Bamboozled, hornswoggled and hoodwinked?

((((((((((((( Byz ))))))))))))))

*****reading, considering, observing*****

-- Thanks Byz & Everybody!

Recover -- to what? What if you never were emotionally "healthy"? What if you never knew what that was like?

It is possible to get to a state of health that is much better than you ever suspected was possible. Is it "normality"? Depends on what you mean by "normal". You may discover a world that you never suspected was out there. On the other hand, you might not!

There to me is no such thing as normal. EVERYONE is disfunctional to varying degrees and off balance. Normal is unattainable in the first place. Functional with things that bring us joy in our lives is what we should be aiming for in recovery.

I do think treatment, and the expectations of recovery, has been oversold. There is not enough known about mental illness and the providers are limited in their abilities to make the promises for recovery that they are making confusing this with hope. Hope should not be abandoned but realistically as of now, each treatment option is a crap shoot and just like with one, we hope for a positive outcome but have no idea what's really going to happen.

Whenever people say things like that I think "Do you know EVERYONE"?

There may really be a lot of people out there who are not particularly dysfunctional!

We don't see them because they don't draw attention to themselves, and we respond to the dysfunctional ones because that is all we ever knew!

Of course, I don't know everyone. However, have you ever met anyone who did not have some kind of impairment or inability- mentally, emotionally or physically? It may not be readily apparent but if you really get to know someone the cracks begin to show. This is disfunction. Disfunction is inherent in the nature of being human; we ALL have some kind of impairment or inability because of genetics or how we grew up, and affects our learning patterns, our responses, how we deal with our emotions, and interact with one another. There is no way that two people are alike to set a normal standard and it is also partly because of our disfunction that is what makes us unique. There can be normal routines but normal humans, it is contradiction b/c of our disfunctions.

Yes, not everyone is FULLY disfunctional, But yes, everyone is disfunctional to varying degrees.

You have to know everyone to be certain of that.

And as I indicated, I think we may overestimate the numbers of significantly-dysfunctional ones because of our histories: those are the ones that surrounded us!

pachyderm, as I mentioned, there are many definitions of recovery out there. I appreciate this one:

Anthony (1993) identifies recovery as " a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness." http://www.mhrecovery.com/definition.htm

It addresses your concerns.

Byz, always liked Frankl. He was one of the few who when i read his work was ready to acknowldege that yes, even a trained psychoanalyst could have subjective experiences that actually have some value when it came to other people as well. Most of the others tried to disguise their subjective views as scientific "observation" or "professional expresience", although sadly enough, some of those couldl have been just as usefull in working with people, and more honsetly easy to trace and control without having to blame the patient when things went south.

I thought of that when you mentioned not giving advice: the idea comes fom the old view that the patient is to learn to be autotnomous. He or she is to find the answers to all things an his or her own, without the input of either the therapist or another. The ideals of western culture are, in my mind, nearly pathologically afraid of dependency on other humans, although our whole way of life is in fact based on dependency on structures and superstrctures we have little relation to (the government, legal system, roadsystems, health systems, tansport of food...).

Nowadays you might get different answers, but most therapists still live in that intellectual-historical framework. This in spite of the fact that many of my adolecent patients have already thought through many things that earlier would have taken YEARS of therapy for most kids to have come up with. We simply don't think about ourselves the same way as we did when the field of psychotherapy was starting, and when people ask for advice, it is usually not because they are seeking to avoid responsibility; they usually have actually hit the end of the rope in what they should do next, and they have no where else to go.

As in all professions, one must weigh the consequenses of advice givning and how it is framed. Does one imply following advice will solve everything? Mistake! Does one suggest it and leave the possibility that it might not work open? Better. Some cases you have no ethical choice. I have had to argue and say straight out to people who's partners were showing signs of becoming violent and/or overly controlling that the best thing to do is run, not walk, to the nearest exit. As a professional, if I see the signs and do not speak up, I share the responsibility of the consequenses.

Actually, therapists influence one al the time. Giving advice is in a way simply a more obvious and yes, agressive way of doing it, but also more honest. You can call a therapist on it. You can debate them about it, you can question them about it. You can't debate, question or call out on a tone, a nuance, a lift of an eyebrow, a certain choice of words one can't quite pin down... Ack, I DO go on. Huggggs.

