Thoughts On Psychotherapy

Last autumn, the clinic contacted me regarding a follow-up evaluation for the medical study. Actually, they had first contacted me in summer, but my family and the paperwork for the renewal of my husband’s residency permit kept me so busy that it got pushed out of my mind. After their last reminder, I offered to drop off the questionnaires in person – I had an appointment with the psychiatrist anyway, and it’s less than five minutes driving distance between the two locations. That way, the clinic would have them faster than via traditional mail, and I’d feel a little less guilty for making them wait so long.

The evaluation mostly consisted of self-report questionnaires like I had filled out so many times before in therapy. The most difficult was a section where I was supposed to rate the difference between summer 2011, when the clinical trial ended, and autumn 2015. On paper, my situation sometimes didn’t look all that different, but on the inside it sure felt like a world apart.

So one dark December afternoon, I was knocking at my therapist’s office door again. I felt a lot more nervous than I had anticipated: I hadn’t seen him in three years, and still didn’t know what medical problems had caused him to terminate back in 2013, whether he’d be visibly altered.

When he stepped out of the door, he looked maybe a few pounds heavier than I’d remembered, but definitely healthy. There was an emergency meeting going on in his office, so I couldn’t go inside, and he had only a minute, but “didn’t want me to leave without saying hello”. He showered me with questions, of which I managed to answer less than half, and we agreed to meet again in January after my next psychiatric appointment.

I wasn’t any less nervous about the January meeting than I had been about the December one. It was scheduled as a follow-up, because strictly speaking he was not allowed to see me outside the medical study – the clinic has stopped outpatient treatment completely, with the exception of clinical trials. Which buried my hopes for ever going back to therapy with him for good. Since he had already received my questionnaire, he was somewhat in the loop of what had happened in my life over the past three years.

“What would you say is the biggest difference between now and then?”
I had to think about this one for a moment, then replied that I felt like I had grown up. That I didn’t let people trample all over me anymore, that the person I used to be just a few years ago seemed like a stranger now.

It’s true in many respects. I don’t have that crippling feeling of worthlessness anymore. Not that I think about how awesome I am all day long – I just don’t bother with that topic at all, neither in the positive nor in the negative sense. It’s just become irrelevant for my life as it is now.

Both the therapist and I agreed that I had responded extremely well to psychotherapy. I am convinced that a lot of the positive developments that were planted in therapy only came to full fruition two or three years later, when I was not having sessions anymore. I don’t even know how to describe it properly, other than that my brain got rewired.
He used that phrase a lot when I first started, but I only came to understand its true meaning now: in situations where everything happens too quickly to think about the best strategies, my brain defaults to different reactions than it did in the past. I stand my ground, I defend myself when attacked. All those hours of roleplaying these scenarios during the sessions are paying off.

I also have the situational analyses internalized, so when I find my mood tanking, I ask myself where I did not behave the way I wanted to, and what I could do better next time. I may sound like an infomercial that tries really hard to sell its product, but psychotherapy was the best thing that might possibly have happened to me.

Here’s the catch: it takes a long time to become fully effective. It only happens when you master a situation you would have failed previously – even when you don’t consciously register it, your brain notices that the new strategy was successful and is more likely to try a similar approach next time. So it takes a row of successfully averted crises for the new behaviour to grow roots. If you are like me and try to avoid adversity, it might take a while until you had enough exposure to such “opportunities”.

Of course, CBASP does not change your personality. I am still introverted and shy. But it gave me the tools to fix the holes in the hull that would have made my ship sink in the past.

The meeting with my therapist was over too quickly. I miss him – or maybe not him as much as what he had to offer (that sounds horribly selfish, but essentially what a therapist-patient relationship boils down to): a safe environment to try out new behaviour. Somebody who asked questions that opened up fresh perspectives. Especially the latter.

Of course, I could just start looking for a new therapist, but regardless of who I’d see, that person would never know the “old me”. The Layara who showed up on the clinic’s doorstep in 2010 was so afraid of everything that I’d never be able to properly communicate this to any other psychotherapist.

