Too stubborn to change
June 2, 2010 8:44 AM Subscribe
I've got issues. About two years ago I finally got help. Now I've been in individual therapy and I've followed an intensive treatment programme. Neither worked and I don't know what to do.
I've been depressed for most of my life and I also have troubles with social interactions. Last I saw my DSM diagnosis it was: dysthymic disorder, social phobia, avoidant personality disorder. I've been conscious of being generally unhappy since my early teens or so; I'm in my late twenties now. The impact it's had on my life is that I have almost no friends or other social contacts, I've struggled to pass even half of the classes I've been signed up for at any time, I'm tired a lot of the time, and have difficulty enjoying anything I do (and when I do, that feeling goes away quickly), general depression stuff.
A bit less than two years ago I finally decided to seek help. I got myself a therapist who I met once a week. However I didn't really feel like I was getting anything out of it, and I wasn't really sure what I was supposed to do in those sessions. After about half a year I told my therapist about these doubts; I didn't get much of an answer. Another session or two later, when i brought it up again, my therapist suggested we'd stop therapy or take a long break (a shorter break was due anyway because of his upcoming vacation). He suggested I try to keep active, keep my days structured and filled, try to meet new people. I wasn't too happy about this. Trying to just go on with my life was what I'd sort of been doing my whole life and it clearly wasn't working.
So I got an appointment with someone to talk about getting another therapist or other treatment options. From there I got a referral to an intensive treatment, which I joined and just finished. For the last four months I've been away from home Monday morning through Friday afternoon, the time away was spent in (group)therapy. I didn't manage to get much out of it. The recommendation from the treating team there was the same as my first therapist: No therapy, pick up your life.
I've been told I'm too stubborn and resisting change. At least the stubbornness part is something I agree with. The problem for me is that when I get exercises and so on to do, I might try them but then again sometimes I don't. I can only see how it's going to be uncomfortable/painful/annoying/etc and I fail to see how the things that have been suggested to me would help in any way. I've had the standard "this will make you happy"-set of regular meals and sleep, exercise, daily activities, and a group of friends; all that at once and I still felt bad. I could try to get those things again, but why should I? It doesn't work. That's sort of the thought pattern I'm in.
I don't know how to get over this apparent resistance to change. My therapists' advice was to just let it go, but I'm stuck thinking that if it was that easy I wouldn't be needing help in the first place. I don't know what to do. I feel like I'm back to square one, back to before I sought help. I didn't manage on my own then, so I don't see why I would now.
Any suggestions?
Other information that might be of interest: I was on venlafaxine (effexor), it didn't work and I've recently switched to bupropion (wellbutrin) but haven't noticed any effects yet. I live in Western Europe.
I've been depressed for most of my life and I also have troubles with social interactions. Last I saw my DSM diagnosis it was: dysthymic disorder, social phobia, avoidant personality disorder. I've been conscious of being generally unhappy since my early teens or so; I'm in my late twenties now. The impact it's had on my life is that I have almost no friends or other social contacts, I've struggled to pass even half of the classes I've been signed up for at any time, I'm tired a lot of the time, and have difficulty enjoying anything I do (and when I do, that feeling goes away quickly), general depression stuff.
A bit less than two years ago I finally decided to seek help. I got myself a therapist who I met once a week. However I didn't really feel like I was getting anything out of it, and I wasn't really sure what I was supposed to do in those sessions. After about half a year I told my therapist about these doubts; I didn't get much of an answer. Another session or two later, when i brought it up again, my therapist suggested we'd stop therapy or take a long break (a shorter break was due anyway because of his upcoming vacation). He suggested I try to keep active, keep my days structured and filled, try to meet new people. I wasn't too happy about this. Trying to just go on with my life was what I'd sort of been doing my whole life and it clearly wasn't working.
So I got an appointment with someone to talk about getting another therapist or other treatment options. From there I got a referral to an intensive treatment, which I joined and just finished. For the last four months I've been away from home Monday morning through Friday afternoon, the time away was spent in (group)therapy. I didn't manage to get much out of it. The recommendation from the treating team there was the same as my first therapist: No therapy, pick up your life.
I've been told I'm too stubborn and resisting change. At least the stubbornness part is something I agree with. The problem for me is that when I get exercises and so on to do, I might try them but then again sometimes I don't. I can only see how it's going to be uncomfortable/painful/annoying/etc and I fail to see how the things that have been suggested to me would help in any way. I've had the standard "this will make you happy"-set of regular meals and sleep, exercise, daily activities, and a group of friends; all that at once and I still felt bad. I could try to get those things again, but why should I? It doesn't work. That's sort of the thought pattern I'm in.
