Hmmm...is it Possibble I Have Been Mistaken?

In my appointment on Thursday I talked with Dr X. about how I think people think bad things about me all the time. One example of this is when I am walking my dog I always feel other people are judging me as a dog owner, and my dog as a dog breed.

My dog is not that common. he is a white boxer and you don't see very many of them. Because of his odd colour and his very square jaw people often mistake him for either a pitbull or an american bulldog. They seem scared of him and avoid us if we are walking.

Given I spend almost every waking minute with my dog by my side I feel, by association, avoided and repugnant.

In my appt Dr. X. asked me if I could challenge some of my thoughts about people thinking bad things about me; challenge them in the moment. So this morning, when an opportunity came up I tried it.

I was walking my dog in my neighbourhood. I know I looked both a bit disheveled and maybe a bit unapproachable (...as I was almost completely inside my head thinking about how much amorous fun I had last night;.)) I looked up and saw an older Sikh woman (maybe 65-75) staring at my dog and I.

The woman kept looking furtively at us, and then away from us like she was dismayed to see such a person, and such a dog on her street. I could feel myself suddenly becoming extremely self conscious and defensive. I suddenly wished I had taken the time to put a bra on, to wear more modest clothing, and to look a bit more conservative. I became annoyed that she was looking at me and my dog the way she was.

Feeling defensive I decided to show her I was a nice person...and I said hello. As I did, she smiled brightly and said, "He is so gorgeous, your dog".

When she said that I remembered Dr. X. telling me to challenge my beliefs and thoughts in the moment. I had challenged them, but not consciously...I was flabbergasted at the words that came out of the woman's mouth. She wasn't judging my dog. She was admiring him.

I felt very humbled by what was really happening. I believe some of my perception was coloured by my own prejudicial beliefs about how "conservative" thinking, and/or judgemental of me an older Sikh woman might be. I like to think I am more open-minded than this, but I think at times we all make assumptions based on not necessarily correctly held beliefs about others, other cultures etc.

So based on my experience today I have challenged two possibly wrongly held beliefs...one cultural and one very personal. I can see how my judgements about others, and how others perceive me might reflect back in how I expect them to perceive me, and in fact how my expectations might actually influence their perception of me.

For example, maybe I act standoffish if I feel I will be judged.
I get stressed out that people are judged, maybe they misread my fear and stress as danger, or threatening and act accordingly. A while ago Dr. X. spoke to me of something called, (I think) "projective identification". It is where how you expect others to treat you actually becomes how they treat you...not magically, but because you send out signals to others about what you feel and they interpret/misinterpret how you are. I think this happens to me.

I will address this phenomenon in my next post.

Long Term or Short Term Therapy

I woke up today embarrassed and stressed that I opened up so much in therapy yesterday. Still I stand by my decision to do so. It was important for me to share my feelings for many reasons. One of the big reasons is I have a sort of "magical thinking" that if I tell someone I care for them they will disappear, or the relationship will end. For this reason I avoid telling many people I care about how much I care for them. Yesterday was my brave attempt to believe that speaking my truth will not affect my relationship with Dr. X. Today I feel the fallout and fear of that decision, but I think sometimes I need to challenge these beliefs, despite feeling the terror of impending loss...

On another note:
In my post yesterday, cbtish said...
"Yes, good therapists recognize the feelings on both sides in a therapeutic relationship.But it has to be said that few good therapists now believe therapy lasting many years, or involving the kind of feelings you describe, is likely to have a positive outcome.So it frightens me, too, that you feel you depend on him so much.The thing is, support, kindness and compassion do not actually promote change — instead, they maintain the status quo. Therapy is meant to be about healing. Things actually happen. Tomorrow is different from yesterday."

I would like to discuss my feelings about the benefits for me, of long term, versus short term therapy.

First thank you cbtish for taking the time to comment. I always enjoy hearing other people's opinions. On some level I agree with cbtish. I think for some people, some of the time, short term Cognitive Behavioural Therapy (CBT) may be the most effective treatment. However, I think we need to be careful that our dogmatic beliefs about a particular therapy do not mean we blanket all people with the same kind of therapy, especially if there are times when it is clear that a particular type of treatment may not be what the patient needs in that moment.

