Therapy, Trust, and Criticism

[content warning: suicide, mental illness]

[I will warn you now that this does not come with advice, recommendations, or conclusions, despite seeming like such a post. It is wholly a reflection. In the end I think I have nothing to offer my friend, in terms of actionable insight on this issue at least.]

My friend Kafka Beluga,1 who is going through a hard time right now on multiple fronts, is having difficulty trusting her therapist. This difficulty limits the use therapy has for her. I have had two excellent relationships in therapy—one counsellor, one psychiatrist—and I am often worried about people who have trouble with medical professionals. Certainly it seems common enough that people do not take well to therapy; I’ve been trying to think about why I am, as one of the various doctors I’ve seen put it, “a good candidate for therapy.”

The particular value that I got from therapy was not so much in simply being able to talk through my problems—if “talking therapy” has some value, I’ve never seen evidence for it—but in talking through my reactions to things so that the therapist can tell me where I’m being silly. My first therapist, a counsellor in Vancouver, was very helpful in making me see myself in terms I hadn’t thought of before, but my second, a psychiatrist in Toronto, was especially good at dispelling my nonsense.

Last summer I quit my interim retail job because of sudden overwhelming suicidiality. While that was not my first episode of depression, the move from intrusive suicidal ideation (thoughts of suicide, often apropos nothing) to active desire (including trouble-shooting my plans, making sure no one comes upon my body unprepared, avoiding ineffective methods, etc.) was new. After a night researching suicide watch strategies and institutionalization, followed by a midnight Skype conversation with my Mom, I made dealing with that particular outbreak of depression my full-time job. The next day I went to visit doctors… and accidentally talked circles around them.

I am fairly well-read and well-informed about depression and learning the jargon of mental illness is a piece of cake after trying to hack it in an English literature program, so I was able to describe my experience in clinical terms. This seemed to reassure the doctors; the first of them even told me that I seemed to have it under control and that he wasn’t worried about me. The trouble, though, is that I’m not so much good at dealing with depression as I am playing a rational, responsible part in most any pageantry.

After moving to Toronto, talking about suicide to doctors got me a psychiatrist somewhat more quickly than the usual six-month waiting list. I started with him how I started with the doctors. He was having none of it.

“You are very good at rationalizing,” he said. “We need to be careful about that.”

He had my number within fifteen minutes.

Of course this was a very good thing. I find that suicide speaks to you in whatever language you find most convincing; for me, it spoke of reasonableness, of rational decisions, of responsibility. I believed, in a way that then felt detached but in retrospect seems obsessive, that suicide was the most economically and interpersonally responsible thing I could do. I’ll spare you the contorted legalism involved in that delusion.2 The point is that the therapist poked and prodded at it and found out its stupid little hide-away premises. They didn’t survive scrutiny. Alas, suicide was never really a reasonable conclusion in the first place, so this exercise did not eradicate the creature, but it did help me make it far less compelling. (Suicidiality is much less a problem for me now, at the time of writing, than it was last winter.)

Therapy is akin to external review. On very specific topics I had to privilege my psychiatrist’s opinions, and prior to that my counsellor’s, before my own. In this way having a therapist is like having an editor, a confessor, or a fitness instructor: you submit your work (whether that’s your writing, your soul, your body, or your mind) for criticism and you take at least some portion of that criticism to heart. This takes a lot of trust!

So the problem that Kafka Beluga is having trusting her therapist might not just stop her from sharing information with her therapist; it might also stop her from following on that therapist’s recommendations. In my experience therapy does have other uses than recommendations—merely having to attend a regular scheduled activity involving other people is a help so long as it isn’t a hurt—but this process of critique is by far the biggest. So I worry about her, and about everybody else, and about myself when the day comes that I need a therapist and don’t get a good one.

One of the reasons that I’m such a good candidate for therapy—at least according to my first therapist—is that I’m an unusual combination of sensitive and self-aware. I had thought that would be a common combination, but she assures me it isn’t. Furthermore, my psychiatrist taught me to turn that rationalizing tendency of mine against depression rather than let depression use it against me. I am analytical and when I have problems, I research them into submission. I therefore have a good idea of what to expect from the relationship: if anything wasn’t above-board, I was fairly sure I would notice. This all helps.

And it also helps that I’m white, and male, and straight, and of average size for someone of my demographics, and educated, and well-spoken, and well-spoken in English. People are likely to trust my account of myself. The various prejudices did not apply to me, especially since the usual masculine restrictions magically disappeared in these contexts. It is much easier to trust a therapist when you have learned the sort of confidence this engenders.

I compared therapists to external review; I also compared editors, confessors, and fitness instructors to the same. It is a truism that relationships are built on trust, but constructive criticism in particular demands a particular species of trust—almost, at times, an abandon—that other relationships normally don’t. I wonder how often such relations are mired in similar ways.


Source: Chaya at This is photograph is unrelated to the subject matter; I just thought it might make you feel a bit better after having read all that.

  1. Just a reminder: pseudonyms on this blog take the form [Dead Person of Letters] + [Animal].
  2. Discovering that depression involved actual delusion in addition to emotional instability is what made me start thinking of depression as a proper mental illness, as insanity, rather than a mere mood disorder.

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