Beyond Blue

But I don't.

Because I want her to like me. It's part of being a stage-four people-pleaser.

I didn't realize the extent to which I was holding back until, the other day, when I mentioned to my therapist something that I had told Dr. Smith--the psychiatrist that I see every four to six weeks--about positive thinking just not cutting it when you plummet to such a low depression.

My therapist asked me to back up and tell her more about that. Because either I hadn't said anything about that to her in the last month or so or else she had missed it.

I stewed on that for a few days: Did I omit my frustration with self-help books and cognitive-behavioral techniques or maybe not express how depressed I have really been? And I realized that I divulge more to my psychiatrist about the status of my depression and anxiety than I do with my therapist.

Why? 

When I'm sitting on my doctor's couch, I believe the most significant culprit to my bad mood is my illness. I'm somewhat like a diabetic going in to get her insulin levels checked.

However, when I perch myself across from my therapist, I feel more accountable for my moods ... that I if I am unable to implement cognitive-behavioral adjustments, and thereby some find relief, that I am somehow to blame. Moreover, if I'm pulled back into addictive and destructive thoughts and behavior, I have gotten there by choice.

1. I honestly don't know whether I can help you or not.

Most therapists honestly believe they can help most people with most problems. However, until you get in there and start working with a therapist, a therapist can't really predict whether they'll be able to help you or not. Most therapists believe they can help anyone who comes to them with a specific problem they're trained or experienced to handle. However, every single individual is unique and there are few reliable predictors of any given therapist's success with any given client.

2. I'm not your friend, but I want you to open up to me anyway.

As I've written about previously, the therapeutic relationship is not a natural one. Nowhere else in our lives do we have this kind of professional relationship that demands openness, honesty and intimacy (not of the sexual kind). Without those components, your therapy isn't likely to be as beneficial. It feels like a close friendship sometimes, but it isn't.

3. If you ask to see your chart, I'll probably give you a hard time about it.

Despite the rights of patients to be able to view and have a copy of their own medical records and data, most mental health professionals still resist attempts for a patient to view their own mental health chart. They'll ask you why you'd like to see it. They may hem and haw a bit, and ask that you pay for copies of it rather than just look at the chart itself while in the office. Your chart likely contains little eye-opening information, as it's probably just full of short progress notes that describe very generally your progress in therapy from week to week.

Sometimes, people confuse being depressed with being philosophical. If I had a dollar (well, maybe $2) for every time I hear "I am not depressed, I am just realistic", "Anyone who isn't depressed isn't paying attention", or "Life has no meaning and I am going to die, how can I be happy?" I could likely support a hardcore latte habit. Depression can have such an effect on your worldview. 

There are a few basic existential realities we all confront: mortality, aloneness and meaninglessness. Most people are aware of these things. A friend dies suddenly, a coworker commits suicide or some planes fly into tall buildings-these events shake most of us up and remind of us of the basic realities. We deal, we grieve, we hold our kids tighter, remind ourselves that life is short and therefore to be enjoyed, and then we move on. Persistently not being able to put the existential realities aside to live and enjoy life, engage those around us or take care of ourselves just might be a sign of depression.

 

We all get sad sometimes, struggle to fall asleep, lose our appetite or have a hard time focusing. Does this mean we are depressed? Not necessarily. So how do you know the difference? The answer, as with most psychological diagnoses comes down to one word: functioning. How are you sleeping and eating? Are you isolating yourself from others? Have you stopped enjoying the things you used to enjoy? Difficulty focusing and concentrating? Irritable? Tired? Lack of motivation? Do you feel hopeless? Feel excessively guilty or worthless? Experiencing some of these things may be a sign of depression.