Are you discouraged reading the above paragraphs? Have you begun to get a sense of how hard it is for a person with symptoms of depression to find their way to talk to someone about it? If they could talk about it, that would be a sign that the depression didn’t have such a hold on their lives!
Perhaps you are glimpsing in small ways how very challenging it is for those that struggle with depression to get help.
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Andrew Solomon has a profound TED talk about his own experience of depression. In the way only a poet can describe, he said that depression is a loss of vitality. With stark candidness, he relates:
And one of the things that often gets lost in discussions of depression is that you know it's ridiculous. You know it's ridiculous while you're experiencing it. You know that most people manage to listen to their messages and eat lunch and organize themselves to take a shower and go out the front door and that it's not a big deal, and yet you are nonetheless in its grip and you are unable to figure out any way around it. And so, I began to feel myself doing less and thinking less and feeling less. It was a kind of nullity. [8]
Depression is often characterized as the “disease of disconnection”. The tentacles of depression drag a person into the swamp of isolation. Depression is quicksand—it pulls people in and every struggle increases its hold with internal lies that say:
“That didn’t work. Nothing will work.”
“She doesn’t care. He doesn’t care. Why should you care?”
“It’s not worth the effort.”
“I’m not worth the effort.”
“It will never get better. It will never change. Don’t even try.”
“Don’t let people see how wretched I have become. They may pretend to care, but they will hurt me, just like everyone else ever has. I’m too pathetic to let anyone really see me.”
When the isolation of depression doesn’t allow for those lies to be reality checked, optimal conditions exist for the lies to spin tighter and tighter until they can only be perceived as unutterable truth.
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Because therapy is, at its core, the creation of a helpful relationships, the very nature of depression which has people pull away from relationships makes therapy difficult to access.
The very symptoms of depression interfere with showing up for help:
Feelings of worthlessness: When you feel unworthy of love, when you know no one really likes you, it’s impossible to contemplate exposing yourself to one more person’s judgement.
Loss of interest or pleasure in activities: The lack of color in depression makes doing anything challenging. A black and white world makes a therapy appointment one more arduous task in a life of blah. Therapy is not an interesting opportunity to hear another perspective, or an intriguing prospect to engage with someone who may have a fresh viewpoint that could create some shifts. Therapy feels like one more hard task in a life of burden.
Low energy: You may feel like you can hardly get done the things your day that have to be done. Calling to make the appointment, filling out the paperwork, and getting yourself to the office then just becomes too arduous. Therapy is an option that doesn’t make it on the “to do” list,
Aches and pains: The body holds the pain of depression. When your back aches, or your head pounds, or your gut twists in pain, there isn’t capacity to think about talking about your problems.
Sleep disturbances: How are you supposed to go to a therapy appointment when you can’t get out of bed because you are sleeping the day away? It’s not just a challenge—it feels unattainable. Conversely, if you’ve been up since 4 am every day for weeks, exhaustion has taken such hold that it’s ridiculous to contemplate making an appointment after work. When your bones ache with fatigue, making a choice to go to therapy just seems absurd.
Difficulty making decisions: Depression can cause you to experience diminished ability to concentrate or have you be indecisive. How is a person supposed to research to locate the right therapist at the right rate at the right time when it just all seems too much? It’s just easier to not to go.
Helplessness and hopelessness: If the very feature of the disease is bleakness, then therapy (along with everything else) seems useless. The very despair of depression regards therapy with great skepticism. How can anything help?
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Initiating therapy can seem nearly impossible for those in a bout of depression. But maybe the person who gave you this book is hoping you’ll see this chapter and give therapy a shot. It might be that a part of you is overwhelmed with the idea of therapy—but there is a little sliver of you that recognizes it could be worth a try.
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In the woman's story—she will have a car, but only if first she can get to it—did you do what most people do? Brainstorm. Did you have some ideas when you first read the story? As someone who just wants the best for her, you don’t believe she is as stuck as she feels she is. Some options might be to:
Book a bus ticket
Ask a friend to drive her out there
Apply for a bank loan to rent a vehicle to drive there
Explain the dilemma to the family and see if anyone can help
Put a note in your grandma’s town’s local paper to see if anyone is heading in your direction and could drive it out, saving them the costs of the trip
And likely, you’ve thought of two or three additional options!
It is a challenge to travel to a remote location to get a car, when you don’t have a car! But isn’t the effort to come up with a solution, even one that requires significant effort worth it? Once she has a car, every day of her life gets easier, gives her more option, empowers her to pursue dreams.
