The Three People You Need on Your Breakdown Team

by Jocelyn Davis

“Do you know about relaxing your shoulders?” asked Natalie, my assigned therapist at the Life Healing Center. She demonstrated smilingly, pressing fingertips to clavicles and letting out her breath with a whoof.

I assured her I did know and gave my own mini-demonstration: Smile. Drop shoulders. Whoof. It was mid-October 2020, the eleventh week of my mind-body catastrophe, and I’d grown used to answering nice counselors’ stupid questions.

During this slow-rolling breakdown, I’d encountered many conflicting perspectives on my problems and their possible solutions, but everyone I saw, professional or non, agreed on one thing: therapy was required. At the Life Healing Center, a now-closed facility where I spent five days descending to a new health low, therapy was pushed at every turn: talk therapy, group therapy, horse therapy, art therapy, meditative therapy, eye-movement therapy. In the psych ward of my local hospital, where I was confined for a couple of weeks, twice-daily “Group” was required; if you were napping, a nurse would shake you awake and insist you take part. When I was discharged (yes, I recovered, no thanks to Group), I had to give the name of my therapist and promise to make an appointment.

Of the dozen-plus therapists I tried to see over the course of my odyssey, about half weren’t taking new patients or were booked far into the future. Of the rest who tried to help, only one, a psychiatrist, was actually helpful. One woman in particular was actively unhelpful: she said she could fit me in but only if I signed a contract promising not to unalive myself while I was under her care. Her bitter tone as she made this demand suggested past experience of lawsuits brought by distraught family members looking for someone to blame. I could understand her hesitancy, but the sight of that contract on my laptop screen sent my anxiety through the roof.

Now, I’m sure some of you are thinking, I love my therapist! Couldn’t do without her. Or perhaps, Stop painting all therapists alike. Maybe you didn’t have a good experience with therapy, but millions of people do. Or even, Dude, my therapist saved my life.

You’re right. Psychotherapists have assisted countless people through difficult times, improved everyday function, and even saved lives. In my opinion, any adult wanting therapy should seek it out. While it might take multiple tries to find the right person and modality, there’s plenty of evidence that good therapy is a good thing, especially for mild neuroses, relationship challenges, and trauma-related issues.

What I’m talking about, though, isn’t the mild stuff, but the crises: what my co-author, Dr. Kelly Kinnebrew, and I call the breakdown lane.

About one in five of us will, at some point in our life, slide into that lane. The mental health industry tells us there are two routes out: talk therapy and/or medical treatment. Unless you’re actively psychotic, you’re supposed to start with the former and give it your best shot. Then, if the therapist thinks you need pharmaceuticals or other medical care, you’ll get referred to a psychiatrist, who will prescribe meds and might in turn refer you to an in- or outpatient facility, whereupon you’ll have a “team” consisting of medical pros (doctors and nurses), therapy pros (psychologists and counselors), plus technicians and assistants of various kinds. As long as you’re under that team’s direct oversight, they’ll have you covered.

OK, but what about before and after the direct-oversight period? Who rides shotgun when you’re heading round the bend? Who takes the wheel when you emerge, shaken and exhausted, on the other side?

Experts agree: Before, as you’re struggling to keep the car on the road, you need a therapist. After, when you’re learning to drive again, you need a therapist. And yes, it’ll be good to have support from family and friends, so let’s get them certified in “mental health first aid.” That way, they’ll know when to look worried and suggest you see … a therapist.

Here’s the thing: your therapist is not your breakdown team.

As research for our forthcoming book, Kelly and I conducted in-depth interviews with two dozen high-functioning professionals who successfully navigated a serious mental collapse. These survivors told us that therapists are helpers, not saviors. When it comes to getting you through the dark canyon of acute mental illness, a therapist is never sufficient, nor is a therapist always necessary. When you’re in the breakdown lane, what you need and what suffices is a team of three:

A therapist might play any of these roles, or none. What’s important is to have all three roles covered, and covered by people competent to fill them, never mind what they call themselves or what you’ve called them in the past. One person might play two roles (we haven’t seen instances where one person has played all three), and more than one person might fill one of the roles (if you’re fortunate enough to have several emotional supporters, for example, so much the better). For many of our interviewees, however, there was a one-to-one match: one person took the lead in each role, and that team of three did the heavy lifting on the road back to health.

Let’s look at each role in turn.

This is the person who, from a position of authority usually born of clinical expertise, tells you what to do and where to go. In other words, they prescribe—not only medication, but treatment plans, courses of action, and ways of understanding the situation.