Then, there’s the question of familiarity. He is “tried and tested”, I know what to expect from him. With any new caregiver, a lot of time and effort would go into reaching that same degree of comfort.

Time is the third problem. Health insurance pays for 26 sessions every two years, and I always wanted to keep that option as my safety net. I don’t want to use them up and then be left with nothing to fall back on if disaster strikes!

And even if I decided to do that, there’s only one CBASP therapist left in my area, with long waiting lists.

When discussing this with the psychiatrist, she basically said she thinks my development over the last six months was promising enough to not necessitate any further psychotherapy right now – that I should see where the new medication and new circumstances (my husband’s new job) take me, and then make a decision. I agree with her – I certainly feel too well to use up my 26 “emergency sessions”. And for paying out of my own pocket we are too poor.

Maybe it is for the best. It took me more than a year to come to terms with the sudden end of therapy, but it also forced me to stand on my own feet. Ultimately, I was ready to do so. And in January, we parted on the promise to keep in loose contact, so unlike 2013, I did not feel like I had to say goodbye for good.

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Depression Symptoms & Antidepressant Side-Effects Assessed

It’s becoming very clear that despite taking twice as high a dosage of venlafaxine / effexor now, the timed-release capsules work much better for me. The nausea and vertigo vanished completely, and in the mornings I don’t go through withdrawals anymore either. I do feel quite drained from the experiences of the last three weeks, though, very tired and listless. I lost 6 kg (13.2 lbs) – 4 kg over the first weekend and another 2 kg since – and even though I would welcome further weight loss very much, it goes without saying that vomiting, diarrhea and skipping meals due to nausea is not exactly a healthy way to drop the kilos and at least partially responsible for the feelings of weakness. On top of that, venlafaxine also suppresses my appetite for a good part of the day, until it returns in the evening and I suddenly start scouring the kitchen for all the stuff I did not buy when shopping…
There has been no improvements of the symptoms I primarily started taking venlafaxine for yet, the cognitive impairments and lack of energy, but I do feel more emotionally stable recently. Next Friday I have a follow-up with the psychiatrist, when I’ll find out whether I’ll increase the dosage further or stay on it for the time being.

As for the welfare process and related paperwork, the main appointment at the job centre had been cancelled on Tuesday already because the lady had become sick, and the one who works on our case at the employment agency was replaced with a colleague due to illness as well. While being very friendly as well, this colleague could do little more than collect the forms we had filled out at home and the documentation we had brought. Other than that, we will have to wait for them to get back to us. I handed in the questionnaire on my medical complaints today; the question was: “Do you have medical conditions which influence your current job or have done so in the past? Please give a short description of your illness respectively your symptoms and tell us which kinds of occupation would be influenced by these.” The space left blank was less than a quarter or a page, so I could not go into much detail:

“Diagnosis: chronic recurrent depression with comorbid panic disorder.
– permanent / daily symptoms: muscle pain in legs and arms; social anxiety; slowed-down thinking; word finding problems; problems falling asleep (at least 2 hours / night); severe lack of energy; hypersomnia; decreased libido
– frequent symptoms (at least 3 days per week): stomach pains; digestive problems (diarrhea); back pain; memory problems; concentration problems; depressive emotions (sadness, emotional emptiness, hopelessness); headaches
– periodically appearing symptoms: insomnia
– under stress also anxiety attacks
– currently (since mid-March 2013) additionally vertigo, nausea and vomiting due to starting an antidepressant regime (venlafaxine)

Because of the diverse symptoms, I am physically, intellectually and emotionally affected with any kind of occupation.”

That is as accurate an assessment as I could give of my daily problems in such a small space, and each of my healthcare providers should be able to confirm them. I learned today that the medical service will first contact my general physician for information, which is a bit of a problem since at least 80% of my depression treatment has been done by my therapist; the general physician does get reports from my psychiatrist, but except for the fact that I have participated in the medical study he does not know anything about the psychotherapeutic treatment. I do hope they’ll get in contact with him as well – if our regular case worker had been present today, I would have asked her, but her colleague was not familiar with the protocol in such cases.

