I need free psychotherapy

Dear Cary,

I need help but can't afford it.

My husband is in grad school, and it's killing me. He works exceptionally hard, into the wee hours almost every night, and I miss him. Coincidentally, almost all of my friends are also in grad school, similarly driven, even on weekends. It's not that I'm not busy, too. I have a very demanding job, and I'm talented at it and could succeed if I invested lots of energy in my personal time. But I think I have depression.

I lost a very close friend recently, and with this combination of things, I am suddenly toppled. I feel I'm in disguise when I'm at work. I seem professional and cheerful, but really I just want to jump out a window. I want help. But now that I'm a sole income earner, I honestly don't think I can afford to seek professional counsel. Even with my insurance, therapy would cost an extra couple hundred dollars a month, and already we are counting dimes.

We could move. I could get roommates. But I so treasure my privacy -- it seems like an indispensable sanity-saving quality-of-life need. My question is, How do grad school spouses do it? How do they come to love solitude? Thank God I don't have children -- the around-the-clock vigor that grad school programs demand of their students seems like an automatic family wrecker to me.

At the least, do you know of a way to find quality mental healthcare without enormous expense?

Insight is hard to find these days; it's like we're all fending for ourselves.

Need Some Help

Dear Need Some Help,

I'm warning you, this is going to be a weird one. So I'm giving you some very practical, easy-to-follow instructions up front.

I suggest you begin by calling up every place you can find that provides mental health services and saying you feel in desperate need of help but fear you cannot afford it. See what they say. Ask if they offer a sliding scale, reduced fees or any kind of free services that might help you get through this crisis. I feel certain that at least someone will suggest that you come in and talk. That can be a start. Many therapists will talk with you whether you feel you have the money or not, in order to determine if there is some way you might be helped. Sometimes out of such a conversation will come a plan that can work for you. It's in everyone's best interest to explore the options.

I also suggest that you take a long walk every day.

You know, I'm no paragon of mental health and vigor, and I am going to confess, this column may be a bit disjointed because I'm not at my peak today, because my wife has gone off to Europe on family business and left me here to pad about silently with the dogs in this old house, and I'm frightened right now and somewhat sad, because in her absence I have turned to my old friends and have realized with a start that my old friends are growing old, and so am I, and I am watching people my age or slightly older disappear -- people who were heroes to me, people who I thought I'd grow old with, who would be there, people I know personally and also cultural icons, people from my childhood, relatives, artists, musicians; it seems a whole cultural layer of my life is being scraped off the earth, and I am thus pushed to contemplate this new sad reality of loss, and I am just going to say that because I don't know what else to do right now but take a walk and write the column and try to take some knowledge or lesson from this, and the lesson I am taking from it is that life vanishes in the blink of an eye, and every chance we miss is gone forever, so if there is anything in your life now that is precious and sacred, I suggest you go and check to see it is still there, and if it is still there, put it in your pocket and take a long walk with it.

This thing goes by in a flash.

Get some exercise. Force yourself to do the boring and difficult things that usually improve your attitude and physical vitality. You know what they are. It's in your body to feel better.

What's going on, physically, actually, at your job? Are they keeping you cooped up in a little warren? No matter how interesting our lives become, we are animals, and animals are happy when they can run around and are not happy when they are cooped up. So I suggest that you tend to your animal. Are you bent over a screen all day? Are you under pressure, experiencing periodic stress shocks, your adrenaline spiking and then leveling out, slowly poisoning your nerves? Are you, on account of your job, having to turn down your happiness invitations and ignoring the many happiness instructions that you used to receive and act on regularly?

Jobs require us to ignore our happiness instructions, and that is how they take us down. During the good part of life, we receive regular happiness instructions. If we can act on them, we can be happy. Often the instructions will read something like, "Go to the beach" or "Play the guitar" or "Call your mom." Growing up involves learning to ignore our regular happiness instructions. You can't call your mom -- you're at work. You can't go to the beach -- it's 500 miles away. After a while we forget that we were ever really receiving regular happiness instructions. In fact, when was the last time you received and acted on a good happiness instruction? What was it? Did it involve clear, cool water, diving in? Did it involve high, dizzying peaks, climbing them? Did it involve noisy brilliant beautiful people crowded together drinking, you among them?

Play your happiness card.

While you are out on your long walk, list 10 happiness instructions that you might receive with pleasure. When you return home, begin acting on them.

I do not know quite where this is going. I know we are required to be adults about it. But I am just a bit fragile today. I am a bit under.

Ha ha. I am such a hypocrite. Am I taking a long walk?

No. That would be easy. Instead I am beginning to wallow. It's just a habit I have. It used to bring a kind word from my mother, but my mother is dead, so there are no kind words going to be coming from her, are there, so what's the point of my moping, hoping she will see me and ask what's wrong?

Get it? We're on our own here. We are only here a short time. So what works for you? Does a good swim work? Have a good swim. Does a long walk in the woods work for you? Maybe you live in Manhattan where there are not really a lot of woods to walk through. Then go walk down the streets, block after block, until your heart is pumping well and you feel alive again and in love with the city. Stop for some street food. See a movie. Do something that always used to make you happy. Find an old, crumpled-up happiness instruction and follow it.

Am I helping you? Are we just passing the time? I have no elixir, no prescriptions. But I did tell you -- up top there -- how to go about looking for low-cost mental health services, right?

OK. So I've done my job. The rest is rambling. We can sit here. I've got time. You can drift off if you like, and I'll keep rambling. I'm not due at my therapist's for another two and a half hours. I have to get to BART though. I have to change my shoes. I need a haircut. The street-cleaning machine just went by. I love the street-cleaning machine. I stand and watch it like a kid. It comes every other Thursday. I see my therapist every other Thursday, too ... I feel like a psychological demonstration model turning slowly on a pedestal in the mall ... Like Houdini, I devise my own entrapments for the entertainment of others ... Oh, and guess what else? I was thinking about forming a postmodern musical group called Cleanser. We would use it to scour our heads of random musical residents. Our first album would be called "Head Full of Jackson Browne"...

Anyway, to repeat: This thing goes by like a flash, so do not delay. You really must take some action.

Thinking about therapy? There's tons of stuff in here about that

Makes a great gift. Can be personalized for the giftee of your choice. Signed first editions on sale now.

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