Depression and what it's really like

Spacecadet, there's a time when therapists just say "maybe this isn't the right time for therapy for you" and there's a time for you to say "maybe CBT isn't the fucking right THERAPY for me" if all they care about is whether you conform to having improved on some NHS check-list.

Like, literally, one of the first things I said to my therapist, when we started was: I am bipolar. I am never going to *stop* being bipolar. There is shit I know and accept about myself which hasn't been fixable by anyone so far, so I doubt you'll make any progress. But there are some shitty things about my situation and my behaviour that I *need* to look at and try to change, before I get fired from another job. And she accepted that as the starting point, and instead of giving me grief about wanting to kill myself every session, she says "I'm rlly sorry you feel that way, I wish you didn't bcz I like you, but..." and then we go on to talk about the person I am *now*, suicidal urges and all, and handling situations with what I've got.

Therapists often like to turn it around and say all "maybe this isn't the time for therapy for you" when the truth is, therapy is a thing that takes two people. The place where the magic happens is when TWO people trust one another. If you don't trust your therapist to open up and lower the barriers and get at the realness of the shit that is eating you, it might not be ONLY YOU that is at fault. It might just be that this is not the therapist or the therapy for you.

I have had SO MANY shit therapists I can't even count them. But I had a good feeling about mine from like the second email, and when we met in person, she had Berenyi red hair, and tattoos on her hands and pirate boots and wore lots of things with swirlies on, and had a total badass attitude, and I looked at her and thought "You are not a bullshit therapist, you are MY PEOPLE" and the magic happened within like 3 or 4 sessions, and there was trust, and stuff started changing. I always thought therapy was supposed to hard and draining and awful, but even when it's difficult and deep, it's actually still OK and it's *easy* and there's as much laughter as there is weeping because we have *trust* not numbers and tick-boxes. If you don't look at your therapist and think "you are my people, you are on my side" why the fuck should you trust them or open up to them?

I don't even know what your therapist will be like. Probably nothing like mine. There is no one size fits all therapy experience, which is the bullshit LIE of CBT. But you will know when you find your therapist that they are *your* therapist, because you will feel OK with trusting them, first a little bit, and then a lot.

CBT is the signature dish of NHS mental health services at the mo i suspect because of its relative cheapness alongside what i believe is sound evidence of relatively high effectiveness in treating depression compared to other treatments BUT relatively high doesn't mean "this will work for everybody" and i worry that the current diagnostic regime is set up in such a way as to create a "CBT or gtfo" culture within the NHS

i've taken some things of use from it i think but i've never fully committed to it and there's no way that it should be offered as the only effective treatment for depression imo.

CBT is the signature dish of NHS mental health services at the mo

as in it's more popular than just putting people on medication?

my recent-ish experiences and those of friends suggest they assess you for CBT much faster than the wait to see a psychiatrist used to take but nah of course they give you the pills first, quickest and cheapest of all

yeah I got seen surprisingly quickly on this go through too, and whereas in the past they've questioned my not taking pills they were just like "oh, well, that's up to you" this time round. PS now I am questioning my not taking pills but I may take that to the pillz thread

I think I'm disappointed (in my lack of commitment/progress/trumpet-heralded epiphanies rather than her) because I do trust her. Or, I like her. That's not the same thing as trust or as her being right for me, but it's a lot better than I've had before.

On the other hand I worry that I like her because she's older, and... she's not My People, she's more of a mother hen, which I feel more comfortable around but it shouldn't be about comfort. And maybe I'm playing it for sympathy and a pat on the head, rather than finding the truth. And she's happy to fill silences while I nod, and that's more comfortable than the people who lay awkward silence traps to see if you fall into them saying something that they can pick apart, but maybe it's not as helpful. Eh.

feel like branwell bell is dishing out a lot of undeserved negativity toward CBT and therapists

what a relief -- was briefly worried that large health bureaucracies weren't the same after all! (Haha)

My HMO's process:

1. are you trying to kill yourself right now? if y -> emergency services, if n -> psychiatrist
2. psychiatrist makes you fill out a survey and talks to you for about 30 minutes or so, generally advises you to drink less alcohol, stop recreational drug use, eat healthier food, get exercise and get out of any domestic/work situation that is dangerous to your mental health. Then asks you how you feel about taking medication. Generally recommends medication.
3. psychiatrist will also recommend relevant group therapy meetings

basically in HMO-land, individual CBT is an expensive service to provide, so they have these classes that are CBT but with groups

group CBT can actually be pretty cool

sometimes it's nice to not have the pressure on you, to learn about someone else's problems and think about ways they can deal with those problems. kind of a good exercise that you can later apply to your own life.

yeah, I considered going a few times, but never did. But, at that point, I was in a good enough space where I had close friends that had similar problems, and I ended up doing the equivalent with them over food and drinks, which I think was better for me, because at the time I definitely suffered from "people are only pretending to like me" issues.

