“It seems to me you have two equally important things going on: chronic migraine and grief about what chronic migraine has meant for your life.” With those words, the naturopath I saw Friday became my new therapist. Although I knew before the appointment that she practices as both a therapist and naturopath, counseling was not on my agenda. However, anyone who can see so readily that the emotional component of chronic migraine has affected me as deeply as the physical illness is someone I need to talk with.
Throughout the two-hour initial appointment, I kept mentioning things I wrote about last week. Like that the emotional toll of chronic migraine is enormous. That almost all my emotional and physical strength goes into taking care of myself, thus continuing my isolation from others. That I’m envious of successful women my age because I believe I, too, should be able to support myself and pursue my dreams. That for the first 10 years of chronic daily headache, no one believed I had a physical illness. Although I told the naturopath repeatedly that I’m so much better off emotionally now than I was a few years ago, the fact that everything I just mentioned was so fresh in my mind that I felt the need to write about it just last week indicates I’m not as “over it” as I thought I was.
I’ve been to therapists in the past, some of whom have been helpful with other issues, but no one seemed to really get what it means to for a young, intelligent, ambitious woman to be rendered housebound by a debilitating chronic illness. (The last one I saw thought I needed help setting goals and following through with tasks. If only it were that simple!) I’d thought this was a failing of the therapists, but now I wonder if the problem was in how the appointment was structured.
Every time I see a new therapist, I introduce the role of migraine in my life by describing all the ways I try to live a good life despite chronic illness. I always came out looking strong and motivated. I wasn’t misrepresenting myself, but was focusing on the positive — because who wants to meet anyone new and tell them all the bad stuff right off the bat? Besides, unless I’d just had an acute emotional crisis, the hard parts are rarely at the top of my mind. Usually such a crisis would spur me to make the appointment, but by the time I saw the therapist three or four weeks later, I’d moved on.
Meeting with the naturopath was more like a standard medical appointment. I started describing my symptoms and what my life looks like with migraine as such a large component of it. Because I wanted to convey the gravity of the physical experience (though I made sure to tell her that I’m so much better than I used to be), I was willing to address unpleasant aspects I’ve held back from therapists in the past.
I’ve long advocated for people with chronic illness to see a therapist, though I readily admit finding someone who understands the complexities of it is difficult. The best advice for finding a good therapist I’ve been able to give is to ask your doctors. But I’ve also always assumed the therapist sets the tone for the sessions. Maybe the person who is receiving counseling is responsible for determining the conversation’s course.
Based on my very recent experience, I’m going to change my recommendation. Yes, ask your doctor and check Psychology Today for therapists who specialize in chronic illness, but also keep a running list of issues that are bothering you. Perhaps write in a journal and see what comes up — I often don’t know what’s eating at me until I see the words written on the page. The most intuitive therapists may be able to figure out what you need to talk about all on their own, but you’re the only one who truly knows what’s bothering you.
I’m writing this advice as much for myself as for anyone seeking guidance on getting the most out of talking with a therapist about chronic illness. I’ll let you know how it works out after a few sessions.