board, when my neighbor, whom I like, was sarcastic about a project I proposed. I expect more respect, particularly from a friend and neighbor, so I really felt hurt and betrayed. But I was able to stand up and let him know I thought he’d been disrespectful. I was hoping he’d apologize, but afterward he walked out without looking at me. My goal is to get him to understand I want to be friends, but I won’t tolerate verbal abuse.

Sure, sometimes people are mean and shouldn’t be, and the hurt is real and devastating. It’s your responsibility, however, to figure out whether the mean people can ever recognize their meanness.

(If you’ve followed this blog, you know that most mean, hurtful people never recognize their own meanness, seeing it as retaliation for the wrongs of others, because that’s the way they are. If they recognized it they would have apologized and you wouldn’t be writing me).

When you try to hold a mean-blind meanie responsible for being nasty, he’ll tell you what you did to deserve it, and more. You’ll wind up more hurt, and he won’t.

Your background may have added to your being a very sensitive person. That’s not a horrible thing; your sensitivity probably makes you a better friend, more creative, and more tuned-in.

The downside is that being very/overly-sensitive may make you over-react, over-speak, and look bad, and then, if your right to feel offended depends on how you interpreted someone’s tone of voice (“tired” vs. “sarcastic and demeaning”), you’ll wind up arguing about the unprovable.

Your job then is to stop looking to change the meanie or bring about justice. Make the best of your relationship with him. If he’s worth the hurt, shut up, don’t fight, and keep the conversation cool, at least until you recover. If he’s not, shut up, bite the inside of your lip to keep from crying, and stay away.

In either case, keeping your feelings to yourself means less pain and more options. As a sensitive person, you always need to stop and think before you react. That’s not letting yourself get stepped on; it’s keeping your emotions from trampling all over your life.

STATEMENT:
Here’s a motivating statement: I have better missions in life than to stand up to jerks, regardless of how easily I’m hurt by them. If a worthwhile friend is a sometime jerk and can’t take a hint, I accept the pain, do my best to protect myself, and focus on what works. It’s too bad; but that’s life, and I don’t let hurt feelings determine how I deal with it.”

Most people thing my mom is really fun, if a little flaky and emo, but they don’t see how crazy and mean she gets when there’s no one around but my brother and me (my parents are divorced). When she’s in a bad mood, she tells us we’ve been mean to her, and reminds us of things we’ve said that hurt her, and tells us how bad we are until we’ve apologized, and then she forgets it ever happened. There’s one cousin who’s seen what she gets like and I rely on him to remind me that it’s OK, she’s crazy, but the other day he seemed charmed by her and then, when I complained, he told me I had to get over her and not be so angry, and now I feel totally unsupported. My goal is to get someone to understand what’s going on.

Nothing gets people more stirred up than dramatically pitched false accusations and punishments by a powerful, inescapable, totally two-faced authority, like your mama.

The good news is that, while you’ve got the makings of a perfect soap opera, it sounds like you’re not getting swept away by it.

The trouble with soap operas, of course, is that they trap the good guys into endless rounds of angry, hurt reactions to crazy bad guys. In the process, they take up huge amounts of time and energy for tears and talk, talk, talk before, finally, there’s a glimmer of comfort and validation…before the cycle starts all over again.

The process leaves no time for any other (boring, make-a-living) activities or relationships, positive or negative, and the good guys’ angry responses and efforts to expose the villain usually make them more vulnerable to slander in an endless vicious circle.

So enjoy validation if it comes your way, but don’t seek it out too intensely or your life will become ready for daytime. Besides, even if somebody sees what your mother’s really like, her behavior is not going to change. Sadly, you drew her number in the mother lottery and won a nut job.

Not to be indelicate, but, as you might have guessed, your mama sounds a little crazy. On the positive side, that basically means, while her behavior is erratic and sometimes cruel, it’s not personal, just like your cousin says.

She’s not motivated by anything except a blip in her brain, so keep that in mind when you’re tempted to “fight back,” because you can’t win against crazy, no matter who acknowledges how crazy she is.

Your goal then isn’t to out your mother as a witch from hell, but to keep doing whatever you think is positive, good for you, and likely to spring you free, like getting your schoolwork done, keeping busy with out-of-house activities, and keeping these goals in mind when she does blow up and accuse you of untold (and likely fictitious) evils.

