"How Are You"? "I'm Okay."

I haven't really written for a long while. and for days now I have been wanting to write about this...and then in my last post I saw the last commenter comment about a similar dynamic when people ask how you are. So I am going to let it out...

It makes me crazy'(er) that I can never be me with anyone. When my sisters or stepmom, or dad call they sometimes ask how am. Sometimes they avoid the topic altogether. My usual response is either, "I'm okay", or "I'm not feeling so great". If I say the latter the topic changes so fast to something else that it is obvious the question was just a polite conversation opener.

My sisters and family are good, loving people...It must be the chronicity of my illness, the awful person it makes me become, and the neediness of myself that has them pull away from me so much.

A couple times I have tried to express how I need help because x, y, z is happening; i.e. I have been honest about how depressed I feel. The topic changes, or the person tries to get off the phone as fast as possible...and the stops calling or e-mailing completely to protect themselves.

What I most often want to write when they ask how I am , and I am unwell, is: " I am feeling really scared and depressed. I cannot stop thinking about suicide. The noise in my head, telling me to kill myself, telling why it is the best thing, planning how to do it, etc., won't stop. I feel like nobody loves "me".

They love the "me" who laughs and is funny and upbeat...that is part of me, but often that part of me comes out when I am trying to help others feel okay around me, or if I am trying to not act as crazy as I feel. When I want to be cared for, or loved, I try really hard to suppress, or minimize all the things about me that others either cannot handle, or understand, or will take as proof that for their well-being, they should get me out of their lives...NOW.

I understand why this happens. It would be hard to have a sister/daughter like me. I understand, but it hurts me so much that my family doesn't try to help me, or somehow let me know I can call them if I need help. I feel so intensely alone.

Even with my pdoc I am afraid if I tell him what I really feel he will think I am overstating, or that I am crazier than I am. I often leave his office thinking God I must drive him crazy. I try to be/say/express less suicidal thoughts/ideas/plans than I really have, or am, or really feel. I tell him I have the thoughts, but I don't think I have been able to express their relentlessness inside my brain; the way, over, and over and over, and over, the thoughts speed through my head, telling me to:

"...wrap a rope around my neck, wrap a rope around my neck, do it, do it, do it, do it do it...shoot yourself, kill yourself, hire someone to kill you, no one loves you, you are alone, completely alone, lonely, this depression just keeps getting worse, and the worse it gets the more people move away from you..."

"...your family doesn't want you anymore, they only want you when you are okay, they don't want to hear about how you need help, they want you to just go away. So my brain says to me, over and over, "...do it, do it, do it, hang yourself, wrap a rope around your neck, etc., etc." All the while, that Violent Femmes Song, "Why Can't I Get Just One Kiss?" is playing rapidly. obssessively, over and over inside my brain...like I can't get away from the song, or the thoughts.

I can't tell anyone these things. I even don't want to write them here, because all I want is to get them out of my head. I am venting; trying to help myself find some relief.

So I answer, "fine, been feeling a bit down, but that's okay"...WTF!!! "...that's okay"?."...a bit down"???? This will never end...end it.

Introducing Myself

I am taking a huge leap of faith here. I hope you don't think it's too corny. I had to hold my voice back quite a bit, because my webcam's microphone starts reverberating if I sing to loudly, or powerfully. Also, sounds much better with a piano, but I can't play, so here is me singing "Nevertheless" all by my lonesome...Hope you enjoy.

Is It Over Yet?

It is 6:01pm. I woke at 7:00am, went back to bed at 9:30am, woke a couple of times for less than an hour, and slept the rest of the day...almost 8 hours more sleep, after I already slept 8 hours.

I know this is not healthy. I know it, yet I am so tired and fatigued and I have such little desire to be here that I sleep to disappear. My sleeping makes the day go away without me having to experience it as just another day I want to go away.

For someone with so much death anxiety you would think I'd at least experience what little time I have on earth, but I can't. I just want to know: Is it over yet.

My death anxiety is not really about being afraid of death, rather it is being afraid that I will not live a meaningful life before I die. I fear I will always be stuck, always cycling, depressed; avoidant. I fear my life will end before I have the opportunity to really live.

In my session on Dr. X asked me what I have been eating...because I have been eating very poorly, especially these past few months. On top of that my blood tests came back with low iron, which definitely could be feeding my fatigue.

So what do I do when I discover I am eating all the wrong things in all the wrong amounts, and leaving out the things I need (i.e. fruits and vegetables and iron and vitamins)? Do I eat better? Do I take my iron and vitamins consistently? And when I recognize that my exercise routine is much like a snail's daily workout...do I pick up the pace? Do I take care of myself?