As the burden of mental illness increases so does the controversy over the efficacy of treatment modalities. The influence of pharmaceuticals is part of the discussion:

Big Pharma, that is, the 50 or so biggest pharmaceutical companies, is an enormously powerful force in government and medicine, and I think people need to understand the depth of this. They have the power to control which “peer-reviewed” research gets published, this in turn has an influence on which drugs get prescribed, and in addition to this they have the power to wage billion-dollar advertising campaigns. They have a tremendous power to influence the very way we think about mental health. They have billions and billions of dollars. http://pasadenatherapist.wordpress.com/big-pharma/

Last July, Robert Whitaker, the Polk Award-winning journalist and author of the recent "Anatomy of an Epidemic," had an invitation to be keynote speaker at the annual "Alternatives" conference withdrawn. He explains:

"MFI: What is it that you write about in Anatomy of an Epidemic that is so threatening?"

"WHITAKER: The story told to the public by the NIMH and by academic psychiatry is that psychiatric medications have greatly improved the lives of those diagnosed with psychiatric illnesses. Yet, even as our society has embraced the use of psychiatric medications during the past two decades, the number of people receiving government disability due to mental illness has more than tripled, from 1.25 million people to more than 4 million people.

"So you can see, in that data, that something may be wrong with that story of progress. And then, if you look at how psychiatric medications affect the long-term course of psychiatric disorders, you find -- in the scientific literature -- consistent evidence that they increase the likelihood that a person will become chronically ill. I know this is startling, particularly since we do know that some people do well on the medications long term, but that evidence, in terms of how the medications affect long-term outcomes in the aggregate, shows up time and again in the scientific literature." http://www.furiousseasons.com/

A report describes the steps drug companies are taking to restrict what physicians who are part of their paid speakers' bureaus say during their talks:

According to the companies, these speakers ("shills" is the term that seems more to get to the heart of the matter) are now told not only that they must use exactly and nothing but the slides that the company provides, but that they must even show the slides in the same order as specified by the company. With the company pulling all the strings, one wonders why they even need the physicians to give the talk at all; any robot apparently could do it. http://brodyhooked.blogspot.com/ http://www.propublica.org/article/dr...-presentations

Combating the influence:

There is a growing need for physicians to limit their marketing relationships with pharmaceutical companies.

• According to the New England Journal of Medicine, 94% of physicians accept gifts, payments, reimbursements or other financial incentives from the pharmaceutical industry.
• Numerous studies have demonstrated that such gifts and payments directly influence medical decision-making.
• It has become difficult for physicians to find and distinguish legitimate, evidence-based sources of medical information from biased, industry-influenced sources.
• The very distinction between marketing and education has been blurred.

We must reclaim medical practice and training environments from undue marketing pressures. The National Physicians Alliance encourages all doctors to join our network of Unbranded Doctors — a national network of physicians committed to reducing the influence of pharmaceutical marketing on our profession.

The National Physicians Alliance’s Unbranded Doctor is unmasking the pharmaceutical industry’s bogus claim that its marketing efforts are just educational ventures for physicians. By signing up physicians to renounce gifts, lecture fees, and “education” from companies, the Alliance is championing objectivity, integrity, and professionalism.
—Jerome Kassirer, MD
former Editor-in-Chief, New England Journal of Medicine
http://npalliance.org/action/the-unbranded-doctor/

Are All Relationships between the Pharmaceutical Industry and Academia Bad?

In summary, we strongly believe that academicians should avoid any personal financial support from industry that is derived from marketing activities that are designed to enhance the sales of drugs. These activities include giving talks for companies and accepting gifts from companies. On the other hand, we believe that it is in the public interest to encourage basic and clinical scientific collaborations between academic medical centers and industry in order to enhance our knowledge about psychiatric disorders and to promote the development of new and more effective treatments. http://www.psychologytoday.com/blog/...ndustry-and-ac

My view is that codes of ethics have failed to deter relationships detrimental to clients and consumers. While I think it is wrong to make broad generalizations, I see pragmatism and expediency overtaking integrity.

Fresia: everyone is disfunctional to varying degrees.

pachyderm: You have to know everyone to be certain of that.

