xiphias | Saw the doctor today

Entry tags:

depression,
medical

Saw the doctor today

Dr. Sagov is very difficult to make appointments with, so I saw Dr. Altman, who's the other physician in the practice. I'm starting to really like him. Not as much as I like Dr. Sagov, because, well, Dr. Sagov has been my doctor since I was a wee tot, but Dr. Altman has many of the same traits that make Dr. Sagov a good doctor.

Anyway, the upshot is he upped my dosage of Lexapro, with the comment that it looked like the medication started failing about when the days started getting shorter, so we'll revisit the dosage in six weeks, and, if things are getting better, possibly cut back to the original dosage, with a note to go back up to the higher dosage in November.

And we also talked briefly about therapy as a possibility. I said that, while I wasn't resistant to the idea in principle, I wasn't enthusiastic about it, because I've seen maybe a dozen therapists of one stripe or another in my life, working with six of them fairly extensively, and had really nothing to show for it.

But Lis and I were talking about it further, and I'm trying to figure out if it's time to re-open the question and maybe start again.

And, well, as my friends list is chock full of 1) therapists 2) medical personel of various sorts 3) generally wise people 4) people who've benefited from therapy (with lots of overlap between categories), I figured I'd ask here.

The problem is that, well, therapy has mainly been a great waste of time and money for me. I don't know how to judge if I'm making progress, and I CERTAINLY don't want to hurt a therapist's feelings by saying that I feel like I'm NOT making progress, and, anyway, if I'm depressed, I'm feeling enough inertia that I don't want to make changes like changing therapists. . .

Also, this livejournal is the only forum I've ever found in which I'm comfortable talking about myself. I mean, the ONLY forum. Writing a private journal seems pointless, because who am I writing it for? Talking about myself in person feels egotistical. And while writing a livejournal IS egotistical, definitionally, it doesn't bother me, because I feel certain that y'all can just not read it if you're bored. Which means that I feel free to be boring, because I know that, no matter how boring I am, I'm not going to bore anyone who doesn't freely choose to be bored. Since there's no way you'll offend me by NOT reading this, I know that, if you ARE reading it, it's because, for whatever reason, you're interested.

So, in person, in therapy, I feel awkward. I understand that I'm paying the therapist for his or her time, so I should feel free to talk about myself. But I'm also pretty skilled at drawing other people out, so I've also managed to get them to talk about themselves. Which I am more comfortable with, but which kind of defeats the purpose of therapy.

And, in general, I can't figure out what I'd be trying to DO with therapy, anyway. I mean, I get depressed. The ability to feel happiness sometimes gets sucked out of me, so quickly and violently that I get a physical sensation of it draining out of my feet. There's not much I can DO about it. Talking about it doesn't help.

I can certainly see that, if I was to get some of the depression under control, I'd need to learn how non-depressed people do things, and that might be useful -- I remember that, when Lis and I were seeing a coach, that had some value for me. But I don't see how therapy would help for me.

I wish to stress that this is not intended as any sort of general dismissal of therapy -- I think therapy is a wonderful thing, and I'm actually a little proud I can list so many therapists among my friends. I just don't see how it would help me.

But I'm also aware that I could well be wrong. So I guess my question is -- how do I know if I'm wrong about this, and that I actually SHOULD give therapy of some sort another shot? It's not like we've got unlimited money, and I'm a bit resentful about the money and time I've wasted in it so far. . .

Flat | Top-Level Comments Only

Did you see my post the other day about depression and IBS? Granted, it's very likely that depression affects you differently than it does me. But for me, therapy has been the default treatment, and medication has only been for the worst of the bad times. But it can be hard for me to articulate why, because it's an assumption I've always taken for granted.

I think in part it's because I don't feel comfortable completely divorcing interal biochemistry from external factors. So the things that go on around me, and the way I interpret them and frame them and react to them, are part of the equation. And while my neurotransmitter levels are a factor in determining my interpretations and reactions, so are my conscious efforts.

But then, I've always been comfortable in a therapeutic setting. It's something that's Just Done in my family, and while I've had problems being completely and ruthlessly honest (I lied to the woman I saw when I was 14, so I could stop seeing her), in general opening up has not been an issue.

And you know, not all of my problems are caused by depression or anxiety. Some of them are my own personal neuroses - and while being depressed at varying levels since childhood will contribute greatly to those neuroses, it is not always necessary to remove the depression in order to combat them.

On the bigger picture: I can't, obviously, say what therapy would do for you. I can say what it's done for me.

First, a fair bit of my depression came from stress, and a lot of that stress came from having feelings that I wasn't dealing with. That showed up partly in attitudes towards work -- I had things that I had decided that I needed to get done, but I felt like they were too big and overwhelming to get done in time, but I didn't deal with the fact that I was feeling that way, because it needed to be done regardless of how I felt about it, and so I sat and tried really really hard to get started and found myself unable to do anything because it was too big and too overwhelming to deal with in its current state. And then the next day I had one day fewer to get it done in, and more work to do, and started out with more stress left over from feeling unproductive the day before. And it built on itself, and I spent more time than I'd like to admit not getting anything done.