Absolutely not. Why the hell would I do that. That would make too much sense. Why would I want top lose some weight, to have higher iron, to get important nutrients into my system?

Dr X asked me why I am eating so much food that is bad for me. I got off track and didn't answer, partly because I have no idea. Partly because I don't have the energy to prepare any food for myself, partly because I don't want to be here anyways, partly because I am self destructing.

All I really want to know about my life is this...Is it over yet?

Let Others Carry the Hope For You

Foreword: I titled this photo "Grief and Shame", not because of how I was, or how I felt in my appointment today. I felt no grief and no shame because Dr. X was sincere and caring about the feedback he provided me, and how he provided it. In fact I felt intensely valued and cared for, in part because he told me the truth about how what I did affected him. No, I titled the picture "Grief and Shame" because it is how I so often felt as a child when my dad made tried to correct me by making fun of me: Grief because I wanted him to love me so much and he didn't, and shame that I was never what he expected me to be. I was never good enough.

My therapy lesson today:

"Let others carry the hope for you, let me carry it for you." Dr. X said this to me today, while I was crying and feeling like all my hope had disappeared. What an incredibly kind and loving thing to say to a patient.

Dr. X did a lot of trying to lift my spirits today. When I was complaining of not being able to remember my songs, he had me try, and when I got a few words he said..."You ARE remembering". When I was crying about my anxiety and ineptness in my choir practice last night he told me to be anxious, have performance anxiety and sing anyways, if you make a mistake be embarrassed and consider that [having sung and been embarrassed and lived through it] therapeutic. When I was stressing out about what is happening in my Art class, he told me I was talented and a good leader.

At first I brushed the kind words off with a, "you're just saying that because it's your job". He told me it annoyed him that I brushed his comments of like that, that I did not feel he was sincere. I immediately recognized what he meant.

I laughed, not because it was funny that he felt annoyed, but because I instantaneously felt that moment of "Touche", (he was right). I knew immediately what he meant by his feedback, I knew I had annoyed him, and exactly how I had done so. It was rude for me to dismiss his comments to me, as though he were lying to me.

I apologized, and he smiled and said, "that's okay I can take it"...and then asked that I please not ruminate on my mistake all day. Which I said I wouldn't, but of course, unfortunately (or fortunately) I will.

I say "fortunately" because rumination is sometimes good for me; especially if it helps me learn a lesson, and/or learn something about my reactions and interactions with others.

I recognize a couple things about my dismissive reaction to Dr. X's support and caring words. First, dismissiveness is a character trait I loathe. It reminds me immediately of my dad, or my husband when they are at there worst. I recognize I have that awful trait within me too. I often dismiss other people's kind words about me. Not good. I am going to work on that.

Second, I believe I dismissed Dr. X. because I could not actually believe someone really felt something good about me, or cared about me that much. I recognize now that is an automatic reaction I have to praise. The root of this reaction may be the hypervigilence I have felt, and continue to feel when I am in the company of my dad. I am never sure if what he is saying is true, or if it is meant to tease, bully and embarrass me; to draw me in and make me feel good, only to later find it was/is a backhanded compliment; one meant to humiliate me.

Due to my dad's unpredictable mood and reactions to me I was constantly on the lookout for a double meaning in what he was saying, or the "real" intent behind his praise. When he paid me a compliment I never knew if it was real or not. It rarely was real. It usually was another means to make me feel I was the bad person, or the loser he thought I was.

Third, because of my previous experiences with my dad, and very similar experiences with other men (I have never very good at picking men who are genuine, or who care much about me), my immediate response to a man's positive feedback is to either discount it, or to dismiss it outright.

It may be a case of 'you get what you expect' (I.E., if I always dismiss men's compliments, then I become annoying to them and they no longer care about me). It would be hard to care about someone who technically is calling you a liar all the time.

I wonder if I dismissed Dr. X because I find it hard to believe someone (especially a man), cares for me? Maybe the disbelief is about myself? Or maybe I dismiss his kindness to further isolate myself; maybe I push him away right now because I feel like I don't want to be here, and if I can only believe no one cares about me, I could go.

Whatever the reason, it was really rude and impolite of me to discount, dismiss and to think Dr. X's was being disingenuous when he complimented and reached out to me. I apologize for that, but I won't "ruminate" on my mistake. I will learn from it. I have learned from it.

