[robomartin]

PLEASE GET PROFESSIONAL HELP FROM ANOTHER DOCTOR RIGHT AWAY.

Here's the framework I see; recent startup founder + therapy for seven years + abused as a child + ten pills per day.

This alone screams for professional help. I don't think that a fellow entrepreneur can help solve all of your problems. There's also the danger of making it worst because of not having any training on how to deal with your framework.

Now to be a little helpful:

What I don't see is a description of your circumstances beyond that:

    - How old are you?
    - Where do you live?  (city)
    - Do you live alone?
    - Do you work where you live or do you get up in the
      morning to go to another location?
    - Do you have family nearby?
    - Are they supportive in any way?
    - Do you have other friends outside of the startup?
    - What does your day look like?
    - Do you or have you had any hobbies?
    - Do you spend a lot of time playing games?
    - If you do.  Are you affected emotionally by the game's outcome?
    - What do you eat and when?
    - Are you overweight?
    - If so.  How do you feel about it?
    - Do you have a girfriend/boyfriend/wife/husband?
    - If so.  How is that relationship?
    - What's your financial situation?
    - What are your goals?
    - How quickly did you expect to achieve these goals?
    - What does your work environment look like?
      (dark, light, windows, comfortable, etc.)
    - What does your daily work routine look like?
    - Is there a routine?
    - What do you do in the weekends?
    - Who do you socialize with outside of work?
    - Do you drink?

The list isn't exhaustive. I am not a therapist, not even close. As an entrepreneur I have navigated depression from time to time. It can be ugly and paralyzing. It also is very personal. That's why a lot more information is needed to really understand you and how you go in and out of that state.

From personal experience I can tell you that it helps to have what I have come to call "non-maskable interrupts". In my case this came in the form of my kids. It's pretty hard to focus on being miserable when your little one's push and pull you into their world. It's great.

If you don't have this option then you have to find another interrupt source. This means focusing your energy and thoughts on another activity not related to work.

Martial arts class can be great. A good class can dissolve away the stress of a days' worth of troubles within a short hour. On top of that you are getting exercise which by itself should make you feel better.

Gyms can suck. If you can find a friend who'd like to go to the gym with you this could be a good exercise + social option.

Swimming. If you don't know how to swim, join a group and learn. I don't know if you are in the US or not. In the US there's something called US Masters Swimming (usmg.org). They have groups everywhere. Sign-up and get in a pool. For me, there's nothing like swimming a 1500m or 3000m run. I come out of the pool like a newborn.

Get a dog. The therapeutic value of dogs is well proven. Also, puppies, just like kids, have a unique ability to shift your mind's focus away from you and onto them. Research the breed a little. If you are the type, get into training. I have always had German Shepherd Dogs and have always enjoyed training them (research: schutzhund). GSD's are not for everyone. A good pet dog like a Labrador could do wonders for you. There are professional organizations that deal in therapy dogs who can advise you based on your circumstances and needs.

Notice that every suggestion I've made involves disconnecting from work and strongly focusing your energy and attention elsewhere. Physical, outdoor and social activities being another common theme.

I couldn't possibly relate to your child abuse experience or the years of therapy and medicine. I am fortunate in that I have not had to experience any of this. That said, it sure sounds like you need to pivot and go talk to a different therapist. Your current on doesn't seem to be helping you much.

I am one of those people who will do the impossible NOT to introduce any drugs into my body unless there's absolutely no other option. I could not imagine taking ten pills a day just to be able to function. There has to be another way.

Not being a therapist I don't really know if talking to others about your problems will help you or push you deeper into a more dangerous state. That's why I am not inclined to offer to contact you via email. It is very easy to justify feeling worst and use someone else as a bouncing board for those feelings. I really think you need to find a new therapist to talk to immediately.

Then, of course, there's the tough love approach. Unless you suffer from a fundamental chemical imbalance your condition is one that is entirely fabricated by your brain. As such, you can --and should learn to-- control it. I did this with anxiety attacks. They can be nasty. Once you understand how to recognize and deal with the symptoms you can literally talk yourself out of one (or prevent entering it in the first place).

