Thursday, October 02, 2008

Processes in Therapy That Help Me

The process of therapy is always fascinating and somehow mystical and magical to me. I went in to my session today feeling really low, guilty, withdrawn, angry at myself for allowing the depression to sink into me again, and for doing things that I know in my logical mind affect my mood. I also still felt very tired. Within about half an hour I felt like a huge load had been lifted off my shoulders. I felt completely different at the end of my appointment than I did at the beginning. Sometimes I feel that all I need is to sit in a room with my pdoc and life becomes less difficult. There are however, obective actions/activities/discussions that take place during my therapy that are of this world, practical and very helpful to me.

As I left I began thinking about what happened in my session that facilitated such an immediate and obvious change for me. I thought of a few things, many of which happen on a regular basis in my appointments, because Dr. X is very consistently non-judgemental about any information he requests, or I provide.

Here's a list of things that helped me this session:

1) Dr. X. has the calmest demeanor of anyone I know. This is where the magic comes in. Just being in the room with him calms me and puts me at ease. Even if I have a preconceived notion that I have done something "wrong" and I have been worrying about it; the minute I sit down and we begin to talk my shame, or fear begins to dissipate.

2) I say "wrong" because it is only me thinking that (or at least vocalizing that:) Dr. X. alerts me to my self-talk, and, without being annoying, quietly helps me see that using pejorative terms when describing things I do makes me feel worse.

Note: I say "without being annoying", because I would get really irritated if it was a constant barrage of CBT lingo and techniques being tossed at me...I see some merit in Aaron Beck's Cognitive Behavioural Theories, but I find his books and his "CBT is the holy grail of therapy" attitudes really annoying. When a person is severely depressed the theories require energy and a "stick-to-it-iveness that are impossible to garner, let alone maintain.

3) Dr. X. asks me the questions I'd rather not talk about. This point may sound strange, but I need him to ask me about some things because I feel shame around them, and they are impacting me, and I need help. For example my drinking. He asked me today about my drinking and immediately I feel sheepish and sensitive.

I feel that way, because I know my slope is getting slipperier. I have gone from 1oz to 2 oz. to 3oz. of vodka/day in a fairly short period. It is not tough for me to see I need to get a hold of it NOW, before 3 become 4 and 5 and so on. I have insight. The problem is, for some reason if it becomes a "don't ask, don't tell" situation I will keep increasing my alcohol intake. I need Dr. X. to ask me. There is something about him asking me that makes me feel a sense of responsibility to rein in my alcohol consumption.

Again, this is some kind of magical/mystical aspect of therapy. He never, ever says anything that makes me feel bad about my alcohol usage. In fact, he is extraordinarily tactful, thoughtful and caring when asking, even when I have been regularly drinking larger amounts of alcohol. He understands that I do it to "help" myself, but he also, gently helps me see that the effect I am seeking (freedom, release, relaxation etc.), might actually end up being the opposite...fatigue and and its companion insomnia.

4) At the end of my session he told me he has been reading my blog, and that he liked it. I immediately played down the value of my blog...even though inside I really do like it too. I like writing. I enjoy the connections I have made with other fellow bloggers. I enjoy the challenge of coming up with something I think others might be interested in etc. I felt really happy that he has been reading my blog. However, I never said any of that. I negated the value of my blog.

We talked about my tendency to put myself down when someone compliments me. The talk was helpful and I sensed he really did enjoy reading what I write. That both made me feel good and made me able to tell you (the readers) that someone I care about enjoys reading what I write(...there!!... that is an exercise in being proud of myself and sharing that pride).

5) We discussed, and decided together, to make some medication changes to try and address my fatigue. I love that he respects and allows room for decision making based on what he thinks might help, but also based on my wishes and what I think might help too. I feel like we are a team and that he is working with me. Trying to make some medication changes made me feel more hopeful than when I went in. So our joint decisions were to:

  • Cut my alcohol in half...and savour the 1/2 that I drink
  • Cut my Valium down from 15mgs to 10 mgs this week...I'm the one who wants to go off it this fast...I really have a hard time with slow.

Dr. X also interjected here that if I cannot do manage to lower the dose of Valium, to not be afraid to tell him. He said he would help me and the amount I am taking is small, so he is not concerned about that. Most important he reinforced that I not be afraid to ask for the Valium if I feel I really need it. This really made my plan to lower my dose seem safer. When he said that I felt comforted knowing he wasn't going to just cut me off and not help me.

  • Increase Tegretol from 800 to 1000 mgs (might help me decrease alcohol/Valium and still manage to sleep
  • Increase my Prozac from 40mgs to 60mgs (because I am wondering if the fatigue is a depression symptom, vs. caused by the medicine. (my idea)

Anyways...I felt much better by the time I was ready to leave my appointment, because I felt very valued, listened to and cared for in my appointment. Unfortunately I feel myself fading right now, so I'm going to have a nap, but maybe I will set my alarm for 3 and try to wake up and paint for an hour or so before dinner.


Polar Bear said...

SOunds like the relationship you have with Dr X is a collaborative one - it's important to feel like you are a team, working together towards a common goal. I think this therapeutic alliance is key to a successful therapy.

CBT techniques can be rather annoying. I don't think it would work on me.

Polar B.

Aqua said...

Hi PB: I definately have a collaborative, and I think mutually respectful therapeutic alliance with Dr. X. I am not a fan of CBT. The techniques did help me during a couple of my short-term initial depressive episodes, but as my MDD progressed I couldn't set or achieve goals...making me feel even worse than before.

s said...


Dr Shock said...

Told you so...., you write very well, regards Dr Shock

Aqua said...

S and Dr. Shock: Thanks for the support and the comments.

Lola Snow said...

Hi Aqua
Just wanted to say that I found your blog today, and will definately be adding you to my google reader. This is a brilliant idea for a blog, and would be a valuable resource for someone considering therapy.
Lola x