How Therapy Helped Me Survive Depression: Why Mental Health Treatment Matters

                  Therapy has been a part of my life for over three decades. That may seem like it has been ineffective. The opposite is true. Therapy is a lifeline and a changing force for me. I process my emotions and struggles in therapy. I work on life issues that arise. I receive support when my depression pushes me into wanting to harm myself. I know my psychologist will guide me into feeling better. Therapy is not a magic potion. It is workspace. Being in therapy requires a commitment. Sometimes it takes time develop that commitment, but it is worth the time it takes. 

                  Let’s look at why people go to therapy, how therapy can help, and what a therapy session might be like. Keep in mind that there are different types of therapy. Different people find certain types of therapy more effective than others. In a way it is similar to different medications working better for different people. We have a right to find the type of therapy and the therapist that works best for us. 

                  First, we should define therapy. Therapy is a structured form of treatment for mental illness. In therapy a trained mental health professional helps a person understand, manage, and improve their thoughts, emotions, behaviors, and overall well-being. The goal of therapy is larger than just a temporary fix, although there are often times when the focus of a therapy session needs to be on the short-term, especially if the person is experiencing a crisis. One of the overarching goals of therapy is improve the quality of a person’s life over time. Embedded in this is learning how to live with depression or other mental illness and how to utilize forms of treatment and coping strategies.

Reasons Why a Person Might Go to Therapy

                  There are many reasons a person may choose to go to therapy. Therapy is an important part of most treatment plans for depression and other mental illnesses. For me it has been vital. I would not be where I am today, able to write this blog, or able to live my life, without therapy. 

                  Therapy can help a person learn about their mental illness and how it affects them. This is an important reason for going to therapy. Living with a mental illness is difficult. There is a lot we need to learn about our illness. Understanding our illness and how it affects us allows us to manage our illness more effectively. A good therapist will guide us through gaining this understanding.

                  Dealing with emotional distress is another reason to go to therapy. The therapist will help a person cope with the distress. There are many types of emotional distress. It might be suicidal thoughts, panic attacks, anxiety, persistent sadness, hopelessness, or emptiness. In therapy a person will receive support coping with depression, anxiety, mania, anger, or trauma. 

                  Therapy can address grief. A person might go to therapy to address low-self-esteem or feelings of worthlessness. A therapist might also address anger, mood swings, or emotional numbness. Therapy is an important part of dealing with thoughts of self-harm or suicide.  Substance abuse can be addressed in therapy. 

                  A person does not need a diagnosis to benefit from therapy. Sometimes people just need a little help. Therapy can provide support when a person is struggling.

                  If a person has a mental health condition, therapy, in some form, is often a part of the treatment plan.  These diagnoses would include major depressive disorder, anxiety disorders obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorder, schizophrenia, and other mental diagnoses. Therapy helps people learn to manage these disorders. 

A Look at a Therapy Session

                  In the first appointment the therapist will spend some time getting to know the person and their needs. First, the therapist will ask about the person’s needs and concerns. The first session is used to begin to establish trust. The therapist will likely take a history. They will ask about current symptoms, emotions, and struggles. The therapist will ask about past therapy experiences. A good therapist with explain how the therapy will work and explain their treatment approach. A plan for session frequency and goals for therapy will be established. 

                  Later appointments will vary depending on the type of therapy being provided. Many therapy sessions are centered around discussions between the therapist and the person receiving therapy. Usually, a focus is established to guide the session. This might look like the person expressing a need and the therapist guiding a discussion and providing support. Often, the therapist and person will talk through emotions, experiences, or challenges. Together they work on coping strategies and problem-solving skills. The therapist may assist the person in working through unhealthy thought patterns and behaviors. Work on interpersonal relationships might be a part of therapy. Sessions vary depending on the person’s need. Those needs can change over time. 

                  Therapy is a two-way process. It requires work from both the person receiving therapy and the therapist. Both need to be active participants. In this process the therapist provides guidance and expertise, while the person should do their best to be open and share what they are experiencing and what they need. When a person is struggling with depression or other mental illness this can be difficul. In these moments being present and doing the best you can is important. It is important for the therapist to create a safe, structured environment where discussions can take place. The therapist can provide support and guide the person. It is the therapist’s role to identify patterns in thoughts, emotions, and behaviors. They then provide coping skills, emotional regulation techniques, and communication strategies. The therapist can help the person practice these strategies. 

                  The person in therapy shares what they are going through. This would include experiences, symptoms, thoughts, and concerns. It is important for the person to be honest. No one needs to hide anything from a therapist. In therapy there is no judgment. A key to successful therapy is for the person to practice the coping skills, emotional regulation techniques, and communication strategies that are being taught. A person in therapy needs to consistently attend sessions, be willing to engage in sessions even if it takes some time to develop this ability, and be patient with the process. Healing takes time. It does not happen overnight.