Welfare & No Therapy

Yesterday I mentioned going on welfare, and that I had been in the process of writing a blog post about it when the news of my therapist’s illness made some of that draft obsolete. Here follows the part which still is relevant:

Financial troubles have been a steady companion for a long time: I cannot work a job on top of uni, and my husband wants to work, but is currently handicapped by a lack of language skills (even though he is making a lot of progress since he started integration class). We have been living off my husband’s savings, support from family members, and once we also had to borrow money from a friend. Our life is rather frugal: 80% of what I buy is on offer or from the “reduced box” – groceries which are about to expire soon and hence reduced in price. We do not go out or buy anything that is not absolutely necessary.
A while ago, my therapist came up with the idea of me going on social welfare, which would roughly equal the salary of a student job. I could not object based on pride as I am not in the position to turn up my nose at any kind of support available. But I kept putting off visiting the department of social services because frankly I was afraid of doing so. For starters, I have a bit of bad history with administration and it is a very anxiety-laden topic for me. But also, the idea of having a place to turn to in even harder times was so comforting that it was difficult letting go the promise of relief at the expense of possible rejection. It is a pretty stupid concept and I would advise everyone to just get it over with as quickly as possibly if being told this story. Inside my own head, however, things are not always straightforward.
Fortunately, I finally managed to drag myself there, with the result that the state support my therapist suggested is not even available for me. As a student, I fall into a different category of welfare which I have to apply for at the employment agency instead, so the journey continues for a while.

To repeat from yesterday’s post, I need a statement from my therapist that I am not capable of working a job; usually, it would be the employment agency’s own doctors who have to come to this conclusion as a result of their examinations, but with mental health problems, that is hardly possible.
Going on state support was not a decision I made easily, or even voluntarily, but it’s the only practical solution left. It would be great if someone gave my husband a job instead with which he made enough so that we could exist from that income, but that’s unlikely in the current situation. All I know is, if I have to work, that is the certain end of my university career – I tried before, and the result was that I prioritized my job over classes, because “without the money I can’t stay enrolled in uni either”, and I had not enough energy for both. And I do not have it in me to make a third start from scratch, should this second attempt fail. It is all or nothing in regards to uni now.

Life goes on, with or without me. With or without therapy. No matter how unfortunate it is that my therapist got ill just now, when I would have liked to be able to write to him about the whole welfare business, I need to try without him the best I can.
My last therapy session was in early December; the one scheduled for January didn’t happen, and it was a bit of a warning sign already when it took three weeks before my therapist could tell me when he’d have the next opening – we were supposed to meet at the end of March again. He’s been chronically overworked for at least a year: last spring / summer it was pretty much the same, when I’d have a session in April, then an emergency appointment in June, and then nothing until September. My blog is full with comments on staff shortage at the hospital. What’s sad is that on the last day we emailed, he told me he was currently working in a new colleague and that he hoped that we could have “at least one session per month” from April on.

I guess this post is rather all over the place, but all of this has become one huge “cluster” to me anyway.

On My Own

Since last week Monday, I had been waiting for my therapist to reply to an email I sent him concerning a statement I need from him to go on welfare (that is a post I meant to write in the meantime, but had not quite finished yet when events took a turn). In about 95% of all cases, I would get a reply within 48 hours, if only to tell me that he’d read my message when he was especially busy. Important emails like this one would always prompt a fast reply, though, and if he was not at the hospital, there would be an automated message about how long he’d be gone and who to contact during his absence in case of an emergency.
This time, however, the days went by without any sign. I was wondering about this, but since it is currently flu season and almost everyone is currently getting sick or recovering from it, I did not follow up on my original message – he would get in touch as soon as he could. My email had been flagged as high priority, too, so there was nothing else I could do.
This morning, as I checked my inbox, I saw an email from the psychologist who had organized all my appointments and psychological tests when I started the programme two years ago, and at that moment I knew something was not quite right. I called her back, and it turns out that my therapist has fallen seriously ill and will not be seeing any of his out-patients for the next three months. He has not been working for the past two weeks and will only return for reduced hours in March. I don’t know what happened to him – the psychologist did not tell me, and I did not ask since that felt like a transgression.

This has been a shock on several levels. To begin with, I can’t wait for that statement for three months. I don’t have anyone else who could give me one either, as my general physician knows hardly anything beyond the diagnosis, and I am yet to meet the psychiatrist for the first time. The psychologist, who will be organizing my therapist’s affairs while he is away, promised she would take care of the problem and work out a solution with him.
Then, I feel a bit like the rug has been pulled from under my feet: all of a sudden, my security net is gone. Since starting psychotherapy, I have been operating under the assumption that help and support is only an email or phone call away. And despite having gone for several months without sessions before, I feel better when having regular appointments every couple of weeks.
Finally, I am worried on a personal level. Even though our relationship is a professional one, I do not want anything bad to happen to him.

It will be a while until I have digested this. Not that anything about my everyday life changes, but psychologically this is a different situation now. I’m really glad about the psychologist’s involvement, to have someone to ask organisational questions this way. She’s really friendly and I trust her; just one problem: as the independent rater of the medical study, she must never know whether I received therapy or medication, and thus talking to her is a bit difficult as we can only use vague terms. I had “appointments” or “meetings” with my therapist, not “sessions”, and instead of “psychotherapy” or “medication”, it is just “treatment method”.

Help Me, Zopiclone

I did not think it was possible, but the last night was almost worse than the one before. It started promising: Got tired and went to bed at 10.20 PM, read for half an hour and switched the lights off at 10.50 PM. Fifteen minutes later, I was asleep – until 1 AM, when I woke up and was so alert that I could not force myself back into the realm of dreams. Got out of bed for a couple of hours, then back into bed, where I read until 6 AM. Lay awake for another hour and finally dozed off just after 7 AM again.

At least I did not cry this time, but it was even more confusing than simply staying awake. So for tonight, I asked my sister for one of the zopiclone pills she got prescribed for her insomnia last autumn. A definite first, as I never took any kind of hypnotic agent before, but I just cannot go on like this. I have tried everything to rectify my sleeping cycle and it only got worse, and even though I am generally not keen on using pills, I feel like I am going to lose my mind if I don’t get back to normal hours soon.

In other news, I have an appointment with the psychiatrist in four weeks. As the psychotherapy is covered by the fundings of the clinical trial, he has pretty much free reign to do with me whatever he deems fit, because with the exception of the citalopram two years ago, the health insurance did not have to pay for anything yet.
I’m not quite sure how I feel about all of this yet. I would have prefered to see my therapist as the psychiatrist as well, because nobody else knows my mental health history as well as he does, and quite frankly it would save me the hassle of having to get to used to another “stranger”. However, I have hardly any right to complain, and maybe it will even be good for something to keep the two treatment fields separated.

Come A Little Bit Closer

The news about the TV appearance were not the only unusual part of the last session. Two years of therapy mean that eventually, the appointments start to resemble one another; the discussions are important, but you know the routine and after a couple of weeks you recall brief scenes rather than the whole meeting.
Over the course of spring and summer, the hospital wing where my therapist sits got renovated and he had to move out of his office temporarily. He’s been back in the old location since September, but had decided to furnish the room differently: the set-up of desk, armchairs, file cabinets and the exam table is mirrored now. All of this was reason enough to break the routine and to make me feel uncomfortable at first. I got so used to always having the same perspective in that room that the familiarity of sitting in that armchair gave me a sense of security. Before that background, the last session took place.