This is where I'll be cheesy and quote Yoda: "Your Focus Determines Your Reality". Print that and tape it where you can see it. What are you focusing on? What reality will that produce? Is that what you want? No? Then change your focus.

The techniques can be simple. If you recognize that you are sliding into a self-lamenting state, get up and go for a brisk walk. Turn up the music. Fucking yell "I am not doing this!". Dance. Do jumping jacks. Whatever it takes. Force your brain to re-focus on something positive.

I wish you the best. This is tough. Reaching out is good. Go get different help. Get a dog. Go swimming. Re-focus.

ABOVE ALL: YOU DEFINITELY NEED PROFESSIONAL HELP. YOUR CURRENT THERAPIST IS MISSING SOMETHING. PIVOT. GO TALK TO SOMEONE ELSE. GO TALK TO SEVERAL THERAPISTS AND FIND THE BEST ONE.

[ForrestN]

Wow! You're doing exactly what you seem to know on some level is bad: you're giving him lots of very specific advice without having any basis for doing so. Apologies for any harshness but I want to answer you strongly.

1. It's very possible that leaving his current therapist in order to "pivot" is a terrible idea. He should talk to his current therapist about his feelings that therapy isn't work, and consider talking to another professional, maybe one who takes a different approach, at the same time until he feels clarity about what to do. A lot of work gets done in 7 years of therapy. Sometimes there are low points, but it is a major step to throw that away.

2. It's incredibly obvious that telling him to try to have a child is an insanely bad idea. Getting a dog is less conspicuously destructive but is also a serious commitment and not something you're in a position to recommend.

3. Your "tough love" approach just sounds like being gratuitously hard on yourself. You can't bully yourself into becoming healthy. His condition isn't "fabricated" by his brain, and he cannot talk himself out of it. I know you didn't mean it in this spirit, but the ultimate effect of that line of thinking is putting responsibility for his problems on his own shoulders. No one chooses to have psychological issues, and they can't just opt out of them either.

4. The rest, doing jumping jacks, taping up yoda quotes, answering a mental health questionnaire in public, these things aren't likely damaging in any way, but they won't do anything to address the underlying problems or meaningfully change the situation in question.

Again, OP: if you feel that your current treatment isn't working, you need to address that by talking to your therapist about it and, if that doesn't help you feel more optimistic about the current regime, you need to talk to someone else at the same time about the current problems you're having. If you have to make a drastic change, like leaving your current therapist and presumably changing your meds, I'd think it would be a good idea to involve someone you trust who can help give you perspective from outside of the therapeutic context.

And, obviously, if you get to anywhere near self-harm, make sure to get emergency care right away, even if it seems like an over-reaction.

[tripzilch]

> 1. It's very possible that leaving his current therapist in order to "pivot" is a terrible idea. He should talk to his current therapist about his feelings that therapy isn't work, and consider talking to another professional, maybe one who takes a different approach, at the same time until he feels clarity about what to do. > A lot of work gets done in 7 years of therapy. Sometimes there are low points, but it is a major step to throw that away.

It is my experience that if things aren't working with a current therapist--whether this is the case needs to be seen, but after 7 years with the same therapist, he's on 10 pills/day, he experiences a serious relapse and feels he has to call on HN for help, is not a good sign. After 7 years there should be some more professional safety-nets installed.

Anyway, if it's not working well, get a new therapist. From personal experience, sticking with the same one for too long while you know it's not going further has done nothing but slow progress. The reasoning is, a therapist is also a creature of habit and they're not going to change their general approach much, even if you discuss the matter with them. And I don't mean trying out different meds or therapy, but the sort of general approach they use in their profession. And there's nothing wrong with that, even the really good ones do it, and even with them I still got stuck after some time, simply because their bag of tricks (as good as it may be) ran out and we tried all the things. And that's nobody's fault because therapy isn't a hard science or engineering problem, so it's very possible that even the "best" one runs out of ideas while another may have some approach that fits you right now (which is another factor: a patient changes as a person, the therapist that was right when you were at point X in your life may not be the one you need right now).