Dude, unless you have met my former therapists, and you were actually at those CBT sessions, I don't think you get to define whether my negativity about them is "undeserved" or not.

My opinion on CBT is the same as my opinion on medication, is the same as my opinion on every other form of mind-brain treatment: if it works for you, great. If it does not work for you, there is no reason on earth to keep doing something which is not working for you. And anyone who tries to tell you that you should keep doing something which is explicitly not working for you, that is not a healer, that is a ideologue.

Spacecadet came on here and said, person was not finding CBT useful. It was not per first attempt at it, and those other attempts were not useful, either. And it was really getting person down, because the therapists kept insisting it was something wrong with *per*. I suggest only this: if person tries something several times and it does not work, the problem might not be with *person*, it might be with THING.

group therapy was immensely awkward & painful for me but it was through my university & i think the people running it were fresh out of college. they were REALLY bad at it.

in fact my non-group therapist was also pretty "new" at her job. I need to find a new shrink with some experience.

but to spacecadet: I think you need to decide what it is you want and commit to that. Like, say, "I don't want to be miserable anymore!" Granted, it wasn't a simple straight line, there were a lot of 1 step forward, 3 steps back periods, not that I am "cured" by any means, but I've definitely realized over the past 4 years, "Hey, wait a minute, I don't actually hate myself anymore!" After 25 fucking years of self-loathing, geez.

if someone tries something several times and it does not work, surely the problem might be with how the person is doing it?

sure! But I think BB is implicitly saying, that if it is not working, then why not try something else that could work

like what?

Much of my personal difficulty with CBT was that the whole thing seemed to be structured around the idea of: have you ever *considered* that other people's motivations and thought processes might be different to your own? And that the behaviour you are reading as meaning one thing, might be caused by something completely different? And you should try to look at the problem from several different angles to see which explanations are most likely?

I'm sure for some people this may be helpful and life-changing!

But when you are a person who has literally spent their entire *life* being reminded of, and considering, and trying to compensate for, and predict, and cope with, the fact that other people's motivations and thought processes are noticeably really different from your own and arcane and neither predictable nor explicable; and when you are a person who suffers from serious OCD as part of your bio-make-up; and overthinking and trying to see things from too many angles at once is part of the problem and not the solution - then teaching someone like me CBT techniques is like handing a suicidal person a loaded gun and saying "Here, we have a new thing called Russian Roulette Therapy which will cure your self destructive urges." It's not going to help that person, and has a high likelihood it will make things a lot, lot worse.

If you find it helpful and it works for you, go forth and be healed!

But the NHS has diverted pretty much all of its mental health resources into this thing, told us it is the only alternative, because it's cost effective or whatever. When one size does not fit all, and telling people it is, and blaming *them* when it fails is really irresponsible and wrong.

People are not all alike. The same treatment may not fit all. If it does not work for you, that does not make you a "special snowflake" or a problem patient, or "this is not the right time for therapy for you is it" - it means that this person requires something else. Mental health is not one size fits all.

maybe your therapists haven't been good at explaining cognitive therapy. what I've gotten from it is that it works more along the lines of the scientific method, and you change your state of mind by challenging your thoughts with empirical evidence and experimentation. then evolving your state of mind based on an expanded set of facts.

getting a severely depressed person to successfully do this, from my own experience, is next to impossible. took me an entire year of hitting my head against a wall before I could even appreciate this. only now I feel ready to do the more hardcore cognitive work.

comparing CBT to a loaded gun seems somewhat OTT

am i right in thinking that what you're saying BB is that CBT might be considerably less effective if you're non-neurotypical? because i'd say absolutely yeah but this is also a problem assumption of a lot of talking cures

xp also from your description it seems like you are focusing on one small aspect of CBT - i don't think of CBT at all as being structured around interpreting what *other* people think

Late Great, if CBT works for you, go forth and enjoy CBT. But please, just stop trying to tell me why it's my fault it didn't work for me. It isn't. The end.

My current therapist is great! I have NO IDEA if she would work for Spacecadet, or indeed, for anyone else. Person is not currently available on the NHS, though, and I'm bankrupting myself to continue seeing her, because I (and my loved ones) have noted that something seems to be working, and I do indeed seem to be operating more easily in the world.