Practicing alternative behaviours is a huge part of our routine: my problem is that I tend to do nothing at all and just remain silent when I should speak up instead, and so my therapist lets me reenact scenes we discussed, but where I behave the way I should have for getting a more desirable outcome. He lets me repeat phrases until I get the words and intonation just right, and then some more to “hammer” them in.
This is by far my least favourite part of therapy as it goes completely against my instincts of hiding myself away. When the acting was still new to me, I would occasionally break out in giggle fits due to the embarrassment, but that wouldn’t let me off the hook. My therapist would just sit there with a smile on his face, wait until I calmed down, and ask me to try again. Of course, I could just refuse and sit in my chair for the rest of the appointment, but that’s not what I go to therapy for… So, the best way to handle this for me is to get it over with as quickly as possible – the more I concentrate and the sooner I get it right, the fewer repeats we’ll go through.
Last time, however, my therapist decided to take it a step further: he had me stand up from the chair. I repeated my little speech two or three times, then he said:
“Come a little closer, please.”
I made a small step towards him.
“And even closer, please.”
Eventually, the distance had shrunk so much that I could have reached out and put my hand on his shoulder; since my therapist was still sitting in his chair, I had to look down on him – a position which makes me feel extremely uncomfortable, and he knows it. I had to repeat my sentences again, then he asked:
“What did you just think?”
“I was thinking about my arms, about how I have been clasping my hands at this really weird, crampy angle.”
“Your arms looked just fine. Why don’t you try a different position?”
I tried to relax my limbs and folded my fingers in front of me, but since I had also inched back a little in the process, I had to step closer again.
“How does that feel?”
“Ok. Better than the crampy clasp.”
“Try something else – why don’t you just leave your arms hanging?”
I did, but immediately felt like they ceased being a part of my body and turned into two dead appendices rather. I stretched and flexed my fingers nervously, hid my hands behind my back and then let them hang down again immediately.
“How does that make you feel?”
“Nervous. Extremely uncomfortable.”
“But you look more relaxed and more approachable. If you fold your arms, you are creating a barrier. And to me, these positions are comfortable. I don’t feel threatened by you at all.”
In the past, we had talked about how this particular constellation – he sitting, me standing up – made me feel like I was being this huge mass ready to bulldoze him. Like a gross, obese entity crushing him under my excessively large body. I am (by now) completely aware that a lot of the negative self-image and negative thoughts exist in my mind only, and that they are very much over the top, but that does not make them go away.
“How do you feel now?”
“Still nervous.”
“Look at my face. What do I look like?”
“Neutral. Relaxed.”
“How can you tell?”
“There are no signs of stress in your face. No creased forehead, relaxed eyes and mouth.”
“It’s good that you can see this!”
We talked a few moments about how I hardly ever relaxed when sleeping either, that I often woke up with my hands clenched into fists, and the muscle pain I had from that.
“How do you feel now?”
“A little better. Still uncomfortable, but not as much anymore.”
“Good! It’s very important that you experience this!”

When I was finally allowed to sit back into the armchair again, I felt fairly exhausted. We have done similar exercises before, but never that long and intense. Rationally, I know what this is all about: by exposing me to an uncomfortable situation and having me observe that the effect on my therapist is not a negative one, my self-image gets altered. Physical proximity is not a bad thing, and I am not causing negative emotions in another person by standing close to them. At the same time, I am forced to endure a situation I’d usually avoid, so that I can experience how the discomfort starts decreasing after a while.
Strangely enough, despite experiencing mostly negative emotions, thoughts, and despite how stressful this was, I felt really good after the session. In my family, nobody would ask how I felt, and if i talked about it, the standard response would be to pull myself together. In fact, that is what I used to do – so much so that I always downplayed all of that or ignored it even, and it felt good to acknowledge the existence of those emotions and having them taken seriously.

