10 things a year as a therapist taught me about life, work & growth

As of 6pm on Friday, I am no longer a therapist.

It’s a strange, bittersweet feeling. For over a year, being a therapist was more than just a job–it was part of my identity. Work didn’t get to stay at work; it was part of my life in a deeply profound way. My co-workers became my supporters in ways that were unlike anything I’d experienced at any other job; the concept of a “mental health day” took on an entirely new meaning, being present in my work became more important than ever.

Looking back on the past year, it’s hard to pick out the things that I learned from being a therapist as opposed to things I learned simply by getting another year older (and maybe a few months wiser). But that, I suppose, is why self-reflection has become such an important part of my growth process. I’ve written before about journaling and how daily reflective practice has changed the way I spend my time, but it really has made a huge difference–not just in my ability to look back at moments of gratitude, but to watch myself experience learning and growth. It’s also allowed me to read old entries and see the places where I learned hard lessons and received some painful reminders of my own limitations–limitations that, thanks in part to that active self-reflection, I was sometimes able to turn into strengths.

But not without challenges, and not without luck, and not without help.

For better or worse, I’m a lists person, and I do my best memory collection through organization. So, here we are:

10 Things a Year as a Therapist Taught Me about Life, Work & Growth

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listening to the wise mind

Readers, it may have come to your attention, as you’ve followed me throughout this blogging adventure, that I’m a bit of a feelings person.

I mean, I’m a therapist, so it makes sense that I’m a feelings person in the sense that I understand feelings. I get feelings. I can look at someone’s face and body language and figure out what emotions are bouncing around their head. I can pluck an emotional heartstring like the prettiest darn harp you’ve ever heard. I can sit down and process emotions with someone in my sleep (not that I would, since it wouldn’t be very nice of me, but still: doable). But there’s more than that when it comes to being a feelings person.

When I talk about being a feelings person, I tend to mean that I listen to my feelings first and my thoughts second. I get vibes. I look for emotional energy in a room. I tend to trust my gut instincts over a logical argument. If my feelings are stuck somewhere, it’s hugely unlikely that any amount of thought or logic is going to change them, much to the annoyance of my therapist, who likes to tell me that there’s a breakdown in my cognitive triangle.

My husband, on the other hand, is totally a thoughts person. This dude is thought-oriented like you wouldn’t believe. He likes logic. He likes reason. He spent a few months as a philosophy major just so he could hang out and talk about logic and reason with other logic-and-reason-minded people for hours on end. He gets very confused when I flail around about feelings and he doesn’t understand why I can’t grasp simple concepts of logic, and then gets much more confused when I explain that I understand his logic perfectly, my feelings just don’t care about it.

So, fellow therapists, the feelings person and the thoughts person–sound familiar?

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The Wise Mind idea is a concept that comes out of Dialectical Behavioral Therapy, a treatment approach that combines cognitive and behavioral therapies. It was originally designed to treat borderline personality disorder by Marsha Linehan, a psychologist who developed the model based on her own lived experience with mental illness and suicidality.

The idea of the Wise Mind is simple: When we make decisions based only on reason, we miss out on the impact of emotional experiences. When we make decisions based only on emotional impulse, we miss out on the knowledge and logic that the rational mind provides. The Wise Mind combines both of these intelligences, and allows a person (or, in our case, a family) to take the logical experience of the rational mind and the sensitivity and feeling of the emotional mind to approach an issue with serene, informed confidence.

DBT is designed to be an individual approach, but I’ve had the luck of watching it apply in my marriage as well. This past weekend, the Husband and I went out to Westchester to explore the place where we’ll be living come April, and I just about had a panic attack in the car. I didn’t really like the apartment we had already decided (in a previous Wise Mind conversation) that we were going to take. I didn’t like how far we were from town. I didn’t like that I couldn’t walk to work. I didn’t like so many things.

But while I was flailing, Husband was thinking. And when I stopped flailing long enough to come up for air (and also to take some more migraine medication, because that was just adding insult to injury on a rough day), he gave me the rational mind approach. But he also listened to my emotional mind, and gave me room to have all of my feelings (and there were many). And what we ended up deciding, once again, was that yes: this was the right choice. This was the right, wise choice for our family–not just the family we have now, but the family we hope to have in the future.