Lessons Learned in Therapy

What have I learned in therapy? Here are some of the lessons I have learned, or am working on learning, in therapy. Some I have managed to learn by practising and failing, practicing and failing...over and over again, until suddenly the lesson becomes ingrained and followed. Some of them have taken medication to allow me to get to the place where I am able to abide by the lessons. I truly believe that medication has tipped the scales in my favour, but I also know that without therapy I would not have gained what I have gained over the past few years...

1. There are people who are trustworthy.
2. There are kind men.
3. Doing things...activities that feed my love for living is integral for my feeling better.
4. Guilt is a difficult feeling to dispense of. It is not helpful to me. In fact it harms me. (I am still struggling with this one.)
5. Lessons learned in therapy must be practised, not just thought about.
6. Hiding at home is not conducive to improved mental health. It takes the stimulation of others, the stimulation of challenges for me to slowly learn I am both a good and knowledgeable person.
7. That while a medication may work for some people, it may even have been shown to work for many people, I am an individual and it may not work for me. I require a personalized medication plan. Medication probably requires small changes here and there depending on my cycles.
8. That having a trustworthy, trusting, knowledgeable, and caring psychiatrist who never gives up on me makes all the difference in the world. I have learned I can lean on Dr. X and he will not give up on me. Knowing I have an advocate and a mentor has allowed me to keep trying and not give up.
9. Even if it takes 7 years to find the right medication/s, it is possible to find a combo that works to quell my symptoms. Again it may require "tweeking" here and there if symptoms change or become worse. It is not simply a matter of finding the right medication. It is an ongoing challenge.
10. The more I struggle against my depression and anxiety, the more depressed and anxious I become. This does not mean I need to give up. It means I have to accept my symptoms, yet continue to calmly try to find a way, or ways, to help myself.
11. That teaching others in a similar situation as me has helped me understand and learn more about myself.
12. That volunteering gives me a sense of purpose.
13. That others might actually like me.
14. That I am not a horrible person...I am an individual, with individual desires and needs. My needs and desires are not weird, they are part of a spectrum of human behaviour.
15. Even if you think you like being alone, it is important to have friends.
16. I have an artist inside me.
17. I should always sing.
18. Feeling guilty about not being able to work is not helpful, because working to get better, and all the energy that takes is working.
19. My sexuality is a blessing.
20. I am a passionate person when I feel better.
21. "Better" is on a continuum...For me I may not always be on an upward trajectory towards well, but the more I keep working on this difficulty, the more I accept there will be setbacks, the more I recognize that setbacks are a normal state or part of increasing my resiliency, the more I am able to recognize the little steps, the big and small activities I need to do to get back on track if I slip up.
22. I need to work towards a life I choose, not one that falls into my lap. It is difficult, but rewarding work.
23. That creativity helps my soul heal, as does helping others.
24. My blog is work. It is therapeutic for me, and perhaps to others. It has helped me to create and build a supportive community for myself.
25. That treatment resistant depression is common. That does not mean the depression will never be treatable. It means it may take a lot of support and a longer period of time to find the treatment that works for the person with treatment resistant depression and/or anxiety.
26. Despite being, knowing, believing I am being spied upon...Do things, Write in my blog. know I am being watched and do it anyways. It is hard to be so open if you think you are being watched, but it is important to know my gaining resiliency, my getting better requires I do all I need to get better, even if I feel afraid.

What Do You Do: Are You Valuable?

A few days ago I went to the optometrist. A task I have been trying to get myself to do for more than a year now. Fortuitously, or not, my dog tried to eat my husband's glasses and I ended up at a glasses repair shop that had optometrists on site, so I booked an appointment and, because I have an intense sense of responsibility, despite not wanting to go when the time came to show up, I went and saw the optometrist anyways.

That is not the point of this post. Part of the point is WHY I do not want to see any health professionals outside my pdoc. It is because after the greetings, the first question out of their mouths is always, "are you healthy?"

My head always swirls with this question...my first thought always being, "I am desperately unhealthy if you include mental health as part of health. Then, "do they need to know about that?" Then, "well it would be lying to say I was healthy, should I lie?" Then, "but I don't want anyone to know I am WEAK" (argh... i.e. all that fear of discrimination, sense that I am doing this (my depression) to myself. It's my fault. If I wanted to change I would. I am such a loser for being like this." Then finally, "if I tell anyone they will think all these things about me too."

