Wednesday, October 15, 2008

How Long Should I Remain in Therapy?

In my the comments section of my previous post "Consciously Challenge My Thoughts" Kara asks:

..."how often and for how long have you met with Dr. X? I ask because I've been seeing my counselor weekly since beginning of January. And it's not that I "want" to stop; actually I'm a bit fearful because it's become a's in my routine..."

The short answer is I have been seeing Dr. X once a week for almost exactly 7 years. At least a couple years of that time (off and on) I saw him twice a week. Kara's question, and the subsequent worries attached to it, often swirl around in my head

I despise myself for feeling like I need the help. I rail against myself for feeling too dependent. I see it as a sign of weakness that every week I look forward to having 50 minutes of time with someone I care about, and someone I feel I can be free around.

I even think I am a bad person for caring about, thinking about, and actually "wanting" to see my psychiatrists. What kind of person wants to see there psychiatrist? Like in Kara's comment I often think I am habitualized to our meetings, too attached; that wanting to go to a psychiatric appointment each week is somehow a sign I should break the bond.

Dr. X and I have talked about my feeling this way numerous times. Before my Mom passed away she wanted to meet him, because she too feared I was too dependant on him. When she came to my appointment she asked him about this directly.

His response was (paraphrased): "In fact I encourage a type of maternal dependence. The type of dependence that allows the patient to feel supported, so they can eventually go out on their own". An example he gave me one time was (and he assured me the example was not meant to be paternal)...the example was that of a parent teaching a child to ride a bike. The child has to feel safe and feel they are completely supported and cared for before the child will feel safe telling the parent to let go of the bike.

For three of the 4 years before my Mom met Dr. X. she kept telling me how concerned she was about my dependency on him. The day we all met together; as we walked out of his office, she expressed an intense feeling of relief and told me she now felt confident I was both in good hands and in the right hands. She told me it was an immense relief to know I had Dr,. X to help after she passed away, and to know that he would continue to help me.

My Mom always loved, encouraged, supported and helped direct us. Even when she was depressed she was supportive, kind and loving. Now that Mom has passed away, I really miss her maternal love and support.

My Dad was a different story. I know he loved us, but he was unpredictable in his anger. He scared the hell out of me when he was mad and I never knew when that was going to be. He controlled me with fear, derision, dismissal and shame. For some reason his model stuck with me and looms large within, and runs through, my life.

His model of parenting led to my fear of authority figures; so much so that almost every day I worked, despite being constantly rated in my work performance as an employee who exceeds expectations, everyday I was afraid I would be fired, let go, or punished for making mistakes. The things I remember from work are the times I received negative feedback. I find it difficult to remember the feedback that was positive. I really need help relearning life in a safe environment.

Dr. X.'s support and unconditional regard is so similar to my Mom's when she was alive and well. I used to think I relied on my Mom too much, and she was family. It makes sense that I feel that way with Dr. X.

More and more I am starting to see that my depression as a chronic, lifelong illness. I will never be "cured". I have to live within the parametres of having a chronic illness, in the way that a person with heart problems, or diabetes, or MS must live within the parametres of their illnesses' symptoms, and with an eye towards reducing the symptoms as much as possible, but also accepting that they have whatever illness they have, and symptoms will come and go.

The previous paragraph is not meant to sound morose or hopeless. It is a way towards peace with myself. The more I FIGHT my illness, the less the symptoms seem to recede. If I can accept my life is different now than before I had so many Major Depressive Episodes, then maybe I can at least try to excel with my limitations.

Maybe I won't ever have a job like I had before. Maybe I am relegated to doing sporadic volunteering when I am well enough to do so. That is painful for me to even contemplate, but ironically the way up, might be to let the downs happen, and accept they create limitations.