Listening to the wise mind isn’t easy. As an emotional mind person, I tend to dig my heels in. I latch, stubbornly, onto anxiety and fear and worry, onto nervousness and apprehension. I don’t like change, and I fight tooth and nail against all logic attempting to remind me that change is, in fact, a part of life. The wise mind, as far as I tend to be concerned, can screw right off.

Fortunately, I’m not the only one in charge of making sure I listen to the wise mind. Until I learn how to do it myself, I have plenty of help. And I’m even learning to step away from my insecurity over needing to be independent, and accepting the help that’s being offered.

Maybe I’m learning to be wise after all.

preparing for change (or: the anxious girl’s guide to major life transitions)

It may seem odd coming from someone who helps people navigate life transitions for a living, but I actually really hate change. I’m a person who loves routine and predictability–there’s a reason why I love my planner so much and why I’d rather grit my teeth and deal with the devil I know rather than letting myself contemplate the anxiety of the devil I don’t. I’d like to play it cool and pretend that this anxiety only comes up about major transitions, but unfortunately I’d be lying–I once spent a half-hour in tears because the husband wanted to rearrange the living room.

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Yeah. That was a fun conversation.

As I’ve been working to improve my ability to embrace vulnerability, it’s ben a difficult journey for me to step back from my automatic reflex of recoiling away from transitions themselves and to instead let myself experience and process that discomfort. And allowing myself to feel anxiety and worry and stress as I approach a series of pretty huge transitions that will be happening all at once just got a lot more important: in just a little over a month, I’ll be starting a new job, and husband and I will be relocating. That means finding a new home and everything that comes with it: new friends, new favorite coffee spots, new doctors, new commuting tricks, all that jazz. For someone who tends to react to “hey, what if we changed our furniture around?” with vague, high-pitched shrieking sounds, this is a huge amount of change all at once. As excited as I am for the new opportunities in the job I’ll be starting in New York, it’s hard not to find myself totally overwhelmed by the amount of decisions, moves, and communications that will have to be made over the next few weeks.

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Embracing vulnerability or not, even a self-described martyr to the cause of anxiety like me can acknowledge that it’s not healthy to spend a month and a half in a constant state of stress and worry. Fortunately, I’ve spent the weeks and months leading up to this process figuring out what I need to make it bearable, and now that we’re heading into the crunch time period, I feel…Well, not great, not even all the way to okay, but not immediately on the verge of a panic attack 24/7. So that’s progress.

The collection of tips I’m sharing tonight have helped me a lot with managing my own stress and anxiety about the moving and job-search process. They’re not meant to be a one-size-fits-all approach, and your mileage may vary in terms of whether or not they work for you. Also (standard disclaimer here), this isn’t meant to be taken as clinical advice. While following steps to reduce anxiety and stress and overwhelming feelings can be very wonderful, this list is in no way a substitute for actual therapeutic interventions. If anxiety and stress are serious problems in your life, please consider contacting a mental health professional in your area. ❤

That said, here you are:

An Anxious Lady’s Guide to Managing Life Change

1. Make a visual.

I’m a hugely visual learner, and whenever I set out to do a big project, I need to have a visual map of the steps that project is going to involve. Being able to see everything I’ll need to do put right in front of me allows me to get a “big picture” view of the process while still seeing the smaller tasks that keep it from getting overwhelmed.

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Shoddy pictures courtesy of my four-year-old phone. Sorry, kids.

I like to do this using the game-changer maps in my passion planner, but there are plenty of other ways to do it, too: flowcharts, goal maps, goal snowflakes, etc.

I think the reason this process calms my anxiety is because it takes away some of the unknowns. When we think about moving or job searching, it can feel like there are a billion moving parts, too many things to keep track of. When everything is laid out in front of me, it feels easier to relax and not panic that I’m going to forget to do something.

2. Break it down.

Once the main goal is mapped out, I break it down into smaller steps. I tend to do this by making more goal maps, partially because they’re pretty and I like doing arts and crafts, and partially because it’s a good representation of how my brain works. These breakdowns tend to have more specific, objective goals: sending two job applications a week, responding to emails, sorting through books, etc.

