by Robert Duff
Of course you can't always avoid those people. Sometimes they are your boss, your professor, or your mom. I know it sucks when you can’t just cut those people out. It can make you feel even more helpless because it is just one more annoying aspect of your life that you don’t have control over. While you may not be in a position to cut these people out of your life entirely, you may still have some control over when you see them and for how long. Much like the tips that I gave about music and other media, I want you to just become more aware of the effect that these people have on your mood. When you are more aware of it, you can plan for it. You can decide when you have it in you to endure some of their bullshit and when you do not. Maybe you need to make sure you follow a visit to your parent’s place with a visit to your best friend’s, so that they can pick you back up after your parents mopped the floor with your heart. Even when you can’t avoid one of these people, knowing the effect that they have on you is valuable in itself. It’s kind of like taking a punch or falling while riding a bike. If you know it’s coming, you can brace yourself for impact, and it might not wreck you as badly. It will still be shitty, but at least it won’t be shitty AND surprising.
Sometimes the people that have a negative impact on your mood are not quite so easy to see. The obvious ones leave you feeling unambiguously bad, while others may have a more subtle effect. How about friends that are always willing to talk to you about what you are going through, but somehow seem to make you feel more annoyed and betrayed by the world when you are finished with your chat? Often, these people have good intentions, but they can’t keep their own drama out of the equation and end up magnifying your own negative feelings instead of lifting you up and out of the murkiness. Just like the sad music, sometimes it feels satisfying to be miserable along with someone else, but at least call it what it is. You are not improving your mood, you are scratching that itch for commiseration and validation. Again, you don’t need to avoid these people completely, especially if you don’t want to. They might be your closest friends or family members that you truly love. Perhaps you just can’t emotionally afford to spend a lot of time with them when you are going through this period of progress and positivity. I know it can be tricky to put this sort of reduced contact into action. They might feel irked at you or wonder what they did to piss you off. For this I would refer to the letter that I showed you earlier. I would encourage you to explain to them that you are in a period of progress in which you need to work some crap out, and that this does not always allow you to be emotionally or physically available.
Recognizing the impact that other people have on your mood can take a little practice. I would encourage you to document your experiences in a journal to help you begin to notice some of the more subtle differences that might occur. This method is effective for any activity, not just interaction with other people. The first step is to write down what you are doing at a given time of the day. Next, you rate your mood on a scale from 0 to 10, where 0 is the most miserable you have ever felt and 10 is top of the world awesome. Don’t overthink the rating. Think of it as a non-specific overall wellness rating. After you pick out an overall rating that feels right, pick out a few emotion words that seem to fit with how you are feeling. I understand it can sometimes be hard to find the right words to describe how you are feeling, so I will include a list of different feeling words here that you can draw from.
Now that you have documented your baseline emotional state, you can go about business as usual with your friend, family member, acquaintance, or enemy, as the case may be. Once you have transitioned from spending time with that person to the next part of your day, that is where you would repeat the steps from above. If you want to be an overachiever, you can include two additional ratings: one retrospectively regarding how you felt during the time with that person and one a little later to look at the lingering effects that the visit had on your mood. This will likely be difficult to figure out and interpret the first time through. Remember that your brain is being a huge douche by distorting your thinking patterns and tricking you into overgeneralizing. The person in question may indeed have a negative effect on your mood, but in order to have a clear “line” in your data, you will need to gather more information than one single interaction. That means you should complete that tracking process the next few times you see them, and then look back on your collected data as a whole picture and try to make sense of it. When in doubt, ask a trusted advisor or a neutral third party, like a therapist, for their take on it. It might sound a little dumb to “track” your relationships, but you might be really surprised by the sort of power you can derive from becoming more aware of what trends and patterns exist within your interpersonal web. It serves as just one more way that you can take a little control back in your life and exercise that ever important self-awareness to give yourself the best shot at success.
The final tip that I have for you in this section is to always have something to look forward to. Depression has a way of sucking out the hopefulness and future perspective from us. It makes us think about the past which is filled with shittiness, and it makes think of the present, which feels pointless. In the few moments that depression allows us to think about the future, it is typically with the dread of knowing that it is not going to go well. Being in that mode really sucks. The cool thing is that, just like many of the other negative symptoms of depression, you can reprogram your brain into looking forward with excitement to things. I don’t mean that you be stoked as hell for every single day of the week, but you can certainly achieve a mild to moderate level of happy anticipation. Basically, we are just looking for enough to pull you through. This is especially important when you are in that zone where every night feels pointless because it seems like tomorrow will be a bland carbon copy of today. Every little bit of motivation or positive anticipation helps to make things feel worth it. These can be simple things. Maybe it is your favorite show on television, an awesome new breakfast spot in your neighborhood, new episodes of a great podcast, or a weekly meetup with one of your friends. The trick is trying to spread out and integrate these awesome little moments into nearly every day of the week. When one gets stale, add in something new.
