What Attending Therapy Is About: (AKA We Are Not Just Sitting Here Chatting)

Everyone’s approach to attending therapy sessions is different: people’s needs, symptoms, and circumstances vary incredibly. People want and expect different things in session.

Clearly, there are specific, well-researched interventions that are likely to be effective with most people who experience a certain symptom or pattern of behavior. Some interventions can be practiced in a therapy session, and some interventions are good for a client to take home and practice on their own. I do have plenty of handouts to work on and books to recommend that you read!

But not every intervention is on a list of tips that I’m going to print out and give you outright, or on a sheet in a manual with steps 1, 2, and 3. In fact, nearly all of what we are doing while in session is an intervention, even if I do not formally announce it as such. That is to say, we are not just sitting here chatting, even if sometimes that’s what it appears to be.

When I’m asking about your week, or how you feel, if you’ve gotten over your flu, or how things are going with your family or job, for example, I’m actually assessing your anxiety, depression, hypomania, behavior patterns, physical well-being, environmental influences, sense of hopefulness, and any changes in how you are interacting…for starters.

But I’m not just gathering data. I’m also intentionally getting you to practice certain kinds of conversing, thinking, and interacting during session.

I’m getting you to practice speaking openly about things that may have felt “unspeakable,” uncomfortable, scary, or just awkward. I’m reframing or redirecting your thoughts as you speak them from “shoulds and musts” to “preferences and wants,” so that you can begin to change your internalized messages. I am giving you the chance to practice openly experiencing and expressing feelings in the presence of someone who will not censor or scold you for how “irrational” or “unacceptable” they are. I am often taking the role of defending you from your own inner critic! I am supporting you in developing an attachment that is not based in power and control or other unhealthy dynamics. I’m also simply being a trained witness to your life; checking in with you over time to see how you are changing and making sure you are okay.

Developing different patterns of thought and interaction takes time, and it’s a great deal more powerful if done with another person. That is why sessions are “booster shots” even for those who do a lot of internal work on their own. Humans are social creatures. Everyone, even introverts (like me!) must interact with others in order to process and develop emotionally.

And you know I can tell you’ve been making real progress when you stop yourself from saying “should” in session before I can give you the “shoulds” lecture yet again! ;D

So that is why–even if I didn’t give you a handout to take home or a list of suggested solutions to your situation–you made a LOT of progress in your session today.

Remember, “talk therapy” actually changes brain structure!

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Depression Part 3: Nurture Yourself Back to Life

Part 1

Part 2

Part 3: Physical Aspects–Sleep and Nutrition

It can be very hard to take care of yourself even at the best of times, especially if you have a trauma history. And when you’re depressed, it can be even harder to take care of yourself. You might feel too drained, sad, and even unworthy of care. But this is exactly when it is most important to take care of yourself, even if you can only do a little bit.

Just do the little bit that you can. And keep doing it.

First, stabilize your physical aspect as best you can. The four most crucial mental health needs of your body are sleep, nutrition, exercise, and social interaction. You may also be considering medication.

Sleep: regular sleep is probably the single most important thing your body needs to maintain mental health. If you have been skimping on sleep in order to get things done, you may need to let a lot more tasks go in order to recover. The purpose of sleep is to release toxins from your brain cells. If you are not getting enough sleep, then you are intoxicated, and not in a fun way–your brain is poisoned. Start developing a sleep routine that is as regular as you can make it, close to the same time every night.

If you are struggling with insomnia, the insomnia needs to be addressed so you can get the sleep you need. It’s not uncommon for depression or anxiety to remit simply by getting your sleep stabilized. Don’t use alcohol as a sleep aid: alcohol is not only a depressant, but it also interferes with sleep cycles, so it can worsen sleep problems.

If depression is causing you to sleep too much, it may be most useful to first address other physical aspects of depression before trying to cut down on sleep. Besides, is it actually “too much”? You may need extra sleep for the time being. If it feels like you are convalescing from an illness, that is because you are.

Nutrition: Your body needs fuel in order to operate physically and mentally. Your mood will be worsened by hunger, even if you are not feeling the hunger. At least get a bit of  protein and some complex carbohydrates. If your appetite has dropped and you are having trouble eating, or caring about eating, then try having something like Ensure, or chocolate milk, or kefir on hand – it can be easier to drink something. If you can eat a little something a few times a day, even if not your usual meals, it will help you not to sink further into depression.

When you’re feeling up to it, treat yourself nicely when you eat. It can be comforting. It may be you’re just eating condensed soup sitting on the couch, but see if you can eat it from your favorite bowl. Or try eating something that reminds you of childhood in a pleasant way.

When you have regained enough energy to attend better to your meals, you can get back to what you would normally eat, but for now it’s okay to just eat something.

If you are suddenly eating a lot more than you normally would, try to be gentle with yourself. There is a reason you are doing this–you feel bad!–and it’s not worth harshly criticizing yourself. Indeed, you will make yourself feel worse and it might compound the issue. Remember the important thing is to fuel yourself and restore your balance overall, and do so gently. The goal is not to sternly restrict. That may backfire.

 

Next: Physical Aspects–Basic Exercise, Social Interaction, Medication

Therapy Changes Your Brain Structure

Experiences change our brains. Not just in some vague way, but the structures and functions of our brains.

It’s true that our earliest experiences cast the longest shadows on our lives. But we can still heal and change our brains in positive directions throughout our lifetimes.

Yes, medications affect brain function directly, but “talk” therapy can also change your brain. For example, the more you practice thinking in a certain way, the more it becomes automatic.

If you were raised with conditioning (traumatic experiences, chaotic or abusive household) that led to depressive and anxious thoughts, you can practice new ways of thinking that will help to re-condition your brain. This is certainly not to say “just think cheerful thoughts and everything will be fine.” This is about targeting certain patterns of thoughts that you may not even realize you experience.

Thoughts are not the only part of your mental conditioning that can be re-trained, but they are often a good place to start.

Even severe conditions such as schizophrenia can show improvement in brain functioning through “talk” therapy, as research continues to show.

 

Compassionate Acceptance of Mental Illness

While there are many aspects of mental illness or injury that we can usefully learn to manage and to cope with, we may still have feelings, reactions, thoughts, and behaviors we would rather not have.  We may have internalized harsh or destructive judgments about those symptoms.

It is useful to cultivate an attitude of compassionate acceptance not only for the struggles of others, but also for our own struggles. When we first realize just how many aspects of life have been affected by mental illness, it can be overwhelming. It is also a chance to forgive ourselves and remember that we do not have to do everything “right” to have value as a human being.

This very useful post describes some of the unexpected ways mental illness may show up in everyday life, in things that we often criticize in ourselves or others: