therapy – Page 2 – Real Social Skills

Distinguishing between gaslighting and distorted thoughts

September 14, 2014June 11, 2021 Real Social Skills

A reader asked:

how do you tell the difference between when someone is gaslighting you and when you’re doing the distorted thinking thing from anxiety/depression? (for example you KNOW they’re judging you because they’re your parent and you’ve learned what that LOOK means but now they say they’re not judging you which means you can’t trust your own perceptions)

realsocialskills said:

One thing that’s important here is that distorted thinking and gaslighting are not mutually exclusive. When you know that you have distorted thinking, gaslighting abusers sometimes exploit that to get you to doubt your perceptions. Even when you are having an episode of actively distorted thinking, that doesn’t mean that the things someone else wants you to believe are necessarily true.

I think there are a couple of things that can help to sort out what’s really going on and what’s distorted thinking: outside perspective, and paying attention to your perceptions over time.

Regarding paying attention to your perceptions over time: Even if you have depression, you’re not always going to be equally depressed. Even if you have anxiety, you’re not always going to be equally anxious. If you still don’t like what someone is doing to you even when you’re not actively anxious or depressed, it’s probably not distorted thinking.

Also, if every time you object to something someone does, they consistently convince you that it’s distorted thinking, something is probably wrong for real. Nobody is perfect, and sometimes you’re both depressed *and* reasonably objecting to something. If someone consistently uses your mental illness to try to make conflicts go away, that’s gaslighting and wrong even if your perspective actually is distorted.

(That said, if you’re actively anxious or depressed, it can be hard to tell in the moment whether or not something is a pattern. It’s possible to feel like it is a pattern when it isn’t, due to distorted thinking. That’s a reason why it can be really helpful to pay attention to how you feel over time.)

One way to keep track of how you feel over time is to write a journal. If you write a journal, you can pay attention to how you felt yesterday and whether you still feel that way today. Writing down your perspective is a more reliable way to track things over time than relying on memory. It’s hard to have accurate memories of how you’ve felt over time, and it’s particularly difficult to have accurate memories of what you thought when your thinking was distorted. (That said, journaling does not work for everyone, and if you can’t do it, that doesn’t mean you can’t figure things out.)

Outside perspective can also help a lot. That’s one reason that therapy is very helpful to a lot of people who struggle with distorted thinking. If you can find a therapist who you can trust to have a good sense of when you’re probably getting something right and when it’s probably depression/anxiety-related distorted thinking. This backfires horribly if your therapist *isn’t* trustworthy. I don’t really have any advice about how to find a good therapist (I wish I did, and if I ever figure it out, I’ll post about it), but I know that for many people it is both possible and important to find a good therapist.

Personal blogging can also help as a way to track your perceptions over time and get feedback, but be careful about that. Personal blogging attracts two kinds of people who can create problems for those who struggle with distorted thinking: mean people who try to make you feel awful about yourself, and people who unconditionally offer you validation no matter what you say or do. Neither of those kinds of perspectives are helpful for sorting things out. In some ways, unconditional validation is particularly dangerous, *especially* if there’s a possibility that you’re abusing someone.

Friends and relatives can also sometimes be really helpful, particularly if they know the people involved or observe things.

If you have a sibling you can trust (not everyone does, but some people do), you might be able to have this kind of conversation:

You: Sarah, when Mom made that face, was she judging me or was I imagining it?
Sarah: Yeah, that’s definitely her judgey face.
or, depending on what she thinks:
Sarah: Actually, I think she probably didn’t mean it that way this time. She just talked to me about her obnoxious boss and I think it was her pissed at my boss face.

Similarly, friends sometimes have a really good sense of what’s going on.

The caution about blogging goes for consulting friends/family and other forms of peer support. Be careful about people who offer unconditional validation of all of your thoughts and feelings no matter what. That can end up reinforcing distorted thinking, which is not going to help you learn how to improve your perspectives and trust yourself when your perceptions are accurate.