I don't know how to get over this apparent resistance to change. My therapists' advice was to just let it go, but I'm stuck thinking that if it was that easy I wouldn't be needing help in the first place. I don't know what to do. I feel like I'm back to square one, back to before I sought help. I didn't manage on my own then, so I don't see why I would now.
Any suggestions?
Other information that might be of interest: I was on venlafaxine (effexor), it didn't work and I've recently switched to bupropion (wellbutrin) but haven't noticed any effects yet. I live in Western Europe.
I'm so sorry you have to go through this, Anon. While you may feel you've exhausted your treatment options, know that there are many, many mental health options to pursue. A few notes (IANAD, IANYD, IANA Mental Health Professional):
- There are as many therapeutic modalities as celebrity reality shows these days, and there are no methods which work reliably and well for EVERYONE. One man's CBT is another man's poison, I s'pose. You may wish to research various therapeutic methods and see which ones sound like they might "click", as well as discussing with a licensed psychologist (preferably one without their own axe to grind - I've had good luck with individuals practicing out of teaching hospitals, but that's in the U.S.).
- I'm not sure of the exact figure, but I've heard it mentioned that the average individual has to try ___ antidepressants before finding one that works. Additionally, many people can benefit from a drug "cocktail" (i.e. an SSRI augmented with Wellbutrin to counteract the yawn-y and sexual side effects). I can't overstate the importance of finding a good prescribing psychiatrist. They're way more versed in the ins-and-outs of various drugs and drug combos than most general practitioners.
posted by julthumbscrew at 9:01 AM on June 2, 2010 [1 favorite]
- There are as many therapeutic modalities as celebrity reality shows these days, and there are no methods which work reliably and well for EVERYONE. One man's CBT is another man's poison, I s'pose. You may wish to research various therapeutic methods and see which ones sound like they might "click", as well as discussing with a licensed psychologist (preferably one without their own axe to grind - I've had good luck with individuals practicing out of teaching hospitals, but that's in the U.S.).
- I'm not sure of the exact figure, but I've heard it mentioned that the average individual has to try ___ antidepressants before finding one that works. Additionally, many people can benefit from a drug "cocktail" (i.e. an SSRI augmented with Wellbutrin to counteract the yawn-y and sexual side effects). I can't overstate the importance of finding a good prescribing psychiatrist. They're way more versed in the ins-and-outs of various drugs and drug combos than most general practitioners.
posted by julthumbscrew at 9:01 AM on June 2, 2010 [1 favorite]
I like to think of therapy as private lessons on your life. You have to do the homework to get anything out of it. Even if it is uncomfortable, it's worth it to at least try them. If you're having trouble in seeing the value of doing the exercises suggested to you, then maybe that particular type of therapy is not for you. Try taking a break for a little bit, and then going back with new eyes. Try to find therapists who are doing a different kind than your previous treatments. Also, as to the failing classes part, try finding a therapist who specializes in helping students. They would have a lot of experience in helping people to study while depressed.
As to the medications, give them time to work. An acquaintance of mine took Wellbutrin for mood issues and (as a side benefit) to stop smoking. It took 2.5 months before she really felt the effects. It was fairly effective (completely effective on the smoking cessation part).
posted by bluefly at 9:20 AM on June 2, 2010 [1 favorite]
As to the medications, give them time to work. An acquaintance of mine took Wellbutrin for mood issues and (as a side benefit) to stop smoking. It took 2.5 months before she really felt the effects. It was fairly effective (completely effective on the smoking cessation part).
posted by bluefly at 9:20 AM on June 2, 2010 [1 favorite]
Have you ever been to a doctor to get a full physical workup with bloodwork and everything? Have you gotten your thyroid checked? Sometimes depression is a symptom of a physical problem and if that's the case then no amount of therapy is going to touch it. It's at least something to rule out.
Also, I can sympathise with the frustration when people say "Did you try making friends? Did you try going for a walk? Did you try smiling?" Yes, if those things worked for me then I wouldn't still have a problem. Anyway, go to your GP and see if he can find something.
posted by amethysts at 9:32 AM on June 2, 2010
Also, I can sympathise with the frustration when people say "Did you try making friends? Did you try going for a walk? Did you try smiling?" Yes, if those things worked for me then I wouldn't still have a problem. Anyway, go to your GP and see if he can find something.
posted by amethysts at 9:32 AM on June 2, 2010
The crappy thing about psychotherapy homework, especially in the case of depression, is that your symptoms get in the way of you doing them, even when you know they might make you feel better in the long run. Sometimes it just takes forcing yourself, unfortunately. IF you do it for a couple weeks, and you still think its pointless, then think about altering or giving up the attempt. But for a while at least, "fake it til you make it." Therapy only happens one hour a week, and in order to change some life-long habits its going to take some practice. Homework helps do that, but it definitely takes hard work. You are to be commended for making such an effort to try various things and keep looking. While the group thing didn't really seem to help, attending such an intensive group shows serious commitment to making a change.