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If you’re a less map-y person, having just a straight-up to-do list can be just as helpful. The goal is to break it up into sections. Rather than having a giant list with tons of tasks all mixed together, separating it by type of task (buying, organizing, donating, contacting, etc) or area of task (rooms in a house, networking groups, etc) can make a huge difference in how daunting something feels.

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One of the sticky notes that hangs out on my MacBook desktop.

3. Figure out where you’re dragging your feet (and why).

Whenever a huge task comes up with a ton of different moving parts, there will always be aspects of that project that make even the most motivated person start dragging their feet. For a novel, it might be writing That Super Emotional Scene, with a job search, it might be sending resumes or doing interviews, with moving, it might be the actual packing of your existing stuff.

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That said, when there’s a major project that needs to happen and you’re resisting tackling a big part of it, it’s important to identify that part and then figure out what it is about that part that’s making you pause. Sometimes it’s not a big deal (I’ve been holding off on bringing our donation books to our library for the sole reason that I’m lazy and I don’t like carrying big heavy books and parking in the crappy library parking lot), but other times it can speak to a bigger problem. I spent a lot of time struggling to send cover letters and completed applications because I kept reading and re-reading them. A conversation with my therapist eventually led me to realize that the reason for my hesitance was that I was convinced that as soon as I sent them, I’d find some huge error that I’d be unable to correct, and that error would cost me the job.

Letting go of that worry is hard, and was honestly one of the hardest part of this process. But as I explored in embracing vulnerability, without sending those applications and exposing myself to that vulnerability, I wouldn’t have opened myself to the giddy job of receiving a job offer, of sharing that offer with my family, of feeling my excitement mount as I prepared to call back to accept it.

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4. Ask for help.

This connects back to #3. If you’re dragging your feet on a tough task, ask someone to help with it. For me, that meant having friends proof-read my cover letters, delegating the bulk of the house search to my husband (who is a champ for taking point on that despite doing his own job search). And in a big way, it meant long, really uncomfortable conversations with my therapist about learning to be okay with not controlling every aspect of this process.

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One of the weird, tricky things that I’ve learned in my time both as a person with anxiety and as a therapist is that anxiety, perfectionism, and independence are fiercely co-dependent with each other. Anxious people are often determined to accomplish things perfectly on their own, because we worry that if we don’t do things perfectly, or we admit we need help, all of the people who love us will realize that we’re not perfect and will therefore immediately abandon us.

But a strange thing I’ve discovered in this process is that asking people for help–again, exposing ourselves to the vulnerability of doing so–allows us to share the joy of triumph and change with those same people. Talking to my friends and family about my struggles with this process makes their celebration feel that much more touching, because I know they understand how difficult it’s been for me. And let me tell you, when the congratulatory emails started flooding in, my wicked, jaded little heart shed a few tears.

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5. Celebrate small steps.

It’s been great to get emails expressing excitement from my friends and family now that I’ve gotten a new job. But those don’t feel nearly as great as the ones I’ve gotten along the way. Around the third or fourth job application I sent, I started texting a few close friends to let them know I’d submitted it, and the “YAY!” and “<3” and “YOU GO GIRL” messages, even if they were off-hand (not that I believe they were) made me feel like I’d actually accomplished something.

Coming full circle, being able to check off small tasks from my initial goal maps (if you scroll up, you can probably see a number of things that are checked off and crossed out) and seeing the ongoing to-do list get smaller and smaller. Maybe this isn’t as much of a celebration to people who aren’t as hugely obsessed with their planners and to-do lists (don’t judge, y’all), but it makes me feel all warm n’ fuzzy.

If you’re not a checklist person, celebrate in other ways. Accomplished your goal of applying to three jobs this week? Take a bubble bath! Finalized your needs/wants/hopes list for your next apartment? Have a glass of wine or a nice cup of tea! Acknowledging a success with a positive activity or reward, especially for difficult tasks, helps our minds connect those tough tasks with those rewards and makes us less reluctant to do them again. It’s classical conditioning 101, and there’s a reason it’s super effective.

