Getting therapy doesn’t mean renouncing all boundaries

If you want to try therapy (OT/PT/psych/CBT/whatever):

  • Keep in mind that you’re under no obligation to do so
  • You should do it if it helps you, and not if it doesn’t
  • It’s ok to judge this for yourself
  • If the therapist doesn’t respect you, find a different one (if you still want to continue trying therapy; it’s ok to decide not to)
  • If the therapist seems to prefer for you to be in pain, that’s a problem
  • Whether it’s emotional or physical pain
  • Some therapy inevitably involves a certain amount of pain, but it’s a major red flag if a therapist seems to be pursuing it as an end in itself
  • You do not need your therapist’s permission to quit
  • If they keep convincing you in person to continue, but you always want to quit when you’re not with them, it’s ok to end the therapy over the phone or email
  • Or to just quit making appointments
  • Some therapists are really good at manipulating people into doing things that are bad for them, and you don’t have to cooperate with that

When you are someone’s imaginary friend

Friendships require two consenting people. Someone can’t be your friend unless you also want to be their friend. Friendship is a relationship and it has to be mutual.

Some people do not understand this. Some people want to think of themselves as your friends, and don’t care what you want.

In effect, people who do this are treating you as an imaginary friend. They don’t want *you*. They want an imaginary different person who wants to be their close friend. (And, they probably want a number of other differences, too.)

If they wanted you, if they were interested in friendship with the person you actually are, they’d respect it when you said no.

You can’t usually stop someone from perceiving you as an imaginary friend, but you don’t owe them your cooperation, either. It’s ok to ignore them. It’s ok to refuse to listen to lectures on why you’re being a bad friend. You don’t have to give them a chance and you don’t have to convince them that you’re right to distance yourself. You don’t owe it to anyone to help them pretend you’re their friend.

You can’t stop them from thinking whatever they want to think about you. If they send you lots of email. Or letters. Just don’t read them. Because they’re interacting with an imaginary person. Not you. And the real you doesn’t have to play along.

Denigrating “The Old Testament God” can be antisemitic

In Christian culture and secular-ish culture in English-speaking majority-Christian countries, it’s popular to talk about how awful the “Old Testament God” is.

This can amount to casual antisemitism, even if it’s not intended. Because this kind of talk is often a coded way of claiming that Christianity is loving and good, but Judaism is backward and violent.

What Christians call the “Old Testament” is what Jews call “The Bible”. So “The Old Testament God” is the God that Jews believe in. It’s not so cool to claim that Christians believe in a loving God but that Jews believe in a violent and vengeful God. It’s not accurate, and it’s a claim that has been used to justify a lot of horrific violence.

The Old Testament God, according to both Jews and Christians, created the world and gave humanity the Ten Commandments. Christians base a lot of their theology on things found in the OT. Christians do not really reject everything done by the Old Testament God. Denigrating the “Old Testament God”, more often than not, is an implied rejection of Jews.

It’s true that the OT depicts God doing some fairly troubling and violent things. But that’s also true of the Gospels. For instance, the Gospels depict a lake of fire in which certain types of sinners are tortured forever. That doesn’t mean that Christians believe in a bad God who likes torturing people. It means that ancient religious texts are complicated and that it’s up to religious people to interpret them in a way compatible with human dignity and human rights.

Christians who believe that the New Testament is a new revelation are entirely capable of doing this. So are Jews who do not believe this. Members of both faiths can be religious in a respectful and good way.

Most people who invoke these claims about the Old Testament God don’t mean any harm, but it is part of an antisemitic tradition that hurts people. There are other ways of opposing the brutality done in the name of religion. It’s counterproductive to invoke the antisemitic trope of denigrating the Old Testament God.

Another thing about therapy

A good percentage of people who need therapy only get it after repeatedly failing at things everyone around them can do. (Especially developmentally disabled children). This is often humiliating.

This means that therapy can be triggering. Therapy involves focusing on difficulties that someone has learned to regard as humiliating flaws. It’s important to keep this in mind when you give therapy.

Don’t expect someone to trust you right away. You have to demonstrate that you are trustworthy. You have to show them that you can be relied on to treat them respectfully. You have to demonstrate that you won’t ever regard them as broken, or make respecting them contingent on them progressing toward a cure.

And it needs to be true. You can’t just affect safety and kindness. You have to actually be trustworthy in a deep way, and let that show through your action.

You don’t get to decide when you have established trust; you don’t get to decide when someone receiving therapy should feel safe. It’s up to the person getting the therapy. (Even if they are a child.)

And if you understand this, you’ll be much more able to help people.

More about respectful therapy

This applies to both adults and children. Respect is really important.

Some of what this means is:

Understand that people who need therapy are going to have trouble with it sometimes:

  • People who have therapy have it because some things are hard for them. This is normal and should be expected in a therapy context.
  • Being in therapy doesn’t make things easy. It just means someone is getting help learning something
  • Expect that it’s going to be hard for the person you’re teaching to learn the things you are teaching them
  • And sometimes they will have trouble in ways you didn’t anticipate
  • When they are having more trouble than you expect, don’t get angry
  • And don’t make fun of them
  • And don’t accuse them of being lazy or wasting your time
  • And especially, don’t tell them that if they’d just *try*, they’d be able to do it
  • Help them find a way to figure out how to do the thing.
  • This means sometimes you might have to spend an hour or hours searching for a way to successfully explain something you think of as simple or obvious
  • This is part of your job. You’re there to help people figure out how to do things, and sometimes that’s hard.
  • It’s not ok to get angry at or frustrated with someone when they’re having trouble understanding something. If you’re feeling that way, it’s your problem and not theirs, and you need to find help dealing with it.
  • Treat people with consistent respect. That makes a huge difference.