So I falter, and do not know how to answer the question. The Optometrist picks up on this and pushes from another direction, "Are you on any medications?" I feel so stressed out now, because as soon as I tell him my medications he will know I am a complete loser. I become hot, and I can feel my face become red. Embarrassment sets in. I list my medications, "Prozac, Tegretol, Valium, and Dexedrine". It is obvious to him now, that my hidden secret is out: I am mentally unstable. I feel little in the room; an "unperson".

Why? I do not feel this about anyone else with a mental illness. Just me. I don't get how I can be an advocate in so many ways for people with mental illnesses, yet feel as though I am less because of mine. I know that a huge part of it is that I feel devalued. I feel because I am not working I am incurring a huge debt to society. I am less worthy than others. I am, in fact, less than what people expect a person to be. These thoughts are drilled into my head. I can try to get rid of them. I can try to move beyond them by writing like I did in my last post, but they are always nagging me. They never go away.

Last night I thought about this picture. It is me, as a child, feeding the pigeons. I am certain that people found me valuable then. I am 100% sure that a little girl feeding the pigeons, a little girl doing what brought her joy, was a beautiful sight to others. I am sure no one was watching me and thinking, "That little girl should stop all this fun and enjoyment and get onto something more serious in her life". I am sure others would have seen me as valuable despite my not working.

What is it about children that makes the inherently valuable in a way that adults are not? Why would we never ask a child, "WHAT do you do?" Rather we might ask them, "What do you LIKE to do?

Why are adults so readily judged by the question, "what do you do? Why do we judge ourselves that way? Why am I obsessed with getting a job? Why can't I get that a job may follow a period of doing things I love to do, things that create meaning and purpose in my life. Why can't I get that a job is just one important aspect of life. Why can't I learn, or believe that a job CAN be simply a means to an end? Why can't I manage to give less power to the idea that a job is the what creates meaning and purpose for me?

Part of it is societal norms. Almost the first question out of a person's mouth when they first meet you is "What do you do?": As though with that information they will know everything they need to know about you.

When I was a banker I dreaded this question, because saying "I am a banker" elicits all kinds of stereotypes about who I am, and I was not those stereotypes, or if I was those stereotypes were the parts of me that I hated the most. The entire time I was a banker it was as though I was being the opposite of how I saw myself. The opposite of who I wanted to be, who I imagined I would grow into. I dread the question even more now that I am off work.

I have always fancied answering the question, "What do you do?" in another way: "I draw, and paint. I like to dance and listen to music. I love watching quirky crime drama's. I have a pretty good voice and I love to sing. I like the idea of tradition, but believe we need to envelope new ideas to. I write a blog. I absolutely love to read and learn. I volunteer at a mental health arts facility. I love to hang out with my sisters. I love my nieces and my sisters. I enjoy going out for breakfast with a friend, or going for long walks on the beach or in the woods. I love to garden, canoe and go camping. The problem is, for a long time, I have had trouble consistently doing and enjoying any of the things I "enjoy".

Of course, I love my sisters and nieces, but leaving home to visit them is frightening and exhausting. I am always afraid I won't be able to manage being away from home. I no longer garden, or hike, or camp, or canoe...I cannot muster the energy. I cannot seem to read. Yesterday I tried to read a book that I started a month ago. I knew I had read some of it before, but could not remember where I had read to so I began again. I remembered parts of chapter one and then nothing until I came to Chapter 6 (page 63)...I had read all the way to there before and remembered nothing except that I had read a part of chapter one. How is that possible? Anyways, my point being I don't even truly enjoy all the things I enjoy anymore.

I just don't get why, after years, and years, and years of therapy I can't accept my predicament; accept the life I have fallen into; accept that I am a different person and somehow learn that I am still as valuable as I was when I was that little girl feeding the birds.

Is Returning to Work an Essential Component of Wellness?

I have haven't slept well the since my last therapy appointment. Something in my session triggered some kind of potentially life changing thinking. I cannot sleep because I keep waking up thinking about how to change, accept and move on. When I wake it seems to take forever to fall back asleep. My mind has been racing with thoughts of how to make the leap, the decision, to change; how to create the will and motivation to change; and finally how to create change for myself despite my lingering and often paralyzing symptoms.

My appointment and meeting with a friend afterwards instilled a sense in me that I have been approaching my mental health "healing" and expectations of what is "well" from the wrong angle. I have been trying to get the old me back, but I suddenly recognize the old me, in many ways, is gone. My job now is not to recreate who I was, but to create a new me. Who I was led to my depression and anxiety. Who I was led to increasingly worsening Major Depressive Episodes)MDE's. Who I was is not a desirable goal to have. I need to be different than who I was in order to heal.