Typically, the prescriptive guide is a psychiatrist or doctor of psychology; sometimes, they’re a licensed therapist or medical professional of another sort. On rare occasions, they are a loved one with the moral authority to stop you short and push you in a new direction. In any case, they’re the firm hand on the reins: the Mary Poppins who won’t hesitate to say, “Spit-spot, into bed,” or “Close your mouth, Michael, we are not a codfish.”

My prescriptive guide was Dr. Funar, chief psychiatrist at the Life Healing Center. Had she not agreed to continue treating me after I left, I honestly don’t know how my story would have turned out. Not well, that’s for sure. The guide for Evelyn, one of our interviewees who suffered from postpartum psychosis, was an academic psychiatrist who specialized in that condition and happened to catch her case. For Kyle, who developed suicidal ideation after his partner died, it was his longtime therapist who, upon receiving his call for help, told him to get on the trolley and go straight to the Mass. General ER. For Jodie, who developed flashbacks and severe insomnia in the wake of 9/11, it was an eye-movement desensitization and reprocessing (EMDR) therapist whose methods worked when nothing else had.

And for Shane, a self-medicator who used alcohol to cope with a longstanding anxiety disorder, it was his teenage daughter, who confessed to her own therapist that she was terrified at the thought of her dad not being there when she needed him. Shane’s daughter wasn’t a clinician, but she was his Mary Poppins—and his guiding light.

This is the friend or loved one who listens, believes, and genuinely cares. Don’t assume it’ll be your spouse, because often they’re too busy playing Role No. 3 to ride to the emotional rescue.

It’s also a mistake to assume your therapist will play this role. “Wait,” you say, “isn’t being emotionally supportive exactly what a therapist is supposed to do?” Yes, of course, a good therapist will support you emotionally; that’s their job. Let me repeat: That’s their job. They are being paid to attend to your feelings, and trust me, when you’re sitting across from Natalie of the Healing Center spilling all your troubles, you know very well that her concern—benign smile, empathetic head tilt, and all—is of the professional kind. It’s no substitute for the real thing.

My emotional supporter was Susan, a longtime friend who, despite living 1500 miles away, was the only person who seemed to grasp just how bad my situation was. While others tried to reassure me (which I appreciated), Susan was terrified on my behalf and did not hide it. She checked in daily as I was sliding down the rabbit hole. She told me to call her any time, day or night, and meant it. She reached out to my husband, let him share his worries, and asked what she could do. When I couldn’t sustain a conversation anymore, she switched to texting me old photos of us with affectionate messages: “I’m still out here, lurking creepily!” she wrote. “I love you.”

Each of our interviewees had a Susan. For some, it was a friend; for some, it was a partner, sibling, or parent; one or two lucky ones had a whole community; and one woman with borderline personality disorder gave credit to, yes, her therapist. Emotional supporter is really too bland a term for what these people are. Lifeline for the drowning heart-mind is more like it.

Last but certainly not least, there’s the person who holds your life together while you’re falling apart.

We normally high-functioning professionals have a problem: we are used to being that person, holding together our life and everyone else’s. We’re good at the role, so we cling to the role, even when we have someone willing and able to take it on. “I’ll manage this thing my own way!” is our cry. Meanwhile, the edifice of job, household, and basic existence is crumbling around our ears. The practical manager is the person with the capacity and gumption to step in and, well, manage—whether we’ve asked them to or not.

Case in point: my husband. In addition to his usual household tasks and his full-time job, he took on laundry and meal prep. He made sure I ate. He picked up my prescriptions. He handled insurance paperwork. He brought me countless cups of tea. Most importantly, he arranged with Dr. Funar to get me admitted to the hospital, then sat with me, uncomplaining, through the six-hour intake process. He wasn’t particularly “supportive” in the emotional sense, but boy, he was a rock.

The medical management piece, whether or not it includes hospitalization, is especially crucial given the giant hairball that is our US healthcare system. Most of our interviewees had someone who acted as a medical coordinator, advocate, and troubleshooter. Those who did not—such as Belinda, a young woman who lived alone, far from family, with suicidal ideation; or Kelly, whose husband’s own health issues meant she was left to do single combat with depressive episodes—were forced to play medical manager themselves. Still, their finances, jobs, and education were strong enough to buy them respect and agency, not to mention food and shelter, even as they spiraled. Without those resources, it’s not clear how they’d have made it through.

***

Prescriptive guide. Emotional supporter. Practical manager. This is the team of three we need in place when we find ourselves skidding on black ice into the breakdown lane. A therapist might play one of these roles, or even two, but can we please stop assuming that “therapist” is the all-purpose savior for anyone having a mental health crisis?

Recovery takes a team, not a savior. And the team leader? That’s us.

Jocelyn Davis writes about leadership, history, and mental health. Her latest book is Ticket to Madland, a memoir of mental illness. Learn more at JocelynRDavis.com.