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The Real Face of Depression

Written by B. Imei Hsu, BSN-RN, MAC-LMHC, Artist

A few weeks ago, I found myself musing about the real “face” of depression.  I personally find it absurd to think that anyone who lives a full life can escape the feeling of being depressed at some point in their lifetime of 365-1/4 day trips around the sun.  A full life – one in which you choose to be awake  – includes its fair share of tragedies, heartbreaks, endings, and losses.  As I am writing this, we are on the eve of experiencing  a hurricane that affects hundreds of miles of homes and businesses, which can only mean that millions of people’s lives and livelihoods are at stake, and the thought of human loss is grieving and yes, depressing. Yet rather than sharing only statistics and norms and “how to’s, I’m sharing my personal and professional musings on depression not just as a situationally-caused mood disorder, but also as a real “face” that seemingly has no cause, or to which we look beyond cause. What is the real face of depression?

“I have no reason to be depressed”

Wil Wheaton, actor and writer, has gone on record to share his struggle with chronic depression. He is a real face of depression for many.

You probably know at least one person who tells you, “I have no reason to be depressed.” Such a statement falls falls from a mouth of an intelligent, successful, healthy adult man or woman who appears well-loved and appreciated for his or her contribution to the community, the workplace, and the home. She or he can count off at least ten or more reasons why depression should have no place in her life, and yet there it is: this heavy, achy, tired, brooding feeling of either not wanting to have to wake up to another day (with suicidal thoughts and fantasies of ending it all), or the same heavy- achy-tired-brooding-feeling, only without suicidal thoughts. That same person may have tried counseling or some form of “talk therapy“, and while strategies for managing the symptoms of depression are discussed and employed, the person expresses dismay that after six months of weekly sessions, she doesn’t feel much different. Just depressed.

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Ten Things You Should Tell Your Therapist

I can see it right now. I have a dear friend Alice (not her real name), and if I were to read off this list of ten things you should always tell your therapist (if they are true, of course), I’m pretty sure she would roll her eyes and say, “Really? That’s just silly! People hire you to be their therapist, and then they won’t talk to you about all this important stuff! That’s just ridiculous!” And Alice would be partially correct. While withholding critical information from your therapist defies the very logic involved in seeking a counselor’s help, it’s not uncommon for clients to feel uncomfortable talking about a number of health and mental health issues that arise during therapy. Even when legal confidentiality is assured, clients can clam up, deny, lie, delay, hide, and even consciously ignore data that would assist the therapist to help his/her client. Here are ten things you should tell your therapist, no matter how uncomfortable you feel.

Even if you feel uncomfortable, there are some things you should always talk to your therapist about in order to receive the best possible care.
Ten Things You Should Tell Your Therapist

1. Tell your therapist when you start taking any new medication, and if you stopped taking a prescription medicine or changed your medication. The presence and absence of medication can have a profound impact on concentration, energy levels, feelings of well-being, hostility, and rapid mood changes, not to mention feelings of paranoia, suicidal thoughts, and significant irritability.

If your sessions are conducted over the telephone or Internet, it’s very important that you make a note to write down the type of medication, dosage, and when your last dosing occurred. In a F2F session, I can often detect subtle changes in mood, smells, and other body language that might lead me to ask about a client’s medications, but technology can make that a little more difficult to detect.

2. Tell your therapist when you become angry or frustrated with something s/he is doing in session. The therapy hour is a time to focus on how you feel and interact with another human being. Unless you start dancing around the room wielding a large knife, you won’t be turned away. Be honest, and tell your therapist how you feel. At the very least, you’ll receive an explanation of why your therapist is doing what s/he is doing, or an opportunity to improve things so you aren’t blocked from the work of your therapy.

3. Tell your therapist when you’ve had a change in circumstances that affects your ability to pay for a session, such as a job change or problems with debt and spending. Don’t just disappear. Terminating therapy early because of money can be heart-wrenching. Your therapist may be able to help you with options both of you can live with.

4. Tell your therapist if there has been a change in your relationship status. Include any changes concerning your sexual libido, number of partners, affairs, and orientation issues.

5. Tell your therapist if you are having unexplained or prolonged changes in sleep, appetite, or interest in your usual activities. These changes can be a sign of depression, other medical conditions, or a response to stress that can be dealt with in therapy.

6. Report ANY hallucinations (audio or visual) immediately, even if you fear that you’re losing your mind, or that the information will be used to commit you to a psychiatric facility. This kind of data is absolutely crucial to your therapist’s understanding of what is going on for you. Self-medicating or hiding from your responses to hallucinations is a poor way of treating what is causing them in the first place.

7. Tell your therapist what is working in therapy for you. Feedback helps your therapist concentrate on what is helping you instead of spending needless time on what isn’t helping you. This includes telling a new therapist what happened in any previous sessions with another counselor.

8. Tell your therapist when you feel suicidal. Even if you “know” you wouldn’t act on it, your therapist can help you navigate feelings of sadness, helplessness, pain, and depression when all you feel like doing is laying down and dying.

9. Tell your therapist when you’ve committed a crime or you are the victim of a crime. If that sounds frightening, let me ask you a question. Which would you rather experience: going through the process of reporting the crime on your own, or reporting it with an advocate in your corner, who may be able to help you navigate the emotional weeks and months afterwards? [if your answer is the former, you’ve probably never committed a crime or were a victim — both suck balls, as one of friends likes to say].

10. Tell your therapist at least a month ahead when you would like to terminate therapy sessions. With proper planning, your therapist can provide supportive feedback, make referrals if you’re moving to a new city, and facilitate a positive experience of closure and saying good-bye that you might not have ever experienced before. Very few people describe themselves as being good at ending relationships. Your therapist is trained to give you ample opportunity to practice the important skill of saying good-bye, a skill needed at the end of a job, a career, a business, a relationship, and a life.

Finally, there is one other piece of information you should at least consider telling your therapist, although I can’t categorize it in the list above. What if there is something your partner/spouse specifically told you never to discuss with anyone, and yet it involves you? I cannot tell you in every case that this is something you should always tell your therapist. Even though everything shared is in confidence (unless it involves one of five reasons a therapist can break that legal confidentiality), you have to decide if you can bear breaking your silence without the other person knowing. However, there are ways to discuss this issue without necessarily breaking your promises. If you find yourself in this kind of dilemma, you can discuss the conflict with your therapist, and decide together if you should go further and share the data involved.

Of course, there are plenty of other things to discuss in a therapy session. A good therapist creates the environment to make this kind of sharing possible, and therefore I did not include them in the list above. You’ll be sharing your stories, your personal history, your fears, and your accomplishments. But leave out any of the ten items above, and you could be setting yourself up for illness, loss of health, or an unexpected outcome from therapy.

Similar to Input/Output concepts with a computer, if it’s “garbage in”, it’s “garbage out.” If a therapist has to guess and read your mind to get accurate information from you, therapy can still be conducted; that’s because a therapist can often read the gaps in your story [I’ve labeled that “calling bullocks”, and my clients know I have no qualms confronting gaps in their stories]. But your therapy process will be much more insightful and effective if you make a commitment to sharing important data as it arises [meaning, in a timely fashion].

What do you think? Do you have a hard time telling it like it is? What other information is hard for you to discuss with a trusted confidante or therapist? Share your thoughts in a comment.