Ask A Therapist: How Do I Know If I Still Need Therapy?

Q: I am a married woman of 24 years with 3 grown children.  I have had a pretty rough past and struggled with mental illness most of my life.  I grew up in a very dysfunctional violent family with an alcoholic parent.  I was abused and neglected.  I attempted suicide at the age of 17.  Through the years I buried my past and attempted to live a normal life.  I did not have an identity, I did what everyone wanted of me, and even believed the beliefs of the people around me. I was an empty shell being filled up by other people.  I had another breakdown in 1999 and attempted suicide again.  That is when I began therapy.  It took me a realy long time to open up to my therapist.  It seemed I got much worse before I got better.  I began cutting and binge eating became  a huge problem.  I had always coped with food but now it brought my weight up to 322lbs.As the years went by, and with medication I began to slowly deal with issues and start to rise out of my depression.  I trusted my therapist and told her things I would never tell another soul.  I was getting better and I decided to improve my life. I had gastric bypass to lose weight and in the past year I have lost over 120lbs.  I was using good coping skills and having more rational thoughts.   Unfortunately my bones suffered from the weight and degenerative bone desease.  This past October I had a total hip replacement and this past February I had a total knee replacement. It has not been 2 months yet and it has been a slow painful recovery.My therapist retired this past December.  I do not have a regular one yet, although I did meet with one just one time to feel it out.  I am unsure if I need to stay in therapy.  I have been in it for a very long time and although I am better than ever before, I still have depression and dysfunctional thoughts.  I am still on medication, Wellbutrin, Lexapro and Neurontin for mood disorder.  I have been labeled as PTSD and BPD. I am starting to binge eat again and I am afraid the gastric bypass will be worthless to me someday.  I do not want to gain all that weight back as I could hardly move then.  I feel very sad that my therapist retired and I feel pretty lost right now. Is it normal to be in a therapy program for as long as I have been? Do some people stay in therapy all of their life?  I feel that I will never get out of this dysfunctional rut. Is there hope for me? I am very tired and very afraid to live this way.  I just want relief and to feel a bit of satisfaction in how I live.  I appreciated any input.Thank you :)

A: What a brave women you are to have faced your past trauma and to have actively sought treatment to move toward a healthier and happier life. I can't imagine how difficult it must be to have your therapist retire after working so hard to develop enough trust to open up and share things you've never shared with anyone else. It is very normal to feel lost, sad, and to grieve the loss of this therapeutic relationship, just as you would if you said goodbye to a close friend or family member. I imagine that finding a new therapist and developing that trust again is a scary thing to consider, but a necessary one.Some health problems, like diabetes, are chronic and require lifelong attention, management, and treatment, while others are acute, like strep throat, and generally require one course of antibiotics. Mental illness can be conceptualized in a similar way. Your mental health history, your history of abuse and neglect, and your psychological symptoms seem to fall in the chronic category. It is common for individuals with severe childhood abuse and neglect to be in treatment on and off throughout life to help manage the emotional and psychological consequences of the early experiences.Your continued struggles with dysfunctional thoughts, depressive symptoms, and binge eating suggest that you need to get back into therapy to maintain the progress you've made and to continue to develop coping skills and insight. You may in be in treatment throughout the rest of your life. If that's what you need to continue to move forward, to manage your symptoms, and continue to create the life you want, then that is nothing to be ashamed of.  You deserve to have nurturing and support.Take good care of yourself!Julie Hanks, LCSW

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