I think that's likely to be a general characteristic of depression: it feeds on itself. Even if the root cause is something brain-chemical or such, the depression messes up everything else. In my case, I don't think the depression really started with work at all; it started with some other stuff elsewhere in my life. But it messed up the work, and twisted the work into a very large source of more depression.

So what did the therapy do? Well, it started out just talking about all the things that I wasn't admitting to myself. Actually saying that I felt like getting my work done by the deadlines I had was hopeless, rather than squelching that thought every time it appeared. Actually saying that I wasn't getting any work done and didn't know how to get started without getting overwhelmed and paralyzed by feelings of things being too much to handle. All of those things slowly got said.

And, once they got said, I was able to do something about them. The impossiblity was easiest -- it really was impossible, but now that I could let myself acknowledge that I thought it was without getting tied up in self-loathing about it, I could talk to my advisor and redo the deadlines so that it was possible.

The feelings of the work being too much to handle was a bit harder; that took a lot of effort into making very small goals, and admitting that I wasn't happy with the smallness of the goals (and, in so admitting, I could deal with it rather than having it pop up like a bridge-troll in the way every time I tried to work towards the goal), and working towards them. And the therapy sessions gave me a place where I could talk about my progress and such, without having to worry about what "the world" would think about the fact that writing two lines of program was a day's work that I hadn't managed to get done some days.

It's also been good for pre-emptive stuff; I recently had a stressful family trip to deal with, and it was good to be able to talk through what I thought the stressors were likely to be -- and to admit to myself the "inappropriate" feelings that I had, before I got there, so that I wasn't in a position of having those feelings pop up in the middle of things.

The result of all this was that, slowly -- yes, this took a while; it's still taking time -- the work situation got away from being a source of stress, and got to a point where I could sanely deal with it. And I felt a lot less depressed, because that bit of stress was gone. Even though the root stuff was in a large part still the same, because I was less stressed, I could deal with it better, and it's started to heal some too (since it was a "not able to deal with this situation" problem rather than a medical/chemical one).

So. That's what it helped me with. Not so much fixing the root problem, at least at first, but helping with being able to deal with all the side problems that the root problem was causing.

[continued]

[continuation]

On a different note:

To indulge in a small bit of armchair psychoanalysis here, which may not be that accurate: This feeling of the ability to feel happiness getting sucked out of you "so quickly and violently that I get a physical sensation of it draining out of my feet" sounds like something that's happening from an emotional feedback loop -- something triggers it, and then your emotional reaction to that trigger causes something that causes an even worse emotional reaction, and boom everything's gone to pieces. For me, a lot of that's Pavlovian -- I associate the raw trigger with feeling overwhelmingly depressed, and so that becomes my reaction to the trigger.

One of the things that causes those feedback loops, for me, is a feeling of being unable to deal with things; I get trapped between feeling that I need to deal with something -- to be emotionally present for someone, say -- and a feeling that I'm emotionally incapable of doing so. And then the stress of feeling trapped means that I'm even less capable of doing so, and ... down it goes. It goes faster, because there's the stress of not being willing to admit to myself that I'm not being capable, because the situation requires that I be capable and so being incapable isn't an option.

That's something that my therapy was able to help a little with; these days, I at least don't get quite so trapped in not being able to admit that I'm falling apart, and thus at least don't fall quite so far quite so fast. It's also helped me find ways to deal with the situation at the bottom, so that I'm not completely useless when it happens.

If your cases of having things collapse like that are sufficiently similar to mine, they're not something that medicine will fix, even if the medicine fixes the root problem -- the patterns and habits and Pavlovian responses to the triggers are still there, and they feed each other regardless of whether the root problem is still there or not.

In my case, the "talking about it doesn't help" -- which I definitely felt -- turned out to be partly that I hadn't found the parts of it that really needed talking about (because they were buried deep in parts of my brain labeled "never ever admit that this exists"), and partly that the talking helped only a very tiny miniscule amount and so it took lots and lots of talking to really get any useful result, and even so the usefulness was in that it was easier to deal with, not that it got "fixed".

And, as one last thing -- a brief note that didn't really fit anywhere else: No halfway-good therapist will have their feelings hurt by being told that you don't feel like you're making progress; they'll see it for the valuable opening into a discussion about expectations and how to progress towards them that it is. And asking about how to judge if you're making progress can be useful, too; they might well be seeing progress that you're not, and can point out to you what they see.

In my case, I've had the same sorts of problem, and my therapist has on a few occasions expressed a bit of concern that I was saying what I thought would avoid hurting her feelings rather than how I really felt.

