The One Where I Almost Cried In Therapy

In therapy, I talked about the upcoming changes in university, explained the original plan of taking my time for coming to a decision about my professional future (which the therapist said was a good strategy) and how I’d chosen continuing university when forced to decide immediately. As a result of the week’s events, the BDI-II score was up to 17 points today.

Half of the session was, as part of our usual routine, spent on a situational analysis of the phone conversation with my mother on Monday morning. This one had been special because even though what I’d felt and thought had set me up for failure (panic, doubt, flight instinct kicking in), I’d managed to get the best out of the situation that was possible considering the circumstances: ending the phone call without making the situation even worse through offending my mother, and thus giving myself time for thinking.
My therapist asked me why that was so, and I couldn’t come up with any other explanation than my reaction being an automatism, developed through seven months of therapy.

I explained my sentiments about prehistoric archaeology and how I felt that changing not only to a different degree, but also to a different subject was necessary if I wanted to go back to taking classes. I had not been entirely certain what he’d think about the latter, but he supported the notion completely and shared some personal experience afterwards concerning his own career choice and how he’d made a new start by becoming a psychiatrist / therapist after he’d started out in a different medical profession which, despite his huge interest in the subject matter, had not made him happy simply because of the way everyday work was shaped. And he said I might actually become able to enjoy archaeology again as a hobby or passion in the future if I liberated myself from all the dreadful negativity and bad memories connected to it.

At one point, I got very close to crying while speaking about this: my voice died mid-sentence and I sat there with a frown and moist eyes, looking out of the window, but my therapist just calmly repeated what I’d last said and I caught myself again. He clearly noticed what a highly emotional topic this is for me and from our discussion I can tell that he understood its significance.
Strangely, I was ok with getting this emotional in front of him – actual crying might have embarrassed me, but I felt no negative response inside myself for displaying so much sadness. Becoming obviously moved is something I rarely do, and never if I can prevent it, because it is very difficult to make myself vulnerable like this without immediately wanting to put the defensive walls up again. The fear of being shamed or hurt is just stronger. Him not fussing about it certainly helped – he acknowledged it afterwards, but didn’t make me talk about it.

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Do It Yourself

Even though it appears that my BDI-II score lingered in the same area since March, there has been a great shift when looking at the individual topics of the assessment. The points used to be evenly spread over a lot of categories, but out of the 11 points I scored on Monday, 7 resulted from somatic reactions to stress: fatigue, lack of energy, hypersomnia, inflamed eyes and muscle pain. They will go away or at least get better if I manage to reduce the stress and relax, but are not related to negative thought patterns.
That means only 4 points are left where we need to work on the way I perceive myself and the world around me: the most persistent over all those months has been the self-dislike category, where it took the longest until any change occurred at all, and where I have never been down to a score of zero. Currently, I rate myself as 1 – “I have lost confidence in myself”. Which is pretty good in my book already, but my therapist thinks it could be even better… He knows that I have strong tendencies towards ruminating over the past and constantly reminds me of staying in the present, “I did not notice anything in the last months that you should blame yourself for.”

A lot of things that used to be very difficult or intimidating have become a lot easier: I am not constantly obsessing over the camera which records our sessions (for documentation and supervision purposes) anymore – though I hardly ever forget that it’s there for longer than a few minutes. I also write the situational analysis on the flip chart myself now, which I always avoided, and even the dreaded role-playing exercises are not quite that bad anymore. For months, my therapist would ask, “Would you like to write on the flip chart?” And I would reply, “I’d rather not.” But now he’s changed to, “Why don’t you write on the flip chart?” And so I did, and it was ok.

I told him about the nice feedback I had received from a former colleague last week, and he emphasized that it was me who had put the new batteries into me, nobody else. According to the theory that depression is “learned helplessness”, people get depressed when they feel that it doesn’t matter what they do, they’ll fail or suffer afterwards anyway – one of the main focuses of CBASP is making you realize that your behaviour does make a difference.
He’s right in so far as nothing we did in therapy would be worthwhile if I didn’t apply it to my everyday life. I have worked hard on myself, and I worked for therapy too: doing my homework, being prepared, being very willing to work with my therapist and not against him.
I agree that the progress has been my doing, but I couldn’t have done it without professional help. After almost a year of most severe depression, I was so depleted that I couldn’t have helped myself even if I’d known what to do, and I also think without guidance, I might have given up trying soon. It was necessary to hand over the planning to someone else and trust that they’d know what to do. For the first three months, I just followed the lead until I was well enough again to even start thinking about how to take my life into my own hands.

Don’t Think, Act!

