In my work, one of the hardest things I face is letting a client know that it’s time move on. There are many reasons for ending therapy, and I’m going to explain some of them so you can see how complex the decision can be. I’ll start with a couple of reasons why clients end therapy.
If you go into a bookstore, or on a e-commerce site that sells books, you'll notice that the self-help section is huge. Really HUGE. It seems like we want to improve so many areas of our lives - our size and appearance, our love life, our business and work lives, our mental health, and so many others. There are self-improvement programs you can buy online, and the books are full of ideas that you can use and apply to help improve your life. However, when we buy these programs or try these techniques, many times they don't seem to work - why is that?
There are a few reasons that might explain this. One factor is that our time and energy is limited. We get caught up in work and work issues, daily hassles like cooking and paying bills, family responsibilities... If you think about it, you'll find there are many, many reasons that we don't accomplish all the self-help and self-enhancement programs we purchase. All of these activities take time, and they take energy. When we do have a few minutes for leisure, many times we want to do something else. It's understandable - if something feels like too much work, we tend to avoid doing it.
Another factor might be lack of support. We know that when people have support, they're more likely to make changes and they're more likely to stick to them. Beginning an exercise program is a great example: You're way more likely to keep moving and exercising when you have someone there with you. They support you, and to some extent, keep you accountable. Your coach is there to mentor you and to cheer you along as you creat the life you want to have.
Accountability is the third factor I want to mention. I'm not thinking about accountability in a pressurized "have to" sense. Rather, I am suggesting that having another person to work with who knows your goals, your struggles, and your strengths can be an amazing support for you as you work to reach those goals and change your life!
I love the word "coach" - it has such a positive connotation. Coaches share their knowledge with you, support you as you challenge yourself to reach goals (and challenge you themselves by nudging you toward your goals), and celebrate progress and life changes as they happen. It's a life-affirming, positive, and healthy profession.
I think I mentioned this story in another post, but I'll tell it here again because I really like the analogy. This was written by a teenage girl who had been dealing with chronic depression. She wrote that it starts with having a bad day. Everyone has bad days, though, right? You don't think about it too much, and go on living your life. Ok, so you have a few more bad days mixed in here and there, but again - everyone has bad days, so it's nothing to really worry about...Then you realize that you're having more bad days than not, but you don't want to think about it because it might jinx you and bring on more bad days - everyone knows that if you let it get to you, then it gets worse, right? So...finally you realize that the bad days are winning - you feel awful, life doesn't seem to have a whole lot of purpose and the future looks bleak. You realize that the beast has caught up with you again, and that you're depressed.
Depression feels like a heavy weight, a wet blanket, and day upon day of lousy weather all rolled into one. AND, it's more than that. To use the example of an antidepressant commercial, depression hurts in a lot of ways - physically, emotionally, mentally, and interpersonally. You feel rotten, it's hard to think clearly and/or move, life sucks and nobody around you seems to understand or care, or care enough. You feel like things will never change or get better. It's bleak.
I'm not going to lie and say there's an easy way out - there isn't. Honestly, what I've found works the best is a combination of medication and psychotherapy, and I'll tell you why. From what I've seen, it's like fixing a house with a cracked foundation. Having the foundation cracked doesn't mean that the house is broken or useless - far from it. It means that some repair work needs to be done, and that the house can be and is worthy of saving.
So...to begin the repairs, you first have to shore up the house, right? Using medications is like shoring up the foundation - it helps get the biological, chemical piece working again so you can get at the root cause and work on that. That's where psychotherapy comes in. Even if there is no deep, dark past to examine, therapy can help you figure out what triggers depression for you, how to recognize it and the warning signs, how to cope when it hits, and how to let other people know how to help you. Therapy also gives you a chance to really let loose and talk about what it's like to feel and deal with depression - with someone who's not going to judge you, tell you to "pull yourself out of it," or try to fix your problems for you. It will give you someone to talk to, who's got some training in how to deal with it, and can help you develop and practice skills for dealing with it.
Now, that said, I realize that for some people depression is more biochemical than anything else - therapy can help you too, though - in the ways I mentioned above. If you do happen to have things in your past that are affecting your mood, therapy will almost certainly help you with that - but you don't have to have had trauma, abuse, or other painful past experiences in order to benefit from therapy.