My entire life I expected that I would get meaning and purpose from my job, from working. I never wanted children, so that was not the way I sought meaning or purpose. It has always been through my job, or my schooling. School was extremely meaningful for me. Although I had two MDE's; one first year university and the other a few years later during second year university; both times the episodes were not triggered by lack 0f purpose/drive/interest/or meaning about school. Both were triggered by indecisiveness and fear of failing at something that mattered so much to me; although these may have been symptoms of an already "creeping in" of depression.

Once I came out of my depression in 2nd year I was happy for the next three years of school. I loved school. I loved the challenge. I had a sense of enjoying the moment, being IN the moment, feelings had not had for a long time. While going to school I worked part-time, but for the first time since I began work with babysitting when I was 12 years old, work became secondary to something more important to me. It was a means to and end, a means to do what I really liked to do; which was learn.

Until yesterday I did not realize what I have been doing for the last 7 years of depressive hell, and for the 11 years of my previous career. I have/had been trying to hang onto the job I had because, I thought it was the only way to create meaning and purpose in my life.

It never crossed my mind (even when I was doing the parts of the job that I hated) that my work was not the path to creating meaning and purpose. I just thought maybe I was not on the right work path. I even turned my favourite hobby (gardening) into work, because that is how I understood meaning could be found: through work.

As I left Dr. X's office I thought..."what if my volunteering really is work like he says?" Or what if even a more dramatic shift is taking place and work (volunteer or otherwise) is not my path to happiness?"

The former thought is a bit easier to accept; although I am loathe to concede Dr. X. may have been right all along. Only because I told him his insistence that "I was working" (i.e. volunteering) was really starting to annoy me. However, maybe I am working. Maybe it is important work. Maybe I am helping more people than I am taking from people? Maybe my volunteering balances out the disturbing thought that I am accepting disability money when so many others struggle more than me and deserve the help more than me.

The latter thought, "That maybe work is not my path to happiness" comes with all kinds of emotional baggage. Not the least of which is my fear of avoiding responsibilities, or feeling like I owe it to society to work, to not receive money for nothing; that awful feeling that I am a drag on my countrymen and women for being on disability, that I am shirking my duties and responsibilities; that I am doing something immoral or unethical in deciding work is not healthy for me. These thoughts are hard to manage.

Yesterday I just tried to take a Utilitarian approach to the idea of not working. I tried to imagine how my not working might be helpful, not only to myself, but to the greater good of society.

Perhaps, if I did not work, did not think of how to get working, did not try to find ways to work I would become well. Perhaps all that energy I spend negating and berating and hating myself for not working would go into constructive enterprises, painting, drawing etc.

Maybe, if I became well, Dr. X could help another person. Maybe, if I stopped worrying about work and focused on the things that bring meaning and purpose to my life: things like art, or music, or building and maintaining friendships, I would have more energy and the means to spread the joy to others who need more joy in there lives.

A tiny part of my mind is willing to concede that "work" as I define it is not healthy for me. Unfortunately, the largest part of my mind is preoccupied with what others will think, what is the right thing to do morally and ethically (for my community's greater good). It always appears that the point of wellness, (according to most mental and physical health providers), seems to be defined by an ability to return to work. If that is so, then how can the counter intuitive idea, that not working may help me become well and stay well, be correct?

Am I supposed to decide to not work? And if I decide that and become well, will a return to work make me unwell again? Am I forever unemployable, yet able to help others while helping myself? I cannot understand what it is I am supposed to be doing; what it is that will KEEP me well if I manage to get there?

Am I misunderstanding what Dr. X is trying to express to me?

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 habit...it'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. X...you may be stuck with me for a while;>)

Therapy and Boundaries

This is to address a couple comments on my last post. It also addresses things I have thought about, wondered about in therapy, things that made me stopped doing things I really enjoyed doing, because I beacame afraid I may be perceived as crossing boundaries.

In my previous post "Co-Blogging Re-visited and a Therapeutic Epiphany", both Dr. Shock and Jcat encouraged me to to continue towards trying a co-blog with my pdoc, in spite of some reservations about this being a means of avoiding the person to person communication issues I have, or a way of overstepping the therapeutic boundaries.

I agree with Dr. Shock when he says not to generalize another therapy's belief onto my relationship and therapy with my pdoc. That was a powerful comment and really made me think. I believe my pdoc and I have a really good and mutually respectful therapeutic alliance. I am not one to try to cross boundaries. In fact my crossing boundaries might signify a breakthrough in my therapy, because I am always so conscientious about doing the "right" thing, about not ever making a mistake, or taking a chance.