That’s the new rule I brought home from therapy yesterday, being the result of a ten-days-long relapse. I even did two assessments of BDI-II scores, one evaluating the usual time period (the past two weeks), the other only for the day of the session, because there was such a difference between them: my relapse had brought me back to 21, while yesterday I was at 8.

Due to growing frustration over failing to stand up for myself and effectively communicating my wishes, I had begun feeling increasingly depressed again. What helped me getting better was talking to other people about it – my boyfriend and friends, who all listened, understood and gave me feedback in kind words. And it was the realization that this was not a simple failure at work here, but that I was uncovering a fundamental behavioural pattern: I’m trying to please other people to such a degree that I panic when I’m forced to express opinions / wishes / emotions that run counter to what I believe the other person to feel or want from me. I do, in fact, expect punishment or abandonment for expressing “unpopular” opinions.

As a combat method, we created the above-mentioned new rule in the session, so that I speak out or act before second thoughts have a chance to shut me up. Intellectually, I know what to do or say, but the emotional part of me ends up in utter terror: my therapist likened it to riding a horse galloping away with you – once it’s on the run, it’s hard to gain back control. So my efforts are now going into preventing the reaction pattern from getting kick-started.

We did a lot of roleplaying yesterday, which always makes me uncomfortable, self-conscious and awkward, but yesterday was the first time I said “I cannot do this.” Not that it saved me, because the response was a smile and simple assertion: “Of course you can. Try again.” And since I always aim to please and am generally motivated to do what it takes to get better, I did try again, resulting in a giggle fit – when I am embarrassed, that sometimes happens. I sat in the chair, covering my face with my hands and convulsing in hilarity while trying to re-focus, but it took a while until I actually succeeded. And, of course, for the rest of the session he kept “proving” to me that whenever I did something he asked me to, it was because I had acted instead of dissecting it mentally: “What did you think when you just told me this?” – “…. Nothing.” – “See? You could speak your mind because you acted instead of thinking about it.”

It appears that the focus of our sessions is going to shift towards behavioural training and feedback on verbal and non-verbal expression in the future. The situational analysis is still just as important, but my therapist remarked that intellectually, I had grasped the procedure and did not require any assistance identifying the crucial elements of situations or interpreting them.

This means even more roleplaying in the future, and other exercises which offer only marginally less potential for awkwardness. Yet, no matter how much I dislike doing this kind of training, I cannot dispute its effectiveness, and I still like going to the sessions.

Chatterbrain

While yesterday I had a good night’s sleep, the last one turned out almost as disturbed as the first. My brain just wouldn’t shut up, going into a frenzy of activity that only subsided in the morning hours. I tossed and turned, but it is like having a blaring radio in your head that won’t let you rest. Naturally, I am very tired once again.
And yet, I also had what after yesterday’s session I recognize as a depression-free phase: it lasted about 90 minutes today and occurred in the early evening, coupled with an increased desire to walk. The urge to move had been back this morning already, but without the elevated mood then.
This morning it proved somewhat difficult to live it out since I was grocery shopping with my mother and maternal grandmother (not the one suffering from Alzheimer’s) and my grandmother uses a walking aid, making her rather slow, but in the evening I just got my sports shoes on and walked out of the house, even running for a short distance. It felt so incredibly good – hard to believe that less than a week ago I still had to push myself, that I had no surplus energy whatsoever.
I walked as fast as I could, making long strides, lifting up my head and taking in the beautiful evening sun, feeling the wind in my hair. I was just at complete peace with myself and the world – no worries, no negative thoughts. About an hour and a half later, I started to “come down” again, but since I’m not in such a terrible place anymore as I used to be, that is alright as well – the decline was smooth, no sudden crash. I had a taste of the things to come now, and am more motivated than ever to fight the depression down completely.

***

My therapist explained that the brain works with thresholds, and that I must have reached a certain threshold which triggered a non-depressed reaction, but because my brain is still re-building the cerebral structure, there is a delay in its reaction. Over time, the gap between stimulus and reaction will become smaller, and eventually there won’t be any delay anymore.

