Madrona smoked hazelnut suman, lola smith apple caramel, elderflower leche flan custard, and young pine from Archipelago. (Photo: Archipelago)

Ask a Therapist: Putting ‘Care’ and ‘Health’ at the Center of Mental Health Care

by Liz Covey, LMHC


Years ago, during a time in my career when I was working with children and families who had encountered abuse and who were involved with the foster care system, I made a new acquaintance who later became a good friend. When my occupation came up, she looked me squarely in the eyes, and asked, “Why on earth would anyone want to do that??

My friend, no stranger to hardship herself, was asking me in a straightforward manner why I would elect to put myself in the face of abject misery. It’s a reasonable enough query, if the job was in fact full of misery, which it is not. But my friend’s question raises a fallacy about mental health work that I am here to dispel: That the work of mental health is drudgery and despair. That it is raking through the muck of degradation, tragedy, and sorrow. 

But let me assure you: This is not the sum total of mental health work, even in the wake of the worst trauma. That view is entirely too narrow. We laugh a lot. And curse. And tell hard truths. And sometimes cry. Working with people in their most difficult parts and in their deepest feelings is the furthest thing from misery I can imagine. It’s engagement with the desire to be free from the terrors of the past. In other words, it’s the work of being fully in the present.

As we evolve within (and hopefully away from) the COVID-19 pandemic, we can reflect on the many features that have marked this time. One is that we have changed in the way that we as a culture address mental health. We have begun to talk seriously and often about it as a regular feature of life, and less so as a phenomenon that affects only a particular community. It was not uncommon before COVID-19 to hear discussions on mental health that employed the language of “the mentally ill,” such as you might hear concerning cancer patients. The difference is, we do not all get cancer. But somehow it was talked about like only some of us will have this elusive thing that is “mental illness.”

I’m here to tell you that there is no us and them in the area of mental health. We are all faulty humans who will have bountiful and also fallow periods in our psyches, and whether due to temperament or genetics, or from the lemons that life is known to serve, ups and downs will occur for every single one of us. These may or may not call for a psychiatric diagnosis, medication, a course of therapy, or other interventions. But over the span of a lifetime, each person will deal with one or more such periods of crises or conditions. For some, these will mark much of their daily existence lifelong, and, for others, they will be a marked aberration. Either way, no one is immune, and that is also to say, this is a function of how we function. Periods of crisis are not a flaw in the design, they are part of the design itself.

So why this insistence on an orientation toward illness? Why the focus on misery and despair as the only approach for facing this fact of life? 

As many of us sat in our homes for months on end during quarantine, considering our lives from within more carefully than usual, and as we slowly walk through a quieter world today, can we not imagine that there is a better way to consider our mental health than only through the lens of misery or medical condition? Can we at long last widen the lens on our human condition instead, and wonder about what moves us, what calls out to us? What calls us from within? What fills us with desire? What makes us feel clear, calm, and compassionate? And what does the opposite?

The longer I work in the field of mental health the less I think about diagnosis and symptoms, and the more I wonder for my clients: What is your life about? What is your life calling you to be and thus to do? What are you moving toward? What are you moving away from?

In one way or another, I am saying, “Tell me how you are growing.

In my office or online, my patients and I sit together, and with care, trust, and a healthy dose of curiosity, we listen closely to what one’s external and one’s inner life has to say (or reveal some other way). We are patient, and I take notes.

A favorite song that I keep playing on repeat lately is by Rising Appalachia, and it’s called “Harmonize.” The lyrics from this song reflect well on what I am saying above:

Tell me, what makes you weary?
Tell me, what lights up your eyes?
I’ll meet you there, in the middle.
We’ll lay down and harmonize.

“Tell me what makes you peaceful?
Tell me what you fantasize?
I’ll take the notes in the moonlight …
We’ll lay down and harmonize.”

Following these recent hard times, I’m taking this concept of harmonizing as a mandate for my practice with my clients and in my own life these days: I want to know my clients’ hardships, and I want to help harmonize them with their gifts, their strengths, and their longings. I am well aware that good mental health care is having the patience and the goodwill to listen to all the parts of oneself, and, in this profession, we take seriously how helpful it can be to have a witness and guide who can bring amplified focus and presence.

As we return ever so slowly to life as usual, let’s practice harmony with ourselves, and together. Let’s dispense with the medicalized notion of our mental health as the only kind, and return to our roots: The knowledge that being clear and being supportive of one another is what makes us live our best lives.

At the end of Harmonize, the vocalist sings, “I’m awake for you.
As far as putting health and care at the center of mental health care, I couldn’t put it better myself.


Counselors Roy Fisher and Liz Covey answer readers’ questions for the South Seattle Emerald’s “Ask a Therapist.” Have a question about a relationship? Wondering about the struggles of being a parent? Others likely have the same questions and Covey and Fisher bring years of professional experience to provide their insights.


If you have a question, please click here and let us know. We will select two questions each month to answer. The form requires no email address or identification and is completely anonymous. If you are in crisis or in immediate need of care, please contact Crisis Connections at 1-866-427-4747.

📸 Featured image by Benjavisa Ruangvaree Art/Shutterstock.com

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