That being said, it sounds like what you've described is behavioral therapy, and as julthumbscrew said, there are TONS of different modalities out there. Options include cognitive therapy, cognitive behavioral therapy, dynamic therapy, the list goes on... It can take time to find the right setup for you. Its very personal, and there's no reason to be shy about telling a therapist that its just not working for you and trying somebody else. You could try telling them "I've done these sorts of things previously and didn't find them helpful...do you feel you have a different approach that I could try?" You could also go peruse the web and read more about types of therapy and specifically recruit a therapist that ascribes to a type you find intriguing.
posted by gilsonal at 9:36 AM on June 2, 2010 [2 favorites]
That being said, it sounds like what you've described is behavioral therapy, and as julthumbscrew said, there are TONS of different modalities out there. Options include cognitive therapy, cognitive behavioral therapy, dynamic therapy, the list goes on... It can take time to find the right setup for you. Its very personal, and there's no reason to be shy about telling a therapist that its just not working for you and trying somebody else. You could try telling them "I've done these sorts of things previously and didn't find them helpful...do you feel you have a different approach that I could try?" You could also go peruse the web and read more about types of therapy and specifically recruit a therapist that ascribes to a type you find intriguing.
posted by gilsonal at 9:36 AM on June 2, 2010 [2 favorites]
This is one of the awful catch-22s of depression. Even though there are exercises that can help, the depression will do its best to keep you from making a sustained effort to do those exercises. It's like a mind parasite that is set on protecting itself at your expense.
When you think about doing the exercises your therapist gave you, it'll tell you things like:
This will never work.
It's too hard.
I don't deserve to feel better.
If this doesn't fix every problem I have completely, then it's worthless.
If I try and fail, it's worse than if I didn't try at all.
This feeling (depression) is who I am - if I changed that I wouldn't be me.
These (negative beliefs about myself) are just facts. Trying to believe anything else would be make-believe.
If I have the power to make myself feel better through my own efforts, then it must be my fault that I feel this way to begin with, therefore I'm an awful person who deserves to feel this bad.
Etc, etc, etc.
All these things the depression is telling you are lies. They feel true, but they aren't.
The truth is as follows:
Your depression is caused by a self-reinforcing interaction between a biochemical imbalance (exacerbating the physical feelings of sadness/hopelessness/malaise) and a set of disfunctional cognitive structures (beliefs/habits/perceptual filters/etc).
Anti-depressants, exercise, and sunshine can help with the biochemical side of things (once you find the right antidepressant), but the real hard work lies in the cognitive aspect.
A therapist can't do it for you. Even the best therapist is like an athletic trainer. He/she can tell you the work you need to do and give you feedback on how you're doing, but they can't do the hard work for you.
It is hard work. Changing even a simple habit requires time and dedication. You're trying to change a bunch of mental habits that are all tied together and that might even feel central to your identity.
This isn't necessarily a bad thing. Think about starting a physical exercise program. If you went through your workout and never got sweaty, or out of breath, or tired, or sore, then you would know one thing for certain - you weren't going to get any fitter. Getting stronger physically or mentally requires that you push yourself out of your comfort zone on a consistent basis. When you do the exercises your therapist recommends and you find them scary/uncomfortable/annoying, then congratulate yourself because that means you're doing something right - something that has the potential to make a difference.
Also, be prepared for the long haul. Making any kind of lasting change to your inner self takes time. Your depression will try to tell you "I tried that exercise once and it didn't make me all better. Forget about it!" That's like saying "I went to the gym once and didn't turn into an Olympic athlete - it's worthless!". A more realistic approach is to do one of your cognitive exercises daily (or at least several hours a week on multiple days) for several months, then ask yourself - "Has this made even a 5% improvement in some small aspect of my life?" If the answer is no, then maybe you need to find a different exercise. If the answer is yes, then congratulations!. Keep at it and find some additional exercises. Over months and years, that 5% improvement here and 3% improvement there can really add up to something that will make a huge improvement in your life. Use your stubborness to keep going rather than to hold yourself in place.