I used to see Dr. Sagov. Great accent, and good doctor too as far as I could judge. But then he wasn't on my new health plan, so I had to change.

Therapy... don't know. It was useful for me in allowing me to get at what I think are some roots of why I feel the way I do, and helping me understand and break my resistance to doing things I wanted to do (like changing careers). Mostly she just asked leading questions that got me to think about things I already knew in new ways, and recognize new connections between them... like, I knew P and I knew Q but it never occurred to me that they might be related because I never thought about them at the same time, but talking about them both with my therapist I was able to realize the connections. Maybe I could have done that on my own, but I didn't. And the fact that she was someone I had absolutely no social connection to allowed me (after several months of trust-building) to talk about things with her that I wouldn't talk about with most other people, some of which were part of the puzzle I needed to put together.

If some part of your problems stems from that kind of situation, then therapy might help you, if you gave it time and trust to work. If not, or if you couldn't bring yourself to keep at it long enough to build that kind of trust and see those connections, or if you couldn't trust the therapist enough to talk about all the pieces, then I'd guess it probably wouldn't.

And it's worth noting I'm still on meds and still being somewhat depressed. So it didn't solve what I hoped it would - at least, not permanently - but it was helpful anyway.

Point of information that may be relevant to the discussion.

Because he's been depressed for so long, Ian seems to have disassociated his emotional state from any external stimuli. I can't ask him *why* he's feeling a certain way, because he doesn't look for causes as I tend to. It's all neurochemical to him.

Just something I've observed...

Well, I know Lis may have said something about this already, but here's my two cents worth...

I'd call, "emotional states disassociated from external stimuli" a mental illness or disablity, separate from depression. The skill of determining the (usually external) sources of my emotions is THE most important skill I have. So it floors me that you can function without it, and, apparently don't consider the it's lack to be a major problem.

Well, it's your life. If you aren't bothered by it, and want to spend your time and energy elsewhere, that's your decision.

On the other hand, IF you want to change this...

1) Take Lexpro... because when you don't, your emotional state IS disassociated from external stimuli. (I'll assume that when you're taking Lexpro it replaces the false emotional state "depression" with the healthy state "emotions respond to external stimuli" rather than the equally false emotional state "always happy".)

2) Determining why you feel the way you do is a skill. Learn it. I can't say that therapy is the best way for you to learn this skill, but it is the most common, the most polite, and, for most people, the fastest. Therapists are the only professionals that I know of who teach this skill, and it is a good part of what most of them do, one way or another. (and, BTW, you are not the only one in this boat. Why do you think there are so many therapists?)

You shouldn't judge the usefulness of therapy with medication by the uselessness of therapy without medication. Several people have said that therapy with medication can help retrain bad habits that were established by depression. The dissassociation of emotions from external stimuli looks like that kind of bad habit. The tendency to avoid long term commitments (a couple LJ posts ago) could be another.

In case you haven't guessed, I'm strongly in favor of therapy. I think it would make you more functional, and possibly happier. And it would decrease the frustration of the people around you who often WANT to know why you feel a certain way and find "biochemistry" a... frustrating... answer.

Kiralee

Dissociation is a lot more common than you'd think. It often appears in conjunction with different things.

And (this is why I'm responding, actually) it /can/ be fairly mild-- as when you try not to pay attention to what's going on with you in the dentist's chair, say. It's one of those continuum things.

I've seen a handful of therapists over the years. Some were more helpful than others. A major breakthrough with the most useful one I saw was when I realized that nothing I could do or say would disappoint her. One of the keys to useful therapy is your relationship with your therapist. Therapy relationships are almost unique in that they are entirely one sided. They exist only for your benefit.

If you have a relationship with a therapist that isn't working for you and that you can't fix, it's the therapist's fault. You should get a new one, and feel no guilt about doing it. (This might be obvious. But some people blame themselves when their therapy isn't working. They should blame the therapist and move on.) At the same time, if you are deliberately sabotaging the relationship, you need to stop. Getting therapists to talk about themselves, for example, qualifies as sabotage.

The dissociation thing is really important. I certainly do it. It's a coping mechanism, and one that our society generally teaches men to have. That doesn't mean it's a healthy coping mechanism, though. It's a problem for me when I'm suddenly angry at everything, and even when I can figure out what the event that made me angry was, I don't know why it made me angry. It's also a problem when I have to explicitly stop and ask myself how I'm feeling. Being surprised by my own emotional state isn't a good thing.

Two questions for

xiphias: Are you happy about being dissociated from your emotions? And if not, what can you do about it?

A book I recently read on male cultural programming and depression is "I Don't Want to Talk About It" by Terrence Real. It's not great, but I found I related to it far more than I was happy about. It's worth looking at for info on how depression expresses itself in men and why. (Part of the argument of the book is that our culture defines depression in terms of how women express it. But our culture also teaches men and women to manage emotions in different ways, so men express depression in different ways than women.)