                  As I mentioned it can time for the therapy to really feel like it is working. Both the therapist and the person receiving therapy need to build trust. Therapy is most effective when both sides have worked to build a trust and communication. It is important to remember that the person receiving therapy can say something to therapist if something feels uncomfortable or if they are not ready to discuss a certain topic. There is no one size fits all approach to therapy. This is why both sides need to work at develop the therapeutic relationship. The therapist may need to change certain approaches or provide different strategies.

                  Healing takes time and it takes work. Mental illnesses are rarely improved without effort. Mental illnesses are complex, but with effort the therapy experience can be healing. 

The Rights of a Person Receiving Therapy.

                  Just as a person in a physical health situation has rights, so does a person receiving mental health care. If something does not feel right in the therapy session, it is okay to make your thoughts known. It is also okay to look for the right therapist. Sometimes the fit is just not there. A person might not find the first therapist they see to be the right one. So, a person might need to try a few therapists to find the one they click with. That is okay. 

                  If you have health insurance, you can ask for a list of therapists covered under your plan. One way to find a therapist is to look through therapist directories. You can do this online. Psychology Today Therapist Finder is one source you can use. Another source is SAMHSA Treatment Locator. You can also ask a trusted healthcare provider. Often, a primary care provider can help you get started. 

                  It is okay to interview a therapist before committing. Ask them about their experience with your condition. You can ask about their approaches with your condition. It is okay to ask any questions you might have. 

                  It is also important consider things like insurance coverage, cost, language and cultural competence, and gender or identity preference. You might also need to consider in-person versus telehealth options. These are all important considerations. You want to make sure that the therapist is right for you in every area.

Final Thoughts

                  Therapy is important when you live with mental illness. I have been in therapy for decades. For me, therapy is an integral part of my treatment. It is my lifeline. Over the years my therapist and I have developed a relationship that allows trust on both ends. I know that I can trust him with anything I am experiencing. I think he knows that I would reach out to him if I had thoughts of harming myself. In fact, there have been times when I have reached out to him when my depression has pushed me to the point of wanting to hurt myself. The fact that he has been there has saved my life. I know this may sound like I am overexaggerating, but having a therapist and a mental health team you can rely on is so important. It can be lifesaving. 

 

Self-Care in the Mental Health World

             Today I would like to revisit self-care. I wrote about it last June (Self-Care Ideas for When You Are Struggling with Depression) but I think it is worth revisiting. At its very core self-care is doing things to take care of yourself. We all need to take care of ourselves. Unfortunately, in the hustle and bustle of life, caring for ourselves often gets lost. Self- care is important for everyone. Today I would like to focus on two groups of people. First, individuals with depression and other mental illnesses. Second, I will address the need for mental healthcare professionals to ensure that they are engaging in self-care.

According to the National Institute of Mental Health, “self-care means taking the time to do things that help you live well and improve both your physical health and mental health.” On the surface this seems like a simple task, but for many of us it is difficult to prioritize self-care. Living with mental illness can make engaging in self-care even more difficult. The depression tells us not to get out of bed. It tells us that self-care is not worth the energy it requires. Depression and other mental illnesses tell us that we are not going to get better even if we engage in self-care activities. We are up against a mountain of reasons not to take care of ourselves. But mental illness is a liar. If we can just get ourselves to start, we would find that we will do so much better. 

What does self-care include? Really there are no limits to what can be considered self-care. It depends on the individual. In general, self-care includes getting enough sleep, but not too much, regular exercise, eating healthily, engaging in relaxing activities, setting goals and priorities, thinking positively, and staying connected. Sounds easy, right? I wish it was. When you struggle with mental illness, these basic routines can become difficult. Try focusing on one to start with. 

There are times when I can only focus on one aspect of self-care. Those are the times when my depression is bad. At these times I need to pick one self-care routine to focus on. Maybe it is exercising regularly. For me that looks like taking walks several times a week. It can be difficult to drag myself onto the sidewalk when I am feeling down. I need to remind myself that I will feel better, even if only slightly, afterwards. This helps me get my feet going. I have found that linking exercise with goalsetting helps me. So, I use the notes app on my phone to track how many times I walk each week. This allows me to see that I am really doing it, which builds my self-esteem. That in turn helps lift my depression.

Self-care is important when you live with mental illness. It helps you climb out of the pit that so often we fall into. It allows us to feel positives. Sleep, healthy eating habits, exercise, and regular engagement are all things that can help us when we are struggling. Start small. Don’t pressure yourself to jump in and do everything. That is likely to result in failure. Starting small allows us to see the positives and experience the successes. Whatever self-care looks like to you, make an effort to do it for your mental health. 

