stigma

If you’re feeling bad about your kid after an IEP meeting

Content note: This is directed at parents, and it’s about mitigating damage that can be done by the stigmatizing language in the IEP process. It expresses sympathy towards parents who are feeling things that can be harmful to disabled kids (as well as a call for parents handle those feelings constructively). This post may be triggering to people with disabilities who have been harmed by these kinds of attitudes. 

The IEP process can be really hard on kids, parents, and families. In order to get your kid the services they need, you’ve probably had to describe them using some awful language. It likely violated every one of your instincts about how parents ought to describe their kids. You may have had to do it anyway, in order to get your kid access to education.

It’s pretty normal to feel awful about either yourself or your child after describing them in such negative terms or allowing others to do so. It’s wrong, and it feels wrong, and you often can’t do anything about it — and it often comes along with pressure to believe that this is being caused by your child’s disability. If you’re finding that you feel that way, it’s important to do something about it. Kids are generally very aware of how adults in their lives feel about them. Feeling that way about your kid on an ongoing basis is really damaging to them and to your relationship with them. Don’t beat yourself up; do find ways to mitigate it.

It can help a lot to remind yourself that nothing about your child’s disability causes this kind of language. No child should ever be described this way, including yours. They’re not being described this way because of the things they can’t do — they’re being described this way because the system is ableist and often unwilling to respond to disability constructively. It’s not their fault, and it’s not your fault — it’s an awful fact about our culture’s attitudes towards disability.

You wouldn’t say that a baby is failing because they’re not talking — it’s just part of being a baby. If someone said that a typically-developing eight year old was failing because they can’t write 10 page papers, most people would be outraged. Your child’s development isn’t failure either, and they deserve appropriate education without stigma or panic. They are allowed to have a body and a brain, and they deserve to be respected as a human being. Language that treats them as a collection of deficits is cruel, and doesn’t reflect reality.

Your child’s differences aren’t a failure. Their development is what it is, and that’s ok. It’s ok to be different. It’s ok to have a disability. It’s ok to need appropriate education. Their need for appropriate education is not failure, it’s just that you sometimes have to cooperate with a system that wrongly describes it that way.

One way you can show yourself that it shouldn’t be this way is to write a better description of your kid after the fact. Rewrite what your child is learning, and what you’d like them to learn. Write about what the barriers are, and what kind of help they need. Write about their rights, and where you see that they might be violated. Write about them as the child who you know and love, not a collection of scary deficits. (It can also help to write down ten of your favorite things about your kid.) Their disability does not call for freaking out. It’s just part of who they are, and that’s ok.

Tl;dr IEPs describe kids using cruel stigmatizing language that doesn’t reflect reality. Having to cooperate with them anyway can do serious damage to parent-child relationships. Rewriting a new and better description of your child can help to mitigate this damage.

An example of both types of mental health stigma

Content note: This post contains both criticism of and respect for the mental health system. If you find either upsetting, it’s likely that this post will bother you.

I wrote recently about two distinct kinds of mental illness stigma. There’s dismissiveness, where people aggressively deny that someone’s mental illness is real. There’s dehumanization, where people believe that someone’s mental illness is real, and treat them as though their condition makes them less than fully human. Both are common, and people who have experienced one more than the other tend to have very different perceptions of the mental health system.

One example of difference in perception: Mental health advocates often say things like “Medication for mental illness is just like insulin for a diabetic”. People who have mostly faced dismissiveness often see this as validation; people who have mostly faced dehumanization often see it as a threat.

From the perspective of someone who has mostly experienced dismissiveness, it might sound like this:

  • I’m really glad that someone understands how serious my medical condition is
  • People have told me over and over that I don’t have a real problem
  • Or that medication is just a crutch I’m using to avoid dealing with things
  • Or that it’s whiny to want medication
  • Or they might say things like “You’re not sick. People with cancer are sick.”
  • My medication is really, really necessary
  • Or even: my medication saved my life, and I think I’d die if I stopped taking it.
  • I’ve had to fight my doctor, my family, or my insurance company to get access to the medication I need.
  • It messes up my life when people don’t take my need for medication seriously.
  • I’m glad someone gets it about how real my medical condition is, and how important it is for me to have access to medication.