Talking about emotional dissociation reminded me of the book, so I figured I should mention it.

I should been more specific, for example, "Disassociation of emotional states from external stimuli, similar to what Xiphias has described in previous LJ posts."

I am particularly thinking of his post from 9/9/04, "So, what is depression like for me?" To quote:

"Because my depression is primarily biocheical in nature, I have gotten used to thinking of emotional states as being entirely distinct from outside events. I rarely think of questions like 'why am I unhappy,' because I've gotten used to there being no cause..."

"I'm beginning to learn that that isn't true. There are times that I get unhappy because bad stuff happens, or happy because good things happen. But I'm not used to thinking that way, so I don't look for causes like that. If someone insults me, or attacks me, and I become upset or depressed, I'm likely to think of those events as entirely unrelated..."

....

One of my first lines of defense against emotional pain is knowing when/where/how/why it happened and working to avoid or prevent it in the future. Xiphias is, apparently, not even aware that unhappiness is the result of an event that could be prevented. It's like watching someone you care about (since I care about Xipias) spend their entire life wandering around a construction site without a hardhat.

I know, or at least I can intellectually deduce, that Xiphias has protection that I can't "see". But it still gives me the emotional willies. And it floors me that Xiphias does not respond to this as a five alarm crisis.

It floors me even more that HE DOES NOT HAVE TO. He can, in fact, function reasonably well without a "hard hat". If I had not seen it I would not have believed it, but I guess nothing is impossible.

On the other hand... given that Xiphias asked what we thought, and that Lis brought up exactly this point... I thought it was appropriate to say that I see this as a problem, and that I think therapy would/could help.

Although I also agree with Mrmorse, when he says, "Two questions for Xiphias: Are you unhappy being dissociated from your emotions? And if not, what can you do about it?"

I know that Xiphias doesn't feel about this the same way I would. And I think he should make his decision based on what works for him. Being dissociated from his emotions is only a problem if he thinks it is... Although I'm aware many people would consider the state he decribes above to be a problem, it's still his choice.

Kiralee

I'm about to start seeing a cognitive behavioral therapist next week. I've never done this form of therapy before, but apparently it's more focused on building tools to deal with the problem rather than sitting around talking about what the problem might or might not be.

I forget if you're on my filter for that. If you'd like to be, comment and let me know, so you can see my progress firsthand.

I've only had experience with two different therapists. One felt like a complete waste...I never did set up a second appointment with him.

The second time, somebody who knew me well did the phoning and did an exceptional job of trying to match me with somebody she thought would be good for me. I knew at the very first appointment we could work together, and I usually take a long time to open up...

If you aren't free to be yourself fairly quickly, you probably haven't found the right therapist. At least, that's my experience.

there's a joke about the profession that feels very much true to me:

how many therapists does it take to screw in a light bulb?

only one, but the lightbulb really has to want to change.

But I'm also pretty skilled at drawing other people out, so I've also managed to get them to talk about themselves.

that's not what you're there for. :) it's obvious to me that this is something that you need to fix so you can get a lot more out of therapy. you also need to fix this idea that you are obligated not to bore the therapist.

I don't know how to judge if I'm making progress, and I CERTAINLY don't want to hurt a therapist's feelings by saying that I feel like I'm NOT making progress

that's another thought of which you need to rid yourself. you're not there to spare the therapist's feelings. you are there to improve your life. if it's not working, your therapist needs to hear that, so zie can find another way to approach you. if you don't know how to judge your progress, ask for help. if this were a physically obvious condition, like a broken leg, you wouldn't be making the same excuses about why you can't get any help from your GP, so stop sabotaging yourself. :)

there is a lot of benefit in therapy if you are open and honest about what's not working in your life. it's a real boon to have a smart, objective person on one's side considering what a mess other people (and oneself) can occasionally make of it, whether or not one has a biochemical disorder.

and as somebody whose depression is very much biochemical (i am 100% certain of that), i am convinced that there is no such thing as beating that only with medication. long-term depression creates very bad habits, and relentlessly pulls one back into ruts. having a therapist help with suggestions on how to break the bad habits, and create new pathways within the constraints the depression imposes is an invaluable aid to living a relatively decent life despite one's handicap. it's an incredibly insiduous condition, and we need all the help we can get.

long-term depression creates very bad habits,

Exactly what I was trying to figure out how to say!

First, let me say that I'm really happy you went to see the doctor today!

The problem is that, well, therapy has mainly been a great waste of time and money for me. I don't know how to judge if I'm making progress, and I CERTAINLY don't want to hurt a therapist's feelings by saying that I feel like I'm NOT making progress, and, anyway, if I'm depressed, I'm feeling enough inertia that I don't want to make changes like changing therapists. . .

