The Couch

“I walked into his office

I felt so self-conscious on the couch

He was sitting down across from me

He was writing down his hypothesis, I don’t know

I’ve got a loving supportive wife

Who doesn’t know how involved she should get

You say his interjecting

Was him just calling me on my shit?

Just the other day, my sweet daughter

I was driving past 203

I walked up the stairs in my mind’s eye

I remember how they would creak loudly

She was only responsive with a drink

He was only responsive by photo

I was only trying to be

The best big brother I could

I’ve walked sometimes confused

Sometimes ready to crack open wide

Sometimes indignant, sometimes raw

Can you imagine, I pay him seventy-five dollars an hour?

Sometimes it feels like highway robbery

And sometimes it’s peanuts

I wish it could last a couple more hours”

Alans Morrissette – The Couch (1998)

It’s the beginning of May, which here in the U.S. is designated as Mental Health Awareness Month. Several research studies have reported that one out of five Americans lives with a diagnosable mental health condition and that only four out of ten of these people actually receive treatment. There are a variety of reasons for this, including access to care, the ever increasing costs of treatment, lack of inpatient beds, and just as important, if not more so, is the issue of stigma.

The stigma of mental Illness has been around for centuries in some form or fashion. Much of this is due to the lack of information and the myths associated with these conditions. Stigma is also present in many cultures due to historical factors as well as the norms that exist to force individuals to remain silent about their plight.

Back to the topic of treatment, and more specifically, the song, “The Couch” by Canadian singer-songwriter, Alanis Morrissette. One way the track can be interpreted is that she is telling a story of a daughter who is speaking to her father, who is seeking professional help for issues that stem from his relationship with his mother, but is struggling with the prospect of the therapeutic relationship.

Personally speaking, I’ve been in some form of therapy since 1981 following my first bipolar episode. I actually go so far back that the first psychotherapy I received was from psychiatrists and lasted for nearly an hour. This was just before the field transitioned into how the field is now where psychiatrists are actually more like psychopharmacologists and who are pressed to see patients for the prescribed 15-minute sessions typically sanctioned by insurance companies.

I started seeing a counselor back around 1982 or so at Horizon Health Services, a behavioral health provider in the Buffalo, New York area. I’ll never forget my first therapist, a guy named Jack. At this time, I was actively involved with using substances and Jack was just the kind of guy who I thought was a major geek. I remember he even had me try an exercise in his office where he had me close my eyes and he attempted to guide me around the office in a feeble attempt to engender trust. This, I have to say, was not the best way to develop a healthy therapeutic alliance.

I saw others after Jack. Among them was Susan, who had a calming countenance that was almost maternal in nature. I really liked her. I liked her as well, but there was still an issue of me using. But then there was Dick, who I’ve referred to in previous posts and who is a major player in my recovery journey. Dick was a recovering alcoholic who broke the invisible wall of counselor self-disclosure. He told me about his participation in Alcoholics Anonymous, his family, and his love of fishing. He also was the one who persuaded me to attend my first Narcotics Anonymous meeting. He eventually left the agency and I’ve always wanted to tell him,”Thank you” for guiding me to a better way of life.

I then worked with another male named Mark, who was really into the male identity thing. You know, Robert Bly and all that kind of thing. It didn’t really resonate with me, but by this time I was clean and life had gotten better. When Mark moved on I was then seen briefly by another seasoned professional at the agency, Carol, who was more of an intermediary until I was linked with Jane. This had to have been around 1994 or so. 

Jane is one of the most skilled therapists I’ve ever known. I worked with her as my therapist for well over 20 years. That’s a long time. And while some people may have difficulty understanding the significance of why I chose to stay with her, I need to say that having someone who knows you, I mean really knows you, “warts and all,” and does not judge you and holds your confidences is invaluable. I even followed Jane when she went into private practice choosing to pay out of pocket for her services.

As time went on our relationship evolved and as I pursued my professional ambitions in mental health advocacy, Jane became more like a mentor. We still have this relationship today.

Flash forward to early 2020, pre-COVID. I had a strong desire to get back into therapy to work on some unresolved issues. I thought that perhaps exploring trauma treatment might be a path to take. I contacted a professional colleague who recommended a Licensed Clinical Social Worker named Jen whose specialty, among other things, is the trauma therapy EMDR (Eye Movement Desensitization Reprocessing). Essentially, EMDR therapy is an eight-phase treatment.  Eye movements (or other bilateral stimulation) are used during one part of the session.  After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.  As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. (EMDR Institute, Inc.).

One thing to understand about going to therapy is that it requires the willingness to be open and vulnerable, which can be very hard to do, especially with someone who, at first, is a complete stranger. But as a behavioral health professional myself, I knew this going in to my first session with Jen. So on my first visit I opened myself up and spoke about things that I’ve shared with very few people. I recall feeling extremely “squirrelly” and uncomfortable when doing so, but Jen simply affirmed what I was saying and offered a sense of security in being able to honor this, what I would call, sacred relationship.

I’m still seeing Jen and our relationship has evolved. One significant thing that I’ve learned is that I suffer from “black and white” or “all or nothing” thinking. Now, I don’t know if this is a manifestation of my upbringing in NA or a character trait. Regardless, I am learning to seek the middle path. One particular way is to practice mindfulness meditation, which I’ll cover in a future post.

If you’ve read this far, then you may already be in therapy, or have been in the past. In my estimation, everyone could benefit from it at one time or another. We all need someone who serves as a guide, not telling us what to do or how to live or what they did in a particular situation. A good therapist is one with whom you can be honest with but also not be a pushover. As Alanis so aptly states in, The Couch, they can call you on your shit.

If you’re looking for a resource for a counselor or therapist, visit the Mental Health America website for a variety of tools. They also have a mental health screening tool that can serve as a means of determining if you may need to seek professional help.

If you are in crisis contact the Suicide Prevention Lifeline at 1-800-273-8255 (TALK). Trained professionals are available 24 hours a day.

Last, but not least, you are not alone. This thing called recovery can be hard. But with hope, hard work, a measure of faith in yourself or something greater than you, you can get better.

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