For someone who has mostly faced dehumanization, a statement like that might sound more like this:

  • People have treated me like I’m not a person, and use analogies to physical conditions to justify it.
  • People have made me take medication I didn’t want to take, that did things to my brain and body that I didn’t like.
  • They’ve done this to me in order to change how I felt, thought, or behaved.
  • They’ve told me that what they were doing to me was just like giving insulin to a diabetic.
  • And that this meant I could not possibly have any valid reason to object to the treatment they wanted me to have.
  • But diabetes and mental illness aren’t actually all that similar.
  • Insulin-dependent diabetics who refuse treatment die. When I refused treatment, I didn’t die. It’s not the same. I’m not sick in that way.
  • The way I am is not the same as having a life-threatening physical condition with an obvious straightforward life-sustaining treatment.
  • It’s important that people understand the difference.
  • When they don’t understand the difference, they treat me as though I’m not a real person unless I am on the medication they want me to be on.
  • People say “unmedicated” like it means violent, dangerous, or incapable of understanding something. It doesn’t. It just means that someone isn’t taking medication. That doesn’t tell you anything in itself.
  • I need people to respect me as a person, and respect my right to make treatment decisions. When they don’t, things can get really bad really fast.

There are numerous other examples of things like this. Most things people say about mental health look very different to people who have primarily experienced dismissiveness than they do to people who have primarily experienced dehumanization. Neither perspective is right or wrong exactly; both are important and incomplete.

Access to psychiatric medication is important; respect for the humanity and human rights of people who have been diagnosed with mental health conditions is also important. Things aren’t great for anyone, and they could be a lot better for everyone.

tl;dr Mental health discourse often looks very different depending on perspective. People who have mostly faced dismissiveness tend to see things one way; people who have mostly faced dehumanization tend to see things a different way. Scroll up for a concrete example.

Two kinds of mental health stigma

Content note: This post contains both criticism of and respect for the mental health system. If you find one or the other upsetting, this post will likely bother you.

There are two basic kinds of mental health stigma: dismissiveness, and dehumanization. Mental health conversations tend to have trouble acknowledging both at the same time — usually it’s at most one.

Dismissiveness stigma is when people deny the reality of mental illnesses. This plays out in a number of ways. One classic example of dismissiveness is “antidepressants are just a tool of capitalism to stop people from noticing that things are wrong”, or “Stop complaining. There are people with real problems”. There are many other examples.

Dehumanization stigma is when people deny the humanity of people with mental illnesses. A classic example of this is people who believe that the purpose of mental health treatment is to reveal the real person underneath — and that therefore, any objections they might make to the treatment “aren’t the real them talking”. There are many other examples of this as well.

Dismissiveness and dehumanization are both major problems. They’re both real, and they both do a lot of damage, even up to the point of costing people their lives.

People tend to perceive the mental health system very differently based on which kind of stigma looms largest for them. For a lot of people, it’s much easier to see one type than the other.

People who mostly experience dismissiveness often see the psych system this way:

  • No one took my problem seriously
  • I was scared to turn anywhere for help
  • Once I finally took the leap and went to therapy, things got so much better
  • Or, once I finally stared medication, things got so much better
  • (Or even: medication and therapy saved my life).
  • (Or even: I’m so glad people finally pushed me to get treatment; they were right.)
  • I wish people wouldn’t be so afraid. I wish everyone had access to this.
  • We need to fight stigma so that people can get the help they need.
  • (And to reform laws so that everyone has access).

People who mostly experience dehumanization often see it more like this:

  • When I entered the psych system, people treated me like I wasn’t a person
  • They forced me to take medication I didn’t want to take
  • The drugs didn’t work, and had harmful side effects
  • When I complained, they treated it as a symptom and raised the dose
  • They forced me to be in therapy I didn’t want to be in, and that made me worse
  • When I tried to advocate for myself, people treated it as a symptom, and no one took me seriously
  • Things only got better for me when I stopped therapy and/or medication and started a different approach
  • (Or even: stopping therapy and/or medication saved my life)
  • I wish people wouldn’t be so uncritical of a system that hurt me
  • I wish “unmedicated” wasn’t used as a slur implying that people who make the choices I make are all terrible people
  • We need to warn people, and reform the laws and systems that allow people to be treated this way

Some people’s experiences in the mental health system are positive in ways that nothing else is; some people’s experiences are horrifying. (And for a lot of people, things are more mixed). Neither type of experience is universally representative; both are real and common. Both matter, and need to be part of the conversation.