A few days ago I began reading Peter Kramer's book, "Against Depression". If I am reading it correctly (and I easily could be misunderstanding as I am having a hard time reading it) in it he surmises that people with depression do not simply need the symptoms of their depression taken care of (the depressive mood, suicidality, amotivation, fatigue, i.e. the psychiatric "markers" of depression). Peter Kramer seems to be saying that ridding a person of the symptoms that psychiatrists have defined as "depressive symptoms" may not be enough.

The person who is depressed may need to review and rebuild their entire "personality"; how they manage rejection, their ability to socialize, their perfectionism, their ability to accept and go with change, and so on.

If Kramer is right, and on some level I suspect he is, then therapy for a chronically depressed person would be expected to last a long time, and would probably be required periodically throughout a person's life. Even if a person's MDE symptoms seem to completely disappear, therapy may be needed to help the person successfully get through and manage life's changes and blips.

So Kara, in the scheme of things, I am saying you have been in therapy a relatively short period of time. It is up to you to determine if you feel comfortable with, and have confidence in, your therapist and the the value of the therapy you do together. I personally believe in quality over quantity.

I also believe there is evidence that supports long term therapies (both medication and psychotherapy). From what I have read, if your depression is chronic, or you have had more than one or two MDE's in your life, long term support can be really helpful and is probably crucial, given the more depressive episodes one has, the more likely one is to have another MDE inthe future. I believe the statistics show a person who has had three MDE's has a 90% chance of having another in the future. To me that indicates the value of taking a proactive approach towards staving off any indicators of depression and hopefully managing to be in the 10% whose deression does not return

For me, I am beginning to believe the "habit" of therapy might be a good coping strategy and a good habit to form; like cuddling your puppy throughout the day, or singing to your nieces and nephews, or enjoying a walk in the sun. Just because you habitually like doing does not mean it is wrong.

Sorry Dr. may be stuck with me for a while;>)


Anonymous said...

I don't know too much about time frames and psychiatrists. I had one once, but he booted me out the door about five sessions in (don't ask, if i didn't have abandonment issues before, i certainly did after that fiasco!)
All i can say is if your life is unbearable & you find someone who makes it better, & neither of you are hurting anyone (Yourselves included) what does it matter? Who cares if you are dependant on him, as long as you are moving on in your time outside the sessions. which you have proven you are. you're trying to do the things which you plan, add some structure to your day, take your pills (despite reluctance), work on changing your perceptions of yourself, write a blog which helps you and others,look after your puppy, and you still find the time to comment on other peoples blogs and support them. Those are only a few of the things which you have written about. If you can do all of those things, and are being encouraged to move on, i would fail to find any reason to stop seeing a person who had this effect your life. Whether they are a psychiatrist, a therapist, a priest, a life coach or a hairdresser, the title isn't important. we all need someone to turn to, nothing wrong with that.
Lola x
I hope that makes sense and is not complete drivel...i may have ranted on :)

Aqua said...

Hi Lola,
Thank you, thank you, thank you! After I wrote this post I immediately thought maybe I'm wrong, maybe there is something wrong with my needing to see a pdoc for so long. In fact I almost deleted it. Your comment made me feel better about what I'm doing. I appreciate that.

Tamara said...

I have been in therapy for 20 years. Seriously! And, I finally made huge breakthroughs (although I have been healing bit by bit all along) and now I can say that I feel well. Healed. A complete whole person!

However, I am still in therapy. I am down to once a month and it is more of a touch-base thing. I am okay with that and not ready to completely let go of the ability to talk to someone who understands and is objective.

I truly believe just about everyone could benefit from therapy and I don't see a problem with going once a month or every couple of months from now on. Life can always throw us curves and I like having someone I can trust to help me sort it out before it becomes something bigger than it needs to.

So, I think what you are doing is fine and wonderful and that you should not be down on yourself at all. In fact, I think you should be proud that you are seeking help and taking the steps to heal. There are many, many people who don't take the steps and they never heal.

Just my two cents.


Anonymous said...

thank you aqua...for this; for taking the time to address a bit of what i've been struggling with by sharing your own. i appreciate it!