I, like Jcat, find it easier to express myself clearly in writing. Like her I have wondered about, and was careful to not cross anything I felt was a boundary.

I used periodically send cards to my pdoc , just to say thanks. I never saw this as stepping over a line, or "acting out". I saw it as, and meant it to be, a symbol of kindness, caring, and to let him know that even though my mood never seemed to get better, I valued his seeing me. Of course one could look for a subtext here: I was fearing abandonment because I felt I was an incredible burden on Dr X. because I was so unwell and not making any progress. I sent the cards to let him know I wanted to continue trying, that I found him helpful and that I really wanted to keep seeing him. That is all true, but the cards were more like a thank you for his consistently being there when I needed someone.

I live on a flower farm, and I used to sometimes bring flowers to my appts for Dr. K. I stopped doing it because I felt really self -conscious that maybe that was crossing a boundary. Flowers seemed too personal, even though there were thousands of them growing all around me, and I found joy in giving them away. It is a shame I felt wierd about bringing some to Dr. X, because the act of choosing the flowers, arranging the bouquet, and the joy of giving a beautiful gift heartfelt gift to him. actually inspired me, the giver.

When I was saying Ms. Fuller gave me food for thought, it was that she reminded me of some of the things I used to do, and stopped doing, because of my fear of crossing boundaries. There is obviously something there, because I rarely bring flowers in, or send cards anymore, because I feel uncomfortable for some reason, though I'm not sure why.

I was also thinking she has a point about how it is really important for me to learn to speak what I seem so easily to write. Despite that I feel I really have been able to speak up many times, because I write.

I think writing directly to my pdoc, about my experience in therapy, as long as we have an agreement that his portion takes place within the therapeutic hour, will only enhance my already great experience in therapy with Dr.X. I will remain conscientious of the boundaries between us; they are as important to me as they are to him. I am looking forward to trying a private co-blog with my pdoc.

Co-Blogging Re-visited and a Therapeutic Epiphany

I had such an incredible therapy session on Friday. I feel like I am really making huge steps forward recently. What was so great about my session?

First, I felt so unbelievably supported during the session, something that I often feel, but, when I am severely depressed, I have a difficult time maintaining the feeling when I leave Dr. X's office. Suspicion begins sneaking into me that the support isn't 100% genuine, or real, or I heard wrong, or it is based on some kind of sneaky way to get me to change. Of course, none of that has to do with anything my pdoc does. It is some strange component of my depressed mood.

In my last session I felt able to ask really direct questions about how supportive Dr. X was of my understanding of my treatment plan. I asked him all the questions that fill my mind with guilt and despair about my understanding of what it means to work and to be well enough to work.

He so clearly supported all aspects of my understanding of our recovery plan, that I feel so much more at ease about my being on the right path now. I feel like I AM working, I AM doing what is not only best for me, but what is best for the people I volunteer to help, and for society in general. I feel like what I am doing now is the ethical thing to do.

Wow! The session was a huge relief for me. It probably helps that I feel less depressed right now and am able to absorb the lesson.

About a co-blog...I discussed it with Dr. X. He seemed to think it was an interesting idea. I sensed some trepidation on his part, but he said we could try it. One thing he mentioned was that he would not be able to read the blog throughout the week, which I had already addressed in my proposal. I also believe boundaries need to be really clear between the two of us. I told him to think about it until next session and we can discuss it again. I have been busy trying to test how private and secure a co-blog can be. It seems like you can make them so only the two of us can view and write in it. I am still checking that out.

I do have a few more concerns about a co-blog than I did before. The worry was brought on by a post I read on a blog called Jung at Heart". In her post titled, "Therapeutic Space Revisited" , Jungian Therapist Cheryl Fuller comments about the idea of writing in therapy as opposed to face to face communication. Here is an excerpt from that post:

"For the purists, a letter from a patient between sessions is an instance of acting out and they would not read it but rather place it on the table and wait for the patient to talk about it. And it is acting out, because it is an extra-therapeutic contact, a kind of effort to gain more time and attention from the therapist outside of the boundaries of their time together, and it is writing rather than putting the feelings into words and speaking them in the session. But that it is acting out does not mean it is useless, meaningless or bad; what it does is signal the presence of unresolved feelings or or need." [I find this interesting, because I have in the past sent Dr. X. cards, and it makes me think of why I do that]
"The actual words of the letter may indeed impart thoughts or ideas not expressed in session but it is what drives the desire to write them rather than say them that is probably of greater importance. And dealing with the fear/resistance to expressing those feelings and thoughts directly is a big part of what depth psychotherapy is about." [(my bold)...I have wondered about this in the past...this reinforces that wonder...?]
So back to the idea of co-blogging --
I have to wonder if, like writing a letter or sharing a journal, this isn't at base a way to sidestep the heart of the matter -- that it takes time and effort to work through our defenses and resistances and to do so in the presence of another human being". (Cheryl Fuller, Jung At Heart")