I'm going to second pleonastic on this one. A good therapist will have you set goals. I always saw that as the difference between counseling and therapy. One thing that should happen in therapy is that you should constantly evaluate with your therapist the progress towards your goals.

As you know, after a rough spot, I had a lot of success with therapy around nine years ago. I think that part of it was that I was paying for it myself, which really motivated me to get something out of it.

One thing I did have to do was to consciously hold back from drawing my therapist out into talking about herself, which I caught myself doing on occasion. So, it is something that happens, but it is something that you can control. Or, if it is a problem, identify that with the therapist as one of the goals for therapy -- to help you avoid tricks that keep you from making therapy successful.

I guess a final piece of advice that I have has to do with how you present yourself during therapy. I know a lot of people who tend to come off during therapy as being much more put together than they do privately or in LJ. I think this has to do with the drive to always appear better off than you are, emotionally. I usually advise them to print out a few key LJ posts (get Lis to pick them out :)) and bring them with them or send them ahead of the first meeting.

I really hope that you pursue this and that things get better!

*hugs and love*

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Therapy is about a number of things, Ian. Determining you're depressed, that's easy. Finding coping strategies, that's the ongoing journey. The medicine can help with the purely chemical parts of it but won't actually make you do anything.

It really is a matter of figuring out what you want - let me emphasize that, <b<YOUR</b> wants. The six basic questions, whowhatwherewhenwhyhow, are what you need to figure out here.

I was in therapy from about age 6 til age 20. Age 20 I told the therapist that I wasn't going back. Part of my reason was my parents sending me regarding issues I felt were not strictly just-me, which made me angry about going. But part of it was, I had some idea of what I wanted to do. I had some handle on the six questions. Mine, for what it's worth, had to do mostly with socializing.

Looking back on the last 15 years, there were some times when therapy may have helped. Still, I'm decent with where my head's at a lot of the time right now.

I am no therapist. Not everyone needs therapy. Many people do, for limited times.

Lemme give you a benchmark: look at the six questions about your wants. Figure out how well you can answer them now. figure out how much any therapy helps with answering the six questions. If this benchmark works for you, great. If not, well, think of another one. I'll help as I can, as long as you'll let me.

You mention coaching as something useful for you.

Cognitive behavioral therapy, as mentioned, does, in fact, focus primarily on the strategies for the here and now. Figuring out strategies for re-learning habits and behaviors instilled by depression.

As someone who has a history of dissociating my emotional state from external stimuli (as so well put by Cheshyre), other forms of talk therapy have been useful in a) helping me realize when I'm doing it, and b) helping me figure out ways of not doing it.

What they all said *gestures upwards* and something else that a wise psychiatrist I've read the work of said once:

Medication removes the roadblocks to therapy, just as therapy helps determine which medications are most appropriate. Ideally, you want to have both.

It may be all neurochemical, but as

pleonastic points out so succinctly above, it's still caused you to develop ruts that are, at best, dysfunctional and ultimately nonworkable. Which is where therapy will help.

Medication removes the roadblocks to therapy, just as therapy helps determine which medications are most appropriate. Ideally, you want to have both.

I like how you put this. Especially the first part.

red_queen clarified it for me a different way: Sometimes medication can help you get out of your own way so you're free to deal with whatever's causing you to need the medication in the first place. :)

I don't think you'll get anywhere much without it, to be honest. I'm not gonig to address the boredom or hurt feelings things, because you know that that's irrational, but -

But I know that I need stated goals in therapy - I need to draw up some goals in the first session and work towards achieving them. Stuff like "recognise when this emotional state is going to hit me and do something to stop the cycle." I cannot cope with therapy unless I have some idea what I'm going to get out of it.

I also need a therapist who will stop me drifting from the point - I will tend to talk about just about anyone or anything other than myself to get away from coping with myself. I am *good* at distracting therapists. It's counterproductive and they have to call me on it.

The stuff I'm dealing with in therapy now is behaviour patterns set up in my infancy and early childhood which I believe will be damaging to my daughter. I want them out. That's my goal. While they were only damaging to myself I didn't mind them so much. Stuff like doormattage, hyper-critical judgementalism, wildly fluctuating self esteem.

A.

So, I'm not going to say much, since I already agree with what everyone else put much more eloquently than I could, but I am going to point out a couple of things that I observe differently now than I did when we were at Brandeis:

1) Since Vekson112 started seeing a psychiatrist, he was diagnosed with both depression (caused mostly by chemical imbalance) *and* ADD. Now, the ADD part came as quite a surprise to both of us, since he's able to sit and work on computer stuff for hours, or he can read non-fiction for hours, however, this only really mean that he's not actually Hyperactive. My point is, that, in retrospect, I recall that while at Brandeis, you exhibited many of the same attributes as Vekson112 does (you were never Hyperactive, however, you did often hyper-focus on things that you wanted to do). It might be worth it to have a therapist, or even your regular doctor, test you for ADD or any other neuro-chemical disorders which might be contributing to your depression. Please note, I'm not implying that you have any disorders, just that it can be worth while to see if you do (especially if there's a way to fix or alleviate them).