These are completely personal to you. I don’t know your preferences, but here are some of my special moments that pull me through the week: Jeopardy at 7 every night, new episodes of my favorite podcasts at least twice a week, solo coffee shop dates on Friday mornings, television binges with my wife from our giant pile of blankets on the floor of the front room, daily vlogs from my favorite Youtubers, and playing games on my iPad before going to sleep. These are probably completely stupid and boring to you, but they really do help get me through. I am writing this sentence at 11:00 PM on a Tuesday. I am pretty damn tired, and I really don’t want to clean the dishes in the sink before going to bed at 12, but I am looking forward to lying in bed and playing some Puzzle and Dragons on the iPad for a few minutes before drifting off, so I have something to look forward to after that boringness of cleaning. Tomorrow, I have to go to the office and do some lame clerical work and psychological assessment scoring, but I know that one of my good friends will probably release a new episode of his podcast that I can listen to while I work. I am sick of doing planks in the morning (seriously, fuck planks), but I know that I can watch Casey Neistat’s newest daily vlog on Youtube while I am doing them. I get to walk to work on Thursdays, which is pretty awesome, and I don’t have to leave as early as I normally do. And Friday is Friday, which is always cause for celebration. That gets me through my entire week. It’s only Tuesday, but having the entire week punctuated with awesome little moments to look forward to makes me feel like it’s almost Friday already.
That basically sums it up for this section. I hope it wasn’t too completely random. The takeaway that I want you to remember is: there are so many small (and large) adjustments that you can make to your life to help set yourself up for success. Depression will always be like a cosmic force that drives you to self
-sabotage and ruin your chances before you even get the chance to try and be happy. By increasing your self-awareness, collecting data from your life, and being very honest with yourself about the current trends that are playing out, you can instead create the conditions necessary for kicking depression’s ass. I doubt that any single adjustment here will be the cure to all of your issues. However, going through this process of fine-tuning these aspects of your life will make it that much easier to make positive, constructive choices for yourself. Every little bit helps. Set yourself up for success.
Ch. 9 Professional Help Is Self-Help
In this chapter, I want to talk about getting outside help from a professional. Ideally, we would all be able to get by on our own. Nifty little resources like this book you are reading would be enough to nudge us in the right direction and get us kicking ass again. Unfortunately, that is not always the case, and we may need a little extra help to get going on our journey. There is absolutely nothing wrong with that. I think that many people have the wrong idea about psychiatric treatment. Getting treatment from a professional does not mean that you have failed at your attempts to help yourself. Self-help is all about making the conscious decision to utilize the tools at your disposal to improve your situation. No one can make change for you. You still have to make that choice to engage with treatment. In that way, I see psychiatric treatment as a sign of strength and as an extension of your own self-help. This tool is available to everyone. It takes a special sort of strength to recognize the need for extra help and to seek it out. (Quick disclaimer: I practice psychology in California, USA. I have little knowledge about how mental health treatment works in other countries, so please be aware that some of the information presented here might not directly translate in your country. The general ideas should still be the same.)
There are two basic categories of psychiatric treatment. By the way… psychiatric is just a catch all term for treatment that deals with psychological or emotional problems. The two broad categories are therapy and medication. You might also hear terms like “counseling”, “psychotherapy”, or simply “sessions” in place of therapy. We just like to make everything stupidly complicated with a bunch of terms for the same thing. For medication treatment, you might also hear terms like pharmaceutical treatment, psychopharmaceutical treatment, or pharmacological treatment. Again, those all mean the same thing. I am a big fan of both modes of treatment, because I think that they serve different purposes. In general, the types of depression that benefit from medications are of the more physiological type. (You know, that type where you feel like the laziest asshole on earth and your body is screaming at you every time you try to muster up an ounce of energy or motivation.) They can also be helpful as a boost when your therapy and self-help are just not doing the trick and the problem seems to be pretty sticky. When therapy and medication are working in tandem, they can make an exceptionally powerful combo.