Disclaimer: this may be bad advice because of reasons of US Healthcare that I know nothing about. So, Think For Yourself. But also don't go waiting for a therapist to fix things if it doesn't seem like they're doing that. Which I need to repeat, is not (necessarily) a failure of the therapist, but sometimes a new pair of eyes can get you moving again, if the old pair got stuck.

[robomartin]

I think you are misreading the intent of my post. I was very clear about the fact that only a professional can help him. The extended questionnaire is rethorical. It is there to highlight the fact that a lot needs to be known before anyone can truly help him. I'm not sure where I told him to go have kids. I simply listed a few things that are known to be effective in changing one's focus away from potentially dark places.

With regards to seeing a new therapist. If this were my own son I'd take him to two or three. Just like there are lousy engineers there are lousy doctors. You never know.

[rfugger]

He shouldn't leave his current therapist, just look for a new one if the current one isn't helping. He should only leave once he has found someone else who can do a better job.

[jlewes]

Do therapists / psychiatrists / psychologists really help? Genuinely interested. I would never consider (have never considered) seeing a therapist / psychiatrist, even if/when depressed. I imagine them to be people with soft science degrees who believe in a wishy-washy mixture of psychobabble and pseudo-science. Surely an intelligent person can see what their questions are getting at and influence the therapist's inferences accordingly, in the same way as you can when taking those silly multiple choice psychological assessments? What would a highly educated person with training in rigorous disciplines get out of talking to a therapist? Not being aggressive; genuinely interested. (I'm mid-30s, male, didn't grow up in a culture where you have your own therapist like they do on Manhattan TV shows (do real people do that?)).

[dorfuss]

Both my mother and step father are therapists, both had clinical experience - my mum worked predominantly with young girls with eating disorders as she was beginning her career, then she switched to adults and then into a business consultant. My step father on the other hand worked with drug addicts, now applying innovation in coaching (using Second Life as a tool, for instance).

I would put it this way: apart from really impressive experience and knowing very well what goes on in people's minds (of course in a different way than the neurologists do), my mother has never paid for a speeding ticket, because she knows how to talk to a policeman to avoid the fine, discovering all his weaknesses, fears, frustrations in 5 seconds - honestly, I'm not exaggerating! She get's paid for two hours of work what many people earn by working the entire month.

She usually deals with CEOs and other top-management guys who, for instance, are extremelly good and efficient in what they do, but their subordinates cannot stand the pressure the boss is creating, or to put it straight - the managers are practically monsters. And so she comes in and turns a Steve Jobs into a Wozniak, if you know what I mean.

Think for a second of a police negotiator who persuades a terrorist not to blow himself up, or a suicidal person not to jump out of the window.

I know I have used the examples remotely related with therapy, but I wanted to give you a broader picture of what this artful science (yes!) is coupable of.

There are of course certain limits to what can be achieved and an experienced psychologist is able to define if a person needs to consult a psychiatrist to get medication, or if recovery is at all possible - the goal of the therapy can be differently defined, sometimes it is just to make the patient "stable", but healing is not possible.

To give you an example, while meeting my mother at the mental institution where she worked, I once stumbled upon the head of the drug addictions department whom I asked what is their "success rate" in therapy. She asked me: "What do you mean?" - "How sure you can be that a person is not going back to the addition", I replied.

"We are sure that almost all our patients sooner or later would return to drug abuse". I was shocked, but this is the realistic, frank approach.

To sum it up let me just mention that when my dear mother was doing PhD she had a very distinguished supervisor, one of the best specialists in the country, for many years the chairman of the National Psychologists Association (not in US/UK obviously), and one of his most important books was titled something like "The therapeutic aspects of therapy", and his conclusion was "talking to people change them, but it is yet to be discovered how and why".

[tripzilch]

> I imagine them to be people with soft science degrees who believe in a wishy-washy mixture of psychobabble and pseudo-science. Surely an intelligent person can see what their questions are getting at and influence the therapist's inferences accordingly, in the same way as you can when taking those silly multiple choice psychological assessments?

A psychiatrist (in NL) first goes through regular medical school (5 years) and then another 4 years of study + on the job study for psychiatrist. (maybe there's one year overlap because I seem to remember it's 8 years total)

While maybe an intelligent person can figure out a lot of things for themselves--even if we ignore the fact that it's harder to figure out without a bit of distance--surely somebody (also intelligent) who's studied for ~8 years in this very field, will be better at spotting and making such assessment than a very intelligent person that trained their intellect in some other field.