This development proved a bit of a surprise to both of us; my BDI-II score was back to 10 in only 6 days, so we compared last week’s assessment to this week’s: I lost a point in the categories “sadness”, “irritability”, “loss of energy” and “tiredness or fatigue” each, everything else had remained unchanged. Irritability was down because I had my privacy back after the trip south and because I could command better over my own time again, which in turn affected all the other categories: being irritated costs energy and makes you tired and sad, the latter also being the case if you cannot do what you want to do.
We also took a look at “things I did right” over that time, specifically over the weekend and on Monday, since that is the time when the threshold was reached. We had started to formulate rules a while ago which, if I abide them, make my depression go away. Those rules are different for every person, so you first have to find them out; mine are rather basic: “Keep in touch with people, so you don’t fall back into social isolation” – “Get active to make things happen, take control over your life” – “Express your wishes openly” and, new since yesterday, “Spend time alone to unwind” as a direct result of the trip to my grandmother. The latter is the only rule I have regularly followed before starting therapy, but as a result usually violated the first rule by not keeping in touch with people…

In addition to following my own rules during the days we were looking at, there also was a new behaviour that had never come up nor been discussed in our therapy sessions before: avoiding to let my own mood get dragged down by those of others. It actually took me by surprise since I had handled the corresponding situation with gut feeling rather than careful thought, but apparently my intuition had led me on the right path here.
In the past, I would often succumb to the “vibes” sent off by other people around me – just had to spend some time in the same room, and my mood would drop inevitably, even if they had not been directed at me. This time around, I managed to stay focused on my well-being without avoiding the social situation or acting inappropriately; a huge step forward for me.

In retrospect, yesterday’s session felt a little like taking inventory: I brought up how I couldn’t possibly imagine making this kind of progress when I first showed up on the hospital’s doorstep back in October, and we spent some time talking about the differences between now and then as well as tracing the steps that led so far. My therapist also confirmed what I had already suspected after last week’s therapy session: that there’s a lot more liveliness to my body language. Rated on a scale from 1 to 10, with 10 being the range displayed by the average healthy person, I would have scored 2-3 in October and 8-9 now. Not quite there yet, but considering my many inhibitions, it is a tremendous change.

For the first time ever, I also spoke about some memories I had only recently unearthed again, after being “lost” in my brain for years – but I prefer keeping that for another time, since the thought process on this story is not finished yet; I remembered more since talking about it in therapy, and believe I also discovered some parallel to an event which took place years later that strongly hints at some underlying pattern for some of my earlier episodes of major depression – I want to talk about it to the therapist first, though.

It was very apparent that my therapist was happy for me, and he even walked me outside the hospital and continued talking to me outside for a few minutes. I rather enjoyed that, and took it as a compliment and encouragement for the path still before me.

Better Again

Today I’m feeling a little better again. The therapy session was really conducive towards organizing my thoughts – looks like the trip last week has stressed me out more than I was aware of at first. My BDI-II score went up to 14 (from 10), which is not as high as I had expected – two days earlier, I most likely would have scored around 18 points. But, considering that I had a score of 49 points when I first met my therapist last October, I’m still doing pretty good. In fact, my relapses are on a better niveau than my “good phases” of the last few years were. So I am not complaining.

Something I noticed about the sessions is that they slowly changed in character, or at least this is my purely subjective impression. It feels like I am sharing more of myself, but not in terms of what I tell him (I’ve had a pact with myself that I would be completely open from the very beginning), but in regards to… my behaviour. My first tendency always is to speak in a manner that will protect me from criticism: friendly, but somewhat reserved. Like you would talk to a stranger who is asking you directions. You are perfectly agreeable and give the directions, but the real self is hidden behind a wall.

Over the last weeks, I have started to let my walls down, to become more involved on a personal level. I don’t know how much of this difference my therapist notices: he does give me feedback occasionally, for example he told me during the last session we had in April that I had smiled at him when he opened the door. I neither noticed nor remembered, but those little things are exactly what I mean. I also think that I have a different posture when sitting in my chair, less tense and defensive.

Two Steps Forward, One Step Back

I haven’t been doing very well over the last few days – today is a bit better than the previous two, but still nowhere near where I was before Easter. There is not one single reason for it, but rather a plethora of small incidents that only in sum have the power to bring me down.

Part of it is a boiling resentment towards my grandmother’s past behaviour that, almost forgotten over years, suddenly has risen up to the surface again through the last two trips.

Some stems from everyday problems that are really too insignificant individually to list them here; annoyances rather than real problems.

There’s a hormonal component also – indicated by “period acne” and a really bloated feeling. Like a beached whale rotting in the sun, growing bigger by the hour. And I have had insane cravings for carbohydrates: pizza, pasta, cake…

And, finally, part of it is being geographically separated from my boyfriend. We are in a long-distance relationship – he in the USA, me in Germany – and it’s been hard to go back to being apart again after we spent the first three months of the year together. I miss him insanely.

Later today I’ll have a therapy session and maybe I’ll feel better afterwards. The BDI-II score is probably going to be a couple of points higher compared to the last session, but I just can’t shed the negative feelings. Even if I ignore them for most of the day, they come back in the evening.