Ms. Fuller really got me thinking about why I want to write, as opposed to talk. I have mentioned some things in my previous posts: My difficulty thinking clearly as I am often intensely emotional in my sessions...it is like my brain shuts down, I find it easier to express myself clearly when I write, Sometimes the medications that I take make it difficult for me to find the right words to describe what I am feeling...in writing I can think for the correct phrase or word, and most important, Usually I am writing in my blog to clarify to myself what happened during my session and how I could use what happened to make my next session better, more open, more honest...a sort of practice session for my next session.

Ms. Fuller is right in many ways though. There are some things I probably should be able to express in my sessions that I am unable to. For example if there is conflict in my session (honestly, by conflict I mean me misunderstanding something) I have a really hard time addressing that in the moment. When I have it has been really helpful. Usually I write about it and try to figure out how to address it the next session.

Also, if I am feeling intensely suicidal, I am afraid to address this in my session for fear I will not be able to make my own decision about what to do about it. I am afraid my freedom to choose will be taken away. So often I do not say anything, until the next session when the intensity of the feelings have dissipated.

Anyways, "Jung at Heart" gave me things to think about and I found her comments very interesting. I will address some of these ideas in my next therapy session.

The Blog as Therapy

This post was inspired by a comment made by Dr Shock on my recent post titled: "Letting People In" .

I found his comment very thought provoking. He said: "...what is interesting is how can a blog help besides "getting it of your chest", what are the therapeutic factors. Another important topic is how can a therapist use the blog for the therapy. Especially when doing a more psychodynamic psychotherapy. For cognitive therapy [CBT] with housework it is relatively easy, you can monitor the progress but with more psychodynamic therapy based on psychoanalytic principles such as transference and counter transference and defense mechanisms it is difficult to use the blog together with the therapeutic sessions."

I was intrigued for a few reasons. I agree that a blog, shared with a therapist, for CBT, would be fairly straight forward. In a CBT situation the blog could be used as a documentation and reference for the activities, goals the patient is accomplishing.

I am not 100% sure I understand what Dr. Shock was referring to when he said " but with more psychodynamic therapy based on psychoanalytic principles such as transference and counter transference and defense mechanisms it is difficult to use the blog together with the therapeutic sessions", but if I understand his comment correctly, I think I believe the opposite . I believe a blog is an incredible way for the patient to clearly layout their defense mechanisms and for the Psychiatrist to have a much more in depth and detailed view of his/her patient's transference. If the blog is two way; one written by both the patient and the pdoc, I could see tremendous value for the therapist to also recognize their countertransference more clearly.

I am very interested, and in fact believe I have been utilizing my blog, more and more to enhance my therapy experience. Second to that my hope is that those who read my blog will see how I struggle and work through different difficulties in therapy; how I depend upon a safe therapeutic experience, a consistent and trustworthy psychiatrist, to both ensure, and allow me to be completely open and honest in therapy. I believe that is the cornerstone of good therapy. If I am not safe to say anything and everything, then I cannot work through the things I have the most difficulty with.

Here are some of my ideas/experiences/hopes for using my blog as therapy:

My experience thus far:
My blog has always been a means by which I both prepare for my therapy sessions and debrief myself AFTER my therapy sessions. This debrief allows me to absorb what I have learned in therapy; to retain the lesson.


My thoughts about my therapy sessions are often much more intense after I leave the session. In the 50 minute session I am so focused on interacting that I find it difficult to clearly reflect on the dynamics happening between Dr. X. and I, or around a specific subject. I often feel so emotional I cannot think straight. While in a highly emotional state I become reactive instead of reflective. To me, what happens between Dr. X. and I; the feelings while we discuss something, my reactions to him etc. are like a microcosm of my feelings and reactions to people in the outside world. Our interactions replicate difficulties in my life. This is super important for me to recognize and work through. My blog assists me with this.

Ideas to enhance my experience and my therapy via a blog:

I have some ideas about how to use a blog to enhance my therapy sessions even further, with each idea I have pros an cons I need to consider:

Idea #1: Keep my current blog and use it IN therapy sessions.