What about mental healthcare professionals? Why is self-care so important for these individuals? According to an article by Posluns and Gall, there is a prevalence of stress, burnout, and professional impairment among mental healthcare professionals. These authors found that self-care is important for mental healthcare professionals. Think about it. Psychiatrists, psychologists, and therapists (and other mental healthcare professionals) work with people who are often struggling. They see people at their lowest and help them cope with or overcome their mental illnesses. These professionals see a lot of struggle. They are expected to express caring in a relationship where the client is often not capable, or at least not expected to, return that care. That can take a toll on someone. 

According to Posluns and Gall a mental health practitioner must be well themselves in order to provide care to patients/clients. This obviously requires engaging in self-care. Posluns and Gall cite the Canadian Code of Ethics for Psychologists, which states that psychologists should “engage in self-care activities that help to avoid conditions (e.g., burnout, addictions) that could result in impaired judgment and interfere with their ability to benefit and not harm others”.

The same guidelines I provided above for self-care apply to mental healthcare professionals. Self-care may look different for mental healthcare professionals because they are not dealing with the difficulties of mental illness. The important thing is that the professional carves out time in their day for themselves. They need to make an active attempt to engage in self-care. Likely they are encouraging their patients/clients to engage in self-care. The mental healthcare professional needs to lead by example. This doesn’t mean they need to share what they are doing with their patients. The fact that they are engaging in self-care will be evident from their overall well-being and lack of burnout. 

Self-care is part of healthy living for everyone. People with mental illness may need more support to engage in self-care. We can all take small steps to improve our lives through self-care. Take a moment to examine what you are doing. Can you take a step to engage in a self-care activity?  If you are already engaging in self-care activities, can you add to what you are already doing? 

We are all worthy of care. It starts with us. We need to take steps to care for ourselves. That is how we all can become healthier. 

For tips on self-care activities see my previous post, (Self-Care Ideas for When You Are Struggling with Depression).

 

Source: Posluns, K., & Gall, T. L. (2020). Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care. International journal for the advancement of counseling, 42(1), 1–20. https://doi.org/10.1007/s10447-019-09382-w

 

 

                  

Different Types of Mental Health Professionals

                  When you are first looking for help with a mental health disorder, the number of different mental health professionals can be confusing.  In today’s post I will try to make sense of some of the options.  I am not a mental health professional.  By no means is this list meant to be authoritative or exhaustive.  I am a person with lived mental illness experience who has seen several professionals about my illness.  My intent in sharing this information is to provide assistance to those trying to navigate the mental health system.  It can be an overwhelming process especially when a person is struggling.

                  You may need more than one of these professionals.  I have a team that includes four members.  That is not always necessary.  From my personal perspective, each member of my mental health team adds to my treatment and healing and are instrumental.  I believe a team approach is beneficial to living with mental illness. 

                  Let’s look at some different mental health professionals.

Psychiatrist

                  A psychiatrist is a licensed medical doctor.  They are either an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).  Psychiatrists have completed a residency training in psychiatry.  They address both the mental and physical aspects of mental illness.  Psychiatrists diagnose mental health conditions.  Once they have diagnosed a patient, psychiatrists prescribe and monitor medication.  They also can provide therapy.  Psychiatrist can also prescribe alternative treatments for mental illnesses including transcranial magnetic stimulation (TMS), ketamine, and electric convulsive treatment (ECT).  

 

Psychologist

                  A psychologist has a doctorate degree in clinical psychology.  This can be a Ph.D. or a Psy.D.  They are licensed by their state.  Psychologists evaluate a person’s mental health.  They use clinical interviews, psychological evaluations, and tests.  A psychologist uses the information they gain from these tools to make a diagnosis.  They provide individual and group therapy.  Psychologist often use psychotherapy (talk therapy) with patients.  Some types of therapy used by psychologists include cognitive behavioral therapy (CBT), dialectal behavior therapy (DBT), interpersonal therapy, humanistic therapy, and psychodynamic therapy. 

 

Psychiatric Nurse Practitioner

                  A psychiatric nurse practitioner has a Master of Science (MS) or Doctor of Philosophy (Ph.D.) in nursing with a specialized focus in psychiatry.  They have either PMHNP-BC, which is board certification in psychiatric nursing, or they have NCLEX, which is National Council Licensure Examination.  Psychiatric nurse practitioners provide assessment, diagnosis, and therapy for patients with mental illness or substance use disorders.   Depending on their state, they can prescribe and monitor medication.  A psychiatric nurse practitioner blends nursing and psychiatric expertise when treating patients.  

 

Therapists/Counselors

                  Therapists and counselors have a master’s degree (MS or MA).  They can evaluate a person’s mental health.  When working with individuals they use therapeutic techniques based on specific training programs.  There is different licensing for therapists and counselors.  LPC stands for Licensed Professional Counselor.  LMFT stands for Licensed Marriage and Family Therapist. LCADAC stands for Licensed Clinical Alcohol and Drug Abuse Counselor.   Therapists work with people on understanding their thoughts, feelings, and choices.  

