It’s not all in your head
Dealing with a chronic illness or medical condition goes far beyond the physiological and medical challenges it poses. Chronic illness can strain your view of yourself, your relationships, your place in society, and your plans for the future. Psychotherapy (also known as ‘counseling’ or just ‘therapy’) is a valuable resource when you are struggling with these challenges. Unfortunately, many people don’t really know what therapy or counseling is or how it can help them cope with chronic illness. There are some common misconceptions that make therapy sound intimidating or even threatening.
The goal here is to help you become more informed about some of the different ways psychological therapy can be helpful by considering different goals or outcomes you could seek from therapy. They are not mutually exclusive, and any given therapist may be more or less expert at helping in one or more of these areas.
Types of Therapy
This is the process of identifying resources that would be of help to you (AKA “assessment”), finding or helping you find specific places to go for those resources, and possibly assisting or coaching you as you access those resources. “Resources” could be counselors, agencies, programs, clinics, hospitals, support groups, doctors, or any number of other sources of assistance.
This is a role traditionally played by social workers. Indeed, social workers at government or private agencies may be able to provide this kind of assistance to you. In private practice, a Licensed Clinical Social Worker (LCSW) might be a good choice. Be aware, however, that not all LCSWs necessarily focus on this kind of work; by the same token, many private practice therapists who are not LCSWs are quite skilled at providing this kind of assistance. Some medical doctors may also be able to provide help of this kind.
A counselor providing this kind of assistance may have specific expertise, such as helping people with chronic illness. Even if they do not have such expertise, a skilled provider should have the knowledge and contacts necessary to research your needs and corresponding resources more quickly, completely, and effectively than you could yourself.
This is the process of helping you understand aspects of individual psychology, emotions, relationships, neurobiology, and any of a number of other areas that could be of help in making sense of your experience and making the changes you want.
Psycho-education is usually not enough by itself to create significant change. If it were, reading a good self-help book would be as effective as therapy. For some people, however, intellectual understanding of what is happening for them is a very important part of the process of change, healing, and growth. It could normalize your experience, help you to stop judging yourself as being morally deficient, and give you insight into how to deal with it more effectively. It can promote a sense of safety and control, and therefore provide or increase motivation.
Most of us learned some very important life skills, like dealing with our emotions or communicating effectively in relationship, by a very haphazard process of observing those around us. For many of us this has resulted in some significant holes in our psychological, emotional, and relational skill sets. Sometimes we learned poor skills that we need to un-learn so we can discover healthier ways to do things.
Therapy can be a kind of life extension course for these skills. This is actually a primary goal of some kinds of therapy, such as couples counseling or relational therapy groups. A good therapist can teach you these important life skills and coach you in practicing them and becoming proficient at employing them.
The goal here is generally to alleviate painful or disruptive symptoms that a client identifies as causing distress or problems in his or her life. Symptoms can be simple or complex, and symptom treatment can be correspondingly easy or difficult, and quick or longer term. A symptom like “panic attacks whenever you get into a car since being in a bad accident” is relatively easy to identify and treat; a symptom like “a lifelong pattern of apparently random outbursts of rage” is likely to be considerably less straightforward.
Simply identifying a client’s symptoms accurately can in itself be a significant task. For example, if you have experienced low-level anxiety for most of your life you may not even notice it as anything out of the ordinary, but it may be related to an apparently sudden bout of depression or panic attacks.
There are many approaches to providing symptom relief. None of them are perfect, and most come with both pros and cons. We would all like to think that every symptom has a clear and consistent treatment to resolve it, but this is probably even less true for psychological symptoms than for medical ones. People have different personalities, unconscious patterns, beliefs, etc., and therefore what works very well for one person may be a poor fit for another.
For example, a common choice regarding symptom relief in certain situations is medication or talk therapy. Medication is widely perceived to be faster-acting than talk therapy, with disadvantages such as side effects, the need to remember to take the medication consistently, and a tendency for meds’ efficacy to change over time for many people. Talk therapy eliminates drug side effects, but some people may find it uncomfortable in other ways, and symptom relief can take longer and be more dependent on the client’s ability to follow the therapist’s suggestions. (I use this as an example; in actual practice, a combination of medication and talk therapy can be most effective, as is often true with depression.)
