How to choose a therapist

The first thing to remember is - you don't have to keep seeing a therapist or counselor just because you see them for one session. In fact, you don't even have to finish that session! If they feel wrong for you it's OK to politely excuse yourself before the hour (or 50 minutes!) is up and leave, provided you pay the bill for the full session. Warmth is a biggie for me so if the person concerned is cold and critical, I don't sign on for another session.

However, I would recommend seeing someone face to face even if they sound off-putting on the phone. My favorite ever counselor sounded awful on the phone but was lovely in person.

How do you know whether it's worth staying? Here's some tips:

• you feel listened to and understood
• you feel respected
• you feel safe
  
• the therapist wants to take the same approach as you.

The last cannot be guaranteed, even if you're seeing someone who specializes in the type of therapy you want to do. I once went to great lengths to get an appointment with a psychologist who did cognitive behavioral therapy, back in the days when it wasn't that common. But despite me telling her over and over again that this was the type of therapy I found helpful and wanted to do, she insisted I needed what she called 'supportive therapy'.

You would think 'listening' was a no brainer but no - I did see one person who couldn't stop telling me irrelevant and annoying stories about herself. Obviously you want the therapist to say something - just not too much! And you also want responses that acknowledge what you just said and how you're feeling.

As for 'safe' and 'respected', that means things like - the person doesn't insult you, patronise you, jump to conclusions about you or come onto you. (It happens!) I saw one psychologist who was very angry and aggressive towards me, because she was also seeing a friend of mine and didn't like the way I'd acted towards her. I lasted the hour, but after talking it over with my partner decided not to go back again! (N.B. while the therapist is long gone, my friend and I are still going strong!)

It may take a while of seeing different therapists before you work out what works for me. It took me a couple of disastrous people to work out I needed someone very warm and accepting to work with. One good way to work out what kind of therapist you might get on with is to think about what types of people you most like in every day life = and what sort of people you avoid!

As for what type of therapy to choose for depression, that's a big question that it will take me quite a few posts to answer.

Has anyone reading this post had an interesting experience trying to choose a therapist?

A good self-help book is a good friend

In the course of averting a relapse over the last week, I did something that surprised me. I reached for two books I haven't looked at for a long time. The first was The Feeling Good Handbook by Dr David Burns, one of my personal heroes. There are things that he says that I don't agree with, but in general I find his advice incredibly useful. I certainly think I wouldn't still be here without his gentle and wise counsel, via the pages of his books. One of the things I love about David Burns is his honesty. He is not scared to talk about the times he felt scared, or acted silly, and that always makes me feel better about my own human foibles. Another is his compassion. He truly cares about people who suffer from the painful illness of depression, and this is as healing as any technique he writes about.

I didn't read much of the book, just dipped into it here and there to refresh my memory. What I don't agree with is his view that cognitive behavioural therapy is enough to cure depression. This might be true in cases of mild depression, but for me it has not been enough. I've found it incredibly helpful, but not sufficient on its own to lift the grey clouds completely and let the sun shine through. But in my current situation, I know that the problem is more the view I'm taking of my circumstances than the circumstances themselves. So cognitive techniques are very relevant here, as they help me to think about the aversive aspects of my life in a way that isn't emotionally overwhelming. I've done so much cognitive work over the past...gosh, almost thirty years, that just a brief refresher was enough to put me back on course. That and a trip to the seaside over the weekend, to spend time with friends and family.

The other book is The Art of Living by the Dalai Lama, another book that is gentle, compassionate and healing, as well as containing great practical advice. But I'll save that for another post.

Is accepting negative emotions enough to stop them?

The other day I posted about how valuable I find simply accepting my negative emotions for reducing them. Not long after I stumbled on the power of acceptance I discovered there's actually a therapy that incorporates this called ACT - Acceptance and Commitment Therapy. I read up on it and to my surprise found that the founder seemed to be advocating simply accepting negative emotions and not doing anything else. Now, I may have got him wrong, but this is not what works for me. While I love using acceptance because it's so simple and takes much of the stress out of managing my negative emotions, it is by no means the only technique I use. It's my first step in most cases, particularly when I am busy or ill (or just can't be bothered thinking about it!). But I also use other techniques, such as writing down the good things in my life, examining my thoughts for distortions and correcting them, planning my day and doing problem solving. When it comes to transforming depression into happiness I've found there is no 'magic bullet', no one pill to cure all ills. What I've found works best is instead using a range of techniques that make me feel better and have a good fit with my lifestyle, vaues and personality. Together they seem to have a synergy (that dreaded buzz word!) whereby using them all together creates a more powerful impact on depression than using any one alone. I really wouldn't want to rely on acceptance alone, but I'm glad it's one of the tools in my toolbox because it makes life a lot easier.

