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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by tabitha on May 22, 2004, at 12:35:47
I found this article about depression and it's sounding mighty compelling to me. What do you think?
http://www.clinical-depression.co.uk/learning_path.htm
If anyone doesn't want to read the whole thing, I'll summarize. It says that the root cause of depression is emotionally arousing rumination, or negative rumination. (I know there were studies on that, it was in the book "Learned Optimism", which found a correlation between depression and the combination of rumination+pessimism. It didn't say there was a causal relationship though. Correlation doesn't prove cause, right?) Then it goes on to say that the emotional arousal results in too much dreaming, which disturbs sleep, leads to fatigue, which leads to more distorted thinking, which leads to more negative emotional arousal, and somewhere in there serotonin gets depleted as well. So it says the key to stopping it is stopping the emotionally arousing rumination. There's a bunch about cognitive therapy, about reframing things so they don't cause such a reaction (I've seen that idea before too, in the "Feeling Good" books). Somewhere they also said that all the negative rumination results in neglecting basic needs, so you have fewer pleasurable experiences, further lowering serotonin.
I noticed the thing they said about seratonin syndrome was b.s., where they implied that it's evidence for long-term damage from ADs. But ignoring that, the whole theory is compelling. I've noticed I just spend so much time focusing on upsetting events, going over them, they become huge, meanwhile I neglect everything else. The frustrating thing is my therapy and group therapy right now seem to trigger this more than anything. We're taught that it's important to trace stuff back to childhood, which just leads to me dwelling on painful past events more. I don't seem to get resolution and relief from doing that. The article says psychodynamic therapy is bad for depression, since it encourages dwelling on past pain, which depressed people do too much of already.
Basically my therapy doesn't seem to be helping now, and when that's happening I start trawling the web looking for some alternate approach. I need to talk to my therapist about this. Maybe she doesn't expect me to go home and dwell on stuff so much. I also want to gripe to her about one specific thing. When I exaggerate, she seems to totally discount what I've said. She says she won't validate black-and-white thinking. Fair enough, but can't she help me restate it instead of tossing it out? I can usually come up with an acceptable way to say it. Like for instance we've been arguing for months about me saying 2 of the group members don't like me. Once I said they just haven't warmed up to me. She seemed to accept that, and almost agree, not quite. I got frustrated because I think I've put it that way before. All this time she's been rejecting my notion that they don't like me. But that's just my exaggerated way of saying they haven't warmed up to me. Couldn't she have helped me get to that instead of getting into this head-butting argument for so long?
Last session I told her it just wasn't working. I'm trying to accept her alternate ways of thinking, but my old ways keep popping up. I keep leaving the group sessions, going home, and getting extremely upset by them. She said I need a medication change. That's so frustrating. What I hear is, if therapy isn't helping, it must be my brain chemistry. Can't possibly be the therapy. Aaargh!
I don't want a med change. I know my depression is higher now. It seems to me to be a result of all the upset from the group and the conflict with my therapist. I'm going to try adding more exercise. And maybe I can interrupt all this 'emotionally arousing rumination' somehow. Step 1 would be to stop believing it's useful. I keep thinking I'll get to the root of my pain and it will be healing somehow. It isn't happening. I'm just spinning my wheels.
Posted by Racer on May 22, 2004, at 14:56:26
In reply to Wrong therapy for depression?, posted by tabitha on May 22, 2004, at 12:35:47
Man, I can relate to what you're saying here, and what it seems you're experiencing, and since I just made a major decision about my own situation, I'm going to rant on and on about it to you about yours, 'K?
First of all, those articles saying it's "only negative rumination" are focussing on ONE aspect of a many-faceted phenomenon. The psychopharmacologists do the same thing in another way, for that matter. It's like the blind men and the elephant, the Cognitive folks say it's nothing more than the negative cognition. The guys handing out drugs say it's nothing more than brain chemistry. It's as if every group out there thinks it has the one true path to enlightenment, for everyone, at every time, and they turn their own belief systems into a quasi-religious dogma. Here's an alternate point of view, from someone else who suffers depression, gets caught up into negative ruminations, and is going to leave a voice mail quitting therapy this weekend:
How about it's some combination of ALL of those factors? Yes, I get caught in a rut of negative cognitions. Yes, I have unresolved pain from my past. Yes, I probably do need medication to help jump start my recovery from all this. So, who's right? Is the elephant like a rope, because that's what the tail feels like, or more like a tree, based on his legs? Or am I just an elephant who is like an elephant? Tree like legs, rope like tail, snake like trunk, and other elements that add up to an entire elephant which is much more than the sum of its parts? All the different groups have some portion of the truth, is what I'm saying, but they're being blinded to the WHOLE truth, which is that different individuals will benefit from different therapeutic models, and whether hte root cause of depression is the biochemical or the cognitive, they feed on one another and create a larger problem than either could create on its own.
