Schizoaffective Disorder and Therapy

Achieving real change is a lengthy process. Find out how therapy helps and how to find the right therapist.

Q: How many psychologists does it take to change a light bulb?
A: Just one, but the light bulb has to want to change.

Early on, in the year before my diagnosis and for awhile afterwards, I saw a number of psychologists. (I had also seen one for awhile when I got really depressed in eighth grade, and had also seen a couple of school psychologists in elementary and junior high school, but didn't feel any of them helped much because I was such an unwilling patient.) I would typically seek a therapist out because I felt really bad, but after a few months I would feel better and stop going. Early on, I really disliked having anything to do with psychologists and wouldn't see one any more than I absolutely had to.

That's a pretty common phenomenon for therapy patients. It seems that many of the people who seek out therapists are not in a position to get better in any substantial way because they have no commitment to making any real change in their lives.

Achieving real change is a lengthy process and it is often painful. Seeing a therapist just until you feel better for awhile is not likely to effect meaningful change. And, in fact, for a bipolar person it's not likely that the therapist will have made any difference in such a short time - you could consult a brick wall for your depression for a few months and after awhile the inevitable bipolar cycle while make you feel better.

Time for Meaningful Change

There came a point, I think it was around the Spring of 1987, that I noticed that I always kept falling into the same hole and that I was not having any success in making my situation any better. I was on medication for much of the time since I was diagnosed and although it provided some relief, I did not feel that it did much to make my life substantially better either. The symptoms weren't so bad with the medication but I still experienced them and life just plain sucked in general.

I made a really important decision then. It's the sort of decision everyone needs to make if they're going to get anything out of therapy and is one of the more significant turning points in my life. I decided I was going to see a psychotherapist and stick with it and no matter what happened that I was going to keep going even if I felt better. I was going to keep going until I was able to effect meaningful, positive, lasting change in my life.

(Simply deciding to see a therapist for a long time is not enough. You have to decide that you're really going to change and face up to the work it will require and face the fear that it will arouse. Lots of people see therapists for years, even decades, and never get anything out of it beside a little temporary comfort. I know some people like this and I find them incredibly vexing. These people don't want to change and quite possibly will never change. They may even feel that they're good little therapy patients because they attend regular therapy for so long. However, they must be very frustrating to their therapists who spend years trying to get their patients to face themselves only to have every effort deftly deflected.)

Finding a Good Therapist

It's important to pick out a good therapist that you can work with effectively. I don't think nearly all therapists are all that enlightened - I'm sure almost all learn a lot of important theory in graduate school, but I don't think any amount of theory is going to make anyone an insightful human being.

Even if you find a therapist that's good in general, you may not personally be able to work with them. For that reason, it's best to shop around. And that's why it's best not to wait until you really need help to find a therapist - if you feel, as I did at first, that psychologists are only for crazy people, then likely you're not going to see one until you are crazy. When that happens it's hard to take the time to shop around and it's also much harder to pick up the pieces. If you think you're ever going to need to see a therapist, it's best to start when you're in a strong enough position emotionally to see one on your own terms.

At the time I made my fateful decision, I was getting by OK. I was desperately unhappy, but life was manageable. It was not like when I first saw a psychiatrist at Caltech, when I was ready to climb out of my own skin.

I got a very poor impression of the first therapist I saw. Her primary concern was whether I had the financial means to pay for her sessions. She was really quite shrill about the money and kept emphasizing that she did not offer a sliding scale. I had a good job at the time and would have had no problem paying her fee, but in the end decided she was just not someone I cared to be around.

The second therapist I saw was someone I rather liked. I'd responded to her ad in The Good Times offering New Age therapy. (Santa Cruz is a pretty New Age kind of place, one reason I decided to stay there after living in the urban Hell of Southern California.) She seemed like a pretty happy and enlightened woman and was quite pleasant to talk to. She seemed to like me at first too.

But when I explained my history to her - mania, depression, hallucinations, hospitalization and finally my diagnosis, she said she wasn't competent to deal with someone as troubled as I. She said I should consult with someone who specialized in challenging cases. I was really disappointed.

She gave me the names of several other psychologists. One of them was someone I'd seen at the County Mental Health department who I thought was competent enough but I didn't want to see anymore because I did not feel that she cared for me as a person. The next one on the list was the therapist I ended up sticking with.

All told, I saw my new therapist for thirteen years.