Cognitive therapy made easy

If you look at a self-help book on cognitive therapy it can look a bit overwhelming and difficult. But it’s actually a lot easier than it looks. Also, some people find that writing down their upsetting thoughts makes them feel worse, so they avoid doing it. That’s probably because they believe these thoughts, and so focusing on them makes them feel bad. It’s a real shame because for me changing negative, destructive thoughts for ones that are more supportive and fair to myself can make a huge difference to my mood. I’ve found a couple of strategies that really help me do it quickly and easily without feeling worse.

1/ building up my positive mood before I consider my thoughts by watching a funny or uplifting movie or play or spending time with someone who makes me feel good: this puts me in a good space to look at my ‘stinking thinking’ and immunise myself against it a bit more. Not only that, but research has found that positive emotions help people think more clearly and creatively, which is good for spotting thinking errors and replacing them with new thoughts. ‘Why bother with the cognitive work?’ I hear you ask. ‘Why not just do the funny movie?’ It’s because I’ve found that my thoughts are HUUGE in making me feel bad so changing my thinking really helps me feel better and protects me against future depression.

2/ asking myself some key questions that cue me into looking at things differently: Look ma, no writing! It can be done in written form but I find it works just as well doing it in my head. My favourite questions are:

Am I focusing on the negatives and ignoring the positives?
Am I catastrophising? Is there a chance things might not be as bad as I think?
Am I criticising myself? What can I say to myself that is nurturing and supportive?
Am I blaming myself for things that aren’t my fault? What are ALL the reasons this bad thing happened, including what other people did?
Am I predicting negatives that might not happen? What are the positives that could happen (including things that have actually happened before)?

It could be worth putting this list somewhere you can easily see it, like behind your bedroom door, to remind you what to ask yourself next time you’re feeling down.

Not every therapy works for every person

It’s easy to think that all anyone has to do to get over depression is pop a pill. But not everyone who takes a pill gets happy. I’ve talked to numerous people who’ve tried antidepressants and felt only slightly better, if that. Which is not to say that antidepressants don’t work – they do. But it’s a matter of getting the one that’s right for you and there’s almost no way of knowing which one that is until you try it. Finding it can take months.

But there are more types of therapy out there than you can shake a stick at so if drugs don’t work (the legal type) then something else probably will. It’s a matter of knowing what the therapies are and having the stamina to keep trying them until you find one that does the trick. It’s unlikely that every therapy will work for everyone. This is just common sense. Someone who’s too ill to exercise much (like me) or simply doesn’t like exercise is unlikely to find that useful. Someone (again, like me) who finds meditation boring and onerous isn’t going to do it, no matter how much they tell themselves it works and they ‘should’. And a therapy you don’t do is unlikely to have an impact on you!

Even if you make yourself do it it’s not necessarily going to work for you. Research on antidepressants show they work for over half of the people who try them. None of them work for 100% of people. Ditto cognitive and interpersonal therapy. It’s a case of different strokes for different folks. We’re all made slightly differently so it stands to reason that we are going to need an approach that suits our unique makeup, both so we will actually keep on with it and so it has the most chance of working.

Therapy can appear useless if it’s done wrongly

Sorry to drag the dog into it again, but as I’ve been training him over past weeks it’s got me thinking about how things sometimes appear not to work because you get only part of the story. When I first applied the Dog Listener techniques from the DVD to Barney his biting got worse. A dog obedience leaflet had helpful information and Barney improved in some ways, but not his biting. Finally I got the book of The Dog Listener.

Reading the book I realised the most important things had been left out of the DVD. Using the full techniques I could soon walk round the yard and sit on the sofa without being bitten and barked at. Whereas when I’d done what the DVD suggested – holding him by his collar until he stopped – it had turned into a vicious wresting match. It didn’t work at first because I learned only part of what works.

I’ve had similar experiences with therapy. Cognitive therapy works for most people. But I’ve had a therapist who made it fail by not treating a relapse. Some psychologists have done it by rote, showing no understanding of the underlying principles. One therapist was so cold he undermined the positive impact of cognitive therapy. If I hadn’t known it worked I would have given up.

And even cognitive therapy wasn’t enough on its own – I needed more to be happy. When I added bright light, proper diet, omega 3, vitamins and minerals, regular exercise, more close relationships, a focus on the good things in life, relationship skills, relapse prevention, work I enjoyed and stress management I got happiness.