 

Social Worker

                  A social worker has a Master of Social Work (MSW) degree.  These professionals can evaluate a person’s mental health.  They use therapeutic techniques based on specific programs. Social workers are trained in case management and advocacy services.  Their role is often to empower individuals with mental illness to lead lives that are fulfilling and independent.  

 

Primary Care Provider

                  A primary care provider (PCP) is a doctor (MD), physician’s assistant (PA), or nurse practitioner (NP).  This provider can prescribe medication.  They can refer a patient to providers who specialize in mental health.  In the best scenarios a primary care provider works with other mental health professionals to provide the quality care.

 

                  Often, the first line of defense against mental illness is the primary care provider.  They are usually the provider who is going to see the patient most often prior to diagnosis.  Primary care providers should screen for mental health disorders and refer patients to the appropriate mental health care provider.  Once the patient has a mental health care provider, the PCP should work collaboratively with that provider to ensure the patient’s care.  

                  I have seen all the above providers except a social worker.  In my experience the best mental health professionals are the ones who listen not only to what the patient is saying, but also to what the patient is not saying.  They are empathetic and patient centered.  High-quality mental health care professionals treat the whole patient by being aware of their needs.  They ask meaningful questions.  They are not quick to slap a label on a person.  Instead, they see the person as an individual with an illness that they can treat.  

                  It is important to be comfortable with your mental health providers.  It is okay to try out professionals to ensure you have the right fit.  Being able to talk to your mental health care provider is crucial.  Even if you are not someone who is comfortable talking, there needs to be a comfort in the communication you have with your provider.  A good provider will support you in the communication aspects of treatment.  Don’t worry if you try a mental health provider and don’t feel there is a fit.  But make sure you try someone else. Don’t give up because a provider didn’t meet your needs.  We all deserve high-quality mental health care providers.  The right one for you is out there.  As an example, I have seen several psychiatrists over the years.  I had to learn that it was okay to change psychiatrists.  I have finally found the right one.  You will know when you have the right provider.  Trust yourself. 

                  There are a lot of great mental health providers out there.  If you are looking for one, ask your medical group for the names of providers.  You can ask your PCP to recommend someone.  There are also a lot of new ways to find a provider online, but that is for another post.  It is my hope that everyone can find the high-quality mental health providers like I have found.  It truly makes a difference.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Finding the Right Therapist

            Therapy is a key part of living with depression.  I believe it is vital to have the right therapist. Whether that person is a psychologist, counselor, or therapist finding the right one is vital.  Finding the right one can be a process.  There will be some that just don’t meet your needs.  That doesn’t mean that he or she is not a good therapist.  It just means the fit is not right.  

            In the early years of my depression, I saw several different therapists.  I have been with the same therapist, a psychologist, for 21 years now.  He provides for my needs and understands me.  Therapy is often a difficult journey in which you face many of your challenges head on.  For me it has been beneficial to be with the same psychologist for years because he knows me, and I am comfortable talking to him.  Therapy requires openness and a willingness to trust.  That has built up for me.  I know that when I go into a therapy session, I will make progress.  That progress may look different each time.  That is okay.  It is part of the journey.  

            So, what should you look for in a good therapist.  A simple search of the internet will give you many qualities.  Here are some that I feel are important:

 

·      Trustworthiness

·      Empathy

·      Communication Skills

·      The ability to listen to what is said and not said

·      Compassion

·      Critical Thinking

·      Optimism

·      Observation Skills

·      Hopeful/Positive

·      Patience

 

            It is important to feel comfortable with your therapist.  You will spend a lot of time working with him or her.  Your relationship, while professional, needs to be sincere.  It needs to be built on trust.  As the patient, you need to know that your therapist has your best interests at heart.  Your therapist needs to know that you will be honest with him or her.  It is not good to hide things from your therapist.  Don’t paint a picture you think he or she wants to hear.  Your therapist needs to know your reality.  He or she deserves to know your reality.  That is the only way they can help you battle depression (or other mental illness).  

            Therapy is a two-way street.  For it to be successful there must be commitment from both the patient and the therapist.  Together you embark on a journey.  You will navigate many aspects of your depression.  Some sessions will be the “feel good” type.  Others will be deep and gut-wrenching.  Both types are necessary.  

            Whether you already have a therapist, or you are just beginning your search, remember that the decision of fit is yours to make.  You need to be proactive for yourself, but it’s also okay to ask for help.  Make the best of your patient-therapist relationship.  He or she is a key member of your support team and will make a difference in your treatment. 

 

Check back Thursday, July 27^th for a new post.