I was thinking of asking Dr. X. if we could together spend the first 10 minutes of my sessions reviewing my weekly blog postings. The next 40 minutes could be spent reviewing what was read/discussed:

Pros:

• I wouldn't forget to tell Dr. X things like I do now
• He would have a really clear record of what I'm thinking/feeling
• I often find it easier to write about a topic, rather than bring it up in therapy. I often use my blog as practice to get brave enough to open up and tell the truth, or explain how I really feel.
• My feelings, thoughts, experiences etc. are clearly laid out,
• I could list any medications side effects (I always forget to tell him things),
• I could clearly list any interpersonal difficulties, successes etc.
• I could make a simple list of discussion topics,
• If he wanted, he would have access to the information later( he takes notes, but if he missed something he thinks might be important, the information is there).
• I could express in clear details what I wanted to achieve in my session (I often get side tracked)
• I believe he would see transference, projection issues etc. even more clearly than he may already...because sometimes I am more shy or embarrassed to say things in person.

Cons:

• Privacy (from my employer, my insurance company etc.)
• Ethics on his part in terms of what he keeps in his files about me
• Boundaries would have to be really clear with me. I.e. I would not expect him to read my blog on his own time. It would be part of our therapy sessions

Idea # 2: Start a new Co-blog

This idea was inspired by an Irvin Yalom story about how, after each therapy session, he and a patient wrote a brief synopsis about each of their experiences, learnings, understandings etc. in that session. They then shared what they wrote at the beginning of the next session. It was intriguing how each picked different components of the session as meaningful. It seemed like a really interesting way for a patient to learn to fully understand their behaviours and experiences from a third part perspective.

I thought maybe Dr. X. and I could set-up a private blog; with the two of us as co-bloggers. Maybe we could shorten our sessions to 30 minutes and then each of us would be responsible for utilizing 20 minutes sometime during the week for each of us to blog about the experience. At the beginning of each session we would debrief what was blogged by each of us.

Pros:

• I often leave my sessions and think, what was Dr. X. trying to tell me,
• What did I miss?,
• I'm not quite sure I understood what we talked about.
• Maybe Dr. X. experiences that too.
• It would be a great way to remember and/or clarify lessons, ideas, sharings, understanding, misunderstanding etc. etc.

Cons:

• Privacy...I checked out to see if you can set these blogs to a private setting. It appears you can, but I need to find out if private blogs are "googleable", if they are really safe to be 100% open about EVERYTHING, like in therapy.
• Unsure how the Canadian medical system would view and reimburse Dr. X. for this type of therapy. I would not do this if he couldn't be reimbursed the same as he is now. (I have heard of a new system being introduce in Canada whereby Drs can communicate online with patients on a patient pay per contact basis)
• A co-blog would be really cool and groundbreaking for others to view therapy sessions in progress...I can imagine it as a really interesting teaching tool for psychiatrists and therapists in training, and for patients in therapy themselves, but privacy in therapy is really a huge part of why I (and I assume many others) are able to discuss certain things.

Idea # 3: Co- Blog as a means of identifying transference/countertransference/defense mechanisms etc.

I think the co-blog would provide the perfect opportunity to address some of these psychodynamic issues.

Pros:

• You would have to really trust your therapist/pdoc, as there would be no deniability about what was said...it is written down for each of you to see.
• I see tons of defense mechanisms on my part when I both write and read my blog. My current blog has been a wealth of information for myself, and, if I remember to bring it up, for my pdoc while we discuss these in therapy.
• Conscious and unconscious thoughts, of both patients and Drs/therapist may become more evident when they are seen on the page.
• Dreams are there to review and analyze more clearly (I am a great believer in my dreams telling me things, so this is important to me).
• Feelings could be clearly written about, there for posterity and further discussion and clearer understanding
• What you write would open doors to both the therapists and the patient's perspectives. What Irvin Yalom discovered was that what he thought was intensely important to his patient was often not the case at all. Often what mattered to the patient, what inspired the patient was some aspect of Dr/patient the relationship that came out in therapy; a gesture of kindness, or respect; a moment where the patient felt really understood.
• Identifying these could really have the potential to add value to therapy and really move the patient's therapy forward.
• Alternately, it could also really help therapists identify what really makes a difference to their patients.

Cons:

• Privacy...again...for this type of therapy to help it has to be very clear that what is said remains between Dr. and patient.
• If there was not an intense sense of trust between the patient and therapist difficulties might arise in what was written (although with the trust I have with Dr. X., even though I am afraid sometimes, I think I would feel safe and secure in this type of therapy)