Respect your client’s priorities:

  • Adults in therapy get to decide which things they want to work on
  • If they want help with one thing, and you think something else would be more helpful, it’s their call and not yours
  • It’s ok to tell them what you’d advise and why
  • It’s not ok to coerce them into doing what you want
  • It’s also not ok to treat them as less-than-human or unworthy of help if their priorities are different from yours
  • For instance, someone might care about reducing pain but not especially care about walking
  • Or someone might care about nutrition for cognitive functioning but not especially care about weight loss
  • And they get to decide that

Kids in therapy also have agency

  • Kids don’t get to decide everything the way adults do, but what they want still matters
  • It’s important to acknowledge that they have opinions and priorities
  • And it’s important to listen seriously. Sometimes they know something you don’t, and sometimes listening will change your opinion of what they should be doing in therapy
  • And sometimes, their opinions and priorities should be respected even if you think they are making a mistake
  • This is especially true of teenagers
  • Don’t equate kids with their parents. Sometimes kids and parents disagree. Listening to the parents isn’t enough
  • Do listen to the parents, though. They probably know relevant things about your child that you don’t know. Not always, but usually.

You don’t always have to argue

Sometimes people want to convince you to do things that you don’t want to do, and which aren’t any of their business.

Sometimes people want to argue with you about politics, and aren’t willing to have the conversation end unless you convince them or they convince you.

It’s ok to decide you don’t want to have those arguments. It’s ok to unilaterally end that kind of conversation.

You don’t have to convince them you’re right. You don’t have to convince them that you’re right about the issue in question, and you don’t have to convince them that you’re right about not wanting to discuss it.

It’s ok to say no to conversations you don’t want to have about things that are entirely your business.

A guest post about phone messages

NOTE: I didn’t write this. It’s a submission. I haven’t tried doing it this way, but it seems to me that it would work:

To effectively leave a phone message:

  1. Write a list of what you need to convey – if you get nervous on the phone this is a good tip in general to call, because you might end up forgetting what you need to say as soon as that person picks up – happens to everybody!
  2. The most important things to include are your identity (name), reason for calling (to make an appointment? because they called you first but you missed it? to inquire or speak to somebody in particular in the building?), and your contact details (your cell/mobile or telephone number, email address).
  3. For example, your list could say: my name is John Smith, inquiring about doctor’s appointment, call back on xxx-xxxxx, evenings.
  4. Listen very carefully to any instructions you’re given on the answerphone. If you didn’t catch it the first time there is no harm in hanging up before the beep, calling, and listening again. Keep a pen to hand to make notes in the meantime.
  5. State your answer in the clearest way possible; you may be nervous, so aim to speak slowly and clearly. You won’t sound silly: the other person who will receive the message will be grateful that they can hear you clearly. Repeating certain details helps a lot too as hearing a number twice will allow the other person time to copy it down accurately.
  6. For example: “Hello there, I would like to make/ask about booking an appointment. My name is John Smith. Please call me back on my cellphone, my number is (speaking slowly) xxx-xxxxx. That’s xxx-xxxxx. I’ll be able to answer your call between 4 and 7pm any day of the week. Otherwise my e-mail address is john[at]email[dot]com. Thank you, goodbye.” Don’t hang up without an end greeting.
  7. You can alter this formula for informal things too, such as calling friends or family. If they already know your number just let them know that you’ll respond to a text more quickly, or when you’ll be available to receive a call.

“One at a time”

Sometimes this happens:

  • Five people are talking to you all at once
  • You can’t understand any of them
  • You say in exasperation “one at a time!”
  • And everyone pauses briefly then starts talking over each other again.

That’s really annoying. One reason it happens is that each person only has control over their own actions; they can’t unilaterally get the conversation back on track. No one wants to stop talking and risk not being listened to, so everyone just keeps talking in order to avoid losing their chance.

One thing that can help is to be explicit about what order you want things to happen in, so that people know they will get a turn and when it is their turn.

For instance:

  • “Guys, one at a time. Steve first. Steve, what are you saying?”

This doesn’t always work, but it works a lot more often than just telling people to stop talking over each other.

Don’t teach kids that their body is wrong

Something that can happen in therapy for disabled kids is:

People hold out hope that the kid won’t be disabled anymore, when they grow up.

So they push the kid as hard as possible in childhood, and tell them (often without saying this explicitly) that if they just work hard, their body won’t be wrong anymore.

This doesn’t work.

People who are disabled as children are usually still disabled as adults. Even if the therapy helped them. Even if they gained new physical abilities. Even if they learned things from it they wouldn’t have learned without it.

Even if they learn to walk. Even if they learn to talk. No matter what other skills they acquire. Their body is probably going to stay very different from most other people’s bodies, and far from the cultural norm.

And… part of living well as a person with a disability is accepting the body and the brain that you have, and working with it rather than against it. 

Because you can’t live in an imaginary body; you can’t live in an abstraction. You have to live your own life, as you actually are. And sometimes that involves medical treatment, sometimes it involves equipment, sometimes it involves therapy – but always, it involves reality. You can’t willpower yourself into being someone else. 

Disabled kids tend to get taught the opposite message, because childhood therapy is usually cure-oriented even for conditions that aren’t anywhere close to curable. It’s about normalization, much more than functioning well.

Then they go through all manner of hell unlearning this once they’re old enough that everyone gives up on pretending that a cure is going to happen.

If you’re responsible to or for kids with disabilities, do what you can to protect them from this. Make sure they aren’t being pushed to hang their self-worth on accomplishing things that are physically impossible or implausible. Help them to understand hat their bodies aren’t wrong. Teach them that they already have lives worth living.