I'm confident that if anyone weren't, I'd soon be reading about them in the news.

I confess I haven't read very much of this thread yet so I'm throwing in my two cents' worth rather casually.

It sounds to me as if those therapists, whoever they were, had learned to follow some kind of cookbook strategy as in, "My mind is already made up. Don't confuse me with the facts." When their treatment recipes didn't work well for you, they couldn't afford to question their own understanding of whatever they were doing so it had to be your fault.

At least tangentially related to the experiences you describe with your therapists is this discussion from six months ago.

Do you suppose there was some kind of pattern to the kind of therapists and therapies you kept choosing, or were those the only ones available? It sounds as if something that was consistently missing for you there was the experience of being validated (a little more about that here -- no doubt lots more elsewhere that I haven't had time to find):

Additionally, I believe I observe a "progress bias," analogous to confirmation bias, among clinicians and therapists. That is, caregivers are often predisposed to see signs of progress, grant undue weight to those signs, and either ignore or downplay evidence to the contrary among their patients.

Psychologically weakened patients themselves may unconsciously abet progress bias by wanting to please the caregiving authority figure with reports that make the latter happy.

Fool Zero, I have had many therapists from social workers to psychiatrists and psychologists. Behavior therapy, cognitive behavioral therapy and eclecticism predominated. Going from one college to another, from one town to the next and finally to the VA accounts for the high number of therapists; that and having a personality "not conducive to therapy," whatever that means. I did not know enough to choose a therapist based on education or treatment approach. At the VA, I was assigned to a therapist who was available.

For the most part, I did not feel invalidated. At least two therapists passed me on to a colleague apparently because they found me difficult. Even so, my frustration arose from expectations and being told I did not understand. Despite asking what it is I did not understand, my question remains unanswered.

I want to make it clear that I learned a lot in therapy. Having to step up my efforts to better my functionality has been helpful. I have accepted my responsibility for not achieving a better result in therapy. Sometimes even the best efforts of all concerned is not enough.

http://www.mayoclinic.com/health/dep...atment/MY00751

For me, that would've been the very model of invalidation. Are you saying you didn't feel invalidated even then, or were those among the few times when you did?

I do not think I ever felt invalidated. I knew I had serious issues to overcome. No one told me otherwise. When I did not start to feel better, my anger and frustration surfaced. I often thought my therapists were as frustrated as I was.

On the contrary: they would not be in the news.

Why deprive us of the ancient, time-tested, always reliable, utterly human, self-soothing method of generalizations without sufficient basis in fact? Ninety-nine percent of PC members would be forced to express themselves solely using emoticons. You MUST be fully aware that outside of peer-reviewed academic articles baseless generalization is the way the world works. If that weren't true, the amount of political and economic misery in the world would be reduced by 85%! (No citation) And no, Pach, you can read about truly functional people in The Christian Science Monitor and www.happynews.com. Take care!

FoolZero's question about my selection of therapists and therapy modalities got me thinking about the haphazard manner I employed. My general practitioner referred me to a the first therapist I had. I had no idea about the types of mental health professionals to choose from or the importance of a good fit:

The key to choosing which one of these professionals is right for you is to determine what kinds of things are important to you and finding a professional that seems to fit with your needs and personality. Often times, finding the right therapist or mental health professional takes more than one try. You may need to “try on” a few professionals before finding one that feels right to you. Don’t be afraid to do this, as it is your well-being and treatment you’re investing in. http://psychcentral.com/lib/2006/typ...professionals/

The importance of a good relationship with your therapist cannot be overstated:

Choosing a Therapist

Research on psychotherapy outcomes tells us that the most powerful factor to assist healing is the quality of the relationship you have with your therapist. [1] Addressing sensitive personal issues with a therapist can be difficult, bringing up intense feelings, thoughts and memories. When you choose a therapist, your ability to disclose sensitive material and work on it openly is greatly enhanced if you feel comfortable with the therapist and can establish a trusting relationship with him or her. You also want to feel secure in the therapist’s skills, competence, and approach to your needs — a nice person without these qualifications won’t get you the best results.