From what you've posted here, both in this post and in the past, I'd say the problem with your therapy right now is that your therapist is not validating you. If you're not getting any outside validation, you can't validate yourself, and that erodes the whole trust dynamic.
Here's how I understand the whole 'childhood' model: through therapy, you express your subjective experience of distressing events and then PROCESS them, so that you can let go of the continuing distress. First of all, that means expressing yourself, and if your therapist is refusing to allow you to express what's happening NOW, what is she doing when you try to express what happened in your past? In order to express these things honestly, you have to feel safe in expressing your subjective experience, and you can't do that if someone is refusing to consider that subjective report because it *is* subjective. Does that make sense to you? If she won't let you say that you feel as though two members of the group don't like you, then she's certainly not going to be able to help you process that enough to reframe it. If you don't feel safe expressing to her the feeling that two members of that group don't like you, then you probably self-censor yourself in other ways, especially in the group. Self-validation and learning to reframe your negative cognitions for yourself are probably excellent goals for therapy. Self-censorship, on the other hand, is not an appropriate avenue to a successful therapeutic outcome.
In other words, I don't think the form of therapy is necessarily your problem right now. I don't believe that cognitive therapy is necessarily the right answer for your dilemma. Nor do I think that your perception that this isn't helpful for you right now is invalid.
Best luck, Tabitha. If you want to continue this discussion, or get any clarification (I know that I'm definitely impaired right now, it's hard to put thoughts into words, so ask anything I didn't make clear), please let me know. It's a subject of major interest to me right now, so I'm more than happy to continue.
Posted by Angela2 on May 22, 2004, at 16:53:06
In reply to Wrong therapy for depression?, posted by tabitha on May 22, 2004, at 12:35:47
I don't think that going over past events and situations helps. My current doctor analyzes things I've said and puts forth weird theories about them like she's Freud. But when I went to counseling at my college, the therapist used an approach which I think is called humanistic, where we would start off by me telling her what was going on in my life at that current point and she wouldn't bring up anything from the past or past sessions. I really liked that because psychoanalysis just didn't sit well with me because it made me depressed.
I hope things work out for you and I hope you find a treatment, even if its just researching alternative treatments like how you found that article, that works for you.Angela
Posted by Aphrodite on May 22, 2004, at 18:27:31
In reply to Wrong therapy for depression?, posted by tabitha on May 22, 2004, at 12:35:47
Tabitha,
Sounds like she needs to stick with energy therapy:)
I had already seen this website and thought it had some valid points. However, the problems in my current life have every thing to do with the unresolved issues from my past. My therapist says that all roads lead to early Rome, so you can talk about the present, but you're going to end up in the past anyway. Still, I think there is a valid point that if your daily life is in shambles, it's a bit of a waste to go in to talk about things that happened when you were 6.
I think that you are trying to research therapy models when the problem may very well be your therapist. Why doesn't she validate black and white thinking? If that is how you see things at this point in your treatment, that is very real. She can validate that you must feel that way and then gently guide you toward seeing things with a more balanced approach. To dismiss it does not seem helpful to me or very compassionate.
From this and previous posts, it seems to me that your therapist doesn't like to be wrong. Am I off base there? The red flag to me is the medication comment -- that sounds like victim blaming. That would have irritated me immensely.
Tabitha, I'm so sorry the group still seems to be invading your individual sessions. I think your response to your therapist's comments is very reasonable. You are trying so very hard. I hope I haven't been unduly harsh about your therapist. I'm just concerned that she is making you doubt yourself and minimizing your feelings.
Posted by DaisyM on May 22, 2004, at 20:26:47
In reply to Wrong therapy for depression?, posted by tabitha on May 22, 2004, at 12:35:47
Tabitha,
I'm sorry you are having such a hard time right now. I know you've been struggling on and off with this group. It does seem that your therapist really really wants the group to work for you.