Good luck!
posted by tdismukes at 9:50 AM on June 2, 2010 [19 favorites]
When you think about doing the exercises your therapist gave you, it'll tell you things like:
This will never work.
It's too hard.
I don't deserve to feel better.
If this doesn't fix every problem I have completely, then it's worthless.
If I try and fail, it's worse than if I didn't try at all.
This feeling (depression) is who I am - if I changed that I wouldn't be me.
These (negative beliefs about myself) are just facts. Trying to believe anything else would be make-believe.
If I have the power to make myself feel better through my own efforts, then it must be my fault that I feel this way to begin with, therefore I'm an awful person who deserves to feel this bad.
Etc, etc, etc.
All these things the depression is telling you are lies. They feel true, but they aren't.
The truth is as follows:
Your depression is caused by a self-reinforcing interaction between a biochemical imbalance (exacerbating the physical feelings of sadness/hopelessness/malaise) and a set of disfunctional cognitive structures (beliefs/habits/perceptual filters/etc).
Anti-depressants, exercise, and sunshine can help with the biochemical side of things (once you find the right antidepressant), but the real hard work lies in the cognitive aspect.
A therapist can't do it for you. Even the best therapist is like an athletic trainer. He/she can tell you the work you need to do and give you feedback on how you're doing, but they can't do the hard work for you.
It is hard work. Changing even a simple habit requires time and dedication. You're trying to change a bunch of mental habits that are all tied together and that might even feel central to your identity.
This isn't necessarily a bad thing. Think about starting a physical exercise program. If you went through your workout and never got sweaty, or out of breath, or tired, or sore, then you would know one thing for certain - you weren't going to get any fitter. Getting stronger physically or mentally requires that you push yourself out of your comfort zone on a consistent basis. When you do the exercises your therapist recommends and you find them scary/uncomfortable/annoying, then congratulate yourself because that means you're doing something right - something that has the potential to make a difference.
Also, be prepared for the long haul. Making any kind of lasting change to your inner self takes time. Your depression will try to tell you "I tried that exercise once and it didn't make me all better. Forget about it!" That's like saying "I went to the gym once and didn't turn into an Olympic athlete - it's worthless!". A more realistic approach is to do one of your cognitive exercises daily (or at least several hours a week on multiple days) for several months, then ask yourself - "Has this made even a 5% improvement in some small aspect of my life?" If the answer is no, then maybe you need to find a different exercise. If the answer is yes, then congratulations!. Keep at it and find some additional exercises. Over months and years, that 5% improvement here and 3% improvement there can really add up to something that will make a huge improvement in your life. Use your stubborness to keep going rather than to hold yourself in place.
Good luck!
posted by tdismukes at 9:50 AM on June 2, 2010 [19 favorites]
Even though there are millions of people diagnosed "psychological disorders," these things are hardly reliable. Human mind/brain is so complex that no one can yet define what exactly causes all these so-called "disorders" and "problems."
Although I'm not an expert or anything, but I can tell you this:
Your mind and brain is much more powerful than you realize. One example is placebo treatments: they can be more powerful than anything else.
Forget all the disorder, phobia and all that crap.
You need to believe in yourself and step out of your comfort zone.
Don't be disappointed at the fact that you don't have no friends. Most people are lucky to have one true friend in their entire lives. Most "friends" that we have are people to socialize with and have fun with. So rather than worrying about having many friends, look for freinds that you can have "real" relationships with. Of course that starts with meeting and making new friends, but what I mean is you shouldn't feel any pressure about having to socialize, etc...
Be spontaneous, go with the flow, don't feel any pressure, because you don't have anything to lose for trying!!!
posted by dustoff at 10:30 AM on June 2, 2010 [1 favorite]
Although I'm not an expert or anything, but I can tell you this:
Your mind and brain is much more powerful than you realize. One example is placebo treatments: they can be more powerful than anything else.
Forget all the disorder, phobia and all that crap.
You need to believe in yourself and step out of your comfort zone.
Don't be disappointed at the fact that you don't have no friends. Most people are lucky to have one true friend in their entire lives. Most "friends" that we have are people to socialize with and have fun with. So rather than worrying about having many friends, look for freinds that you can have "real" relationships with. Of course that starts with meeting and making new friends, but what I mean is you shouldn't feel any pressure about having to socialize, etc...
