My therapist overall is very nice. She's very encouraging, and she listens when I talk. Overall, I like her. Today though, I don't really know what happened: we were talking, and it sounded like she was kind of wrapping it up, and said stuff about how well I seemed to be doing. I didn't want her to get an inaccurate reading of me, so I brought up how I'd been feeling bad lately (see my other thread here, specifically this post). I tried to tell her about it, but she didn't, well, get it, I guess. She kept saying things like I needed to figure out WHY I was feeling bad. I said I figured there wasn't a why, I've felt that way before and there never seemed to be any kind of rhyme or reason to it, that I was just feeling bad because of depression and brain chemical imbalance and what-not. She said that that wasn't, a, thing? She said "there's always a why, you just gotta figure out what it is." She also said that stuff like the venting I was doing in my journal thread is not conducive to getting better-- that I need to try to be positive too. I said if I force it, does it even count? Well no, she said, it has to be genuine, but I can't just focus on the negative, that it has to be accompanied by something positive, even if it's small. That that's what CBT is. "Can't I just, be negative for a while?" No, she said, not if you want to get better. I don't know if it's just me or not, I figure it might be just me, or maybe she wasn't understanding me at all, but I felt really attacked! I felt like she was saying I was depressed because I didn't want to get better enough. And I tried to communicate this with her, but I don't think she fully got the gist of what I was feeling; I think I didn't describe it well. It just kind of really upset me. I immediately shut down and closed off, and she could tell, she asked about it, but since I was upset I couldn't bring myself to talk about it freely at all. She just, it really hurt me. I was reminded of those spiritual new age type things that are like, if you're depressed just do yoga! Or, just go outside and get some fresh air! And then you'll be better! But like, instead, it's if you're depressed just think about positive things and you'll become happy! The power of happy thoughts! And apparently CBT is the #1 recommended method of treating depression and anxiety, but that just feels so incredibly phony to me-- am I missing something major here? Is that seriously what CBT is? Most importantly-- isn't it possible that I was just feeling bad for no reason? Couldn't I just be feeling bad? Is there really always a WHY that I have to find?? That doesn't sound right to me at all! I'm really frustrated and upset, please respond, please help me out.
One of the big things with CBT is the idea that your behaviours feed into your feelings which feed into your thoughts, and often what gets emphasised there is that you can control your behaviours (whereas you generally can't control thoughts and feelings as well), and so changing behaviours may help change thoughts and feelings. So that was probably what she was getting at with the idea of Doing Positive Things so that you might feel better. HOWEVER. The issue with that is that it's very variable from person to person. There are some things that you can treat pretty much universally as Something To Be Replaced - self-harm, eating-disorder behaviours, really obviously self-destructive things - but beyond that, figuring out what's helpful and harmful to each person is very much an individual process. So, for this example, if venting makes you feel sad and small and reinforces to yourself how unhappy you are, then that might be something you'd want to work out a better way to deal with. On the other hand, if it makes you feel better because you feel like you're being heard, feeling validated, etc, then that's at least something useful. (And it's something you might want to work on long-term, because validation is a complex thing with many fuckups, but it's not an immediate abort-replace-now.) And yeah, as far as I can tell some types of depression are in fact 'hey your brain chemicals just hate you'. So while technically there is always a why, the why can be as annoying as 'because brain chemicals' 'because the days are really short' 'because you haven't consumed enough iron recently', etc etc etc.
There's a significant subset of the psych community who think, yes, that's basically what CBT is. Edit: oops! Sorry guys, linked the wrong article. Have changed the above link to the one I intended. This is the one I linked by accident.
This is why I like what I'm learning in DBT. One of the parts of DBT is radical acceptance - basically going, 'yeah, this part of my life right now does suck, yeah, i can't get out of this specific situation until a certain timeframe hits, yeah, i'm sad and i'm angry.' Like, I think the idea is that you aren't able to work on fixing your problems until you can admit they're problems? And then you're supposed to take concrete actions to help, even if it's less 'solve this problem forever' (because maybe you can't! Maybe you've got chronic pain or a bad boss or a dead pet!) and more 'do something that will distract me or make me feel better for now'.
@EulersBidentity Thank you for the article! That was an interesting read. Is it possible that the depression/dysthymia I have is just something that needs to be treated chemically? I don't really see how I can talk or otherwise work my way through "I just feel bad, nothing I do works"? Like, there are things going on that I could blame it on, but it doesn't feel, to me, to be the source of anything, just a side bonus. Likewise, even when I'm in a 'bad' situation or whatever, I could still be feeling good, or rather, an absence of that bad feeling that plagues me. That kind of choking, stuck-in-my-throat feeling that I can never seem to pin down. It really seems to me to come and go on its own, mostly unaffected by outside influences. On the other hand, this could be more evidence that I don't actually have anything wrong with me at all and I'm just a giant fakey mcfakerson. Basically, if therapy isn't doing anything for me, then that means there's nothing to... therapeutize? (shrug) Which means nothing's wrong with me.
For me, using CBT to treat depression is basically like that one guy on Reddit who told someone with chest pains and a history of heart disease in their family that "It's just anxiety, try meditating!"
Ok, but no. Just because whats wrong with you doesnt respond well to a specific style of a given method of therapy doesnt mean there's nothig wrong. Ive found cbt useful for depression actually BECAUSE i spent so long looking for the why. Oh, im upset because my house isnt 100% spotless, because i havent lost that last ten pounds, because my relationship isnt whatever enough. I ended up making myself way more miserable because i started building really disordered thoughts, and being able to step back and go "ok, THAT thought is depression moon logic, the actual situation is _____" was really helpful to me. Im not upset because im not perfect, im upset because my brain chemicals dont physically happen right because genetic mutations, and also probably low vitamin d. Working hundred hour weeks wont make that better. But that doesnt sound like what your therapist wants you to do. It seems to me that therapists see two different groups of people for depression: people who physically have something wrong with them and peoplewho've made a mess of things or had bad things happen to them. The symptoms are pretty similar but the causes are polar opposites so what works for one doesnt help with the other. It sounds like your therapist has you assigned in her mind to the wrong group.
I dunno. Aspects of CBT seem like they'd be great for treating depression. Lissiel is proof of that at least. While I understand the frustration at it being presented as THE ONLY WAY and some therapists being especially shit at it I don't think it's entirely useless. I've never had personal experience with it myself, though given what I know of how psychology uses Buddhism I'd rather not. I do have quite a bit of experience with what Lissiel described though. Mindfulness has been amazingly helpful for me because my depression and anxiety issues are more brain being stupid than anything else. So it's very handy to stop and point out that yeah no this is how I feel and this isn't even real. The issue is less that it's not useful I think and more that it gets applied as a one size fits all solution. That and shitty therapists.
there's an NPR podcast, called Invisibilia, and the very first episode went over the different schools of thought about thoughts-- freudian, CBT, and mindfullness. it was fascinating for me, and made the differences between my different therapists/counselors make a LOT of sense. i think the best approach is probably some combination of the three, depending on the person and the issues. i don't seem to be able to link to the specific episode, but: http://www.npr.org/podcasts/510307/invisibilia scroll to the bottom