What I learned from this is not to give up on therapy just because of one bad experience. The Osmonds sang ‘one bad apple don’t spoil the whole bunch, girl’. My lyrics go ‘one (or even two, or three or more) bad therapy experiences don’t mean the whole bunch sucks – give it one more chance before you gii-iive up on therapy’. OK the scansion sucks, but the message is clear. Therapy can help. If it’s not helping it’s worth trying a new therapists and/or therapies and/or more types of therapy until you find the right one(s). That’s what worked for me.

Why don’t more depressed people write about getting happy?

Yesterday’s post about books that have helped me feel better got me thinking about why there aren’t more books by people who’ve transformed their depression into happiness. In fact, counting them up on my fingers there are exactly…none. Actually that's not completely true. On the Edge of Darkness edited by Kathy Cronkite has at least one story of someone who found happiness. But as someone with a long and serious history of depression who is now happy for most hours of most days I find the lack of such books amazing. Why are the shelves not full of them?

It’s not as if there are not a lot of effective therapies about. Cognitive, behavioural, TLC (that’s therapeutic lifestyle changes for the uninitiated), ACT (acceptance and commitment therapy), omega 3 fatty acids, interpersonal therapy, exercise (both aerobic and anaerobic), bright light, positive psychology…there are more effective therapies for depression than you can shake a stick at. So where are all the books by people who have found happiness as a result of doing these therapies? This is a message that people suffering from depression desperately need to hear – that it is possible to be happy if you do proven effective things. That's my experience anyway.

Success (sort of) using problem solving techniques

Today I went and sat in the sun with Barney on his duvet and we had an almost bite-free pleasant time. He snuggled into my side, biting on his chew toy instead of me or my clothes. This is such a contrast to even two days ago when sitting on the duvet with him outside would lead to a vicious wrestling match ending with me angry and nursing sore, bleeding hands, almost hating him. Now Barney is snoozing by the wood burner on his blanket, looking like a placid puppy who wouldn’t dream of biting anyone.

This seems like a miracle, and I hope it lasts. I achieved it the way I’ve achieved every improvement in my mood, every conquest of a relapse of depression – by trial and error, researching the evidence, reviewing what I’ve tried so far – what worked, what didn’t – and brainstorming new ways around the problem. My father taught me problem solving techniques when I’d had a fight with my best friend at 16. Despite initial scepticism I found them marvellous and have used them ever since. They’ve been reinforced by the problem solving approach inherent in cognitive therapy, which I’ve been using for over quarter of a century.

So it is natural to apply a problem solving approach to the Barney situation. I know I’m doing something that is accidentally rewarding his biting. Somehow I need to get the message into his little doggie head that biting results in no fun. I’ll keep trying, reviewing, revising until I get back the non-bitey dog I first knew and liked. I just went outside and got nipped again so it’s back to the drawing board, but I know I’ll get there in the end if I just keep trying and don’t give up.

Light up my life – puhleeaaase!

I cannot believe the difficulty I’m having buying a light box. I suffer from mild SAD – Seasonal Affective Disorder (one of the finest acronyms ever invented, in my book, and I am a connoisseur of acronyms). Normally I cope with it by going for a walk every morning. Since walking any significant distance has become a no-no because it knocks me out for the rest of the day, I’ve had to look for other solutions. Apparently the winters in my new home are long and grey, so I thought a light box would be a good idea. My approach to getting happy and staying that way is that ‘every little helps.’ I use lots of different techniques at the same time, working on the theory that the cumulative weight of them will make the positive difference. I’m not interested in finding a magic bullet – in my experience there is no such thing. What I am interested in is proven effective techniques, and lots of them. Even cognitive therapy, without which I would not want to be in the world (and probably would not be), is not enough on its own for `me.

For someone whose depression started later than mine did, or has been less severe or less chronic, one, or even two, techniques would probably be enough. Like exercise and an activity schedule, or meds and cognitive therapy. But I’ve found that I need many more than that to stay in the feeling good zone. Currently I use cognitive therapy, behavioral techniques, diet, St John’s Wort, fish oil (for omega 3 fatty acids), a mix of vitamins and minerals, keeping note of positive things that happen and things I’m looking forward to, social contact and support (a wonderful counselor), a rough activity schedule, savoring, and others. Bright light and exercise are two of my favorites but they are harder to do now that my energy is so limited. Hence the attempt to buy a light box – it may be just enough to give me that extra edge and help me stay in my happy place. Why it’s so difficult to buy one in New Zealand I have no idea. The best offer I’ve had so far is from a company who can ship me one from their Netherlands warehouse. That might be the best I will get. But I will keep on trying to find one closer to home.