The following is a work of fiction, based on my experiences working with clients but not a reproduction of an actual session with a specific person.
My office, any given day:
— It just feels like I’m not making any progress. I mean, I know I’m making progress, but…it just doesn’t feel like it.
— Yeah. It’s hard to keep going when you can’t tell where you are.
— Yes, it’s like, I keep doing the things that are supposed to help—getting in to see you, getting in to see the psychiatrist, getting the referral for the assessment, starting the medication—but each step takes such a long time, and then that psychiatrist turned out to be unable to do the assessment, and then when I finally got the referral and scheduled it, it turned out they don’t even do those assessments either…
— Does it feel like those steps—for instance, getting in to see the psychiatrist or starting the medication—are getting you to where you want to go?
— Not really, because the psychiatrist couldn’t do the assessment, and the medication isn’t really helping so now I have to try another one.
— Right. It’s frustrating when the steps you take don’t seem to “count.”
— Exactly. Like, if the medication isn’t helping, did that step really take me anywhere?
— What does your gut tell you?
— No. Well, I don’t know. Obviously I had to try the medication that was offered first. The doctor wouldn’t have known it wouldn’t work until I tried it.
— But nevertheless, it doesn’t really feel like a productive step.
— No, it doesn’t.
— So, what if…we know that this process can take a really long time. That’s really frustrating and disempowering, but the delays are part of the process—
— But a lot of those delays are because I keep procrastinating. Like, I don’t even know why I haven’t called the next place yet. I got the referral from the doctor and it’s in my phone somewhere but I don’t even remember what it’s called right now. And if I hadn’t missed that one appointment, I would’ve seen the psychiatrist much sooner, started the medication sooner…
— That’s what I mean, though. That is part of the process. You’re struggling with executive function. So of course it’s going to take a bit longer to do some of these things than it might for some other people. And that’s not even taking into account the other part, which is the delays inherent in the system—waiting for the doctor to have availability, waiting for insurance to approve the medication, and so on.
— So, imagine you could somehow know all of the steps that this would take. And imagine that the steps are a literal staircase that you’re looking up at, and each flight of stairs is a stage of this process. At the top of the stairs is your goal—having an accurate diagnosis, having effective treatment, managing the symptoms, succeeding in school. It’s a really tall staircase—obviously, we’re not making this too fantastical of a thought experiment—but you’re already part of the way up. For instance, the first flight of stairs was realizing you needed to go to counseling. The second flight was getting in to see me. The third was telling me about your symptoms, and me figuring out that you probably have ADHD. The fourth was getting in to the psychiatrist, who could prescribe some medication that might help but couldn’t do a formal ADHD assessment. The fifth was trying the medication. The sixth was getting the referral for testing—you get the point.
— Right, so I can tell that I’ve gotten off the ground at least.
— Exactly. And you’re looking up to the top of the staircase and it still seems quite far away, but you’re also a ways off the ground now. How would that feel?
— I mean, that wouldn’t feel nearly as bad as I feel now, but that’s because I would at least know where the top was. Like I could see how far away it was.
— And instead, it’s more like the staircase keeps expanding.
— Yeah! It’s like I keep climbing the stairs but the top keeps getting further away.
— That’s where your frustration is coming from. Unfortunately, in the real world, you can’t actually know how many discrete steps some overwhelming task is going to take, especially when it involves factors you can’t control, like what doctors can prescribe, what insurance will pay for, which clinic provides which assessments…and you know which steps you have taken so far.
— But what does it matter how many steps I’ve taken if the staircase just keeps growing?
— Because in reality, it’s not actually growing. It’s more like that thing where you’re walking towards a distant landmark, like a skyscraper in a city, and you feel like you’ve walked so far but it still seems just as far away. It’s not, though—that’s just a trick of our vision and also of our frustration with how long the journey is taking. In reality, there is an actual physical distance being crossed, and that gap is closing inch by inch whether or not it appears that way in the moment. This is even harder, because while you can Google how far away the Empire State Building is from Battery Park and get some sense of how long that walk will be, there isn’t a knowable answer here. Not right now. When you reach the end, you will know exactly what steps it took, and how long you spent climbing the staircase. There is a real number. You just can’t know it yet. …How well does that fit with your experience?
— I agree with that. I do believe that there will be an end, at least, even though I often feel like there won’t be. Do I have to just accept feeling that way?
— I think you do have to accept feeling that way, but you don’t have to just accept feeling that way. You feel that way for now. Just as you’d feel frustrated on long walk that’s taking even longer than you thought, towards a landmark that doesn’t seem to be getting any closer, you will feel frustrated here, in this situation. But in the example of the long walk, you would know, rationally, that you’re making progress. You wouldn’t just quit walking, unless of course you need to—that’s a separate thing. You would tell yourself, “This is a really frustratingly long walk and I had hoped it wouldn’t take this long, but I’m going to get there.”
— That definitely sounds more reassuring than what I’ve been telling myself, which is that I’ll never get there.
— And that’s not the only tool at your disposal, either. Imagine the staircase again. We talked about what it’s like to look up. What’s it like to look down?
— Well…I definitely keep getting further up from the ground. As long as all those things you listed were actually steps, and not just like…detours.
— Do you think they were steps? Even if they didn’t propel you all the way to the top?
— Does your distance from the ground ever shrink?
— I sure feel like it does…
— Do you, though? What brings you back towards the ground?
— I mean, no. I’m only feeling that way because of the thing where the stop of the staircase seems farther away.
— Exactly. And, not to bring math into this—
— Please no math.
— Okay, no math, just words: there’s a difference between absolute and relative. As you revise your estimate of the height of the staircase—unfortunately, you keep learning that there are more steps than you expected—your relative progress changes. Maybe before you hoped you were at 50%, but now you realize it’s more like 30. Hence your frustration. But your absolute progress never changes. If you’ve climbed six flights of stairs, you’re always gonna have climbed six flights of stairs, no matter how the top of the staircase is looking at this particular moment. Feeling shitty about how hard this is doesn’t just suddenly knock you back down a few flights.
— But how do I actually, like, feel that?
— When you find yourself looking up, try looking down instead.
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