2) I agree with you that you have always been able to draw people out to talk about themselves--heck, I do that, too. But, you might want to self-analyze a bit and try to decide *why* you do that.

I do it because I *don't* want to talk about myself--I don't want people to know the real me (since I'm sure I'm a lot more messed up than people realize). Only recently have I started to think about that, and have decided that it's okay for people to know that my family isn't as picture-perfect as my mother would like everyone to believe, or that I'm chronically depressed, since I now realize that people aren't going to run away screaming if I tell them.

Anyway, good luck with finding a therapist/therapy that works for you, and, if you ever just need a listening ear or a virtual hug, I'm here for you.

*Hug*

I started to read through the comments of others here, but I'm running out of time, as I need to leave for work soon. So I hope that what I'm going to say here isn't duplicative. And if it is...well, I suppose you can treat it as another "vote" in support of.

My bouts of depression have been either a) short-lived, or b) situational in nature. I tend to be moody and unsatisfied a lot of the time, which will, if frustrated enough, spiral down into a short-lived depression. The last six months I have been seeing a therapist because of when I was dumped in August, on top of knowing that my marriage was an utter failure that I didn't feel I could get out of without messing my husband's life up because of his INS issues.

Basically, from what I have experienced, I come to the conclusion that a therapist is like a guide. They cannot solve your problems for you (and shouldn't), but they can help you sort through all the reams of rational and emotional data to find patterns. What good are the patterns? Well, my therapist goes on the theory that no one is perfect and that at some point in our development, we all developed our own ways of coping with things as children. Some of those things we grew out of as we matured emotionally. But others of those things, if they were a form of coping developed out of a stronger type of childhood stress, became more lasting methods of dealing with things. Compare it to a tree. If you hack deeply enough that you get through the bark, into the wood beneath, you'll leave a wound. Yes, the bark will grow over it if you didn't do enough damage to kill the tree, but a cross-section of that tree's trunk will show you that the scar is still there, pocketed safely away. It's the same thing with people, and when things in our adult life "trigger" these wounds, that is, things that resemble whatever happened to us back then, the whole situation sort of slides into a groove, a pre-made pattern in our heads that our little child-selves perceived at the time of the original problem/wounding/what have you.

For me, therapy has been a way to uncover all those childish patternings and all the faulty things that those events "taught" me about the world, and then to attempt to change them. Which of course, is really hard, because you have to first change the way you perceive and process some of these things at a really deep, basic level that is connected to your limbic system/primal/emotional center before you can even think to start to change them. It's not that we were "wrong" exactly in dealing with things in certain ways that worked at that time, it's just that after those events are over, those methods linger on, even though they no longer apply to anything.

From what I read, I did see someone before me saying depression feeds on itself. I can say from experience that this is true. It's like an energy sink that gets set up by some trigger, like some elaborate Rube-Goldbergian machine that transports and obscures the emotional energy until its source is well nigh unrecognizable. For me, at least, therapy is about dismantling that machine and going back to the source in order to see things more clearly, to identify negative, useless, draining, injurious patterns that are at times labyrinthine in nature, demolish them, and reset the system.

The last time I said on LJ that I'd never had therapy and that I'd always been horrified at the idea of people trying to poke around with my brain, and that there was nothing wrong with me and when there's nothing broken don't fix it, a group of well-meaning people rushed to tell me I should have therapy, it would help me, there was nothing to be scared of. The fact that there was nothing wrong with me didn't seem to get through. The rush of people telling you to do it, it's helped them, seems to me a little like that.

In my experience of other people, therapy seems to help some a lot, and others not at all, and the ones it hasn't helped at all in the past it continues to not help at all in the future -- it seems to me to be very like a drug that works on some percentage of people with a given problem.

Well, ick.

Um, that is. I'm in training to be a counselor-type, and I very firmly think that therapy works /very/ well for some people, and not as well for others, and I shouldn't go around saying, "Hey. You. Have therapy." If I did that last time you posted about the while thing, then I'm sorry.

OTOH, I have experience with clinical depression (in that I have it), and therapy has worked in certain ways. Therefore, I give my experience. (And he did /ask/.)

I've got a couple of comments on this.

First, yeah: Therapy when you don't see anything broken is a waste. That was my other experience with therapy, that I didn't mention. When I started high school after being homeschooled, my parents were worried that I wasn't good at socializing, and I was feeling very unsure of myself, so I went to a counselor to help with that. It turned out to be largely useless; most of this was before I actually started school, and so the problems were mostly academic, and the counselor was providing generic solutions to generic problems. And, for what few specific problems I did have, I didn't really think to bring them up. The result was pretty much a complete waste.