Person practices a mix of Jungian analysis and Existential therapy and "whatever the hell I keep my eye out for, that I know will Branwell will probably respond to, because I've got to know person really well."

Person listens to what per clients need, and responds to what they tell per, and tailors therapy to what the client responds to best. Person sometimes even asks me "What was that book, or website that you mentioned, because I'm going to recommend that to another client, it sounds like what they need right now." Person listens to, and responds to, and works with per clients, and together, we come up with what the therapy is going to be, and what actions I am going to take in the next week. Person has taught me that I know myself better than any of the people around me, and I'm the only person who can work out how to fix me. *I* am the only person that gets to define my narrative. CBT and the whole "THIS MUST WORK ON YOU OR GTFO" was just one more external narrative that other people imposed on me. How the fuck was that ever going to work, for a person like me?

The irony is, I've spent much of the past decade going "Therapy is worse than useless, therapists are useless charlatans, don't waste your time or your energy" and I certainly understand why people are projecting that narrative onto me still. But my current therapist is the first therapist I have *ever* had (and I've had shrinks of one kind or another since 1982) who has made me go "Therapy is great! Therapy is so amazing and life-changing and everybody I know should get therapy!" I am now 100% therapy-positive, because of this person, and their *bothering* to try to find something that works for me, instead of just imposing one more narrative on me, whether that's CBT or whatever.

Keep looking till you find what *you* need, Spacecadet. It might not be "comfortable" but it will feel *right*.

Medication worked for me. Therapy did not work for me without the medication. It was like conversations with my mom when I was a teenager.

xp i'm not talking about *you* bb, i'm talking about CBT. i never said it was your fault it wasn't working for you.

i do think it would be a shame if you scared anybody away from the most clinically effective treatment for depression

I think it would be a shame if anyone else was scared it was their own fault if this magic therapy didn't work for them. Good to hear both sides.

Now that my brain feels more "normal" -- those teenage conversations with mom make sense and seem relevant. Am I just rambling to myself?

Kinder OTM.

but it's not a "magic therapy". it's a hell of a lot of work, kind of like a diet + exercise regimen for the brain and lifestyle. so if it's not working, there is a good chance it IS down to you, though i would hate to use such a loaded term as "fault".

BB, Existential Therapy is a close relative to CBT ... cognitive therapy was born in large part out of existential philosophy (at least Albert Ellis and his REBT are). so if that's working for you then there has to be some parts of CBT that'd be cool by you, depending on what type of CBT you've done. there are lots of kinds ... Aaron Beck/David Burns (which seems to be the most popular), Albert Ellis' REBT (which I think is the most interesting, and has more of the existential elements to it), etc. plus you have different therapists and what they bring to it, etc. CBT just isn't one method, it's a huge field with lots of different types of practices, people involved, etc.

kind of like a diet + exercise regimen for the brain and lifestyle

I think that's a good analogy.

Maybe you could work some of your CBT thinking on why you keep turning my "If it works for you, fantastic! If it doesn't work for you, it's not necessarily your fault" into "scaring people away from the best therapy" - that might be a start. The moment you compare things to "diet & exercise regimes" you have to "work real hard at" - which HEY YOU KNOW WHAT DON'T WORK FOR EVERYONE EITHER - you have lost my attention. Now good day, to you, sir.

yo i wasn't even talking to you i was talking to kinder

eh I have some mental blocks against putting the effort in, but there are definitely aspects of CBT I think may be promising (also some I find kind of shallow and unconvincing or just impossible though)

plus I've also had non-CBT counselling, just talking and no homework, and got nowhere too. Actually those were strangely frustrating to me, cz even though in CBT I feel like I'm enjoying the play-acting thing and being listened to more than actually working out steps to solutions, without that pretence it was like, why am I here at all?

What are the current CBT alternatives? Mindfulness is kind of in vogue I guess. I've heard of DBT for borderline personality disorder - I don't think I'm borderline but I def. have some abandonment/splitting/anger issues so maybe the techniques could be helpful. Haven't heard of Existential psychotherapy as mentioned by BB, will look into that now.

so which parts do you find shallow and unconvincing?

my therapist does a combination of CBT and psychodynamic therapy, psychodynamic therapy might be something to look in to. it's basically a lot of "hmm, based on what you're saying to me to sounds like you do X when you feel Y because Z happened to you in your past and you never got over it". i find it useful.

Spacecadet, it's totally worth investigating and checking out many different flavours, and reading up on them, and feeling through which one instinctively feels right, and which one smells "omg no, this is bullshit."