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The process of getting this new job was long, complicated, emotionally and mentally taxing, and hugely exhausting. I’m totally and completely drained by it, and super hugely glad that it’s over. That said, accomplishing that task and seeing that I was able to do it without having multiple major breakdowns (note: I said multiple, not none, and I would like to reiterate my earlier statement about therapists being super hugely useful) is a huge change from the way I handled this process the last time I had to do it. (Poorly. I handled it poorly.)

I don’t think I’ll ever be the kind of person who can be excited about a major change without having to seriously balance excitement with anxiety and panic, no matter how much I teach myself to lean into vulnerability. But it helps me feel a little bit better to know that there are, at the very least, ways to make the process a little more manageable. And maybe, someday, I’ll even be able to do it without color-coding my flowcharts.

But I’ll probably color-code them anyway. It just makes it more fun.

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my happy place.

Have you found any tried and true methods for handling the anxiety of major transitions? Got some tips to share? Feel free to share them in the comments!

 

embracing vulnerability (happiness project, part 5)

Fairly early on in my graduate social work program, our program director sat down with my cohort and talked to us, pretty frankly, about the burnout problem. Some fairly ridiculous percentage (like, 21-67% across multiple studies) of mental health workers report high rates of emotional exhaustion and cynicism with the profession, leading to increases in anxiety, depression, and stress-related health issues. She told us, gently but frankly, that in her experience, a significant number of MSW grads end up leaving the social work field, or at least direct service work, within five years.

I remember, distinctly, looking around that room of bright-eyed, bushy-tailed MSW students, and thinking to myself, “Okay, some of us are gonna burn out, but I’m not going to be one of them.”

What’s that saying about famous last words?

When I chose social work as a field, I knew I was getting into a profession with long hours, low pay, and high rates of compassion fatigue. I’ve written before about the struggle I’ve had balancing my own need for self-care with the desire to spend all of my emotional energy on my clients, and in all honesty, it’s something I’ve struggled with throughout my career–and probably always will, regardless of whether I’m in direct service work or not. It’s just another part of who I am, much to my husband’s chagrin.

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But as convinced as I was at the beginning of my graduate program that I was not going to be one of the social workers who burned out in their first five years, I’m beginning to admit that maybe I am. It’s impossible for me to ignore that in the year that I’ve been in clinical work, my health issues–both physical and mental–have gotten worse, my stress levels have skyrocketed (despite pretty significant work over the last six months on self-care routines), and overall, may happiness has just decreased. I love my clients, and in many ways I feel deeply fulfilled by the work that I do. But I also feel tired, frustrated, angry, sad, fiercely furious with the social systems I’m forced to work within, and overall, exhausted.

So, as I recently announced to my work colleagues–and therefore now all of you readers–it’s time for a change.

Besides being one of my absolute least favorite things on the planet just on principle, being on the job hunt means exposing myself to one of my biggest anxiety triggers: putting my own future in someone else’s hands.

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I spend a lot of time hanging out with my therapist and talking about why this is such a big deal for me, and in all honesty, we’ve been digging around in it for awhile. We’ve spent a while going back and forth talking about how much I love to plan and control things (case in point), and how job searching is basically impossible to plan or control, because all you’re doing is sending cover letter after cover letter out into the void, hoping like hell someone will send you an email.

(Also, can I just say that whoever started the “due to the amount of responses, we will only contact you if you are invited to interview” thing is an absolutely terrible person? Because seriously. Send a batch “rejection” form email if you have to, but leaving everyone else in limbo is awful, and I hate that it’s become the norm.

Anyway. I digress.)

Wrapping my mind around just why it is that this job search thing makes me so uncomfortable–beyond just the aforementioned frustrating limbo–has been an ongoing challenge over the past month or two that I’ve been engaged in this process. I’ve probably spent two or three days’ (or at least nights’) worth of time trying to connect to the feelings of fear and anxiety that come up every time I think about writing another cover letter or sending another email, and each time, I find myself back at the beginning of my thoughts, deciding that this must just be some kind of personal failure.

But help comes through in weird places.

