Laura Smallwood, DVM, DACVIM (SAIM), RYT-200
Chair, GVMA Wellness Committee

Earlier this year I started seeing a therapist.

It wasn’t my first time. While I have been fortunate not to struggle with particularly serious mental health challenges, there have been many times in my life that my mental and emotional wellbeing has been less than optimal and my coping strategies less than helpful. At one point in my life—newly married, newly transplanted to the south, unhappy in my job, and deflecting constant criticism from my mother for my choice of husband, residence, and work, I started seeing a therapist on the recommendation of one of my coworkers. I don’t remember how long I was in therapy but I know that it helped me immensely at a time when I was struggling. Thirty years later, when I found myself overwhelmed at the intersection of too much responsibility and too much loss–navigating my aging father’s care as his health deteriorated, managing the transition of my veterinary practice from private ownership to corporate ownership, and dealing with the embarrassment of a failed business relationship—I again sought the help of a therapist. Therapy again helped me immensely at a time when I was struggling.

In the years in between, there were many times that I could have benefitted from seeing a therapist but didn’t choose to see one. Over the years, I had somehow come to settle for mental and emotional states that were less than optimal. I had also mastered a slew of coping mechanisms to help me deal with the unpleasantness of those states—I worked excessively, volunteered excessively, and trafficked in perfectionism, worry, and an excessive need to control outcomes. Often, in the evening, my mind would continue to reverberate with the busyness of it all—obsessing about things left undone or consumed with worries about things I had no control over. Too often the solution was to have a couple of glasses of wine and fall asleep exhausted, only to wake up at 3 am, my mind racing.

During this time, this thirty-year hiatus from seeing a therapist, I was also raising two daughters. I know both of them grew up feeling loved, safe and supported and that the good far outweighed the bad for our family. However, I also know that I passed on to them ways of coping with stress that were not helpful—along with, perhaps, the message that “less than optimal” is “good enough” when it comes to mental and emotional health.

So, this year I decided to see a therapist regularly. I decided that I owe it not just to myself but to those in my orbit to do whatever I can to support my personal mental health and wellbeing. I still have lots to learn and plenty to work on but adding regular visits to a therapist to the other things I do to support my personal health and wellbeing has helped me to find greater joy and ease in my life.

Like many people, I had always viewed mental health care through the lens of intervention—i.e., you see a therapist when you just can’t cope with things anymore. I didn’t see, until much later in life, how it’s the coping itself that can be problematic. As a child, busyness, perfectionism, and the belief that I could control outcomes were rewarded with praise and attention. As an adult, those same behaviors continued to be my go-to as ways to manage stress and uncertainty and it felt to me like I was doing great. Except I wasn’t. I wasn’t doing great. I was getting by. When I woke up to that and finally began the process of “adulting” my coping skills, a whole new way of living began to open up to me.

Mental health care in America is, to say the least, undervalued. It is typically viewed as a treatment of “last resort”, the cost is often poorly supported or unsupported by health insurance, and many who would benefit are either underinsured or uninsured. Furthermore, the choice to seek mental health care is often stigmatized, and that stigma can be institutionalized. Within the veterinary profession, the requirement for license applicants to divulge their history of mental health care to professional licensing boards is an example of the institutionalization of stigma.

As I write this, I recognize my privilege. I have financial resources that allow me to pay the out-of-pocket cost for mental health care. I live in an urban location where therapists are easy to access. And, I have more time available now than I did when I was working in clinical practice and raising children. I understand that reperceiving mental health care as “wellness care” rather than “illness care” will require a major shift in our collective narrative about the role of mental health and perhaps our very definition of what it means to be mentally and emotionally healthy from childhood into adulthood. It will also require a major shift in our willingness to financially and institutionally support access to mental health care for all.