When most of someone’s experiences are with dehumanization, it can be hard to understand that dismissiveness is also a problem. Or why anyone would regard mental health care as positive, or lack of access to it as a problem. They may also find the terminology of “mental illness” repugnant, and have a strong preference for “crazy”. But it really is the case that for some people, mental healthcare including therapy and medication is a really good thing. And that for some people, the biggest problem with the system is difficulty accessing it (either because others discourage it, or because it’s too expensive.)

When most of someone’s experiences are with dismissiveness, it can be hard to understand that the dehumanization experiences are also real. (Particularly for people who were really afraid of mental health care and then had a transformative good experience with it.) It can be hard to understand why someone would prefer an apparently pejorative term like “crazy” over an apparently-netural term like “mental illness”. It can seem like people must be exaggerating, or that these things only happened in the past, or something like that. But dehumanization is still a problem now, and fighting treatment stigma will not address that problem.

Both dehumanization and dismissiveness are important barriers to people being treated as they ought to be. Because of both types of stigma, people lack access to help they vitally need. For some people, that help is treatment. For others, it’s access to resources like housing, respite, and assistance with food. For a lot of people, it’s both. People’s very real mental health struggles should not be dismissed; neither should the humanity and human rights of people with mental illnesses be denied.

tl;dr There are two types of mental health stigma: dismissiveness, and dehumanization. Dismissiveness is when people deny the reality of your condition; dehumanization is when people think that your condition makes you less than human. Dismissiveness is often made better by the mental health system; dehumanization is often made worse. People whose experience is primarily in one category often don’t understand that the other category exists. Both matter, and both need to be part of the conversation.

Drugs, crutches, and other tools

Psychiatric medication is highly stigmatized, and so is physical disability. One way that this comes out is that people say pejoratively, “medication is a crutch.”

Why is “crutch” an insult? What do people think is so terrible about using crutches?

I think that it’s a kind of ableism where people don’t understand that disability actually exists. They believe that anyone can do anything, if they put their mind to it and work hard. When people with disabilities can’t do something others can, they assume that we are just being lazy. They assume that about moving, they assume that about moving, and they assume that about thinking.

They believe that if they push us to try harder, then we will learn to stop being disabled. They think that if we stay disabled; it’s because someone’s giving us permission to be lazy. They’re constantly on guard against the possibility of a disabled person getting away with something.

They are aggressively hostile towards any visible adaptive strategy. When they see crutches or medications or whatever, they are terrified that we are getting permission to be lazy.

Sometimes, they think it’s ok for us to use these things, but only if we fall into a very narrow category of people think think have real disabilities. For instance, they might think wheelchairs are ok for paralyzed people, but have no respect for wheelchair users who can walk. Or they might think it’s ok to use medication if you’re trying to stop, but have contempt for people who need medication long-term and have no plans to stop taking it. Or whatever other combination of things. People have a lot of really weird ideas about disability, and just about any prejudice you can imagine exists.

Crutches are a tool. There are other mobility tools. Medications are several different tools. There are other mental health tools. They all have advantages and disadvantages, and everyone has to figure out what works best for them. Every strategy is stigmatized, because ableists expect us to think our way out of being disabled. But crutches aren’t actually bad things, whether they’re literal or figurative. We all find the ones we need.

tl;dr People with disabilities need adaptive strategies to work around disability-related limitations. Ableists think that we’re just being lazy when we use adaptations such as mobility aids or psychiatric medication. They often pejoratively say “you’re just using that as a crutch,” as though using adaptive equipment is the worst thing you could possibly do. But actually, there’s nothing wrong with crutches. We all find the ones we need, and that’s a good thing.

Small talk when you don’t want to reveal your stigmatized job

Anonymous asked:

I’m a sex worker but I don’t feel like that’s always an appropriate honest answer when someone asks me what I do. What should I say instead?

realsocialskills said:

I’m not sure of anything specific to sex work since I don’t have any direct experience and I’ve never discussed this with someone who does. I’m hoping people who’ve done sex work will weigh in.

I do have some general thoughts on deflecting unwanted questions in social settings: People don’t like to be bored. If you make something you don’t want to talk about sound boring, people tend to make it easy to change the subject.