If I had a big and important carpenting job, I'd hire a skilled and trained carpenter as well, even if I could probably do and/or figure out most of it myself. Over some level of complexity, I wouldn't even try, I'd hire a carpenter. Add to that, "figuring it out for yourself" becomes much harder if the subject is "yourself" instead of "my house/furniture".

From what I understand, psychiatrists in the US are a bit more like psychologists here. But with 4-5 years of study and who knows how many years of experience, they're still pretty good at it.

One thing though, a very important red flag (IMO), if after a while with a therapist you really get the idea "I could do this better, this person doesn't really get me", then get a new one. Therapists come in many shapes and sizes, and often it's important that you get one that can at least match your intellect to some extent, or it may become hard to trust them (if you can't help but second-guessing them). There will be therapists that can deal with this, talk about particular skeptic feelings and explain it in a way that is acceptable to you. But if they keep setting off all those alarm bells, you're not seeing one of those.

[Crake]

Don't most people see psychologists, though? Psychiatrists cost much more, so most people see the less rigorously schooled psychologists instead due to insurance policies. That's been my impression of it, anyway. You really don't have to be all that smart to be a psychologist, unfortunately; psych being one of those squishy soft "sciences" that doesn't really have much in the way of academic rigor. Psychiatrists here go undergrad (4 years), med school (4 years), and then go on to their residencies and etc. Psychologists have to do psych undergrad and then complete a doctorate I believe to practice on you, but again: chances are pretty decent that someone in a technical field will probably be more intelligent. (An argument could probably be made that psych people might have higher EQ, I suppose.)

I'm sure they work for some people, but there are so many bad and underqualified ones who basically just sit there and listen to you without offering much in the way of insights (but sometimes offering up insults, in my experience). I think a bad therapist can be really damaging, which is unfortunate. People in these sorts of situations don't really need any more things going against them.

edit: I'm in the US, so that's where I'm coming from. When I reread this I realized you're referencing a system outside of the US.

[tripzilch]

In NL, psychiatrists are able to prescribe drugs, because they did medical school before their psychiatrist education. Often a therapy centre employs psychologists that do most of the sessions, and one or a couple of psychiatrists for the prescriptions (usually after seeing the patient at least once--that's probably mandatory, would make sense). Of course a patient's GP could also make the prescription, at request of a psychologist.

[dtf]

A therapist can just be someone non-judgemental to talk to, most importantly one not tainted with any particular ties - be they familial, business or whatever. It's amazing how much you can get out of the simple act of talking through your thoughts with another human being who has no agenda other than what you've already seen on their rate card.

To use a programming related metaphor, it's a bit like rubber ducking (http://c2.com/cgi/wiki?RubberDucking), where a deep and difficult abstract problem can suddenly cease to be such during the mere process of explaining it to a stranger. Suddenly the faults in your own reasoning become obvious, and the very act of sharing what's troubling you makes it more concrete and approachable.

[meepmorp]

They can help. It depends on finding someone worthwhile talking to, and being in a frame of mind where it'll help.

As for this:

> Surely an intelligent person can see what their questions are getting at and influence the therapist's inferences accordingly, in the same way as you can when taking those silly multiple choice psychological assessments?

If you're seriously seeking help, why would you bother doing this? You're going to a therapist because you've got problems you think might be helped by talking them through with someone. If you're just interested in proving how clever you are or showing the superiority of "training in rigorous disciplines", there's cheaper ways to do it that don't waste other people's time.

[subsystem]

Someone previously posted this lecture and I remember it being quite good -> http://www.youtube.com/watch?v=NOAgplgTxfc

[dholowiski]

>PLEASE GET PROFESSIONAL HELP FROM ANOTHER DOCTOR RIGHT AWAY.

Seconded. There are also hotlines that you can call any time of the day or night if you are desperate. SEEK HELP. New help if the old isn't working.

[cafard]

Agree with paragraph 1. Skip psychologists, go for a psychiatrist.