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PaperclipPerfector  2d ago (text post)   1238 thread views

Wellness Wednesday for January 15, 2025

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

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Two thoughts:

  1. Your presentation seems pretty biochemical - rapid response to an therapeutic dose (5 is too low), somatic symptoms, a significant amount of side effects (the stomach is common and usually self limited and associated with specifically the initiation of medication and changes of doses). You should keep that in mind and inform your doctor if you need to make changes or you get a new one.

  2. This advice will may mean less to you if your presentation is in fact pretty biochemical, but therapy and medication is superior to either alone. Our best guess for how SSRIs work (and you may not actually be one of these it sounds) is that they make your cognitive structure more flexible and allow good decisions and therapy to stick better. If you feel like you could do more to be better, get a reputable therapist.

Additional thoughts - also sounds like you have a decent chance of being the kind of person whose brain isn't good at listening to their brain or body, so you get random ass symptoms as your brain flails around in confusion. In those situations it may be wise to reach outside yourself to try and figure out if you are doing okay/how well you are doing. Of note it's not uncommon for successful people to be like this because they establish patterns of just puttering along and getting it done and burn themselves in the process.

If you feel like you could do more to be better, get a reputable therapist.

I am highly skeptical of therapy after an annoying experience as a teenager (several sessions of mandatory therapy as part of a settlement of a frivolous prosecution for terroristic threats).

Also, Big Man Siskind says:

I work in a clinic with about ten therapists. Some are better than others, but all of them are competent. I send my patients to them. In a few hundred patients I’ve worked with, zero have had the sudden, extraordinary, long-lasting change that the therapy books promise. Many have benefited a little. A few would say that, over the course of years, their lives have been turned around. But sudden complete transformations? Not that much.

Why go for therapy when medication has already brought about "sudden, extraordinary, long-lasting change"?

He also says:

Medications and psychotherapy are about equally effective in treating depression, but psychotherapy costs a lot more, takes more time, and is harder to get your insurance to cover.

it's not uncommon for successful people to be like this because they establish patterns of just puttering along and getting it done and burn themselves in the process.

You may rest assured that I have been confiding in my favorite coworkers that my days of masochistically taking on extra work without being told to by my boss are over.

As usual blah blah I don't agree with Scott on most aspects of doctoring.

Therapy works, and it works great, and has a great evidence base. The problem is that unlike medication management and general medical care, it's very hard to tell if you are getting good therapy, or the therapy that is good for you - not only is proficiency level variable, but the match between the therapist and patient is important and that can be hard to manage (classically: a good chunk of men are not going to respond well to the more ooey-gooey therapists)*.

Quality therapy also intends to end, it's not open ended or indefinite.

That said it sounds like you are skeptical, had a bad experience, and aren't necessarily the best type of patient for it (plus the expense).

But it is something to consider in the future if you are not satisfied with where you at or slide a bit.

Alternatively you can use the classic man-therapy type approaches. Sportsball! Teams! Friends! Woodworking! Blah blah.

*Yeah I really don't know what Scott is going on about here. There are absolutely the type of patients who therapy isn't likely to work for but DBT for BPD is well validated, and every therapist I've ever dated (pro-tip: don't date therapists) will endorse patients with radical improvement or development, even if it's just catching a college student who needed to grow up. If Scott isn't ever seeing it work something about his catchment is fucked or he is exaggerating in an unhelpful way.

pro-tip: don't date therapists

Fuckin' A, man. Fuckin' A.

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