If you’ve been tracking your symptoms for at least a month, you should have a fairly detailed picture of your particular variety of depression. You understand the full range of symptoms, when they occur, what other conditions in your life accompany them and which ones you’ve got to deal with first.
Now comes the hard part – figuring out how to control the symptoms as soon as possible and, hopefully, get rid of them forever. You may hit the mark with the first treatment you try, but there’s a good chance you won’t.
The search is likely to be a tough test of your patience and hope, and those qualities are in short supply when you’re in the midst of this illness.
Focus on Learning Skills
I lived through years of discouraging relapse and failed treatment, constantly looking for the right therapy that would at last undo depression. Finally I realized that I was looking for the wrong thing. This was the wake-up call:
You don’t need therapies, you need skills. You need to drive your own treatment. Psychiatrists and therapists can be thought of as guides who teach you the skills you need.
Focusing on learning skills is more helpful than focusing on finding the right therapist or treatment. Those choices are important, but they’re the means to the end of training yourself to get rid of depression.
You can evaluate the usefulness of a form of treatment by looking at the practical skills each one teaches you. Some therapies depend on professional guidance while others can be mastered on your own, with the aid of recorded lectures and exercises, workbooks and support groups. However you learn about them, you have to practice the skills over and over.
When you need them most, you won’t have the time or clarity of mind to recall how they work. They need to become habits you can automatically use.
Most therapists draw on a variety of techniques to respond to your needs. If you want to go further with one approach, they can guide you to resources and contacts. In this way, you can learn new skills even without the benefit of working with a specialist in each treatment model.
Types of Therapy and the Skills They Teach
There are hundreds of books and studies about each therapy, and each has its promoters and detractors. It’s easy to get caught up in the endless debates about which therapy is best, which has the strongest evidence behind it, whether its claims are true or fraudulent. But all that is beside the point.
It’s not a question of which therapies are right or wrong. If you’re focused on skills, you need to zero in on the ones you can learn from each form of treatment.
To do that, I’ve found it helpful to relate therapies to the basic areas that depression affects: thinking, emotion, behavior, relationships and body systems.
For example, Cognitive Behavioral Therapy (CBT) and its many spinoffs, like Positive Psychology and Well-Being Therapy, teach you methods for changing the distorted patterns of thinking that reinforce depression. I don’t buy the underlying concept that your thoughts determine your feelings, but that doesn’t matter. The cognitive skills this approach has taught me have been invaluable for dealing with negative thinking.
Mindfulness-based therapies use meditation as a way of combining impacts at cognitive and emotional levels. Acceptance and Commitment Therapy or ACT combines cognitive techniques with skills to identify and change patterns of behavior that support depression.
Psychoanalytically-based psychotherapies build awareness of patterns of behavior, feeling and thinking that are self-defeating. Dozens of therapies, like exercise, nutrition and yoga, teach you ways of influencing mood and brain health through the body.
This sort of grouping can help you link therapies to the skills most relevant to your symptoms. Over time, you need to put together a variety of skills to deal with all the dimensions of depression you live with.
Awareness
There is one skill that I’ve found essential in order to benefit from any form of treatment, and that is awareness. It’s important in a couple of ways. If you’re not alert to all the changes that depression brings with it, you probably won’t use the therapies – or develop the skills – needed to deal with them.
As a result, you may make some progress with the treatments you’re using but still feel that something is missing. You’re not completely well, and those remaining symptoms, even if they seem minor, are often the predictors of future relapse.
Awareness is possible when you’re able to step back a bit from your symptoms. You can observe what they are and recognize them as dimensions of depression rather than unchangeable parts of your identity. Without that skill, I wouldn’t have gotten far with recovery.
Meditation, writing therapy, peer support groups and many other methods can help you cultivate a level of awareness that keeps you alert to warning signs of depression. It’s one of the most important skills you can learn.
Clustering Symptoms
As you follow your depression, you’ll probably notice that certain symptoms feed off each other in a vicious cycle.
I find that looking at these clusters of symptoms gets me away from formal labels and closer to what I’m actually living through. Labels for symptoms are pretty abstract, and there’s limited value in trying to understand the technical meanings assigned to each one.
When I’m depressed, I tear myself apart and feel like a worthless creep. In terms of symptom labels, I can call that a cluster of low self-esteem, feelings of worthlessness and negative thinking. In my life, they’re three sides of one terrible problem, and I know how to fight them with a certain set of skills that I’ve learned from cognitive behavioral therapy, among others.
That’s how I think about matching therapies to symptoms. I apply internalized skills to counteract painful experience.
CBT helped me because it wasn’t all talk on my part and all listening on the therapist’s part. Believe me, I went through 5 years of meaningless, fruitless therapy where I just talked and someone else just listened. I began to wonder just what kind of training she had received…then I began to wonder what I kept seeing her, so I stopped for a long, long time. Now, I am seeing a cognitive-behavioral therapist who speaks her mind and gives me assignments when I get stuck. I never wonder what her training tells her about what I’m saying, because she lets me know. I really do appreciate that. But early-on, before the “listening only” therapist, I had tried CBT and it was a total washout. I think a lot of what a particular type of therapy can do for you depends on where you are in the wellness process and what you’re ready and willing to do to move forward.
Hi, Donna –
I agree that therapy’s value does depend on where you are in the process – are you really ready to deal with things yet. But it’s also the therapist – a good person will draw you into the process even if you’re only partly with it. You can trust the current one because you know what she’s thinking and how she’s responding – and that she is responding. I went through two periods of therapy with psychiatrists who said nothing – apparently their interpretation of Freudian methods. I guess they were too young to have gotten more flexible. Two older psychiatrists with similar training were as open and responsive as could be, and I got much more from them.
I’m interested to hear about your CBT therapist – I think there’s the same variety in therapists of every persuasion. Some use the methods mechanically, others bring it to life and make it deeply meaningful – they really see you as a person.
John