People who are offering you useful perspective will sometimes tell you that they think your perceptions are off base, and they will not be jerks about it when they are critical. They will also not try to coerce you into adopting their perspective. Sometimes they will be wrong. Sometimes you will disagree with them and be right. You are allowed to think for yourself, even if your thinking is sometimes distorted. No one else can think for you, even if you go to them for perspective and help sorting things out.

tl;dr: Gaslighting and distorted thinking are not mutually exclusive. It’s common to experience both, even simultaneously. If you have distorted thinking, people inclined to gaslight you tend to exploit it. Tracking your perceptions over time, and getting outside perspective, make it much easier to sort out what’s actually going on. Sometimes therapy is helpful. Sometimes blogging is helpful. Sometimes friends and family are helpful. Be careful about trusting people who are mean to you or who offer unconditional validation.

More on therapy referrals

May 13, 2014June 21, 2021 Real Social Skills

whirling-ghost replied to your post “About making therapy referrals”

Make sure it’s the appropriate type too. Like I got referred for group, despite the fact I was terrified of being in a room with people I didn’t know. Obviously that wasn’t going to work

realsocialskills said:

Yes, this too. Therapy isn’t just one thing. It’s a lot of different things. It also matters who is involved; therapists are not interchangeable. Even when someone unquestionably needs therapy, the wrong therapist can still make matters worse.

Generically telling someone “get therapy” is not likely to be a helpful suggestion. Everyone knows that therapy exists; everyone will have had others tell them to get therapy.

A useful referral has to be more specific and based on something. It also needs to involve respecting the person you’re working with, listening to what they think of your suggestion, and recognizing it as their decision.

Eg:

“It sounds like you’re struggling with your sexual identity. I know a therapist who has a good track record of helping men think through that. Would you like their name?”
“Some people who find that talk therapy doesn’t help them have found that CBT does, since it is concrete and based on learning skills and changing your thinking. What do you think about trying that?”
“A lot of students who have come to me with similar problems around finals have found the counseling center helpful. Is that something you feel comfortable trying?”
“It’s hard to go through that kind of loss when none of your friends can relate; I think that peer support might help you. There’s a grief support group; would you like to try that?”
“The problems you’re describing are often caused by clinical depression, which is often treatable. I think it might be a good idea to get evaluated in case that’s the problem. There is a doctor we recommend who is respectful and listens to patients. What do you think about that?”

About making therapy referrals

May 12, 2014June 21, 2021 Real Social Skills

Content note: Today’s post is primarily directed at people who make therapy referrals and recommend therapy as part of their job (social workers, doctors, ministers, rabbis, school counselors, etc). This post is specifically about something that goes wrong when people make therapy referrals for the wrong reasons. If you haven’t been in a position to recommend therapy from a place of authority over someone you have a responsibility to help, this post might not make a lot of sense.

There’s something that can go wrong in therapy referrals. This is a thing that happens:

A social worker, doctor, teacher, clergyperson, chaplain or someone in a similar role is faced with someone suffering really serious problems
They don’t know how to help with most of them
And they are afraid of the magnitude of this person’s problems, and need to set a boundary to avoid becoming responsible for managing them
And, so, they default to making a therapy referral, as a way to assert boundaries and feel that they have done all that they could
Therapy referrals are often appropriate, but sometimes people make therapy referrals even when they are not appropriate as a way of asserting a boundary

This is how therapy referrals ought to work:

You assess that a person you’re working with might benefit from therapy
You make this suggestion to them, and you say why
You suggest specific therapists you think might work well with them
And you assume that they are the ones who should be making this decision
And therapy is one decision/referral among many; it might be the solution to finding space to work on emotions and relationships, but it doesn’t replace the need to find food stamps or medical insurance or housing or proper diagnosis of a medical condition

This is how therapy referrals often do work:

You assess that someone has problems that are much, much bigger than you can handle
You want to assert a boundary so the full brunt of their struggles do not become your problem
You don’t actually want to say flat-out to a person who is suffering that you’re not going to help them
So, you tell them that they should get therapy, and make that referral as a way to gracefully assert a boundary without having to say outright that you’re not going to help them even though you know they need help
Don’t do this. It isn’t good for anyone, including people who really need therapy.
Be honest about boundaries you’re asserting, and make sure that any referrals you are making are appropriate
Therapy referrals are for the client, not for you

