The treatment programme I chose is CBASP – “Cognitive Behavioural Analysis System of Psychotherapy” – mainly because it promised results where other therapeutic models fail for chronic depression. Not that I had a history of failed attempts in psychotherapy to look back upon; I was completely therapy naive.
Ultimately, it was because the task of finding a therapist was almost too much and I was constantly afraid I would make the wrong decision: it was bad enough that I had to deliver myself into the hands of a stranger and I worried about ending up with a “charlatan” and having to look for another one. CBASP seemed to offer at least security in terms of treatment options; I wouldn’t go wrong with that.
CBASP is a talking therapy that largely relies on “Situational Analysis (SA)” as a treatment tool: by analyzing everyday situations in regards to behaviour, thoughts and emotions as well as the actions and reactions of all people involved, you learn to adapt your behaviour accordingly. If you got what you wanted, the SA reinforces desirable behaviour, if not, you work out alternative strategies together with the therapist.
As simple as it sounds, I find this approach quite helpful, because its set structure makes you think situations through rather thoroughly and also helps you figuring out what it is that you want, or why you want it. It leads you away from thinking “I wish person XY would stop doing that” or “Why can’t he/she do this?” and instead makes you think “Ok, what can I do to change how this makes me feel?” Even if said person continues with the pattern, you stop feeling helpless and hopeless about it once you run it through a short SA.
Within the Situational Analysis, the therapist uses a number of therapeutic measures, for example the Socratic dialogue, feedback about body language or the way you speak, and roleplaying. The latter is something I don’t like at all, even though in the long run it certainly helps, but usually I find it rather embarrassing to go through those staged situations and repeat them – not that my therapist lets me off the hook because of that. It’s almost funny that I’d rather tear my inner turmoil out to be exhibited for an hour than do five minutes of roleplaying.
CBASP assumes that patients with chronic depression don’t feel “safe” in interpersonal relationships and as a result develop avoidance patterns. For me, this is certainly true. I’ve been very shy all my life long, even before entering kindergarten; but instead of outgrowing it, my social skills only became worse. I became, simply, afraid of other people. Fear of rejection, fear of being shamed or ridiculed or criticized, but also the nebulous but nevertheless persistent conviction that interacting with me must somehow be very unpleasant for other people.
I have never enjoyed parties and usually counted the hours until I could leave without offending anyone (there were a very few exceptions only over the years); later, I wouldn’t even attend in the first place. My new friends from university I lost again because they never saw me outside of class anymore and eventually I had become so afraid of my professors and fellow students that I didn’t even go to lectures or classes anymore. I would leave the house and visit the botanical gardens or a museum or go window shopping in the city centre instead – all activities where I avoided getting personally involved with anyone.
Rationally, I was aware that my behaviour was not “normal” anymore and that all I had to do was entering the lecture hall, sit down, listen, take notes and leave again. But even this had become such a source of stress and potential threat that I broke out in sweat on the way to university and on eight out of ten occasions skipped lectures.
Looking back, I do realize that the worst could have been avoided if I’d sought out help back then, but that would have involved making contact with therapists or doctors too – it appears I had to hit the proverbial rock bottom first before managing getting over myself.
Which makes me all the happier with the therapist I’ve got. CBASP is a bit different from most therapies as the therapist gets personally involved with the patient on a controlled level. You get to know the person “behind the title”, you get personal feedback. It’s part of what’s supposed to make you feel better through teaching you to discriminate between people and not expect the same behaviour out of everyone.
All the new friends I made over the last years I met online, and I always had plenty of encouragement to pursue these relationships that prevented me from “avoiding” them. By the time we would meet in person, I knew them so well that I was willing to endure all the anxiety prior to the meeting (“Oh God, they are going to despise me! They’ll think I’m dull, unpleasant, unfunny, fat, ugly and absolutely disgusting and will never talk to me again. Ever.”) and come out of the meetings relieved and – again – with plenty of reassurance from their side. But in everyday life outside the internet, my problems and self-imposed isolation persisted.
With my therapist, it was a gradual process of getting to know each other. Sure, I told him lots and lots of very personal facts about me during the first couple of hours, but I think I remained… cautious in the beginning. Now, I feel a lot more relaxed around him; in the beginning, I’d trust him because it was his “job to be trustworthy”, now I trust him as a person (if that makes sense to anyone else).
He also will give me feedback to let me know how I come across, or he will highlight how different behaviour can change the message one sends, even if they are trying to communicate the same fact.
I read that one of the characteristic of chronic depression is “global thinking”, basically meaning that you tend to see your problems and shortcomings in a very generalizing way instead of focusing on the specific cases: “Nothing ever works out for me.” – “Nobody understands me.” – “It doesn’t matter what I do, I will always fail.” – “My life is a series of failures.” – “Everybody thinks I am stupid.” I’m guilty of that, too. Not always, but sometimes, and it makes you give up after a while because “nothing is going to change anyway.”
You could say, they are trying to re-wire my brain in therapy: change the way I think, change the way I behave, alter my perception. At times, I slip back into the old patterns first and have to remind myself that this is not the way I am supposed to do things anymore. It’s not easy, but the difference is so noticeable that even if I doubted the premises of CBASP – which I really can’t, because they describe my past behaviour so accurately – I’d have to admit it.
I believe another reason for not getting therapy any earlier was being afraid that therapy would change me and make a different person out of me. Again, it took a long time and probably unnecessary suffering to realize that the depression changed me more than any therapy possibly could. It took away the joy in about anything I once loved doing and reduced me to a helpless, miserable something that only got out of bed because other people expected it.