For these reasons, I recommend that you don’t settle for the first therapist you meet if you don’t feel the potential to form a strong healing alliance. As you get into the work, feel free to ask your therapist about your treatment plan and progress. If you aren’t happy with her or his approach or with the results you’re getting, voice your concerns early, as discussed below.
http://psychcentral.com/lib/2009/get...therapy/all/1/

DocJohn has assembled a lot of useful information about psychotherapy here: http://psychcentral.com/lib/2009/get...therapy/all/1/

He tells us:

Most psychotherapy tends to focus on problem solving and is goal-oriented. That means at the onset of treatment, you and your therapist decide upon which specific changes you would like to make in your life. These goals will often be broken down into smaller attainable objectives and put into a formal treatment plan. Most psychotherapists today work on and focus on helping you to achieve those goals. This is done simply through talking and discussing techniques that the therapist can suggest that may help you better navigate those difficult areas within your life. Often psychotherapy will help teach people about their disorder, too, and suggest additional coping mechanisms that the person may find more effective.

The most effective therapy for me included a treatment plan that established goals, formulated the means to attain them and included homework. Therapy without some structure was much less beneficial. Here is another article that touches on the subject: http://www.wellsphere.com/mental-hea...therapy/782440

Dr. Jacqueline Simon Gunn wrote a book entitled, In the Therapist's Chair.

Her approach is one of therapist/client equality – both affect each other and self-awareness on the part of the therapist is crucial to success. She says, “In order to be open and receptive to each patient’s particular uniqueness we need to be sufficiently accepting of ourselves. We need to be aware of our own unique traits, whether they elevate our feelings of self-worth or make us uncomfortable. Self-awareness, empathy and acceptance of both our strengths and inadequacies are all vitally important to our work with our patients.” http://psychcentral.com/lib/2010/in-...rapists-chair/

This quote reminds me therapists are not superhumans to be placed on a pedestal. They have a very difficult job. A good therapist is invaluable.

Most of the therapists I saw did not design a treatment plan or tell me the type of therapy they intended to employ or state what was expected of me. Many talked about getting paid. When I started with therapy I was so unknowing of what I wanted from therapy. I was too ignorant to ask intelligent questions. I just knew I did not like what was going on and could not change it for the better alone.

I'm not sure when you were in therapy but I do notice that therapy seems to have come a long way since I last was.
I think a major problem for me was that I assumed there was something wrong with me that my therapists would see (since they were the experts) that I couldn't (since I was the patient), and that for the same reasons, they'd be able to tell me what to do whereas I'd never find the right direction by myself.

Since I was already used to hearing that whatever difficulties I was having were my fault (although for a different reason each time ), I was wary of stumbling into a situation where my therapist could possibly tell me I wasn't trying, or I misunderstood, or I was doing it wrong. The result was that I'd try to anticipate what they expected and give it to them, even if it meant saying things that I wasn't quite sure were true or sometimes not saying things that might make me sound like (my idea of) a bad patient. I'd present with those problems in particular that I thought would be easiest and most rewarding to recover from and least likely to confuse or freak out my therapist. Then, once we'd established that their methods worked for me and I was a good enough patient for them, we could go on to the hard stuff if we had time.

I was in my early 20s at the time, and accustomed to unequal relationships with authority figures. I figured the therapists would be deciding how the therapy was going, whether to keep me as a patient, and what to try next. I didn't trust them to do the right thing or make the right decision every time, but I wasn't going to be in a position to argue or appeal. I needed to keep looking like the kind of patient they'd want to keep working with, and hope that whatever they decided to do did me some good.

I later came across several authors who did seem to show a good understanding both of therapy itself and of my experiences with it. The first few I think of are Carl Rogers, Irvin Yalom, and Steven Hayes. I have to admit that they, and therapy, make a lot more sense to me in retrospect. I'm not sure how useful I'd have found them if I'd read them before starting therapy.

---------------------
edited to add: While looking for some of those other links, I also found this collection.

Thanks for your comments and links, Fool Zero. Thanks to all commenters, for that matter. While in hindsight it may seem ridiculous for me to have thought all I had to do was show up and the therapist would fix me, I am not embarrassed for thinking so.

At the time I was trying to overcome a chronic illness. I was seriously struggling, Even then, it took a lot of will for me to accept I could not get through this myself and needed help. Once I made the decision, I thought I had taken the biggest step to getting better. After all, therapists were the experts. My therapist would rid me of my malaise and have me smiling in no time. All I had to do was respond to the therapist's questions, listen carefully, follow instructions and live happily ever after.