There’s more good news in that it sounds like that’s what you’re doing; you’re not describing angry, “cry-for-help” drug-downing or cop-defying behavior that will accelerate the soap opera cycle at the expense of your health and future independence.

You’re moving ahead, regardless of anger and turmoil, and that’s what you need to do. Forget exposing her two faces, because nobody will be happy if the soap hits the fan.

STATEMENT:
Here’s a standard business plan for growing up with a closeted witch. “I’ve got good reason to believe I don’t do bad things unless she gets me mad, and I can’t stop her from getting me mad, even if the world knows it’s her fault, so I’ve got to believe in myself and pursue my regular goals, like schoolwork and building a life. I can’t expect to be happy when she gets going, but if I can keep my mouth shut and fight the temptation to join her in big, dramatic scenes, I’ll be doing a good job and acquiring an excellent training in how to be a therapist.”

I’m a psychotherapist with a small but thriving practice. I’m also recovering from an addiction to pain meds (please note: I cannot prescribe medication, nor can anybody in my practice, so there’s no ethics violation there, I got my pills like any other druggie would). I’ve been completely sober for three years now, but I’m afraid to be open about my problem with almost anyone, including my family, because I can’t see how people would respect or want to get help from someone who was as messed up as I was (and I know most drug counselors are addicts, but I think this is different). The problem is, I feel more stressed than ever. I’m burning out on my practice because I’m always staying late and trying hard to make sure everyone is settled before I let them out of my office. And I feel terrible about not spending enough time with my family, and I never have time for myself. I feel I’m in danger of slipping, but there’s no escape.

Your drug use might be under control, but right now, your life isn’t.

Your life is being managed by your need to do a perfect job and keep your patients safe and happy. Meanwhile, you’re running out of gas, losing credibility with friends and family, and slipping closer to the pit of pain pills.

You’re not at the wheel, your desires are, and we know where that road leads. Caring too much about how people feel and doing a perfect job are what got you into this mess in the first place.

You can’t make people happy, particularly if you’re a shrink. Patients are unhappy; that’s why they’re patients. So far, there’s no cure to life sucking, so, like a good physical therapist, your job is to use your time efficiently to offer coping tools. After that, it’s quitting time.

Sometimes people are helped; but sometimes they’re disappointed. Your job is to do a good professional job and then move on to other responsibilities.

Then there are patients who want to hold someone responsible for their unhappiness, and their therapist is target number one. They know you haven’t done enough, or you’ve done the wrong thing, or you need to do more. If you react too much to their beliefs, you’ll never leave the office.

Of course, you can’t stop being sensitive, because that’s your nature; I might as well ask you to start writing with your other hand or grow a foot overnight. Instead, accept your sensitivity and learn to manage it.

You need to take pride in how you manage your weaknesses and, to do that, you must first acknowledge them, not disown them. Out yourself and lay claim to the management credit you deserve.

STATEMENT:
Here’s a management directive. “I always feel better if people respect me and are happy with my work; but I will not let that need interfere with my building better self-control, limiting workaholism, and doing what I think is right to balance my life. The greater my weaknesses, the more right I have to be proud of what I’ve done with them and intend to do.”

My psychiatrist thinks I should increase my medication, but it already makes me sleepy and has caused me to gain 10 lbs. If anything, I’d really feel better getting off it entirely, because I hate being dependent on it. For the time being, I know I need it, because I’ve barely recovered from my last depression, but even thinking about increasing the dose makes me feel depressed. I’ve seen this doctor throughout my entire illness and she’s been very good with me up to this point, but now that I don’t agree with her I don’t know what to do. I don’t want to have to take more medication.

It’s much easier to have an agreeable disagreement if you’re not pushing someone with your emotions; after all, lawyers use evidence, not tantrums, to win a case.

Still, it’s hard not to push with your emotions when the issue is personal and scary. Unfortunately, you don’t have a choice.

If you don’t put your emotions, you’ll sound (even to yourself) like a kid who hates needles. Your doctor will then feel like you need protection against your fears and impulses, and so will become even more insistent and condescending (and afraid of a liability lawsuit when your fear turns to anger).

