Advice From the Trenches

How to Make Real Change: Advice givers square off

Dear C and Dr. B;

I went to a therapist because I had longstanding problems in my marriage. My therapist and I could agree that there were conflicts that might never be resolved. My husband was emotionally abusive – he refused to come to therapy with me and would just get up and walk out when I tried to talk to him. The therapy convinced me that my husband eroded my self-confidence and the marriage was holding me back from a better life, so I decided to move ahead. Unfortunately, things didn’t work out as planned. Now I am alone and broke and I have to work two jobs to make ends meet so I have no time to make new friends. I’m too tired to even think about a better life. My husband isn’t messing with me, but my life is NO better than before in any other way. I thought the “new” me would meet someone I could have a healthy relationship with, but I haven’t met that person in four years. Now I wish I’d stayed where I was, ignored my asshole husband, and just developed my own life and friends more outside the marriage. I joined a support group thinking it would help, but no one in it has a good relationship – they just bitch about how dysfunctional every potential partner turns out to be.

Does ANYONE actually get therapy, take the advice and find a better life? I have yet to meet a single person who has. A depressing number of them just wish they’d stayed where they are.



Dr. B says: Italo Calvino, a children’s author and philosopher, said that we are all born into a story but at some point you have to decide to accept that story or instead write your own. You don’t know “everyone.” It seems you know mostly people within the same culture you already were familiar with who have similar sets of skills and circumstances as your own. 

Just like a diet doesn’t work unless its a total life change and years of consistency are devoted to work these changes, life doesn’t change simply because you remove one asshole from your total story. You have to identify your goals and make friends with positive people who reflect the type of life you would want to have. You need to focus on the positive strengths that you would bring into a relationship and you need to have good boundaries, avoiding life-sucking and energy-sucking people. At the same time, you need to meet a lot of people. Relationships are just a statistics game. Everyone I grew up with met their partners on or the newspaper, and none of these matches are divorced. So does ANYONE actually get therapy, take advice, and find a better life? Yes. If they actually internalize change and growth, develop relationship skills, have good boundaries, and live a total healthy package, ie, embrace a completely different culture than that which they knew – and write their own story.  

C says: I believe that Constance has a valid point. Yes, Dr. B, that was great advice, but what exactly is this woman supposed to do with it? She writes that she is working two jobs to make ends meet and is too exhausted to find new friends, yet you tell her to “meet lots of new people.” She is also given a list of tasks that must be keep up on a constant basis for years before she can expect changes – what is she supposed to do in the meantime? And by what means is Constance supposed to “embrace a completely different culture” than the one she knew? People who work two jobs spend most of their time with people at work, and I suspect she is stuck in minimum wage position — hardly a way to broaden her horizons. Establishing a new group of healthy friends in her few off hours is an optimistic, but unlikely, stretch.

Advice has to be doable in order to work. Dr B’s suggestion is like telling a diabetic who has been on a junk diet since birth that if she’d just change their entire lifestyle and keep it up for five years straight, she’d be much healthier. Duh! Who doesn’t know that? But knowing it and doing it are entirely different things. That’s probably why recovery rates are so low and psychiatric drug use is so high. Making changes in real life is easier said than done.

There’s a serious gap between the advice given here and the average person’s ability to follow it. Why? Consider this: The annual salary for a psychiatrist is about 100K to 200K. Even a lowly therapist makes about 60K a year. Their advice is tailored for their own socioeconomic group. Unfortunately, the people who face the greatest mental health challenges are those who live in poverty – and the reality is that those who seek psychiatric help at the poverty level seldom get real therapy at all. They get pills to keep them quiet and that’s about all. It’s the great divide between the Haves and the Have-Nots.

Making long-term, consistent changes requires economic stability and sufficient leisure time for contemplation. If some patients had that, they wouldn’t need therapy to begin with. For many, better job training may be the most doable, and most important, first step toward being able to write their own story.

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