Going Public With Depression – On TV

In the first session after my recent participation in the student class, my therapist paid me a compliment on that. He said he could see a huge difference between the way I carried myself in April and November respectively. And then:
“I think it would look pretty good when filmed, too.”
I didn’t know what to make of this comment, assuming he was talking about having a camera roll in another, upcoming student class:
“You think? I don’t know – and can’t really tell; it’s not like I’d ever watch that anyway.” (We’ve had discussions in the past about whether I wanted to see footage from the early sessions, which were all filmed. I always refused.)
“We are planning a featurette for [news show on TV] next spring and I could imagine you making an appearance as a patient.”
I was rather dumbstruck after that and don’t quite remember what my response was, something very non-committal in any case. We dropped the topic afterwards and it was only after a night’s sleep and some serious thinking that I sent my therapist the following reply via email:

“After giving the TV featurette you mentioned yesterday a lot of thought, I came to the following conclusion: should you really do this and by that time still be interested in having me in it, I would participate.
My biggest question was whether I’d be willing to have relatives (likely), neighbours (possible) and fellow uni students (unlikely) recognize me in the feature and asking questions about it. The result is that I am willing to accept that.”

And he emailed back:

“Thank you. In such a featurette, the main focus is on the treatment method and on what you learned through it. It’s great that you are going to be a part of it!”

I know the news show he was talking about very well; it’s on every day except for Sundays, in the early evening. Each region within the federal state has their own version, where they focus on what is going on in that particular area. It’s certainly not nationwide. Once per week they have reserved broadcasting space where they highlight a medical topic. One week it may be the latest development in terms of laser surgery for cataracts, the next week the specific problems of teenagers with diabetes mellitus, and after that it might be migraines or heartburn or coronary heart disease or hearing aids or dentures etc. They tend to focus on health problems which are common among the general demographic here in Germany and on treatment methods available in the area, including mental health issues, and one of the episodes planned for next spring is going to be about chronic depression and CBASP.

Generally speaking, the filming process shouldn’t be much more difficult than talking in front of the student class. It’s going to be a little different, but it does not spark any more anxiety in me than being in a presentation in front of an audience I can actually see.
However, since the exchange of emails with my therapist, I had time for contemplation and realized that the underlying issue is not so much going public, but rather relinquishing control over who knows and who doesn’t. Right now, I recall exactly whom I told about the depression and psychotherapy, and I have a pretty good idea of who told somebody else. In total, it should be about 25 people who are in on it, give or take a few. Once I appear on TV – with my real name, my face clearly visible, my voice saying the words – it will be impossible to tell who has and who hasn’t seen the feature.
For people who suffer from anxiety, it is very important to be in control of problematic situations, because that is what keeps the anxiety at bay. If I decide who is being informed or not, I also control for whom I’ll be vulnerable and who is excluded from knowing that “secret”.
There has been a similar situation in my life before: when I was in my early twenties and had to decide whether I wanted to come out of the closet or not regarding my sexual orientation. Before I came out, if I got into an argument with someone or somebody hurt my feelings, it comforted me to have a secret. They did not really know me; there was a part of me hidden from them which they could not reach, which they could not hurt. With the depression, it is the same mechanism at work.
Coming to this conclusion doesn’t change my position. I said I’d do it, and I will, but it’s always better to be clear about what is happening emotionally and to adjust one’s behaviour accordingly. I do not want my mood to tank afterwards because suddenly I feel exposed and vulnerable. And everything else is a challenge, I guess.

Looking Back At Two Years Of Psychotherapy

Exactly two years ago, I was officially accepted into the therapy programme and started sessions. I still remember the relief when signing my name under the contract – finally an official diagnosis, finally a glitter of hope.