(Of course, it didn't help that the counselor was a bit of a twit. A friend of mine was also seeing him, and the counselor's advice to my friend's difficulty of how to deal with peer pressure of fellow teenagers trying to get him to drink at parties was "Would it be so bad to just have one drink?")

So, yeah, in that situation: definitely a waste of time.

But there's a different situation, too.

The most recent time, I also spent a while thinking "I don't have anything that really needs therapy; yeah, I'm stressed, but I have reasons to be." Then, after my wife worrying about me for most of a year, and things getting more and more piled up with work, and things like that, it finally got through to me that there was something Not Normal about the fact that I couldn't remember having felt genuinely happy in months. Once I finally realized that there were things wrong, and that they weren't things I knew how to fix on my own -- that was the situation where the therapy could be helpful. It wouldn't have been helpful before that point, I think.

I don't know Ian well enough to say if he's in the same boat, but the things that he's saying sound very much like the things that I was saying when I was in that position of saying "There's nothing wrong with me" and having it be about as believable as the Black Knight insisting it's only a flesh wound.

And, you're right; I don't know that therapy would help him the same way it helped me, even if he is in a similar situation. I do think it's worth another try, if he's in a situation where he feels that there's something clearly broken that therapy would be good at fixing, though, despite the possibility that it might simply not work for him.

In looking over what I just wrote -- I feel like I did a really bad job of conveying that I see your point, and generally agree with it; I ended up writing this big large bit on what I think is one little place where I disagreed. And that doesn't really convey what I meant to convey. My apologies for that.

If you don't really believe it will help, it probably won't. That said, I hope you can open up to consider that it MIGHT help you and give it a chance, because I do see that therapy can help a lot of people with depression. Perhaps set a goal in the beginning even if the therapist does not - that if you do not feel any better or see progress within 2 months (or X number of visits) that you will stop going to that therapist.

The thing that has helped me the most in dealing with depression this winter was learning new hobbies (crafts in this case). These are absorbing my interest and giving me a creative outlet. Creating new things makes me feel a sense of pride and success and less frustration and boredom with the rest of my life. Is there anything new you want to learn or a project you want tø create? Supplies or training for that is probably less than the cost of one or two therapy sessions and may be worth a try. :)

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First of all, *hugs*. Always. Taking action is hard and you need to give yourself credit for it.

As previously mentioned, I've been in therapy for the last 4 years, mostly on a one-session-every-six-weeks maintenance plan. (Besides which, my mom's a social worker with a B.A. in psych, so I guess you could say I've grown up in a therapy-friendly environment.) This is in combination with daily medication for anxiety and mild depression.

And, in general, I can't figure out what I'd be trying to DO with therapy, anyway. I mean, I get depressed. The ability to feel happiness sometimes gets sucked out of me, so quickly and violently that I get a physical sensation of it draining out of my feet. There's not much I can DO about it. Talking about it doesn't help.

I think that this, right here, is the kernel of your lack of interest in therapy. It sounds like what you're saying is that your past therapists have tried to analyze why you feel this way, and/or help you come up with solutions to 'fix' it. Most therapists are going to want to focus on figuring out the external factors that contribute to depression, and if I understand you correctly that's not what you hope to achieve from therapy--you believe the depression is a neurochemical issue and to treat it as such. A therapist who tries to talk you out of that belief is probably not going to be helpful. So it seems to me that what you need is a therapist who has a different approach. My therapist is teaching me tools--how to recognize the symptoms of an oncoming depression episode, how to quantify my anxiety on a scale of 1 to 10, etc.--but it doesn't sound like that's what you want either.

You mentioned that seeing a coach was kind of helpful, to learn how to do things, which suggests that solution-based therapy might be helpful too. Maybe you'd derive some benefit from talking with a therapist who's willing to focus on how to recognize when you do feel happiness, what factors cause it to increase or to drain away, etc. Trying to analyze and capture a positive behavior is as much a part of a therapist's repertoire as trying to analyze and avoid a negative behavior.

My therapist made me keep a journal, for the first few months, of when I felt any strong emotion (joy, sadness, anger, fear, etc.) and of what physical events surrounded it. Not 'how did I feel before this happened' or 'what do I think caused this' but 'what happened at work that day, what did I eat, how much sleep did I get, what did I talk about with my roommates, did I learn anything new' etc. Seems to me your LiveJournal entries sometimes serve a similar purpose for you. Printing some of them out and taking them to your therapist, as someone else suggested, is definitely a good idea.