Focusing on symptoms can be both a strength and weakness in therapy. One strength is that identifying a clear, specific problem to resolve helps the therapy stay focused and makes it easier to assess how successful the therapy is and when the therapy is done. A weakness is that it requires a definitive specificity that many clients are not able to provide, especially at the beginning of therapy. Also, some life situations that bring people to therapy are not easy to reduce to symptoms and diagnoses, and attempting to do so can create other problems.
This is primarily emotional support: the proverbial shoulder to cry on, a place where it is safe to express whatever you need to. It is a role that for some people is provided by friends, family, clergy, or their community.
Unfortunately, many people in today’s society have limited support networks or do not want to “burden” those close to them. Some people can not safely share some of their experience with those who might be expected to be supportive. Sometimes it is difficult to find people who will just listen, rather than try to fix or change you.
This is a legitimate use for therapy. Everyone goes through rough patches in their life at times: the loss of a loved one, a professional setback, a difficult transition from one phase of life to the next, etc. Sometimes temporary emotional support is all that is needed, or part of what is needed.
A good therapist has a large capacity for being compassionate and empathetic. You can unburden yourself to a counselor without having to worry about offending a loved one, being judged, or having someone else find out what you said.
Sometimes the task at hand is in the form of major healing or growth that is more like a caterpillar turning into a butterfly than a broken bone healing. The written Chinese character that means “crisis” also means “opportunity”, because in every crisis is an opportunity for something new to emerge.
As with many significant life events, chronic illness can present a risk of becoming hopeless and self-hating as well as possessing a great potential for transformative psychological healing and growth. This is the domain of life work, where people transform deeply held unconscious beliefs and patterns, expand their awareness of possibility in their lives, and find ways to create more satisfaction and fulfillment in their relationships with themselves and others.
This is the work you want to do when you are asking big questions, such as: “Who am I?” “What is my purpose in life?” “Why am I never satisfied?” “What am I wanting from intimate relationship?” There can be a spiritual aspect of such work, although this is not essential.
The most powerful life work will often move fluidly between bigger spiritual or philosophical explorations and specific personal challenges and wounds. Some therapists do this better than others; if this is your goal, it is worth the effort to find someone adept at this kind of work.
Counseling and Chronic Illness
Having a chronic illness would pose a challenge to even the most psychologically healthy individuals. We all use conscious and unconscious coping strategies, and none of those strategies is perfect. Chronic illness sometimes produces a “perfect storm” that exposes and magnifies every weakness in those strategies. On the other hand, for some people their medical condition presents a less earthshaking but still challenging set of logistical and practical obstacles to deal with. As I hope the above list shows, there are a number of different ways that therapy can be helpful throughout a wide range of degrees of distress.
If you suffer from a vestibular disorder or other kind of chronic illness, the last thing you want to hear is that it is “all in your head.” However, it is true that stress, anxiety, depression, and a number of other mental health challenges can sometimes exacerbate and even precipitate some medical conditions. Also, medical conditions, especially chronic ones, can certainly cause or create “mental health” problems. So there are very good reasons to think that counseling could be helpful and appropriate for people dealing with chronic illness – reasons that have nothing to do with hypochondria or craziness.
Some people are understandably put off by the language of the mental health field that is currently common, particularly the label “mental illness.” Please be aware that you do not need to be “mentally ill” to benefit from therapy, and that plenty of therapists will work with you without pathologizing you. It is true that some therapists work from the “medical model” – where the steps are assessment of the symptoms, diagnosing the illness, and treating it – but this is not a prerequisite for good therapy.
Author: Tod Fiste, LPC
Learn More About Counseling for Chronic Illness
Cognitive Behavioral Therapy (CBT) for dizziness and migraine by Vestibular Expert Dr. Timothy C. Hains, MD