That's a lot of head-shrinking. I made a lot of changes during that time. Aside from my emotional growth, I got my career as a programmer started and built it up to eventually become a consultant, dated several women and eventually met and got engaged to the woman I am now married to. I also got my B.A. in Physics from UCSC and started (but unfortunately did not complete) graduate school.

Life certainly hasn't been easy for me as a consultant, especially since the economic downturn, but despite that, I've been doing well mentally and emotionally for quite some time and I credit that to my work with my therapist, not to any medicine I might take. The only professional help I require is a brief appointment with a doctor at the local mental health clinic every month or two to check my symptoms and adjust my medication.

Life's been pretty damn hard but I'm able to deal with it and despite the obstacles I face I am able to maintain my optimism most of the time. That's a far cry from my experience of 1987 when I had few external difficulties but could barely tolerate living through the day - despite medication.

Who is this miracle worker you ask? I'm sorry, I can't tell you, much as I'd like to. When I wrote my first web page about my illness, I had her read it and then asked her if she'd like me to give her name. She said she would rather her name be kept private. I would rather give her the credit she deserves, but I respect her feelings so I won't give her name.

Insights From Therapy

One of the main objectives of therapy is for one to develop insight into one's condition. I would like to discuss the many insights I found but I feel I could not discuss them adequately in the space I have here. I would like to discuss just one of them, as the key point I learned also applies to many other engineers and scientists. If you feel that you would like to know more than I can say in what follows, then I encourage you to read David Shapiro's book Neurotic Styles, especially the chapter on Obsessive Compulsive Style.

One day, after I had been seeing my therapist for about seven years, she said to me: "I think it's time" and handed me a photocopy of the Obsessive-Compulsive Style chapter of Shapiro's book. I took it home to read and found it nothing short of astounding. As I read it, I often burst out in hysterical laughter as I came across something that seemed deeply familiar from my own experience. I still find it very embarrassing to find a lifetime of experience so neatly summarized in a single chapter of a book that was published when I was one year old. I just had to read the whole book so I bought my own copy and have since read it several times.

Obsessive-compulsive style is distinguished from obsessive-compulsive disorder by being a personality trait rather than a psychiatric condition that can be treated with medication. It is characterized by, among other things, rigid thinking and distortion of the experience of autonomy.

Shapiro says:

The most conspicuous characteristic of the obsessive-compulsive's attention is its intense, sharp focus. These people are not vague in their attention. They concentrate, and particularly do they concentrate on detail. This is evident, for example, in the Rorschach test in their accumulation, frequently, of large numbers of small "detail-responses" and their precise delineation of them (small profiles of faces all along the edges of the inkblots, and the like), and the same affinity is easily observed in everyday life. Thus, these people are very often to be found among technicians; they are interested in, and at home with, technical details... But the obsessive-compulsive's attention, although sharp, is in certain respects markedly limited in both mobility and range. These people not only concentrate; they seem always to be concentrating. And some aspects of the world are simply not to be apprehended by a sharply focused and concentrated attention... These people seem unable to allow their attention simply to wander or passively permit it to be captured... It is not that they do not look or listen, but that they are looking or listening too hard for something else.

Shapiro goes on to describe the obsessive-compulsive's mode of activity:

The activity - one could just as well say the life - of these people is characterized by a more or less continuous experience of tense deliberateness, a sense of effort, and of trying.

Everything seems deliberate for them. Nothing is effortless... For the compulsive person, the quality of effort is present in every activity, whether it taxes his capacities or not.

The obsessive-compulsive lives out their lives according to a set of rules, regulations and expectations which he feels are externally imposed but in reality are of his own making. Shapiro says:

These people feel and function like driven, hardworking, automatons pressing themselves to fulfill unending duties, "responsibilities", and tasks that are, in their view, not chosen, but simply there.

One compulsive patient likened his whole life to a train that was running efficiently, fast, pulling a substantial load, but on a track laid out for it.

My therapist focused on my own rigid thinking starting very early in our work together. My experience now is that I have a sense of free will that I did not possess before I began seeing her. However obsessive-compulsive style is a trait that is so deeply ingrained in me that I don't think I can ever be completely free of it. However I find that being able to focus my attention so intensively is an advantage to my computer programming. I find that programming allows me to experience being obsessive-compulsive in a way that I find enjoyable, like taking a holiday to go back to a familiar place from my past.

next: The Reality Construction Kit