I think for me, during the early years of my illness (17-25) when I had had only a few Major Depressive Episodes CBT worked well for me. By the time I was 25 I had been depressed several times at 25 I saw a Counsellor for 6 sessions of CBT and I remained well for approximately two years. It really helped me. The difference is that at that point my illness was less severe and I was able to do the activities I needed to do to help myself become well again.

However, there were a few things every therapist, counsellor, psychologist and the pdoc I saw before Dr. X missed, or misinformed me about, or neglected to inform me about:

1. That there are medications that can help people. Not a single counsellor/therapist discussed this with me. I discovered this on my own after reading a book about depression. Personally, I think it is negligent to encounter a patient like me, who has had numerous MDE's, and understand that for the most part each seems to last longer and become more severe, yet not inform the patient that medications help some people.


2. Until Dr. X every Counsellor/Therapist I saw was very rigid in the type of therapy they practiced. One believed in CBT, one believed in Eye Movement Desensitization and Reprocessing. (EMDR), another was Jungian, another Psychodynamic etc. I do not believe for me that a particular therapy is necessarily the best approach. My mood disorder is such that my mood cycles between complete inability to even get out bed sometimes, to highly agitated and anxious, to feeling disconnected from everything, to how I feel right now: extremely motivated, content and relaxed. When I am fatigued and extremely depressed short term CBT, or even the ideas of challenging negative thinking does not help me. I do not have the ability to do the actions I need to do to challenge my negative thinking or to change my behaviour. During these times I need supportive therapy. Therapy that helps me understand it is not my fault I am unable to change, or get better. I need help understanding that guilt about how I am is unproductive. I need to know I am cared for no matter how I feel.


3. I need different approaches in therapy depending on how my mood is, and what kind of cycle I am in. When anxious I need someone to help me relax, and learn relaxation techniques. I often also need medications to calm me down. When I am high I need someone who is familiar with CBT and can help me set goals and activate my life, because during these times I have the energy and power to change, when I am agitated and depressed I need to have a therapist who is not rattled by my intense suicidal thoughts, someone I know will listen and not judge me, someone who allows me to speak my truth, When I am severely depressed I need someone who understands and helps me learn to participate in activities outside my house; someone who knows I am struggling, but believes I can do things anyways. Sometimes, I just need someone I feel connected to; someone who I believe accepts and cares for me no matter what.


4. My depression has been treatment resistant believe it is unconscionable to treat a patient for 12-16 sessions, see they were not well still, and end therapy despite the patient remaoning ill. Basically this is what would have happened to me, and happened to me, numerous times. The therapists would treat me, I seemed a bit better, or even much better, but I continuously slipped back into depression. I did not need short term therapy. I needed (and need) long term support to change huge areas of my life, to learn how to make healthier decisions and choices, to learn what kinds of activities drive me forward and which hold me back. My lifestyle has had to change dramatically for me to survive and thrive with and in spite of having this illness. Dramatically changing ones life cannot be done in short term therapy. Personally, for me, I often see that small changes take a very long time. In long term therapy I am able to practice my changes and polish them. I am able to find who I truly am, who I want to be, and how I want to live my life. Before seeing Dr. X I was lead to almost every decision by fear; fear of ending up homeless, jobless, loveless. I am not certain I made any decisions based on what I wanted and enjoyed doing. Long term therapy has allowed me to work through my fear and work towards what stimulates me. I feel I am working towards having a life based on Joy.

I guess what I am saying is there is a time and a place for short term therapy, but to be dogmatic about either short term, or long term therapy is to miss an opportunity to really help a patient change the outline, or structure of their life to one that supports ongoing wellness and resiliency. Patients like me may need ongoing support indefinitely. If I discontinue therapy, it will not be with an eye towards never going back. If I need help again I will return. For me long term therapy, and different types of therapy within my sessions has been extraordinarily effective and helpful . I really believe it is the relationship between the patient and therapist that leads to lasting positive change.

Relationships, trust, and the ability to be truthful and open about all aspects of my life in order that I have the opportunity to address those aspects, can take a long time. The relationship between myself and Dr. X. is strong and I feel safe to make the changes I need to make. I am grateful I have a therapist who understands the psyche may take time to adapt, change, and grow. For me, long term therapy has led to a great deal of positive change; not just surface change, but change that is becoming embedded in my character. This is a great thing.