I want to explain more to you about these different types of treatment, but before that I should give a disclaimer. Teeeechnically, I am supposed to be an expert about therapy, since that’s why I spent a zillion years in school getting my Ph.D. However, I am most certainly not an expert in medication. Later, I will explain the difference between different types of care providers. Just know that I am familiar with medications in my capacity as a therapist, but a medical doctor will be the one that can truly advise (and prescribe) when it comes to psychiatric medications.
So, let’s talk about therapy first. Basically, there are two main ways of categorizing types of therapy. The first dimension is what format of sessions you are looking at. In other words, are they individual, group, family, or couples sessions? The other dimension is the type of therapy that you will be getting. There are many different types of therapy out there that are driven by particular theories about where issues come from and how it is that people can change and improve.
The first type is pretty simple. Individual therapy is probably what you are most familiar with, either from personal experience or from pop culture portrayals of psychological treatment. (Quick side note: television and movies are so goddamn bad at portraying therapy- please don’t let them influence your opinions.) Anyway, individual treatment basically looks like one-on-one sessions with a therapist or psychologist. These sessions are typically 50 minutes long. The “therapeutic hour” is 50 minutes because your shrink needs to write notes on every session for record keeping purposes. Some will write their notes during the session as you speak, and others wait to write them up after you are gone. Either way, they are probably scrambling during the 10 minutes between your session and their next client to wrap up notes, take a drink of water, and pee real quick. The way that these sessions take place can be a bit different depending on the setting. For example, a private practice might be in a small office building or even in a repurposed house. You will likely talk directly with your therapist on the phone or via email to set up your initial appointment. There will probably be either a very small waiting room with at most one or two other people, or there might be no waiting room at all. The picture with larger healthcare systems is a little different. Not worse by any means- just a slightly different experience. I have worked in both settings, and I have found that most people seem to associate the idea of therapy with the private practice setting I described and are sometimes surprised when they find themselves in a healthcare situation that doesn’t look all that different from going to the doctor for any other medical reason.
If you are part of a large healthcare system, you will probably talk to the front office staff to schedule your first meeting. Often this first “intake” appointment will be scheduled with whichever clinician is available at a time that works for you. This doesn’t necessarily mean that you will stick with that therapist after the first session. Healthcare systems sometimes have people that are specifically employed to conduct initial sessions and then direct you to the most appropriate clinician or other resources that they have available. That said, you can usually expect to see the same therapist for each session once you get the ball rolling. Scheduling can be a little more flexible with private practice, since the therapist is the one who decides what their own business hours and availability are. Appointments in healthcare settings typically need to fall within their business hours, and it can sometimes take a little more negotiating to find a time that you can get an appointment. In this setting, you will probably also be waiting for your appointment in a larger room with other people doing the same thing. If that is concerning for you, just remember that everyone is there for the same reason and values their own privacy. Typically, it’s quiet and people are just reading magazines or playing on their phones while they wait. When someone comes into the waiting room to find you for your appointment, they typically won’t call your name out loud. Instead, they might ask out loud, “Hello. Is anyone here for Dr. Duff?”
So, let’s talk about the first session. In the field we generally call this the intake session, though it can go by any number of names. It all means the same thing. The point of this first appointment is to gather information. It most definitely can be therapeutic and helpful, but it is not going to be the same thing as the routine therapy session that you will have later on. This is a good thing. Sometimes it can be a little frustrating to feel like you are being interviewed when you just want to get some damn help as quick as possible. However, a good therapist should be able to balance hearing you out, gathering information, and being helpful to you in an intake session. The idea is to obtain a solid picture of what you are going through and your personal history. They may be related. You also want to make sure that there is someone there who is a good fit for you. Therapists have different strengths and specialties. Neither of you need to waste too much of your time if for some reason they may not be the best person to help you. If this is the case, it is not your fault, and they can still be helpful by having all of the information that they need to point you in the right direction by making a specific referral
to another clinician. In the first session you will go through a diagnostic and historical interview. Basically that means getting your personal story, information about what is currently happening, and trying to develop a working idea about what your potential diagnosis might be. At the end of it, you should be aware of any working diagnoses that are being considered, a greater familiarity with the system that you are working in, and an idea about what the course of treatment might look like.
Courses of treatment can vary. I’d say that the most common interval is weekly appointments. There was a time where session limits were more popular, but treatment is more often open-ended now. Check with your provider, insurance company, or school, as the case may be to find out what their policy is. In my experience, some insurance providers and schools still have loose session limits where there is a required “check in” after a certain number of sessions to see if additional sessions are necessary. If you are still making good use of the support, they generally with not cut you off.