Psychotherapy is a long process, at least when you are talking chronic conditions. At the age of 30, I had a depression history of almost two decades, and you don’t wipe those away in just a few short weeks. There were aspects of the depression which vanished within a few weeks, and others which I am still labouring around with. But generally speaking, a bad day now still is better than a good day two years ago.
Psychotherapy also is a lot of work. Hard work. You revisit a lot of bad memories. You get confronted with your own shortcomings. You have to practice both in the session and outside of it, relentlessly. I won’t lie: there have been days when I got fed up with all of this. Days when I cried, when I got frustrated with myself, when I didn’t want to do my homework. What’s worse, the majority of people you meet will never know how much effort you put into recovering from depression – be it because they don’t know you are suffering from it, be it because they don’t have enough empathy to put themselves into your shoes.
However, I do believe it was worth absolutely worth it, not only in terms of symptom reduction, but also because it made me grow. I changed more in those two years than in the ten years before. I feel like I am much more in charge of my reactions than I used to be: where I would just run a “standard response programme”once triggered by certain emotional stimuli, I am now actually aware of what is happening, of how I react, and why. I am more confident, more secure of myself.

I already wrote a post exclusively dedicated to my therapist in August 2011, and everything I said there still rings true. However, almost a year and a half later, I find that our relationship has matured. For a while, during the first therapy year, I was under the spell of transference regarding my therapist – not that I was in love with him, but I saw something like an ersatz-parent in him. He gave me the kind of emotional response I would have liked to get from my parents: protective, but not smothering me, and at the same time encouraging me to try myself out.
I think that kind of transference is not only the rule in CBASP, but actually accounted for as part of the therapy process. After all, chronic depression originates in the childhood. I believe my therapist was both expecting and aware of the transference, but never mentioned it to me, and I didn’t breach the subject either. Maybe I was more susceptible for it because at the time my husband was back in the United States and I was feeling lonely without him, and I could talk about this situation much better to my therapist than with my parents. That actually still is the case, but since my husband and I are not geographically apart anymore, the need to talk about this has naturally vanished too.

Back in the day, I would email my therapist at least once every week, to keep him up to date about my life – which had been his idea, not mine. Every other week, I’d have a session and see him in person.
Now, I have sessions in intervals of six weeks, and I email him maybe once per month, if something really important happens. The therapeutic relationship mimics that of parent and child again, and it looks like “I’m growing up” now and become independent from him. In fact, I do not need him anymore for my everyday life. The transference has faded away.
Does that mean I could do without him? Absolutely not. I am still looking forward to every session, but now in a strictly professional way, because I still want and need to work on myself. I still need the “security net” he provides, take great comfort in knowing that I could get in contact whenever the need arose. If shit hit the fan, he’d be only an email or phone call away. And I’m not quite ready to let that go. Yet.

The Jubilee Post

Today, I celebrate the 100th blog post. If the counter didn’t keep track of the statistics, I most certainly would have missed the milestone, but I’m glad I didn’t. When getting started, I had no real direction to follow and was more concerned with not running out of steam early on than with developing a writer’s voice or any long-term goals for “Lugubrious Layara”: I simply talked about what was happening in my life, in therapy and in my head.
There also was (and still is) an educational facet to the blog, even though from a strictly personal, non-professional angle. I get a fairly consistent number of hits through people googling CBASP, and I’m really happy that I can provide links, information and my own opinion – when I was about to start the therapy programme, there was very little to be found online, and nothing in regards to other blogs. Even now, the situation changed only marginally. And despite knowing that there are other people being treated with CBASP all over the world, and even at the same hospital, I have never encountered any other CBASP patient, neither online nor in the real world. If I have accomplished nothing else with this blog, at the very least it added a new voice to the plethora of mental health blogs out there.

Blogging means walkig a tight rope. How much of yourself do you put out there? And how much of the people you write about? I try protecting the privacy of everyone I mention as much as possible, even if it means that my writing sometimes suffers from the vagueness. Occasionally, I don’t post because it would mean discussing the personal history of another person more than I’m comfortable with – I can decide to put my own history out there, but not my husband’s, for example.