That attitude will make you feel more like a helpless kid who isn’t being heard, and long story short, it’s a vicious circle we’re all familiar with, and it requires you to shift approaches, not give in.

Besides, if you’re pushing someone with your emotions, you’ve got to wonder whether you’ve conned yourself into doing what you want, rather than what’s best for you.

Switch your language (and maybe your way of thinking), list risks and benefits, and prepare a list of the questions you need answered to make a good decision. Put your feelings aside, put facts first.

No one likes medication, but it’s your job to know enough about the possible course of your long-term, incurable mental illness to judge whether the beneficial promise of a given medication outweighs its costs and sluggish, chubby side effects.

Becoming educated about your illness and its treatment is the only way to avoid being a medical victim who feels helplessly reliant on a doctor’s judgment.

If you want to have a discussion with your doctor that doesn’t sound like you’re trying to escape the ouch of your camp shots, learn what your odds are for relapsing and whether resuming meds at the beginning of a relapse can be counted on to stop your symptoms before they damage your life and/or your brain. Also, find out what the chances are that a higher dose will make a positive difference in the short or long run.

Don’t forget to ask what evidence the doctor is drawing on for his answers. Then you’re prepared to announce your verdict as a responsible adult.

STATEMENT:
Here’s a formula for a worst case, high risk disagreement. It alludes to your fears but sticks with a managerial point of view. “I know that rejecting your recommendation carries a 10 percent higher chance of relapse, that there’s no guarantee that we can stop a relapse once it’s started, and that relapse can cause a little brain damage. But I’ve weighed these odds against the risk and side-effects of the medication and my own conviction that I’m less vulnerable to relapse now and I’ve chosen to keep the dose where it is and wean off in the not-too-distant future.”

Admittedly, I’m a neurotic, depressive guy—I’m a New Yorker, I’m normal here—but when I had a shitstorm a year ago when my girlfriend left me and my job changed/became horrible, I started going to a therapist. It was helpful to rant and get some perspective, but now I really think I’ve come through the other side of the situation and don’t need therapy anymore. My therapist, on the other hand, thinks I still have a lot of work to do, because we never really talked about my relationship with my father (not great) or why I had trouble with my ex-girlfriend. Thing is, I don’t really think my dad has anything to do with anything, and I know what my problem is with my ex-: I chose badly. How do I convince my therapist I’m ready to leave and that there’s nowhere deeper to dig?

There are always therapists out there who, when it comes to accepting the fact that people are the way they are and treatment is a limited tool, need more therapy than their patients do.

What your therapist may have trouble facing—more so than you—is that your treatment has produced all the change and relief that it’s going to, despite the fact that you still have pain and other problems.

Many therapists can’t accept imperfect results. They feel they’ve failed if they can’t help you and, so as long as you’re suffering, they’ll look for a deeper level of change.

If they could bring themselves to accept you the way you are and let go, they could also become more creative about teaching you methods for minimizing the harm your behavior can cause. Obviously, this is not the case here.

So prepare for your decision by gathering data about whether or not it’s really time to stop. See your therapist less often, or take a designated break, and see what happens.

If you slip back into that shitstorm feeling, your goal is to figure out what the treatment was doing to help you, whether you can get that help for free from any other source and, if not, how often you need to see your therapist to sustain the benefit.

If, after running that test, you decide to stop treatment but don’t want to get drawn into a fight with your therapist in which you sound like you’re trying to avoid your homework and your therapist sounds like a concerned adult, there are 2 options.

You can lie, and tell your therapist you’re feeling better and last night you had a dream about a happy bird flying high above the clouds and missing its nest down below but confidently soaring towards the mountains in the distance where your dad and ex-girlfriends were waiting to give you a hug.

Or.

You can be straightforward and truthful, telling your therapist exactly what you told me, backed by the results of your experiments with withdrawal, and stick to it.

After all, you’re an adult who can make your own decisions, and your therapist will have to accept your decision. And if s/he can’t seem to cope, s/he’s the one who needs time on the couch.

STATEMENT:
“I know I’ve still got problems but I think I’ve got what I’m going to get from this treatment and I’m managing things well enough. I wish I were less grouchy but I don’t think that’s going to happen and, meanwhile, it’s not doing me any harm. I’ll always look for new ideas about how to manage my problems but, for now, I don’t think I need more psychotherapy.”