A challenge differs from an impossibility.
Sometimes, you just need a friend or a book or a therapist to help you see it.
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If you can, get support from:
Someone in the human resource department in your factory
A social worker or public health nurse who drops by
A friend who cares
A relative who sees you struggling—and is themselves impacted by your symptoms
A colleague who recently went through a bout of depression himself
Your family physician
These resources may be able to assist you with the internal inertia to see a counselor. They may help you find the right therapist or make the appointment with or for you. They may help you be able to hold the internal resistance—all the reasons that make therapy impossible—as valid and yet help you get there, anyway.
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Doesn’t it follow that if depression is a disease of disconnection, then finding and meeting with a person who specializes in connection would be the first step to climbing out of that deep, dark hole?
Hearing your fears and thoughts out loud in the presence of a non-judgemental person can be the first step in climbing the ladder out of depression. Having someone express compassion after the internal violence that depression inflicts is itself a healing balm.
Seeing a therapist can change the internal conversation. Counseling can release the confining chain of beliefs that hold your feelings hostage.
If you haven’t already talked to a physician, a therapist is likely to suggest a visit to your doctor. While medication may be one topic of suggested discussion, it’s not nearly the only one. It may not even be an important one. It also makes sense to consult a physician to rule out the many possible physical conditions that create feelings of depression.
When a therapist suggests a visit to the doctor, it says nothing other than: “Let’s be thorough and make sure we are considering all the reasons life feels this painful for you.”
Going to a therapist may seem almost unworkable, but perhaps it is just barely possible.
Seeing a therapist won’t be a magic fix. Therapy isn’t like a pill that has you change instantly. But seeing a therapist can, over time, reverse the descent into the vortex
of darkness. As you hear yourself saying something to a therapist that together you realize has a nasty hold on you, you may find it slightly more possible to engage in your life. You listen to the critical voices differently. You are kinder to yourself in ways that improve your life. As you engage in your life, soft shades of color emerge. You may not even notice the slight color in your life until you speak of it in therapy. But, little by little, as therapy changes your life, and life changes your therapy, you get a gradual positive upward ascent of mood.
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Therapy is like a ladder that the therapist will drop down into the hole of your depression. The counselor will climb down the ladder and sit with you in your darkness during your session.
At the end of the session, you may go home, but the ladder remains.
The therapist uses that ladder each week during the session to be with you. As time passes, you may let others use the ladder to be with you in between sessions. Then, over time, you may find yourself able to climb a few rungs of the ladder yourself for a while.
One day, you may find yourself poking your head out of the hole and noticing the beauty that awaits you.
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Starting therapy may be one of the hardest things a depressed person may ever do. But it also may be one of the most worthwhile. Let this chapter be a vote in your life that says: “I believe you can identify a way. I hope you find a way. I think you are important and worthy of therapy. I want you to get help. I don’t believe it has to stay this hard for you always. I want you to find a way to feel less miserable. If therapy is one way you may get better, then I really hope you reach out and grasp at it.”
May you receive this as an invitation to reach out for the help that we all need.
23 C
ounseling for Anxiety: A million reasons to be anxious about therapy
Let’s list some reasons for why going to a therapy session could provoke feelings of fear:
Will I be able to locate the office?
How will I find parking?
Will I know what to do or where to go when I get to the office?
How will I handle the waiting room once there?
What will the therapist ask me, and will I be able to answer all the questions?
What if I get so nervous in the session I have to use the restroom? What if I have a panic attack? What if I freeze and can’t speak?
What if I blurt something stupid to the therapist and embarrass myself?
What if I don’t wear the right thing and the therapist says something about it?
What if the therapist says they can’t help me because my problem is too bad?
What if the counselor asks me to do something for homework that will be impossible?
I suspect that you can think of a few I haven’t included. You are concerned therapy will create more apprehension than you can tolerate.
What if, what if, what if?
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I’ve been a therapist long enough that therapists come as clients to see me. I had an insightful therapist ask me the first time she sat on the couch, “Do you mean to tell me that my clients go through what I just went through as I sat in the waiting room?”
She told me she had sweaty palms and butterflies in her stomach before our session began. She felt awkward while she waited and wasn’t sure what to do with her hands.
It reminded me of my own anxiety that I felt when I began therapy. I have the regular run-of-the-mill angst feelings, not clinical levels of anxiety and it created significant feelings of unease to go for my first session.