I think there are a few basic reasons people ask about jobs in social settings:

  • They’re making polite small talk
  • They want to get to know you better and are trying to identify a conversation topic of mutual interest
  • They’re asking you about yourself in hopes that it will give them an opportunity to talk about themself
  • They are trying to figure out your social status
  • They are using the gathering to network, and they’re trying to figure out if you’re in a related field

All of these reasons are amenable to redirection through boredom, along these lines:

  • Say something that’s true, but sounds boring
  • Along the lines of “I run a small business from home”.
  • Possibly with a couple of boring details that will discourage further questions, for fear of having to listen to a verbose explanation of something dull.
  • Change the subject to something that they are likely to find more interesting.
  • One thing that tends to work well is to ask them what they do
  • Once the conversation has shifted away from your job, find a point of mutual interest and discuss that.

eg: 

  • Them: So, what do you do?
  • You: I run a small business from home. The taxes are so complicated these days. I’ve had to spend so much time this week pouring over the tax code. You wouldn’t believe some of the categories.
  • You: Yourself? What do you do?
  • Them: I’m a cabbage farmer.
  • You: What got you into cabbage farming?
  • Them: I grew up on a family tobacco farm, and we’ve had to find new crops.
  • You: A lot of things have changed in the past few years.

People don’t like to be bored. If they think your job is boring and that a more interesting conversation is available, they will probably not be too inquisitive about your job.

Do any sex workers or former sex workers want to weigh in? How do you handle questions about your job when you don’t feel that the whole truth would be contextually appropriate? 

tl;dr Making things you don’t want to talk about sound boring is a fairly effective way to prevent people from asking unwanted questions.

autism is a disability

Anonymous said to :

You know, I follow this blog because I think it’s cool and although I don’t really read your advice posts, I can see they’re very respectful and well thought out. That aside, I want to ask: how do you feel about labeling autism as a disability?

realsocialskills said:

I feel very strongly that it is important to refer to autism as a disability. It’s not just a difference; it’s a particular kind of difference, and that kind of difference is called disability.

There are all kinds of things that most people take for granted that autistic people can’t do, or struggle with, or can only do intermittently. Autistic people face ableist discrimination in response to not being able to do those things, or being perceived as not being able to do those things.

We have all of that in common with people with any other kind of disability. Acknowledging that allows us to learn from and collaborate with one another. Denying that we’re disabled just isolates us.

I think that every single thing I’ve written about autism has been reblogged by someone with another kind of disability saying “I can relate to this too”. As a result, my writing has become increasingly cross-disability. We have a lot in common.

If we try to separate ourselves from other disabled people, we lose a lot. Overlapping disability communities have a lot in common, and a lot of built up tools for dealing with disability, dealing with discrimination, and supporting one another. If we admit that we’re disabled, we can be part of that. If we don’t, everything gets a lot harder.

tl;dr I think that autism is a disability and that admitting that makes life a lot better for autistic people.

Being with family can do weird things to you

Something to be aware of if you’re with family for the holidays/break/visting/etc:


If you’ve been working on self-acceptance lately and making progress, some aspects of that are likely to be harder when you’re around family. When you visit family, you might feel bad about things you’ve learned to feel good about in other environments. That might be very frightening. It helps somewhat to know that it’s normal, and that most people struggling with self-acceptance go through this. 


It will be easier when you leave again. And, in time, as your self-acceptance solidifies, you will likely learn to hold on to it more consistently when you’re with family. This takes time and practice. It’s not your fault that it’s hard. It’s not a failure and it doesn’t mean you’re doing self-acceptance wrong. It just means that it’s hard. 


An example: If you’re fat and you’ve been learning body positivity and feeling good about yourself and your body, that’s likely to be harder to maintain while you’re visiting family. Most people aren’t in tune with that particular kind of body positivity. And some families are actively awful about it. You might feel worse during your visit, and feeling worse may linger after your visit. But it’s a temporary setback; it’s not permanent and it’s not your fault. It’s just that these things are hard, and close relationships complicate things when you’re trying to learn to live by values people you’re close to don’t share. 


It can help to actively stay connected to people who share your values while you’re visiting family. (Eg: take time to read body-postive blogs; talk to your friends; write emails.) It can also help to journal. 