I think different therapies work with different people. If there is crap in your past that you haven't dealt with yet, talking it out, getting it out, can really help. Otherwise it festers and effects your life in other ways. But i agree with Aprodite, if your life in the here and now is a mess, it does no good to go into the past. Connecting the dots and seeing patterns can help us all feel better.
My experience with CBT has been with my son. He did great and is handling his anxiety so much better using the techniques. And I think Terrics is trying it now and thinks it will be helpful. So maybe you should look into it...
I hope your depression lifts soon and you start feeling better.
Posted by Dinah on May 22, 2004, at 22:51:02
In reply to Wrong therapy for depression?, posted by tabitha on May 22, 2004, at 12:35:47
Tabitha, have you ever seen the movie "The Four Seasons" with Alan Alda and Carol Burnett? There's a line in there that sort of formed my relationship expectations. It compares relationships to a wave, with crests and troughs. (And I think adds that at the moment, the couple were in a trough. :) )
You've had a long history with your therapist. It could be that you two are just in a real trough right now. A long lasting real trough.
Or it could be that the relationship has changed with the addition of group so that the two of you don't have the same goals or expectations?
My therapist and I are in trough right now that dropped abruptly off of a real crest. His view of my level of functioning is not as optimistic as mine is. He doesn't see change as being on the therapeutic table. He sees his job as pure support. (Except for making me look nice for company.) I'm a bit discouraged and angry at his assessment.
It sounds as if the opposite might be happening with your therapist. That she used to be more supportive, and is now pushing change more than support. Which would be bound to be jarring. Especially if her view of what needs to be changed doesn't mesh with yours (which is my therapeutic problem at the moment).
Have you talked about this with her? I'm guessing you have since she's talking alternatives.
I suppose I'm always in favor of trying to salvage a long term relationship that's been rewarding in the past. But I also realize that there comes a time when salvage efforts must be abandoned.
Geez, that was helpful, wasn't it.
Sorry Tabitha. I know how painful this must be for you.
Posted by tabitha on May 23, 2004, at 1:17:57
In reply to Re: Wrong therapy for depression? » tabitha, posted by Dinah on May 22, 2004, at 22:51:02
Oh, I probably won't ditch her. I think I'd quit the group first.
Thanks to whoever reminded me depression is a mix of factors. I'm just not wanting to do a med change now is all, so anything that says meds aren't the answer is appealing.
Racer, yup I think you grasped the central issue, I'm not getting validation since I started the group. Last session after more of my griping she started validating. But she's still telling me she disagrees with my perceptions. So it feels insincere, but of course I wouldn't want her to lie to me (would I?). We talked about me quitting the group, but I'm not really ready to make that decision either. It would feel like giving up on ever being able to tolerate closeness with people. Maybe it will get easier.
To Aphrodite (I think, I'm sorry I'm not remembering who said what too well), who thought she was defending her rightness, I don't think she has issues with being right or wrong. Actually she's finally got me convinced that nobody is right or wrong, we all just have different perceptions and different filters. It's my twisted perception you're picking up. I hear her trying to make me wrong, but she isn't. She explained it all pretty well once-- she's trying to challenge my criticial parent, but I'm so identified with those critical thoughts, I feel as if I'm being attacked. She always suggests I check out my perceptions with the group, but I'm usually afraid to do that. I don't want to open myself up to possible negative feedback, since it seems to be hurting me so much. Or it really is a huge mindf***, but I doubt it. I have those thoughts, but honestly, I trust her more than that. I don't think she's working as well with me as she used to, but she's not an awful therapist.
I hope I'm not frustrating people by complaining so vigorously, then defending her. I'm confused right now. I'm having a harder time with therapy that I've had in years. Thanks for the support.
Posted by gardenergirl on May 23, 2004, at 13:27:20
In reply to Wrong therapy for depression?, posted by tabitha on May 22, 2004, at 12:35:47
Tabitha,
I'm sorry you are having such a hard time right now. Your therapist does sound like a challenge. In reading your post, it seems to me that she is wanting you to move from black and white thinking to a more balanced approach, without allowing you to go through the steps it takes to get there. You can't just make that leap from A to B without a lot of repetition and examples. She needs to HELP you with that and work from where you are, rather than wait for you to get there on your own and then validate you. It's called shaping. A little bit at a time, step by step, until the person can catch B/W thinking and reframe themselves. But in times of stress, we all often go back to bad habits, anyway. It sounds like a rough time with group and individual therapy.I wish you the best. I hope things feel more helpful and productive soon.