In my post about New Years’ Resolutions, I talked about wanting to make an effort to watch one TED Talk each month. I spent most of January vaguely scrolling through the TED site from time to time and occasionally bookmarking things to maybe watch later, and ended up scraping in right under the wire last night, thanks to a list of 5 Must-See TED Talks for Social Workers that a friend of mine shared on Facebook. The one I picked was “The Power of Vulnerability” by Brené Brown, and you guys, I don’t say this much, but it was actually life-changing.

 

In her talk, Brown talks about the biggest barrier to human connection is shame–something that each and every one of us feels at one time or another. Shame is that deep, emotionally exhausting feeling of not [blank] enough–not good enough, not smart enough, not worthy enough. And that to overcome this shame, what we need to do is allow ourselves to be vulnerable; “to allow ourselves to be seen, really seen,” in order to embrace connection. And that, of course, is absolutely fucking terrifying.

So Brown set out to do some research, to deconstruct shame and kick vulnerability’s ass, and to figure out just what it is that separated the people who were able to overcome shame and believe themselves worthy of love and happiness from those who couldn’t. What she found, at the heart of the matter, was this:

“There was only one variable that separated the people who have a strong sense of love and belonging and the people who really struggle for it. And that was, the people who have a strong sense of love and belonging believe they’re worthy of love and belonging. That’s it. They believe they’re worthy.”

Brown wanted to dig deeper, so she sat down with her interviews and did a more in-depth analysis to see what those people with a belief in their worthiness had in common. And she found four factors. The first three, I thought, seemed to make pretty perfect sense. They had a sense of courage, or as Brown phrased it, “the courage to be imperfect.” They were compassionate to themselves. They had connection.

But the last factor, to both Brown’s and my chagrin, was this: they embraced, wholeheartedly, vulnerability. They knew that in life, vulnerability was a necessary, if uncomfortable, emotion–necessary for connection, necessary for learning, necessary for growth.

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Brown’s reaction, and mine, was essentially this:

What the hell, research?!

(It was at about this point in the video that I realized that Brown and I would probably get along really well.)

I’m not going to recap the entire video, because you should really watch it–please, please watch it–but I will tell you what I really took away from it. Vulnerability, as awkward and stomach-churning and anxiety-producing as it is, is something that we must connect with if we are to connect with all of the emotions that come with growth and progress. When we close ourselves off from vulnerability in order to avoid the painful feelings that sometimes come with it–fear, anxiety, disappointment–we also lose out on happiness, on personal growth, on excitement.

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When I meet with my clients and they bring an uncomfortable feeling into the room–depression, grief, worry, pain–I ask them to spend a moment sitting with that feeling. I ask them where they feel it in their bodies, where they carry it–in their shoulders, in their chest, in their belly? I ask them to connect with the feeling and allow themselves to feel it, rather than instinctively away, because listening to those feelings is part of the process of understanding them. But doing this for myself has always been something I’ve recoiled against, preferring instead to press past vulnerability and project an air of surety or calm.

It may seem strange to bring vulnerability into my happiness project, but the more I think about it, the more I begin to understand that embracing vulnerability is a critical part of practicing happiness. Where my clients need to connect to the feelings they bring into my office, as I prepare to leave that office I need to connect to the vulnerability of allowing others to control where I go next. I need to lean into my discomfort, not push it away, and only through that discomfort and vulnerability will I be able to reach out to opportunities.

As uncomfortable as it is, I don’t know where the next step in my career will be. But I know that vulnerability is part of the journey.

And, strangely, I’m excited to start.

#readingwednesday: is it me or my meds?

“On Prozac, Sisyphus might well push the boulder back up the mountain with more enthusiasm and creativity. I do not want to deny the benefits of psychoactive medication. I just want to point out that Sisyphus is not a patient with a mental health problem. To see him as a patient with a mental health problem is to ignore certain larger aspects of his predicament connected to boulders, mountains, and eternity”

– Carl Elliott

 

I’ve had a complicated relationship with psychotropic medication.

 

When I was in college, I spent a lot of time being not-so-gently nudged into therapy by multiple people (my family, my friends, my then-boyfriend who is now my husband). While it might sound odd coming from a now-therapist, I really wasn’t into it. It seemed very weird to be talking to a stranger about my problems (cue ironic trombone noise), and I didn’t like the idea of doing it–it set off major alarm bells with what I now know is my anxiety. But hey, hindsight is 20/20, right?