And, in the words of Laura Hershey, it helps to remember that you get proud by practicing. Feeling good about stigmatized attributes you have takes time and practice. Feeling good about those things even when you’re around family members who feel bad about them is an advanced kind of pride. It takes a lot of practice to level up and feel ok even in that context. It’s hard, and that’s not your fault. You’re ok, even if you feel bad right now. 

What it means when kids aren’t allowed to know about bad things

There are a lot of things kids are often considered too young to know about. For instance:

  • Rape
  • Violence
  • Racism
  • Sexism

The problem is, almost every bad thing kids are considered too young to know about happens to some kids.

The rule that kids should be shielded from these things has some really negative effects on the kids who are most vulnerable.

It hurts kids who have been abused, because they’re considered dangerous to other kids if they ever talk about it. Their peers aren’t supposed to know about it, so they’re supposed to just never talk about it ever. That creates a lot of shame, and living with that kind of shame hurts people.

It also hurts kids who are currently being abused. They get the overwhelming message from everyone that kids are not allowed to talk about these things. That makes it hard to tell adults what’s going on, especially if they don’t quite know the right words. If they try to tell indirectly, they might even be hushed and told that they’re too young to be thinking about that kind of thing.

It hurts kids of color, because they’re often required to put up with racist things rather than have the white kids find out about racism. Because they’re old enough to have to deal with racism, but their white peers aren’t considered old enough to be told about it.

There’s also parents who don’t want their kids to play with disabled kids, because they think their kids are too young to know about disability or serious illness or injury. Or even, to the point that a kids’ show hosted by an amputee actor got a lot of complaints that her missing arm was upsetting to children. This kind of attitude is all over the place.

Preventing kids from thinking about bad things hurts all kinds of kids, all kinds of particularly vulnerable kids. And I don’t see how it does much to protect the safer kids, either.

I’m not sure what the solution is. But I think it is a problem.

aura218:

nichtigen:

aura218:

actuallyrlysrs:

aura218:

realsocialskills:

aura218:

realsocialskills:

stripesweatersandwaterbottles:

youneedacat:

Social skills for autonomous people: boundary violations in therapy

realsocialskills:

all-women-kick-ass asked realsocialskills:

do you know what particular boundary violations in therapy AREN’T considered unethical? because i am also studying to be a therapist and would very much like to avoid said boundary violations with future clients.


Boundary…


Something horrible one of my therapists did to me:

He told me that because I was I’m the system, I was not a real adult and never would be. And that therefore I would never be allowed to make major life choices without consulting him.

He then told me exactly how he’d manage it. He would make my choices for me. Then he would communicate to my parents such that they would make all my decisions for me.

Another thing he did was hold my sleep disorder against me. He said real adults can control their circadian rhythms and he would not let me make choices until I could sleep all night.

He and another therapist also communicated with my parents, without my permission, signed out otherwise, about me, after I reached adulthood. That’s not only wrong, it’s illegal.

My psychiatrist had a lengthy conversation with my mother that was basically about how if I didn’t take a medication for narcolepsy (after it was clear I didn’t have narcolepsy), my life would go to hell in a handbasket and I’d lose all my friends because I didn’t care enough to take care of myself.

Same shrink decided that the only valuable course my life could take, was to overcome my autism, and go on to become another Temple Grandin. He wanted me to become a psychiatrist just like him, work with autistic children, and contribute to autism research. Anything less than this and my life would be a waste.

This was combined with another huge boundary violation:  He basically every time I went along with his plans for me, he wrote that I was making progress and becoming higher functioning. If I went against his plans for me, he’d say I was regressing, becoming lower functioning, or ruining my life.

Going against his plans for me was one of the best things I ever did. It was my first step towards being able to run my own life and my life has gotten better and better since.

Mind you, he was probably my best shrink. But not realizing the power he had, he abused it without even trying.

Another shrink told me that I would never be able to think for myself. That it would probably kill me to do so.

Same one told me that he was going to get inside my brain. Create a version of himself that lived inside me. Kill off the me that lived in there. And replace me with a version of me he built himself. And then climb in there with me so I couldn’t disobey him anymore.

I don’t know what the hell he did to me but there’s still remnants nearly two decades later.

And that’s just off the top of my head. All of these things are in the category of things you should never ever do to someone.

The easiest to do accidentally are protecting your goals for your patient onto them. And then seeing moving towards those goals as progress, moving away as regression. Watch out for that.

