Artists on “Depression”

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The blog Hyperbole and a Half has been receiving a lot of attention today due to an entry which very effectively illustrates (literally and figuratively) the author’s own recent experiences with depression. There is no single, monolithic “depression experience”. In other words, the author’s illustration doesn’t necessarily need to be seen as definitive (you may experience it differently).

The image here is from the blog entry. If you click on it it should take you there.

* I would like to make this part of an ongoing series, since the more shared perspectives on depression there are the better an understanding I feel people will have of what others go through.

 

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Seen, Heard, and Understood

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I found myself on vacation recently. My partner and I went to France. It was equal parts charming and idyllic. It was also curiously stressful.

You see, in Toronto – at the best of times – when I go out I will inevitably have a selection of personalities to encounter: the barista making my americano, the TTC operator at the front of the streetcar, the person operating the cash register at the local grocery store. Ideally, in this sequence of events, even if I’m not consciously aware of it, I’ll be seen, heard, and understood.

These are three very important things to experience in day-to-day life: it feels good to be recognized, to be listened to, and to feel that the person on the other side of our dealings-with acknowledges our existence. Sadly, this doesn’t always come to be. The barista may get my order wrong, the TTC operator might be a bit gruff, the person operating the cash might talk to me without making any sort of eye contact. All of this may come true over the course of single day and I may be left scratching my head as to why (or more likely, why me?). Accumulatively, it can have an alienating effect for people.

Now…take those naturally occurring human variables and transpose them onto a country I’ve never visited before, whose language I only have a rudimentary understanding of, and you can see how France proved to be a little bit of work as well as vacation. A day didn’t go by where there wasn’t some sort of struggle – big or small (mostly small) – to make sense of myself with someone else and not to take any incidental lack of being seen, heard, or understood to heart.

Overall, the work had a strengthening effect – I know that next time I’ll be better prepared for the challenge. But, as I mentioned, not without a little stress first. The experience also had the effect of reminding me what people with acute social anxieties must endure every day.

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Should I See A Male Or Female Therapist?

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I was recently preparing a presentation for men who are training to become registered massage therapists – men being, until recently, a minority in a profession largely staffed by women. The idea was to discuss societal gender stigmas and the myths which arise from them (one, for example, being that “men are better at deep tissue massage than women” – not true).

Here are my thoughts on the matter, when it comes to choosing a psychotherapist:

First: There are always going to be personal preferences. Given the potentially long-term and intimate nature of the profession, if a client seeking a psychotherapist prefers the company of a man or a woman to seek help from, whatever that selection is based on is not mine to judge. From where I stand, for anyone seeking help, the freedom of having that choice is sacred. For some clients, being able to to make that choice is an important first step.

Second: There are some public misconceptions about male vs female abilities in a therapeutic environment which mirror the “deep tissue” myth mentioned above. Though personalities between therapists are unique, with some therapists being more empathetic or insight-driven than others, it’s important to note that competency in their chosen field is just as crucial.

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My Friend Needs A Therapist – Will You Contact Them?

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Short answer: I can’t.

Longer answer: this question has been asked many times and in various forms (exchange “friend” for “wife”, “husband”, “child”), and each time I’ve been unable to accommodate the request. Why? Part of seeing a therapist is the idea of will and choice – the will to investigate something which we feel is bothering us, and the choice of whom to see for this service. If I were to go ahead and contact someone at the behest of a friend or relative, I would be imposing myself upon that choice and that will (symbolically at least).

Even if someone I contacted ended up never-minding my intrusion (and their friend’s intervention) and became a regular client, that initial lack of choice and will would probably linger in the therapeutic space. It could prove disruptive to the extreme, especially as they become more and more attuned to their situation.

So, no, sadly I cannot contact your friend, no matter how much they may need to talk to someone. That person needs to take the first step, because it’s a very important one.

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Do People Ever Truly Change?

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I bumped into an old acquaintance the other day. We had both worked for a rather chaotic company years earlier. The so-called “survivors” met for dinner once a year to catch-up and share stories of our time in that company. He asked why I couldn’t attend the most recent dinner. I guessed that, because I’d changed my email address a while back, the invitations were being sent to an account that was no longer in service.