That therapist’s comments were impactful. They reminded me to always carefully consider pre-session anxiety. I created a book, Is there still time to run? [9] for our clients to read while in the waiting room. Our clients who are anxious find it helpful to read the supportive and encouraging messages about what therapy will be like and that we honor their courage. There aren’t a lot of words on each page—who can concentrate on long paragraphs when it feels like one’s heart will burst out of one’s chest? There are beautiful and soothing pictures as the background, because, sometimes when you worry won’t make it into the session, reading becomes utterly impossible.
Our clients tell us that the book is helpful and that it understands how difficult it is to come to therapy. Oddly, when people feel understood, even just slightly, even just by a book, they feel just a wee bit better.
Just better enough—barely enough—to stay waiting in the room until the therapist comes to invite them into the session.
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It’s ok to find it hard to come to therapy. It’s ok to go online and view therapy websites for a long time to get a “feel” for them. Sometimes, clients have told me they have read my blog for months or even years, developing a familiarity with us until they feel ready to come for a session.
The other day, I heard the counseling office line ring. Melanie, our client care manager said, “Hello, Conexus Counselling” and then it was silent. Then she said: “Hello?” After a moment, she repeated herself, “Hello, this is Conexus Counselling.” Still silence—it was evident she heard nothing.
Perhaps it was a bad cellular connection.
Perhaps it was someone wanting to inquire about counseling that suddenly found it too difficult to utter a word. Then I heard the response that Melanie gently and compassionately uttered: “We are glad you called. If it doesn’t work to talk right now, please call back. We’d love to talk to you.” She knew that the person just calling and saying nothing was an important step that deserved celebration.
Sometimes, people call and make an appointment, and then call to cancel it. Usually, they provide what seems to be a good reason: they got called into work, or childcare fell through. From time to time, the cancellations for those appointments are genuine but sometimes, they are a cover story for anxiety. They may call back to remake the appointment, but I wonder if some avoid re-booking, ashamed of their actions. They haven’t a clue how much we admire people who have approached something, had to step back and then somehow dig deep to take another run at it. It’s not humiliating to cancel and reschedule. It’s sheer courage.
We have a policy at our counseling clinic: if you cancel with less than a business day’s notice, we charge half of the session fee. The late cancel fee is for two compassionate reasons:
1. Our therapists have bills to pay and count on their clients coming. When there is a last-minute cancellation, there isn’t sufficient notice to book someone else in that slot. Our therapists need compensation for their time and expertise like anyone else who earns a living.
2. Our clients often get cold feet. Last-minute jitters are perfectly normal. More than one client has been grateful for the policy which signals that they cannot back out of the appointment in the last moment without penalty. Knowing they will have to pay if they cancel can be the push they need to come. Generally, clients are grateful that they made it through our door.
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At Conexus Counselling, we let people know that our policy is to help a client get over the anxiety that comes with a first appointment. People get anxious about the anxiety. This rapidly evolves into whirlwind of panic. The anxiety turns in on itself making an ugly spin even tighter and more fearful.
We have a variety of options open to clients who are very nervous about coming:
A “walk’n’talk” option. After signing a waiver, we go for an hour-long walk during the session outside, weather permitting. Anxiety often creates energy internally, and this can be managed by allowing that energy to burn off with a hike through the neighborhood. Not all clinics allow for this. If you feel it would be helpful, ask about it.
The “bring a friend” option. When it is just too hard to go to therapy alone, bring a friend. Again, different clinics may have different policies, but ask if you can bring the support you need. At our office, people can bring a friend or family member for support. Depending on what the client chooses, the friend travel with
them to the office, sit with them in the waiting room, and sit vigil there during the session. Or the friend can come in with them to the session and stay during the introduction. Maybe this friend will be there for the first few minutes while the client gets used to the space and may decide to proceed on their own. Perhaps the friend is there for the full session, helping to answer questions and voicing concerns and questions on behalf of the client. At our clinic, we trust the client to recognize what is right for them and make these decisions.
The “record the session” option. For clients who are anxious, they can find that their memory doesn’t serve them well after the session. They can’t remember what I’ve said, or what they found important. Occasionally, one of us will take notes for the client to take home. Other times, clients have asked if they could record the session on their phone. There are legitimate reasons that not all therapists allow for a recording of the session. However, if you expect this will be helpful, determine if recording your session is a possibility.
Hell No to Hmmm, Maybe Page 17