Frankly, I do not understand how I could have been expected to think otherwise. I had no idea about the various types of therapy or what qualifications I should be looking for. I should have interviewed potential therapists? News to me. Etc., etc.

Even if I had known more I doubt it would have made a lot of difference. For me, the experience of therapy was my teacher.

There's no way anyone can know what to expect and even once going through it, it is still a maze. The mind in of itself is a mystery, how can anyone expect to know?!

I too had higher hopes than I initially started with and at times have lost it along the way. I continue to hope for more knowledge, insight, understanding, and compassion as time goes on. It is more gradual than would like but it has become better than times past on one hand and less in some respects on the other.

Everyone's posts have been so valuable into the nature of the treatment and the profession. It has been considerate, thought provoking, beneficial, and at times very difficult, yet important. I just wanted to thank everyone for posting. Thank you TheB for sharing and for starting it. This has meant more than I can say.

There is nothing to be ashamed of at all; for a long time, that "come in and be fixed" attitude was, perversely in a way, encouraged by the culture of the times. The the professional would pathologize the attitude that you had that said "fix me" instead of trying bravely to fix yourself Catch 22 all over again.

For a long time, the goal was that we were al supposed to be "happy". I don't know, I find it hard to define what would be "happy" for me especially if it was supposed to last my whole life. For me, the meds HAVE made the difference between having to be on a form of disability and being able to work and manage myself. All the insight in the world wouldn't have been able to save me.

But no, nothing has reached the old time therapy goals of making me HAPPY, and the more I have accepted that nothing can make me that way, the better I feel. Wierd, I know, but like, with Christmas, I ´'m much happier if I manage to make the kids really get into it than if I try to recapture the feelings I had as a kid, because well, I'm not a kid anymore. But this Christmas I found myself darned close watching the kids with each other, not even with the darned gifts, with each other and the tree we cut under the power line. I'm not making much sense, but...

Are we and our therapists working for the same thing? Are we defining our terms the same way? Is what I want and what the therapist would want in my place the same thing? If not, whose definition should win out? what do you think, Byz? I have my druthers both as a prof and a pat. I'm kind of interested in hearing if I'm the only one who has wondered this as as well.

Our pharma television advertising promotes this expectation even now, it seems to me!

Hello, lonegael. Your question is one I have pursued with vigor in "discussions" with more than one professional. I want to make clear my answer is subjective and is not intended to be persuasive. The thread on inability to change comes to mind.

Happiness for me is a slippery concept that I find rather unhelpful. My goal is to increase functionality. This definition of recovery by William Anthony is my exemplar for enhancing my ability to function at a higher level:

" a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness."
http://www.mhrecovery.com/definition.htm

As the years passed, I became more assertive in expressing what I wanted and expected from therapy. I felt some of the professionals needed to be reminded it was I who had hired them; I was not one of their experiments and definitely expected to have a voice in my treatment.

This quote from an article entitled A New Model of Recovery from Mental Illness is one I would like to incorporate into my treatment plan: "Self-Direction: … By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals."

One of my therapists asked me to envision standing in front of a door. On the other side of the door was the life I wanted for myself. He asked me what that life would entail. He further stated my life would always be changing to some degree. He wanted to know about the core values I admired and the requisites I needed to make my life more fulfilling. The exercise was very thought-provoking.

If my recovery (increased functionality) is going to be self-directed, what is the role of the professional? The professional is the one that helps me get well enough to sell-direct. He/she tells me when I am grandiose, intellectualizing or short-sighted and narrow-minded. She/he helps me formulate a treatment plan to get better and reach my goals. The plan must have micro goals and a macro goal. The plan should be revisited frequently for updating and accountability. In short, the professional is my brain trust, my cohort and my sounding board.

At the onset of the relationship, it is important that the professional familiarize the client with the Patients Bill of Rights, informed consent, client autonomy and the professional's expectations of the client.

APA's Ethical Principles of Psychologists and Code of Conduct sets forth the core values of our profession. The title of the document conveys that the Ethics Code consists of two central aspects: a set of principles and a code of conduct. While the code tells us that the principles are aspirational in nature and that the ethical standards are enforceable rules for conduct, much more can be said about this subtle and rich relationship.