Because the best therapist is really someone who will work with you, and is willing to mix and match the bits that you find helpful, rather than - and I'm going by the NHS dudes I had here - someone who turns up with a workbook and photocopied worksheets that you will take home and do, because that is what the NHS has recommended, regardless of whether it has anything to do with you. I mean, hey, if you enjoy worksheets, by all means, do more worksheets. But I just found the expectation of "This is the book, you have to do it page by page, whether or not it is relevant" was just so... no. Effort is necessary, but effort directed in the wrong direction will not move the heavy object, it will just break your leg.

But I really do believe that it is the therapist as much as the therapy. A lot of people really resist that idea, because it's not Scientific!!!!11. Science and Medicine should just *work*, regardless of who it is administering the cure. And mind-brain stuff is... it's just different. It really does matter who administers the cure, and whether *you* feel listened to is hugely Urgent and Key.

xp I know I'm lucky here but I don't have any particularly traumatic childhood events to blame for my feelings. Wonder if my therapist does that too because she accidentally gave me the wrong 5-column thought record today before noticing and getting the right one, and column 5 in the other one was something about "past event this reminds me of: who said this to me? when?"

I uh... I just find the "what other ways are there to look at things?" bits awkward, because the blurb I was given said it wouldn't help if you didn't believe them. Well, I can make up other explanations for things all day, but no, I don't believe any of them. Things like that.

(this is kind of vague, there are other things too but tbh we haven't been doing much CBTing for the past month, partly because of the holidays and partly because I guess I was starting to flake and she was going easy on me)

yeah i always struggled with that too ... it's easy for me to come up with positive affirmations but i find it hard to internalize them.

it has gotten easier over time ...

aps don't have anything but i hope you find whatever method is out there to help you

xp

that's where the habit and repetition comes in, no? part of why i mistrusted the idea of CBT was because i cdn't see the route to internalization but now i feel like worrying about how stuff happens is counterproductive, for me.

which is perfectly sensical if you believe that you didn't acquire your self-destructive thinking habits in a couple of days

otm

TS: therapists that tell you to pull yourself together vs. therapists that tell you to accept yourself as you are.

accept who you want to be and work toward it imo

I'm going back to therapy starting this saturday and I am going to try to take the CBT exercises really seriously this time. I think tangibly changing my habits would be empowering, and is necessary for me to actually accept myself.

Thanks for this conversation. It's been really helpful for me, both in terms of solidifying my understanding of why CBT didn't work for me, and also the basis of my mistrust of the use of it as an NHS panacea.

Any time a person, or a method starts disregarding the variety of human beings, and starts insisting "This method will work for everyone, if the method doesn't work, it is the fault of the person not working hard enough, not the fault of the method" - that is not science, that is cult-like thinking.

And that analogy - it's like a diet and exercise regime - that was the moment that the realisation snapped into my head. I have heard this *exact* argument before. Many, many times. "Diet and exercise regimes work for everyone, and if you are not losing weight, you're just not working hard enough!" Thank goodness there are movements like HAES and Body Acceptance that have said, quietly compared to prevailing culture, but often enough for the message to reach me: "that is bullshit." It's empowering to stop blaming myself for failure which is not my fault, and look for something that just helps me be more healthy.

Even in the realm of more physical medicine, after the advent of "wonder drugs" which really did save the lives of billions of people, penicillin and the like, there was the slow realisation that 1) some people (including myself) have penicillin allergies, and the drugs will harm them more than help them and 2) that there are such things as penicillin-resistant strains of disease.

I'm putting CBT firmly into the category of "penicillin" - works great for many people, not so great for others. But I'm putting people who continue to advocate CBT as the "best treatment" in the face of the many people it does not help, into the realm of "dangerous, cult-like thinkers" to be avoided the same way I avoid the "OMG death-fatties" crowd.

Thanks for the reassurances upthread BB. :)

I agree with BB, but also see how people who think they are benefiting from CBT would get defensive at the suggestion that it's not 100% effective for 100% of people. Having faith in whatever therapeutic model you are using is probably an important factor in whether or not that model is effective. This connects to a larger issue I have where I think my skepticism -- or "objectivity" -- about things can be self-defeating. To get results in anything, I am slowly realizing, you have to look down and follow some sort of plan while blocking out distractions and uncertainties. This is hard for me, and I don't even find it appealing as a personality trait or whatever, but I think it's necessary sometimes, and a thing CBT tries to help people do with its emphasis on "productive" rather than "open-ended, infinitely regressive" thinking. People who are fitness fanatics, or really defensive about whatever habits they've cultivated, are probably just scared of looking up, recognizing they don't know everything, and losing the motivation to keep doing the thing that's working for them.