Ok, before I start sounding too much like an informercial...what can you do on your own? As trite as it sounds, I usually recommend that people start at the beginning. Accept the reality that you're dealing with depression. For some people, that alone is a huge step - there is still stigma out there about "mental illness" and many people don't understand what depression is, or how it affects you. So, accept reality and then realize you have a choice in how you're going to deal with it. (Yeah, I'm taking a page from my DBT training - radical acceptance again!)
Dealing with depression takes a LOT of energy. Depression is a condition that saps your strength - emotionally and physically. It feels sometimes like you're trying to slog through thick, sticky mud and is every bit as exhausting. You can choose, though, whether you're going to stay in it or not, and there are consequences either way.
Choosing to try to move out of it means choosing that you're going to move, even if it's just a little bit. It's a form of opposite action. It may mean something as simple as getting up and taking a shower, or making yourself go outside for a few minutes.I tell the people I work with that I don't underestimate how much of an accomplishment getting out of bed is. It might be the only major movement someone has made in days or weeks. Moving may mean more - calling a friend, a doctor, or someone you trust and asking for help (and believe me, I know that's HUGE.) Either way - if you're going to choose to deal with it, it means YOU have to do something. And, as I always say (and mean), seeking help really is a sign of strength, and not a weakness in any way, shape, or form. Moving - and then moving consistently are important parts of this process.
If you choose not to deal with it, then you have to be willing to take those consequences - it may mean that someone else has to make decisions for you, if you're not able to do so. It may mean giving up some control so that someone can get help for you...it may even mean hospitalization for some.
One thing I want to make crystal clear here is that I don't think that being hospitalized is shameful. In fact, I believe that it's helpful, and that getting well and being able to function is the goal - and I realize that there are many of you who disagree with me, and I respect your right to do so. After all - I'm not walking in your shoes. However, if you're not able to or are unwilling to make decisions for your care - or if you're self-harming or threatening to self-harm, hospitalization is a possible outcome for your safety and well-being.
The point of all this is that I'm assuming you don't want to deal with feeling depressed. You can't control what's coded in your genes, but you can choose how you're going to deal with it. And I'm not saying that positive thinking, affirmations, etc. are going to magically pull you out of it. These may help, but depression is a lot more complicated than just negative thinking. You can choose to shore up your foundation with meds, or you can choose not to. You can choose to use therapy, or not. You can choose a combination of the two - the point is, you have a choice.
When you're in the throes of a major depression, it may not feel like you have any choices, or that no matter what you do it's not going to work. This is where you have to use your active trust - your emotions are not necessarily giving you the best information, and you may have to let your head overrule your heart on this one. Get help if you need it, and help yourself. Depression is nothing to be ashamed of, any more than kidney disease or diabetes is. It's a treatable condition, and there is hope.
Does getting help mean it's going away for good? For some people, maybe...for others it means that the beast is pushed away again for a while, but will keep following you. For you...well, learning about your triggers, symptoms, etc will help you. Learning this stuff also helps you feel more in control and stronger - nice side effect, huh? One great program, developed by a lady who both does therapy and has bipolar disorder is called the "WRAP program."
WRAP (Wellness Recovery Action Plan) is a system that helps you recognize your triggers and symptoms, and put into place a plan to help yourself feel better. If that plan doesn't work, WRAP also helps you develop a plan that tells who you want involved in your care, how you want to be treated, and who can make decisions for you. It's a great system, and Mary Ellen Copeland (the creator) has some great articles on her website: www.mentalhealthrecovery.com. The purpose of WRAP? "Getting well and staying well." Copeland is also the author of several wonderful self-help books/workbooks for coping with depression and manic-depression - her work is widely respected and used. (I highly recommend her books both to clients and non-clients.)
So, bottom line is that even if it feels like there is nothing you can do or that nothing you do works or has an effect, there ARE things that will help. Talking to a therapist (heck, talking to someone you trust, period!), working with medications, using some great self-help resources, and your own strength all help. (And yes, you ARE strong - it takes a lot of energy to deal with this!) Cognitive behavioral therapy is one route that seems to help a lot of people - Copeland's books actually use a lot of CBT-style work. DBT skills help too - trying them won't hurt, and you have a lot to possibly gain.