When I asked him how it went, he shrugged and smiled. He said: “Oh, you know, (x) is still high-strung. (y) is still gloomy. (z) still acts like everyone’s Mom.”

“People don’t change.” he said, shaking his head. It felt like a definitive statement for him.

We parted ways and his words echoed with me. After all, what’s my purpose as a therapist if that statement were true? I believe in change: I’ve experienced it myself and have seen it successfully expressed in the progress of my clients.

I realized there were two misconceptions in my friend’s statement. First, the people he used as examples of “not changing” were arguably people who, as far as I knew, hadn’t sought change to begin with. To this end, what if they didn’t have a problem with their behaviour to begin with?

Secondly, weighing more largely, what do we mean when we talk about change? When you get to a certain age, you’ve got a lot of “wiring” in place. If you come into my office as a 32 year-old bartender who was raised on a milk farm, I’m pretty sure you are going to walk out the same way. That said, we can still be the people we are and still address aspects of ourselves which are causing problems, which somehow don’t seem to “fit” us anymore.

It reminds me of when I quit smoking: would I be the same Matt Cahill on the other end of the process as I was going into it? The short answer is, yes, I was the same Matt Cahill – just a version of Matt Cahill who had learned to eliminate the need for cigarettes.

On a more interpersonal level, it works the same for people who, going into therapy, wonder if they are going to lose more than they gain: is the therapist going to make me feel bad about my temper tantrums? Force me to be artificially “happy” when I’m feeling depressed? No.

You can change without losing you. If anything, the person who undergoes therapy will come out of it a lot more knowledgeable about themselves than when they came in. You will have a better sense of yourself and, depending upon your reason for seeing a therapist, feel more in control of your life.

 

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How Long Does Therapy Take?

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When does it end?

It’s a good question, and there are a few reasons why this is raised:

• If you’ve never been in therapy before (i.e. you are starting from scratch and overwhelmed by all of the information you discover) it may be a source of comfort to look for structure; to see if there is a beginning, middle, and end to the process.

• Some modes of therapy advertise a pre-set number of sessions. After, say, nine sessions, they will isolate your issue and you will have been handed rational strategies for dealing with it. A problem with this approach is: what if that issue isn’t “it”? What if there’s more to it than the “it” someone told you you suffered from? Not least, what if you are suffering from something that doesn’t lend itself to rational strategies (grief for the loss of a loved one, for example)?

• You may think that seeing a therapist creates an addiction or crutch which you will not be able to shake, thus endangering your independence.

Whether you are experienced in therapy or not, not many people look forward to the unknown. If you are concerned about “how many sessions”, then this is a conversation you should have with your therapist at the outset (along with standard questions about rates, cancellation fees, and directions to their office).

I can’t tell you from the outset how many sessions you and I will have. It would be foolish of me to do so because each individual is different and each individual has a unique spectrum of concerns they may wish to discuss. However, I do make it clear to my clients that they are in charge of stopping and starting therapy – what good would this process be if that choice were taken away from you?

If you want to see a therapist but are scared of how long it may take, why not find a therapist you think you’d like to see and book an initial session, with no commitment for a follow-up?

Concerned about a therapist’s qualifications? Perhaps you should ask whether they belong to a professional association, such as CAPT, which ensures that its members practice within clear, established ethical guidelines (among which, respectful termination of therapy would fall within).

Remember: if it’s important to you, then it deserves to be raised. If a prospective therapist can’t answer your questions to your satisfaction then it’s probably best that you consider someone else.

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You’re Just Going To Ask Me About My Parents, Right?

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Short answer: not really.

Less-short answer…

The legacy of so-called classic (or Freudian) psychoanalysis is that, from the outside (where most people stand in relation to talk-therapy) the process seems to be nothing more than talking about our parents. Regardless of whether, like me, a therapist practices a modern (or evolving) approach or whether they prefer the classic perspective, this perception from the outside can be difficult to undo.

After all, most (but not all) of us spend the first 17-21 years of our lives under the same roof as our parents. Whether they be our birth-parents or our adoptive-parents, all of us were raised by others until we could fend for ourselves. This makes an indelible mark on us. Patterns for how we perceive others are etched by our self-with-other relationships from an early age: from parents, caretakers, siblings, friends, and strangers.