It’s important that, when you make therapy referrals, you’re making them to meet the needs of the person you’re working with, not your own needs

You have to have boundaries in order to do your work. That means that you will be routinely faced with suffering people who you won’t be able to help
That’s awful, but it’s something you have to face and be honest about
There will be people you can’t help with most of what they need, and people who can benefit from therapy. These are overlapping, but not identical categories.
Recommending therapy to people who can’t benefit from it can sometimes just be a dishonestly comfortable way of saying “I’m not going to help you, and I’ want you to feel good about my refusal”
Whether or not someone should get therapy is a separate issue from whether or not you can or should try to help them yourself
Some people who you can’t help should go to therapy instead (eg: someone whose primary problem is probably treatable depression or learning certain classes of things about relationship dynamics)
Some people who you can help in some ways also ought to go to therapy (eg: someone who comes to you for prayer might need prayer, Bible study *and* a therapy referral)
Some people you can’t help should not go to therapy (eg: a gay person whose primary issues have to do with their coming out process who lives somewhere where all available therapists are homophobic probably should not go to therapy; that doesn’t mean that you are going to be able to help them through that in your role as a crisis center intake social worker)
Some people who ought to get therapy also need other help, and that might be the more pressing issue. Don’t imply that therapy is the solution to a broader range of things than it actually is. (eg: therapy might help a homeless person deal with their emotional issues, but it doesn’t provide housing; don’t use your therapy referral script as a way to avoid telling them that you aren’t offering help with housing)
Therapy is an important tool, but it’s not magic. Don’t treat it as universally important, or as the solution to all problems that you don’t know how to or can’t solve.

Short version: when you’re recommending therapy to someone, make sure that it is an appropriate referral and that it’s about meeting their need for care rather than your need for boundaries. To that end, make sure that making a therapy referral isn’t the only way you can assert a boundary; develop other ways to say no respectfully.

The problem with ‘autism experts’ as a source of help with autism-related problems

December 7, 2013June 14, 2021 Real Social Skills

A reader asked:

I’m just curious why is an autism expert the last person you’d go to.

Because ‘autism experts’ are taught things like this:

Autistic people are mind-blind and can’t understand emotions
And need intense social skills training, or
Don’t quite reach adulthood ever, or
Should be steered into STEM majors, or
Need intense ABA in order to make them look normal, or
All think in pictures, or
Any number of other stereotypes
Many of them also do things like routinely prescribe anti-psychotics to autistic people

That’s pretty much dealbreaking in terms of trusting them. Among other reasons.

Therapy is a choice

November 27, 2013June 14, 2021 Real Social Skills

Sometimes, when you are dealing with a really awful therapist, people will tell you “That is a terrible therapist! You should find another one!”

And sometimes that is the right thing to do.

But sometimes it isn’t.

Sometimes the right thing to do is decide not to go to therapy anymore. Or to decide not to go to therapy *right now*, even if you’re open to it in the future.

Therapy is a choice. And it is possible to decide to stop going to a bad therapist without making plans to find a new one.

Breakup aftermaths when other things are going on

August 23, 2013June 21, 2021 Real Social Skills

A reader asked:

I’m going through a breakup and am dealing with pretty crippling anxiety and depression despite the fact that my ex and I didn’t end on bad terms. I am a very socially awkward normally and my ADHD sometimes causes me to act impulsively.

I have three questions:

How/when/who is it appropriate for me to discuss my problems with (Like when people ask how I’m doing I normally lie but I think that may not be good for me.)

How long should I wait before spending time with my ex, seeing him is like tearing off a band-aid and

What is a good way for me to cope with my loneliness when my social anxiety prevents me from being able to be around most people?

Realsocialskills answered:

A few thoughts:

First and foremost, there is no one solution to this problem. You’re going to have to slowly find ways of making your life better. You’ll probably feel better if you think of it that way.