Just remember - you're not alone, even if it may feel that way. There are many, many people who are dealing with and have dealt with depression. I have tremendous respect and admiration for those of you dealing with this, whatever the root cause may be. It takes a lot of energy and strength, and pulling yourself out takes even more. You're not alone - really.
Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.
If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: email@example.com
Today, I went for a walk. That might not seem like a big deal, but for me it was a change, and I’d like to share its importance with you. I moved, and that IS a big deal. I’ll explain why it’s a big deal in just a bit, so bear with me while I give you some background first.
Like many of you, I struggle in this economy. I try to be financially fair to the people I work with, because I realize that services like mine are expensive, and I want people to be able to get the help and support they need. This has been hard for me, though, because I struggle financially as well. I have been waiting for things to change, which brings me to the purpose of this post and the next few to follow. I’m finding that if I simply sit and wait for things to happen, I feel depressed, anxious and frustrated – and I’m generally not a pleasant person to be around when I’m feeling this way. A lot of us are like this - I know I'm not alone.
So, I decided to change the way I’m looking at my situation and living my life. Here’s where coping with tough times and moving comes in. There are things I can’t control, like the economy, and the fact that many of the things I'd like to do in my business rely on people wanting what I have to offer. There are a multitude of things I can’t control, and if I focus on them, then it’s an easy slide down to feeling lousy.
However, I CAN control myself and how I choose to react to this situation. After talking to people and experiencing unemployment myself, I know that it’s very easy to slip into feeling helpless, hopeless, and paralyzed about the future. There IS something I can do though. I can move. I can move my body, my mind, my feelings and my thoughts.
Ok, I can hear some people groaning, “Oh no…another Little Miss Sunshine who thinks that if I think good thoughts, everything good will happen to me.” So… hang in here with me. I’m NOT going to promise that if you change your thoughts you will automatically attract good things. What I AM telling you is that if you work to change the way you’re thinking, feeling and being now, you may start to feel better. How do I know this? I do it. It's the simple - I practice what I preach.
What I’m suggesting is that you move, somehow – even if it’s just getting out bed to face the day. Moving can be as simple as reframing your thoughts from “I’m never going to get a job” to “Things are tough right now. I’m doing the best I can.” Moving can be, “OK…I’m feeling pretty crummy right now and I have no money. What CAN I do to help myself feel better?” and coming up with ideas. Moving can be noticing the very little, simple things that make life worth living. For me, this is the smiles on my children’s faces and hearing their laughter. It’s feeling the sunshine on my face and noticing the colors and fragrances of the spring flowers. It's enjoying the feel of the wind on my face. For others, it might be the smell of a freshly-brewed cup of coffee, or the feel of your favorite blanket wrapped around you. The point is, moving – no matter how or how much – is a change that may help you start to feel better. And that’s why my walk today was so important – I moved.
I moved my body, and while moving my body, I moved my mind. Moving my mind (thinking) helped me move my feelings. During my walk, I thought about what I have to offer – what are my skills and talents? What am I passionate about? I thought about how to share what I know with others who might be feeling the same thing. And I felt better about myself, in spite of my job situation. I thought about how to market myself, and what I can do to promote my business. In short, moving helped.
SARK has made some worksheets that come from her book “Make Your Creative Dreams Real” involving what she calls “microMOVEments.” These involve taking baby steps toward creating and realizing a dream that you have. Whether you call them baby steps, micromovements, tiny leaps of faith – it’s still movement.
The world isn’t necessarily going to change because you move (but who knows - maybe it will!). However, YOU may start to change because you move. Honestly, this post – and the idea of coping with tough times - came out of my desire to feel better. I am “moving” by writing and sharing my knowledge with you. I can’t change the world, but I can offer my skills and gifts as a way to help me feel better and to hopefully make a difference for others who feel like I’ve been feeling.
I’m going to continue to write on ways to cope in tough times. If you have suggestions on topics you’d like to see, please get in touch with me: firstname.lastname@example.org. I’m always interested in feedback and ideas. For you? Move with hope in your heart and life in your soul!
Please Note: The information on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral. If you are in crisis or danger, please call 911 for immediate help.
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