 

While I wasn’t in therapy in college, my sophomore year was when I started seeking medication to specifically deal with my fibromyalgia and migraines, and suddenly found myself on a series of antidepressants. I didn’t realize it then, but SSRIs and SNRIs are often used to treat physical  conditions as well as psychiatric ones, and that meant dealing with all of the many side effects, some of which exacerbated the very conditions they were supposed to be treating.

 

Now, working as a mental health therapist for a child and adolescent agency, I often find myself referring clients for medication evaluations with our psychiatrists and psychiatric nurses–sometimes at their request, sometimes at the request of their parent or guardian. In our practice, clients receiving medication are, with some rare exceptions, also required to be in counseling with a therapist. I would estimate that probably about 60% of the clients in our practice take psychotropic medications, which leads to a lot of questions about the nature of how we refer kids for meds, how we decide when they need meds, and what it means to use psychotropic medications on young, still-developing personalities and minds.

 

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I first read David Karp’s Is It Me or My Meds? for a sociology course in college, but found myself drifting back to it a few weeks ago after having a conversation with a teenage client about her difficulty in deciding whether or not she wanted to give meds a try to manage her depressive cycles. Part interview report, part research project, Karp’s text explores the relationship between “pills and personhood”, looking at the ways in which people of different ages, backgrounds, and mental illnesses relate to their diagnoses and prescriptions.

 

When I read this book back in college, my knee-jerk reaction was almost to recoil. It freaked me out to learn about the ways that psychotropic medications changed the way people think and feel. I didn’t like how easily it seemed that psych meds were prescribed and the high rates of people–especially kids and teens–on multiple meds at once. (In all honesty, this is something that still worries me–the CDC reports that one in thirteen American kids between the ages of six and seventeen takes at least one psychotropic medication, and rates of psych medication prescription soars when kids are involved in the special education, foster, and juvenile justice systems.) That said, even in my first read-through back in college, I could see that Karp is careful to take a nuanced approach to understanding psychotropic medications, and for good reason–Karp discloses in his preface that he himself has taken antidepressants for years, and had spent a significant amount of time struggling with the changes he noticed in himself when he began taking medication.

 

Reading the book again as an adult and a therapist, I have a different experience. I’m more appreciative of the way that Karp works to understand the entire system of each person he interviews–looking at the whole person, the context of their experiences. In the work I do now, I’d estimate that eighty-five to ninety percent of my clients come to me with a trauma history–some kind of experience of pain or fear that had a significant impact on the way they currently function. I’ve learned the way that trauma can disguise itself as ADHD and Oppositional Defiant Disorder and depression and anxiety, and while I deeply appreciate the ways in which psychotropic medications allow my clients to function while we work through the underlying issues that contribute to their symptoms, I also understand that without the therapeutic component of their treatment, medication alone would not be sufficient to keep most of them functioning.

 

There’s a reason why the recommended treatment for most mental health disorders is to utilize a combination of medication and psychotherapy. Two of the many medications I take currently to manage my physical chronic health conditions are psychotropic, and even though those meds aren’t prescribed for to treat my anxiety and depression, I’ve found that I do considerably better managing those symptoms when in therapy than I do while taking those same medications without therapy. Is It Me or My Meds? isn’t the most academic or always-engaging of texts, but it is a great read for anyone who is trying to explore the decision to start medication, and I would absolutely recommend it for clinicians who want to improve their insight into what their clients might go through when they make the decision to start–or to stop–psychiatric medication.

 

Karp’s book asks its main question right in the title, and in all honesty, it doesn’t find a real answer. As clinicians, we tell our clients that medication can help them be the best, safest version of themselves; as patients, we do our best to hope that medication isn’t changing who we are. There is no single experience with psychotropic medication, but each person who takes them makes that decision carefully, and often uncertainly. If nothing else, what I take away from this book–and back to my clients and myself–is that medication is a step on a journey to living as one’s best self.

 

It’s not the destination.

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For more great images about conquering the mountain of mental illness, check out The Doodle Chronicles on Tumblr.