I suppose what I am getting at is that our relationship with our social environment is inevitably affected by social influences from childhood (and continuing onward). This can be a little frustrating for the individually-driven client who wants to get to the bottom of something, who, upon being asked a question relating to their childhood feels disappointment that all the attention is now going to be put on how well they got along with their parents in the past and not what’s going on with them right now.

I do believe that the present is everything: what’s bugging us today is the whole reason we seek therapy to begin with. But the present is informed by the past. No matter how much we aim on keeping things focused on the here-and-now, context is king, and context is a past-tense thing. Therapy is not about your parents, it’s about you, so once any applicable information (or feeling) is provided from your childhood it should be viewed within the framework of the here-and-now, within the framework of today and not simply a meditation on yesterday. Your past contributes in shaping the way you see and react to things, so it is always good to explore previous experiences in order to make present conflicts clearer. Parents and caretakers play a role in this, but it is just a that: a role in the larger picture of you.

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The Effectiveness of Psychotherapy: Supported and Endorsed

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Not that I had doubts, but it’s great to have more support behind talk-therapy. The American Psychological Association has released a Resolution on the Recognition of Psychotherapy Effectiveness. An excerpt:

“Be It Resolved that, as a healing practice and professional service, psychotherapy is effective and highly cost-effective. In controlled trials and in clinical practice, psychotherapy results in benefits that markedly exceed those experienced by individuals who need mental health services but do not receive psychotherapy. Consequently, psychotherapy should be included in the health care system as an established evidence-based practice.

Be It Further Resolved that APA increase its efforts to educate the public about the effectiveness of psychotherapy; support advocacy efforts to enhance formal recognition of psychotherapy in the health care system; help ensure that policies will increase access to psychotherapy in the health care system, with particular attention on addressing the needs of underserved populations and encourage integration of research and practice; and support advocacy for funding.

Be It Further Resolved that APA encourages continued and further research on the comparative effectiveness and efficacy of psychotherapy.”

 

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You Are Not Weak

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One of the quiet, yet pernicious, ways which serve to steer people away from seeking the assistance that psychotherapy can bring is the idea that, somehow, seeking assistance is a sign of weakness.

I think part of this comes from movies and TV (though their depictions are getting better), which have historically portrayed individuals seeking therapeutic help as hopelessly neurotic.

Let me be frank: anyone seeking the help of a therapist soon discovers that the opposite is true. Seeking increased self-awareness (an inevitable part of psychotherapy) is an act of will. It is you, saying that you can feel better, be better. It is saying that you deserve to understand yourself better than you currently do. It is to say that keeping things the way they are is not good enough.

Self-improvement is not the admission of weakness of character, but the admission of strength of mind.

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What About Me(n)?

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With all that has been written, advocated, or spoken about lately with respect to “mental health awareness”, it occurred to me how, perhaps in spite of its intentions, the message may be missing it’s mark. And by “mark”, I mean men.

When I look at the public service announcements, take for instance Bell Canada’s “Let’s Talk” campaign (featuring Olympian Clara Hughes), or consider the large percentage of women who both practice psychotherapy or who see a therapist, I have to speculate, in the mind of the average “guy” standing on the outskirts of all this information, two assumptions might be poking about:

1. Therapy is for women.

2. If therapy is for men, it’s not speaking my language.

First, it goes without saying that therapy is for everyone. Yet, it’s one thing to throw around phrases like “therapy is for everyone”, quite another to show how therapy can benefit everyone, particularly those portions – of which men largely consist – who historically have not embraced talk therapy as passionately as you would assume from movies and TV depictions.

This leads us to the second point: language.

I do believe that the language – heck, even the imagery – we use to raise awareness of mental health perhaps does not yet speak clearly to a wide variety of people. Within the context of this blog post, I’m thinking specifically of men who may not be feel comfortable speaking openly with others about their feelings or conflicts – it is specifically this category of people, I feel, who still struggle in silence.

There is definitely a place for men in talk therapy. Therapists such as myself are here for you, male or female, straight or gay, young or old, even if at first it takes time for you to become comfortable talking about your concerns.

 

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