I’d also recommend the video, the ethics of touch, by Dave Hingsburger. It’s not just about touch, it’s about boundaries in general.

I have had my sleep issue be ignored, glossed over, and have even had a therapist get angry with me because I was so desperate for sleep I wasn’t getting and they thought it didn’t matter. Literally “so?“ was said many times. Everyone thinks that my complete inability to sleep without meds/enough meds is my fault snd if I can’t sleep even with meds then it is clearly my fault bc i must be doing something wrong. This attitude coming from s therapist whom I enjoyed and trusted up until the last year I was in school, was damaging.

A lot of people I know who have sleep disorders have been emphatically told that it’s just because they’re practicing poor sleep hygiene and if they’d just try harder their problems would go away.

These stories above are bizarre, like, 60s shit. This is so far beyond ethics and legality it’s unbelievable. That should NEVER have happened and is NOT the norm or typical of ANY kind of therapy.

The Judge Rotenberg Center openly uses electric shock and food deprivation as behavior modification techniques.

Given that, which part of what youneedacat described is something you think no longer happens?

Those methods are contrary to AMA and APA guidelines and not how the typical psychiatrist acts. I don’t want to scare anyone off therapy by telling them that any of this is likely to happe nto them, because it won’t. This is NOT how psychiatrists are trained in modern universities.

Someone was unlucky to get stuck with a psychopath. Anyone can encounter a criminal, in any situation. If your psychiatrist is displaying warning signs, you don’t have to stick with them because you think the next one will be just as bad.

you really can’t say that it won’t happen because it absolutely does happen. therapy is not exempt from criticism just because it helps people.

Of course it shouldn’t be exempt from crit, I just think we should be presenting a balanced opinion to people considering going to therapy, who really need help. I’ve been in therapy for 15 years and it’s done me worlds of good. And I once had a really hideious therapist who should be disbarred or disbanded or whatever. Incarcerated for preference. 

But I don’t open the conversation with “I’ve been in therapy for 15 years and once, for a few months, I had a therapist who was awful.” Because there’s so much stigma against getting help, that most people don’t get help when they should, and stay sick, stay depressed, hurt the people in their lives, and don’t become the people they CAN be, because pop culture tells us that psychiatry is fake and wrong. 

So. Is there anyone following this thread who’d like to say that therapy helped them? That their therapist was professional, competant, helped them work out their issues and taught them helpful and adaptive skills? Because of my, like, 10 therapists across multiple offices and universities, that was the majority of my experience. 

obviously therapy helps people all the time, but this thread is specifically about boundaries and therapists breaking those boundaries and how the breaking of certain boundaries with certain patients isn’t seen as unethical for whatever reason. if you’ll notice, a lot of this thread is centered around the treatment of autistic patients, which are at a much higher risk for medical abuse.

so I don’t think this thread is adding to the stigma of getting help, I think this thread is an open and honest conversation about the abuses that are rampant in the medical field, specifically dealing with mental health, and more specifically dealing with patients that are viewed as disabled. and I think you’re derailing that conversation by saying that not all therapists/therapy is bad. we all know that. that’s not what’s being discussed here.

and sure, if you want to start a conversation about people’s positive experiences with therapy, I totally encourage that. but don’t use that to shut down this conversation, which is an important and necessary conversation for all of the people who have experienced abuse at the hands of their therapist.

Okay. I see what you’re saying. I didn’t mean to derail an important topic. I’ll stop now.

Thank you.

And I’d like to add explicitly:

I’ve seen therapy be dramatically helpful for many of my friends. Medication too. I think it’s great when those things work for people, and it’s horrible that there’s such a stigma attached to them. So many people are needlessly pressured into struggling alone.

I think it’s also horrible that the problems with therapy culture make therapy and medication unsafe for so many people who would otherwise benefit from them. I wish it was safer. I wish these things were realistic options for more people.

I also wish that people who have serious problems and address them in ways other than therapy/medication got more respect. Therapy and medication can be important tools, but they are not the only tools.

The stigma of seeking help is large, and can mess people up badly.

The stigma of having a mental illness or other serious problem and *not* going to therapy or using medication, or otherwise being noncompliant, is an order of magnitude worse.

People need to know that the risks are real. People who’ve been mistreated in therapy need to know that they are not alone.