The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
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Hello all, how are you? I hope you all have been doing well.
I haven't been doing so great. I have personal contacts and a support system, but I think this community is one of the few places where my actual feelings will be understood, and my thoughts appreciated.
I'm struggling with finding psychotherapy that's effective for my combination of depression and anxiety, which I've dealt with since I was a child. I had my first recognizable depressive episode in the first grade, not kidding, so this is something that's obviously deep-rooted and temperamental in nature. In that sense, I'm not looking for "insight therapy" where I'm supposed to suddenly figure out what's causing my problems, but for skills-based therapy that can provide discrete and specific interventions I can rely on when my distress or my anhedonia get the better of me. Even solutions-focused brief therapy sounds better than insight therapy at this point.
I actually have a pretty good handle on my emotions and their causes -- counselors in the past have said I have a lot of insight into my problems. The issue isn't that I don't understand them, or are alienated from the true causes, but that I don't know what to do about the negative behaviors I have already identified I have. I'm not really coming into psychotherapy looking for a diagnosis, but a treatment.
I'd like to illustrate my problems with psychotherapy by talking about my most recent, and current, attempt at seeing a shrink.
The most concerning sign of my worsening depression is my attitude towards other people has gotten pretty harsh -- I'm quick to get angry, make snap judgments, even be tempted to be rude -- which is outside of the norm for me. I see this problem as more of a symptom than an underlying issue; I feel more pessimistic and irritable, so I'm eager to lash out. My real problem, I think, is that I don't have as much patience for others as I used to, because I feel on edge all the time.
Unfortunately, I think my new therapist saw this as a bigger part of my problems than it is, and we ended up going down a rabbit hole of "let's explore your feelings of annoyance to see what they tell you about your hidden emotions," and "your negative judgments of other people must be reflective of too much self-criticism." I didn't get any value out of this.
Another issue for me is that psychotherapists are all-in on "unconditional positive regard." This often feels to me like therapists pledging never to actually criticize the problems of the clients who are coming in for a critical eye on their problems.
My current therapist likes to bill himself on being "shame-free," but I'm coming to believe that the optimal amount of shame for personal growth, even in a therapeutic relationship, is not zero. While I don't think a therapist should be mean to their clients, I do think some level of fatherly Jordan-Peterson-style, "get yourself together, man, make something of yourself, you're better than this!" would be incredibly helpful and motivating.
One particular incident stands out -- I was talking about how I got in a social media rabbit hole of drama-reading that made me angry (a common thing for me, as themotte knows), and how I knew I shouldn't do it but did it anyway. He was quick to jump in and suggest "taking the shouldn't out of it," which instantly rubbed me the wrong way and made me feel like my convictions weren't being respected. He seemed surprised when I expressed a strong resolve to just... not use social media, because I see it as harmful to me. Has he never had a client who resolved to avoid things that are bad for them?
It's not that I feel my "shouldn'ts" in this area are imposed on me, or act as a source of guilt... I just recognize that this thing isn't something I like, it's not compatible with my value system, and I don't want to do it any more. I worry this particular therapist has made "avoiding negative judgments" so integral to his therapeutic approach that even when a client comes with an earnest sense that a particular behavior is wrong for them, he still feels the need to taboo their sense of resolution as maladaptive.
I do wonder if this is just a personality difference between men and women, where the average man is motivated more by rising to the challenge of fulfilling expectations and the average woman is motivated more by knowing people care about her and will support her regardless. This is one of the strong reasons why I wonder if the severe over-representation of women in psychology is really distorting the practice, so much so that even men are tailoring their treatment of male clients to the average woman's preferences and needs. When someone a while ago talked on here about "lefty mental health," think that was part of what they were talking about.
So, I feel like my current bout of therapy isn't working. We're not clicking. I've never actually had this happen before, despite trying therapy several times in my life -- I've always just kind of gone along with things, not thinking too much about what I'm looking to get out of therapy other than someone to listen. Now that I've thought critically about what I want to gain from treatment, I'm more judicious about what I need in a therapist. So I don't think this particular guy has the expertise or the right frame of mind to offer skills-based therapy, and is just generally a bad fit for me.
But I'm kind of stuck. As I've said, I've tried psychotherapy several times in my life, and it's made little difference in the overall trend of my mental health. In an earlier attempt at therapy, the only actual unit of value was the advice to use deep, slow breathing as a quick antidote to anxiety (something something parasympathetic nervous system), which to this day can legitimately feel like taking some sort of dissociative drug in terms of how chilled out it can make me.
If therapy has anything to offer me, I don't think it consists of therapeutic theories or piercing insight, but would offer more practical steps to counter negative self-talk and reduce bad thought/behavior spirals. The problem I have is not that I don't understand my problem and don't understand when my thoughts and behaviors are unhelpful, it's that, in the moment, I either feel egosyntonically aligned with the unhelpful things, or I feel situationally powerless to counter it. What I need is a therapist who recognizes that, and can provide direct and practical advice.
But increasingly I just feel like psychotherapy is a dead-end, and what I actually need is to finally get my GP to refer me to a psychiatrist, who might be willing to try one of the fancier anti-depressants that sometimes help people with treatment-resistant anxiety and depression. I've bounced between a few SSRIs and SNRIs in my life, but haven't seen much difference other than the fucked-up sex drive.
Hell, shock my brain at this point, I just don't want to feel on edge any more.
Any thoughts? Please be gentle.
In terms of situation, you sound pretty similar to myself, though your condition might be more severe. My own perspective is that skills based therapy is probably going to do nothing for you. When it comes down to it, my ability to rationalize my negative thoughts is too strong for me to overcome. On anger, I sympathise. Holding a lot of anger is really unpleasant especially when you don't have any good way of expressing yourself.
To that end, I think insight-based therapy could be a better choice. The way I see it insights are basically ways of fitting your symptoms into a narrative that you can resolve.
Since it usually comes up, I personally found that exercise doesn't really help at all with this stuff, except acutely and sometimes not even that.
This is definitely something I've struggled with. I think one of the big challenges for smart, philosophical people who struggle with emotional regulation is how powerful the rationalizing impulse is in them.
That's one of the big reasons I want to lean more towards skill or solution based therapy, actually -- I'm not particularly interested in altering my worldview or doing extensive cognitive restructuring, and to be entirely honest I would find it impossible to lean on the judgment of a psychotherapist when doing so. I think someone would have to be close to enlightened -- as @TheDag said -- to actually offer insight into my cognitions or personality that would both ring true and motivate change. Otherwise, and this is what I've run into with the current therapist, I would quite easily be able to argue against their supposed insights to my satisfaction, if not theirs. My hope would be that, with a more skills-based approach, we could talk more about behaviors than cognitions. And my behavior is really what I want to be different.
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