gg
Posted by terrics on May 23, 2004, at 14:09:01
In reply to Wrong therapy for depression?, posted by tabitha on May 22, 2004, at 12:35:47
Hi Tabitha, Seems to me you have thought this out quite well...very thoroughly. The hardest part is deciding the action. Also, there is no doubt that you are really trying cause you're increasing your exercise and you realize that the negative rumination is not good for you. I think distraction is a good way to block neg. rumination. [I cannot do it]. Can you print out your post and bring it to your T.or might that start more problems? I think you are on the right track. Also, don't completely rule out a med. increase or change even for a little while. It may help you cope better with the therapy problems. [I had a little increase in wellbutrin temporarily and it did take the edge off the neg. thinking.] Very good luck. terrics
Posted by Racer on May 24, 2004, at 12:56:06
In reply to Re: Wrong therapy for depression?, posted by tabitha on May 23, 2004, at 1:17:57
You know, Tabitha, I'm not a good hugger, in real life or online, so the fact that I gave you a cyberhug on the subject line is profoundly meaningful for me.
{{sigh}} This is so hard, because I can't separate out what I'm projecting onto you from my own situation, from what you're actually going through. It may be totally distorted, but as long as you know it, you can add liberal salt, right?
When you wrote:
"... I don't think she has issues with being right or wrong. Actually she's finally got me convinced that nobody is right or wrong, we all just have different perceptions and different filters. It's my twisted perception you're picking up. I hear her trying to make me wrong, but she isn't. She explained it all pretty well once-- she's trying to challenge my criticial parent, but I'm so identified with those critical thoughts, I feel as if I'm being attacked."
That's all really, really good -- if it's sincere. Not if *you're* sincere in believing it, but if it is a sincere development within a safe, appropriate therapeutic environment. That means that the therapist has to be sincere on her side, too, when she judges how ready you are for a push, versus how much support you need through a topic. That balance really has to be reset session by session, and sometimes minute by minute within the session. If she has "convinced" you, then that may not be entirely real, you know? I mean, you may be convinced only within the boundaries of the therapeutic moment, and it may still feel incongruent for you because of some deeper issues that are not being addressed. And I think gardenergirl said that it sounded as though your therapist may be trying to jump from A to D, without realizing the importance on B and C. That's what it sounds like to me, too.
As for the question about your prefering the therapist to be honest with you, even though she thinks you're wrong, guess what? You're right -- there's a sincerity issue there, too. My own situation is pretty much on point, so I'll tell you a bit of what happened at our last session. She jumps around too much for me, never following up on some of the most important things to me, going instead to her own concerns -- that's frustrating and not really relevant, but I really wanted to vent about it ;-) Anyway, she said something along the lines of, "We're all trying so hard to help you, what is it you want from us? If you'll tell us, we'll try to do it." First of all, I was in so much distress at that moment -- something that a better match of a therapist for me might have caught on to, and put off something like that for a better time -- that I couldn't have answered that question at all, even if I trusted her enough to try. But the thing that I *need* -- not want, but NEED -- is to be able to trust them. If I say, 'this is what I need you to do' and they start doing it now, I'm going to *know* that it's not genuine, it's not sincere, and it'll add to my distrust, not diminish it. Does that make sense?
I think, overall, that if I got to make decisions for you, and money and so forth was no consideration, this is what I'd tell you to do:
Take a week off from therapy and group and work and school and housekeeping and all the rest. Then go to your own private island, where you have the full on spa treatment: facial, body wrap, manicure and pedicure, have someone brush your hair twice a day, let the heat of the day sink through to your bones, run on your private beach with the sand tickling your toes, wander through your private art collection, whatever it is you would do if you could do anything at all with no worries. At the end of it all, ask yourself if you're afraid of changing therapists because it's so frightening to make such a major change, or if you really think that this fit -- despite the problems -- really is the best for you at this time. Then make a decision about what to do.
As for driving us crazy, at least we've got great company and lovely scenery, eh? Your confusion sounds par for the course to me -- 'course, I'm nuts so what do I know? -- and the conflict between your problems feeling heard by her and your defense of her just sound painful. I -- nolo me tangere -- wish I could hug you into feeling safer, but the best I can do is say that I think I hear you and anything you feel is real, even if it's not objectively accurate. And in this case, what you've described sounds as if it's probably more accurate than she's allowing you to process.
{{Tabitha}}
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