Principle E of the code's General Principles, "Respect for People's Rights and Dignity," begins by stating "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality and self-determination." Throughout the code are examples of how psychologists respect their clients' right to self-determination. Respecting a client's right to self-determination both manifests a core value of our profession and plays a helpful and important role in providing services that will benefit clients.

Perhaps the most apparent way in which the new code supports a client's right to self-determination is found in four ethical standards with "informed consent" in their title: Standard 3.10, "Informed Consent"; Standard 8.02, "Informed Consent to Research"; Standard 9.03, "Informed Consent in Assessments"; and Standard 10.01, "Informed Consent to Therapy." Obtaining informed consent respects a client's right to self-determination by informing the client about central aspects of the relationship and obtaining from the client consent to proceed. Through the process of becoming informed, the client receives information on which to base a considered decision; through the process of obtaining consent, the psychologist ensures that the decision to proceed belongs to the client and is not the product of coercion.

The process of obtaining informed consent also holds important clinical meanings. Through informed consent, the client is made a collaborator in the work. Research has shown that when clients experience themselves to be true partners in the therapeutic process, the likelihood of a beneficial outcome increases. Here is an excellent example of how good ethics can promote good clinical care.

The Ethics Code emphasizes and elaborates the centrality of informed consent in a variety of ways. Standard 3.10, in the "Human Relations" section, provides that psychologists obtain informed consent when they "conduct research or provide assessment, therapy, counseling or consulting services," while other standards take this general language and apply it to specific circumstances: Standard 8.02 to research, Standard 9.03 to assessments, and Standard 10.01 to therapy. Numerous other standards that do not make explicit mention of "informed consent" nonetheless promote self-determination and autonomy, as well as excellent client care. http://www.apa.org/monitor/jun04/ethics.aspx

http://www.healthyminds.org/Main-Top...of-Rights.aspx
http://blogs.psychcentral.com/therap...ill-of-rights/

The premise of autonomous decision-making fits well with my preference for self-direction. It also lessens over-reliance on the professional while curtailing client finger-pointing.

Enough. I am so windy!

Very good points, both of you!

I mentioned Steven Hayes a few replies ago; well, he also wrote the foreword to a book by Russ Harris called The Happiness Trap. <--- Google Books (partial copy online) A month or so ago another member posted a link to a worksheet (pdf) taken, as I understand it, from that book.

I just tried to download a promising-sounding video, Steven Hayes on Happiness, but it doesn't seem to work well with my browser. I'll let anyone else interested pursue it further.

Years ago, the pursuit of happiness actually felt like a big breakthrough for me. My family of origin had been pushing me to choose a suitable career, get the right training for it, and set up my circumstances so that I could (eventually) be happy; if I failed to do that, they warned me, I was sure to end up unhappy. It bothered me no end that in order to (theoretically) be happy I'd quite likely end up working in some field that I didn't really enjoy that much and giving up most of what I was really interested in.

I was 17 or 18 when it dawned on me that happiness wasn't some place that I needed to get to by doing all the right things but (apparently) a natural consequence of doing what I enjoyed. Of course this brought its own complications: if I were to find I enjoyed reading poetry or getting drunk or skipping school or dating unsuitable girls, wasn't that likely to cost me in the long run? How could I tell, though, if it was going to cost me more or less than persevering with an education for some career I didn't expect to enjoy? In retrospect, of course, I was lumping together lots of dissimilar and perhaps incompatible experiences to represent "happiness" but I had no way of figuring that out at the time. I don't know if my therapists would have been able to explain it to me (or how well I would've followed their explanation if they'd tried), but in any case I didn't ask. I was probably expecting to be told that it was all up to me, that I had to study the alternatives, make the best decisions available, follow through, and find out much later if I'd chosen well or not. It seems to me, though, that I was in therapy precisely because I was having difficulty with every step of that. Probably my therapists did the best they could to help me back off from whatever immediate crises I felt stuck in and start exploring how I actually felt about my choices. It was a long way from enough but it was definitely a step or three in the right direction. I did end up changing my major in school (from math to psychology! ) just a few months after starting therapy.