Battling Depression

Dear Dr. Darcy: 

How do you be happy when part of you fights against it? For the last year I’ve been coming out of what I term “walking depression.”  I met my obligations outside, but inside was pretty bleak. My life is actually pretty good, although my job is soul sucking (child welfare worker).  I’ve experienced depression before (cycle every 5 years or so) with some suicidal ideation when things got really tough.  I usually just wait it out; however, this was pretty bad and lasted for about a year.  I got to the point that wishing/fantasizing wasn’t enough. Fortunately my brain wasn’t working that well and my suicide plan sucked.  Even though I’m no longer actively suicidal, I find myself wishing that it had worked because coming out of this sucks. I’m working with a therapist because I figured I needed some new/better coping skills but it has not been as simple as that. Shocking, I know.  I hate therapy and it’s been harder and taken longer to get out of this dark place than any previous time.  One of the hard days I mapped out an “exit strategy” because I’m not going to go through this recovery process again.  I figure I have 5 years before/if it gets really bad again.  In the meantime I can’t rely on my old coping mechanisms because they obviously weren’t that effective, but I kind of suck at all the new ones I’m supposed to be developing. I’m trying to take care of my body through good nutrition, exercise, sleep, etc, but I’ve discovered that part of me is just fine staying here in this place where it’s not so bad but it’s not so great either. I hate being half assed but that’s where I find myself.

ANSWER 

When people have been depressed or anxious or [insert struggle here] for many years, the ailment becomes familiar. And humans crave familiarity because it helps us feel certainty, which is a basic human need. In trying to rid yourself of the depression, you’re essentially threatening your nervous system with uncertainty, which your body is going to fight against. The depression is like an old friend. You know what to expect. Change sort of blows. Especially in the beginning when all you feel is the discomfort of the unknown and little benefits that will eventually come from sustained change.

All of this means that you cannot rely on how you feel to guide you on which actions to take. What will feel better is the old pattern of thinking and behaving, which, as evidenced by your suicide attempt, has not worked. Essentially, the less comfortable it feels, the greater the confirmation that you’re on the right track.  

You’re going to suck at your new coping mechanisms because they’re new. Stick to them anyway. Stop considering how you feel before taking action and just do it. Just eat. Just drink water. Just exercise. Just call or visit a friend. Just take the shower. Just do your journaling. Just do your meditation.  Just go to therapy. Just do what your shrink told you to do. At the end of the day, your best thinking got you where you are today, so it’s OK to rely on someone else’s thoughts for guidance. At least for a while.

PS: You should be on meds.

Gender & Orientation: Female, Straight.

Why You'll Suck At Picking Your Own Therapist

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Virtually every week, a colleague, a friend, or a friend of a client, asks me to recommend a therapist to them. As much as I hate doing this (mostly because the pool of talented therapists is about the size of a puddle), I’m always willing to help. Left to your own devices you will pick poorly. Below is an incomplete list of the reasons you’ll likely suck at picking your own therapist.

1. You’re a layperson, and lay people don’t know what to look for.

2. You’re going to pick by price. Newsflash: “My therapist is the cheapest!” is terrible marketing for a shrink. I’ve seen moderately priced therapists throughout my life – and I’ve been in therapy for a total of 19 years. Do you want to be in therapy for 19 years?

3. You’ll pick by availability. “My therapist had sooo much availability, I had my choice of 6:00 p.m. appointments Monday through Friday.” That sort of availability is not a good sign.

4. You’ll pick by neighborhood. Does that really sound wise to you?

5. You’ll pick the pretty, thin, ugly, fat, gay, straight, young, old, shrink-who-represents-your-race. This is the exact criterion you use to find partners, and we know what the likelihood of that working out is.

6. You don’t know the difference between a therapist who claims to have specialized training and one who actually has specialized training. Furthermore, you don’t know that a therapist who is trained in something isn’t whom you want to see. You want to see the therapist who is certified in their specialty.

7. You don’t know how to look for those therapists who are going to be different, and you don’t know what differences to look for. Some differences should be avoided, such as this nut (linked to here), and this one (linked to here). That said, you do want to find a therapist who is different, because if you choose a run-of-the-mill therapist, you’ll have a run-of-the-mill experience. Refer to the last sentence in point #2.

The Worried Therapist

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Dear Dr. Darcy:

My therapist tells me that he worries about me and he's always afraid that I will kill myself, he thinks that he will come in for our session and I won't be there because [I’ll have] killed myself. He says it causes him stress. Do you think he cares too much? What should I do?

ANSWER

Your therapist has problems for sure, but caring too much isn’t one of them. I’m presuming you see him in his private practice, which, in my opinion, is completely inappropriate. You should be in a higher level of care. If you have suicidal thoughts, you should be seen immediately by a psychiatrist and evaluated for inpatient hospitalization / medication.

His biggest problem is his willingness to work with a patient who isn’t stable. That, and his choice of guilt as a clinical intervention. I've heard of people seeking therapy to rid themselves of guilt - I've never heard of a therapist attempting to provoke it in a client. He sounds like he needs his head examined.

Find yourself a psychiatrist ASAP. If you’re having suicidal thoughts right now, go directly to your local emergency room.

Writer’s Stats: Female, Straight.