Sometimes, I want to post, but don’t have the energy for writing. There’s a good deal of regurgitating going on when developing a new blog post – I type, erase, type again, erase again, scratch certain formulations, phrases or entire paragraphs. And there were a few incidents where I had an entire post ready for publication but never chose to put it out there – because the situation described didn’t exist anymore, or because it had taken so long to jot the story down that I had already moved on from it by the time I was done.
And then, there are the blog posts I would like to write, but that are too emotionally exhausting to go there: for example, my sister’s “borderline meltdown” the day before my wedding. Or the post about my husband’s immigration process I started writing back in September, but the 800 words on that which I got so far only covered everything prior to our marriage day and revisiting the events make me feel depressed, so the progress on that is very slow…

Despite and because of all of that, blogging is very beneficial for me. My therapist always urges me to become “more visible”, to put more of myself out there, and the blog is one way of doing so. My friends and my husband not only know of its existence, but some of them even are somewhat regular readers. This allows me to talk about my feelings and problems at length without pushing them on anybody – they can decide when to visit, and how often.
There is a similar effect to writing about depression as visiting the student classes had; it gives me a sense of not only dealing with it, but of making it a little less like I wasted all those years with the illness. At the age of 32 years, I have spent a minimum of 20 years with the condition, about ten of them severely depressed. By sharing, it does not feel like I wasted those.

Being A Guest Speaker Again

Last week I was a guest at my therapist’s student class again. Unlike the first time in April, when he’d asked me weeks ahead of the event, this time it was on very short notice, less than 24 hours before the class. I gave a positive reply without hesitation. Appearances like that make me rather nervous, but I am a firm believer in doing something for the greater good. If my appearance helps students to see chronic depression as less abstract, if they can put a face on textbook knowledge, it makes me feel a little better about my own mental health history – one positive aspect among so many negative ones.

The class was about the same size and gender ratio as last time (women vastly outnumbering the men); very well-behaved and quiet. The April-group was maybe a little more engaging, but then, they had only seen one other in-patient before me. This month’s group had already met an elderly in-patient with treatment-refractory depression, a bipolar patient and a young woman with chronic depression in the very early stages of therapy. I was meant to be her counterpart, who could talk about the changes which happen when you go through psychotherapy in general and CBASP in particular.
I was with the students for 25 minutes only, so naturally we didn’t go into as much detail as last time, and focused less on my personal history and more on the importance of trust and the professional’s behaviour: that in the long run psychotherapy is more successful if time is allowed for establishing a trusting relationship between therapist and patient first. More often than not, patients battle anxiety in addition to the depression, and they are easily scared away for good if not handled carefully or not taken seriously by therapists and hospital staff.

It is rather ironic that despite my social anxiety, I am a somewhat capable public speaker. I know that you have to enunciate clearly and speak with moderate tempo, that you have to talk louder than in a normal conversation and that eye contact with the audience is important if you want to come across as competent. I have held a number of lectures in university in front of up to a hundred people, and have almost always been congratulated on my “professionalism” afterwards. But it is just a mask I wear and afterwards, I am terribly exhausted and crash, and it takes weeks to fully recover from this.
Generally speaking, I was not as worried this time around, even though there always is this phase a couple of minutes before actually getting started where I become somewhat panicky, cursing myself for saying yes and badly wishing I had avoided this situation. And I’m always afraid of “forgetting” crucial facts, of not being able to access the memories of the early treatment days properly. Fortunately for me, my therapist knows me so well by now that he can anticipate problematic situations and guide the conversation around them, or take the edge off by moderating.

The chart of my depression indices was shown again – I noticed that this time, it had the title of an article printed on the bottom, stating it was “in press”. (For those who are not familiar with the rules of scientific writing: an article being “in press” means it has been accepted by a journal for publication, but has not been printed yet at the time being.) From the very beginning I had known that my anonymised data would get published sooner or later, and in the beginning I was itching with curiosity. Now that I had stopped thinking about it altogether, that silent announcement took me somewhat by surprise.
I can’t help but wonder whether this obsession about the article in the early days had something to do with the urge to chronicle my own life, as mentioned in my last blog post. As if my own thoughts and ideas and feelings about the topic don’t count if I can’t back them up with written proof.