Be spontaneous, go with the flow, don't feel any pressure, because you don't have anything to lose for trying!!!
posted by dustoff at 10:30 AM on June 2, 2010 [1 favorite]
Have you ever been in love, dear? Falling in love and personal spiritual experience can be most, transformative. In your place I would consider whether I'm being open to these. Schedule a solitary retreat somewhere close to nature. Take along reading that appeals to you, preferably "spiritually-oriented, and spend long hours staring out the window and really being with whatever comes.
posted by Pamelayne at 11:07 AM on June 2, 2010
posted by Pamelayne at 11:07 AM on June 2, 2010
> After about half a year I told my therapist about these doubts; I didn't get much of an answer. Another session or two later, when i brought it up again, my therapist suggested we'd stop therapy or take a long break
> I wasn't really sure what I was supposed to do in those sessions.
> My therapists' advice was to just let it go
Granting that these are your characterizations of the counseling you've been given... still, it seems like weak stuff: Go Out and Do X, or Internally Feel X, instead of
Do X Internally So You Perceive the World Differently, and Thereby Create a Mechanism for Naturally Feeling Differently.
To repeat the standard advice, try working with someone skilled in NLP or CBT.
Better yet: New therapist, with a more modern and precise toolkit, PLUS different meds.
posted by darth_tedious at 11:47 AM on June 2, 2010
> I wasn't really sure what I was supposed to do in those sessions.
> My therapists' advice was to just let it go
Granting that these are your characterizations of the counseling you've been given... still, it seems like weak stuff: Go Out and Do X, or Internally Feel X, instead of
Do X Internally So You Perceive the World Differently, and Thereby Create a Mechanism for Naturally Feeling Differently.
To repeat the standard advice, try working with someone skilled in NLP or CBT.
Better yet: New therapist, with a more modern and precise toolkit, PLUS different meds.
posted by darth_tedious at 11:47 AM on June 2, 2010
> I've been told I'm too stubborn and resisting change. At least the stubbornness part is something I agree with.
To be more precise:
The fact that your therapist helped you label that particular behavorial pattern as "stubbornness" suggests that he/she is incompetent. He or she may as well have called you "iron-willed". Really, sometimes a person needs to work with someone who can unpack the fear/desire combinations underneath the behavior which that person's old, past therapist may have, in some circumstance, labeled as "stubbornness"... so that this person can (if he/she were to learn from what you are about to do) *use your creativity* and *desire to make a comfortable and reliable change* in ways that work for you (again, if this person were stepping outside of him or herself, and seeing the bigger, brighter range of possibilities you are about to see) a real and lasting possibility, as you *find someone new* (inside yourself)... because these are the things one does, when one is as determined and persistent at remembering that one can feel better, and want even more, than one already does...
and that's the kind of persistent drive that can lead someone to test out new therapists, new drugs, new approaches, and just relentlessly, willfully hunt down ever newer and better options.
posted by darth_tedious at 12:15 PM on June 2, 2010
To be more precise:
The fact that your therapist helped you label that particular behavorial pattern as "stubbornness" suggests that he/she is incompetent. He or she may as well have called you "iron-willed". Really, sometimes a person needs to work with someone who can unpack the fear/desire combinations underneath the behavior which that person's old, past therapist may have, in some circumstance, labeled as "stubbornness"... so that this person can (if he/she were to learn from what you are about to do) *use your creativity* and *desire to make a comfortable and reliable change* in ways that work for you (again, if this person were stepping outside of him or herself, and seeing the bigger, brighter range of possibilities you are about to see) a real and lasting possibility, as you *find someone new* (inside yourself)... because these are the things one does, when one is as determined and persistent at remembering that one can feel better, and want even more, than one already does...
and that's the kind of persistent drive that can lead someone to test out new therapists, new drugs, new approaches, and just relentlessly, willfully hunt down ever newer and better options.
posted by darth_tedious at 12:15 PM on June 2, 2010
Definitely try another therapist. Quality varies WIDELY.
posted by callmejay at 12:28 PM on June 2, 2010
posted by callmejay at 12:28 PM on June 2, 2010
There are a lot, a LOT, of less-than-effective therapists. Many therapists, when a client wants to ask questions about therapy, don't behave well. Instead of focusing so much on who you are, try focusing on what you do, how you act, and what to do to achieve your goals. If your goal is to be a certain kind of person, then define the actions that get you there. And find a therapist who's really good.
I've gotten a lot from reading Playing Ball on Running Water.
posted by theora55 at 10:37 AM on June 6, 2010
I've gotten a lot from reading Playing Ball on Running Water.
posted by theora55 at 10:37 AM on June 6, 2010
This thread is closed to new comments.
posted by xingcat at 8:51 AM on June 2, 2010 [2 favorites]