I get the sense that you might be thinking of the problem as “How do I get over my ex, stop being so impulsive, not be depressed, not be anxious, and not be so isolated, so that everything will be ok?” That’s a really overwhelming problem, but it’s not actually the problem you have to solve. The problem you have to solve is “What things can I do to start making my life better?”

And there are a lot of things that might be worth trying, and other things worth avoiding. I’ll start with the things I think you should avoid:

Don’t rely on your ex for emotional support:

It’s not good for either of you
Part of what being broken up means is that you need to separate emotionally and regain your own space
Relying on your ex for emotional support makes it damn near impossible to do this
Especially if you don’t have much else in the way of support
It is not your ex’s responsibility to make your life ok post-breakup
It’s probably not a good idea to spend time with your ex until you’re past the point of the breakup feeling like an excruciating loss when you see them

Respect other people’s boundaries:

Someone asking you how you are isn’t necessarily an invitation to share
“How are you” is usually a fairly meaningless socially greeting.
Sometimes people ask because they are concerned and really want to know. These are usually people you are already close to, or people you’re related to.
If you’re not sure whether they really want to know or if it’s just social noise, you can say “It’s kind of hard right now” or something similar, and see if they ask follow up questions
If they ask follow up questions, it’s usually ok to tell them what’s going on
But keep in mind that it’s ok for people to decide they don’t want to be your support system
And it’s important to respect that

Meetup.com

Meetup.com can bee a good way to meet new people in an unthreatening way
It’s easier to talk to new people when you know that you share an interest and are gathering to talk about it or do something
It’s also often ok to go and listen to other people talk
And it’s ok to leave if you need to

Interacting with people on the internet

A lot of people who can’t interact easily in person get a lot of social interactions from Tumblr
This counts as social interaction. Don’t devalue it
It also might help to seek out some other type of forum, like a message board about your interest/fandom/whatever
Email lists can be good too, especially if they’re the kind that don’t have archives that can be googled
Even with people you know, it might be easier to interact on chat or Facebook or some other internet based way

Religion

If you have a faith tradition, it might help you to go to church/temple/synagogue/mosque/place of worship.
If you have a bad experience with the place of worship you grew up with, you might be able to find one that works better for you
Most communities have a number of places of worship. Some of them probably have nice people
Unitarian Universalist churches work for some people who don’t feel comfortable in the organized forms of the religion they grew up with, but don’t want to reject it either
Going to a place of worship can be a way to meet people
It can also be a way to be around people without having to interact too much directly
For some people, being near people without having much conversation can be a way to feel less lonely without anxiety-inducing pressure
There also might be things you can volunteer to help with that aren’t too socially intense
There also might be study groups that work for you, because you can talk about the topic or just listen
Prayer can also help some people. Talking to God can help, even if you can’t talk to people.
Organized religion is not right for everyone, but it can be really good for some people

Reading fiction or watching TV

For some people, stories are a good way to cope with loneliness
Reading or watching stories is sort of like vicarious social interaction
It can also help you to learn a bit more about people and relationships
There’s a reason why lonely isolated kids coping with growing up by reading novels is such a pervasive trope
This isn’t helpful for everyone. Fiction can be really misleading and not everyone can understand it. But for some people, it can be good.

Therapy is helpful for some people

Some people find it helpful to talk to a therapist
Sometimes therapists can help people manage social anxiety and depression better
Or figure out executive functioning strategies
Or learn appropriate boundaries that make friendship easier
Therapy is not a good idea for everyone.
For some people, it isn’t helpful.
For some people, it’s a matter of finding the right therapist
For others, it’s actively anti-helpful and damaging.
For some people, it’s sort of helpful but not worth the costs
Therapy is something that can help some people to get support that helps them to figure out how to improve their life incrementally
Only you know whether therapy is a good idea for you (and it’s ok to decide to stop going to therapy if you decide that would be better)
In any case, therapy isn’t magic and it’s not a cure. There isn’t actually such a thing as “getting help” and that fixing your life. There’s just trying things and seeing what works.