Good luck. :)

Lots of people said lots of good things and I agree with quite a bit of it. :) I'm not going to retread that ground, but I'll expand on a few things that occurred to me as I was reading your post and the ensuing comments:

As a number of people have noted, long-term neurochemical depression leaves fingerprints all over our lives that medication can't address. One of the things I got out of talk therapy was learning to sort out causes of what was going on with me. Living with decades of under-treated depression left me with destructive habits of both action and thought, and I needed a lot of help identifying and addressing those habits that had been dysfunctional coping mechanisms when I was unmedicated and that now are actively problematic. That was really difficult -- those habits *had* served me well, for a long time.

I still have neurochemical ups and downs. But now I can much more reliably recognize when a downslide I'm feeling is chemical and when it's situational, and I can react to it appropriately. It's nice to be able to recognize that it's time to up (or in some cases, down) my meds *before* I hit crisis.

It also helped me a lot to have a more-objective viewpoint on what was going on with me. Most of us are terrible at objectively identifying our emotional state -- a friend of mine reported that he could tell when his medication was working, because when it wasn't, more bad things happened to him. He recognized that for the most part, the same kind of things happened to him whether or not his medication was working, but when his depression was active he couldn't shake the deep-down emotional conviction that the problem was external, no matter how much time he spent recognizing on a logical level that that wasn't the case. That's not exactly the way it works for me, but it did take a couple of years of talk therapy to develop the skill to sort out "this sucks because I'm depressed" vs. "this sucks because it sucks." I really needed that objective voice who could say, "no, actually, that *does* suck; that's not your depression talking" or "you seem to be reacting to things from a very depressive state; let's consider upping your meds for a little while and see if it goes away."

Right now, I'm taking a hiatus from talk therapy. First I dropped to every-other-week, and then when I had five successive sessions in which I had nothing to talk about, I told her I'd call her if anything changed. I've made a deal with myself that I'll go back if *anything* gets difficult for more than twenty-four hours -- even if I'm *sure* that it's something I can handle on my own. Because once it's clear I can't handle it on my own I'll be too depressed to actually go make the appointment. And if that means a couple of sessions I pay for that I really didn't need, well, that's much better than getting to the "too depressed to get out of bed" stage.

My partner also goes to talk therapy. He's not neurochemically depressed; he's dealing with other things, some neurochemical, some situational. From what he's said, his sessions sound a lot more like life-coaching. They talk about his goals and passions and how to bring his life more in line with what he loves. And that's a perfectly valid brand of talk therapy, too, and you might find that's what works better for you.

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A lot of highly intelligent non-mainstream people seem to share a similar set of resistances to conventional therapy: we've been pretty introspective much of our lives and it's hard to bring a therapist up to speed on what we've been thinking about for years. We're smart and we may have known that about ourselves for awhile, and especially if we've found a peer-group who can keep up with us, we're impatient with people who don't understand our angle. If we've felt different from our peers for a long time we've probably developed a sense of self resistant to outside pressure, so we resist suggestions that therapists make just like we've resisted pressure to change ourselves to fit societal norms. Particularly if we had a period of social-outcast-ness when we were young, we may not have developed the same kind of interpersonal tools around expressing our emotions to people (and sometimes, since we've not done emotional processing with other people, we've not really had to develop the skills to identify our own feelings in the first place). We've protected the softer bits of our personality thoroughly over the years and honed the ability of our logical sides to interface with people, so the language of emotional intelligence sounds like new-age hoo-hoo to us, and we're suspicious of ideas that don't translate neatly into pure logic.

I think that's why we so often hear "take up a new art form" as an adjunct or alternative to talk therapy. It gets us out of our comfort-zone and away from the intellectual confidence that normally serves us very well. It gets us away from the realm of pure logic via a path that most of don't *expect* to adhere firmly to logic. (For the extra-geeky subset of us who've developed our introspection and social marginalization into an exceptionally stubborn sense of self, it can shake us up into realizing there are in fact things we can learn about ourselves from or with the help of other people.)

Figuring out some of the underlying causes of *my* particular resistances to therapy was, well, very theraputic. :)

I wanted to comment on your recent journalpost in relation to this one, but I see that that one's public and this one's not, so I comment here.

I've been stressed about it. I didn't realize I was stressed about it until a couple hours ago. But I think it's been stress over that that's knotted every muscle I have, sucked away all my energy, and made me dizzy and nauseous.

That sort of thing, I think, is one of the things that therapy can be helpful for: it can help you find the things that you're feeling stressed about, and learn how to find them yourself sooner, and help you deal with them (and learn how to deal with them) before you start getting to the point of muscles knotted and dizziness and nausea. (And spending time being stressed to that point is very likely to be contributing to the depression, too.)

Even if the therapy doesn't fix the depression at all, it would (I think) still be useful to give you coping strategies to not get stressed like that.

Oh, and one more thought: you've recorded a lot of little things like this in your LJ over the months. If you do decide to go to a therapist, it would very likely be quite useful to go through these and print them all out and bring them with you. It's a quick end-run around the problem of not being comfortable talking about such things, aside from simply being a very large pile of useful stuff.

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