Medication can be helpful for some people

Anxiety, depression, and ADHD are all conditions that some people find easier to manage with medication
For some people, medication is useful in the short term even if it’s not good in the long term
Some people don’t benefit from being on medications regularly, but do benefit from having medication available for occasional use to control anxiety or panic attacks
Medication is not right for everyone.
For some people it doesn’t work
For some people, it works, but has intolerable side effects
For some people, it works, but it takes a lot of experimentation to find the right medications and doses
Only you can decide if medication is right for you
Medication is not a cure or a way to become a different kind of person. It’s a strategy for managing things that works well for some people
If medication doesn’t work for you, that doesn’t imply that you don’t really have depression/ADHD/anxiety.
It also doesn’t imply that your condition is mild
Or that you’re not serious about making your life better
All it means is that medication is not a good strategy for you

When crying in therapy is a red flag – and when it isn’t

July 28, 2013June 21, 2021 Real Social Skills

A reader asked:

I used to cry (I mean weep, sob, have tears in eyes) sometimes when someone said something that made me feel understood. I used to often cry in therapy sessions. I liked crying in these cases; I felt I was working through things. I can see how some therapists might feel that they’re being successful if the person cries. Sometimes it’s that way. But they shouldn’t just do whatever makes someone cry. That could be very bad, too, I imagine.

Yes. Crying, in itself, is not a red flag. Crying in therapy *can* be a good thing.

What’s bad is when a therapist pursues getting someone to cry as an end in itself.

Making the point about therapy more sharply

July 13, 2013June 20, 2021 Real Social Skills

Three year old children in preschool are some of the least socially powerful people in our culture. But, they are routinely given a lot of choices about what they do and how they do it.

They’re not usually required to do painful and boring things over and over with no regard to their feelings or their experiences. And, from time to time, they can say no to something an adult had planned for them and have it stick.

Preschool teachers know that their work depends in large part on getting the willing cooperation of most of their students. That doing things to them over their miserable protests over and over is probably going to end poorly.

All too often, therapy for people with disabilities is less respectful, consensual, and individualized than the average preschool class.

If you’re exercising more control over a ten year old kid with a disability than you’d feel comfortable exercising over a nondisabled three year old child, you’re doing it wrong. All the more so if you’re doing it to an older child or an adult.

When you have mixed feelings about an abusive relationship

July 2, 2013June 20, 2021 Real Social Skills

Content warning: this post probably uses language that gets used against abuse victims. I’m trying to avoid that, but I don’t think I’ve entirely succeeded, and some of these words might be triggering. Proceed with caution.

So, here’s the thing.

People are complicated, and relationships are even more complicated. Abuse victims are often pressured to pretend that things are simple. They’re pressured to believe that if there was any positive aspect whatsoever to an abusive relationship, then it wasn’t really as abusive as they think it was.

But it doesn’t work that way. People aren’t averaged. People can do some really good things, and some abusive things. They don’t cancel each other out. They coexist. Whatever else happened, the abuse was real, and you’re right not to tolerate it.

Sometimes… sometimes your abuser is also the person who taught you your favorite recipe.

Or something fundamental about how you understand the world.

Or a major skill you now use professionally.

Or maybe they gave you a lot of valuable criticism that made your art better.

Or maybe they supported you materially when you were in real trouble.

Or any number of other things.

And…

…none of that makes the abuse ok. None of that is mitigating in any way. It doesn’t cancel anything out. Sometimes people talk like the abusive interactions and the good ones get put in a blender or something, and like some sort of theoretical blended average is what really counts. That’s not how it works. It’s the actual interactions that count, not some theoretical average. The abuse is real, and significant, no matter what else happened.

It doesn’t have to be one or the other. If some things about an abusive relationship were positive, it’s ok to acknowledge and value them.

And you can still refuse to ever have anything to do with your abuser ever again. You can still be angry. You can still hate them. You can still decide never to forgive them. You can still warn people against them. None of these things are mutually exclusive.

And, most importantly, valuing some aspects of the relationship or having some positive memories does not in *any way* mean the abuse was your fault.