Content note: depression

Miri has a great piece at Brute Reason about how to get the most out of therapy. If you’re thinking of getting into therapy, or if you’ve been in therapy and not gotten as much out of it as you wanted, I strongly suggest that you check it out.

I have my own personal addendum to Miri’s list. #5 on Miri’s list says, “Set goals for therapy.” Based on my experience, and with all the caveats Miri included about how not all these suggestions are necessary or appropriate for everyone, I would add an addendum to that.

#5a: Set goals for therapy — but be prepared for them to change.

When I look back on my times in therapy, and think about the ones that were really successful, some very vivid themes pop out. In my first successful stretch of therapy, the main thing I got out of it was learning how to identify my emotions. Literally. I’d talk about something that was happening or that I was thinking about, my therapist would ask me, “How do you feel about that?” — and I’d say, “I don’t know.” He’d then talk me through it: “How do you feel in your body? How does your stomach feel, how does your jaw feel, how do your hands feel?” In talking through my physical sensations, I learned to identify my emotions, which sensations meant I was angry, scared, excited, confused. It’s weird looking back on it, I’m now pretty in touch with my emotions, but that was a skill I had to learn.

In my second successful stretch, the main thing I got was learning how to let myself experience feelings and sit with thoughts I was frightened of. I had a lot of fear about certain emotions or thoughts that I thought would overwhelm me, and I kept pushing them to the back burner for fear that they’d consume me and control my life. A huge amount of what we did in therapy was creating a safe place for me to experience these emotions. When I had a trained witness sitting with me, someone who stayed calm and didn’t try to fix my feelings but who also know how to intervene if it was necessary, I was able to let myself have these thoughts and feelings — and I learned to trust that even when they were temporarily overwhelming, they always eventually passed.

In my third successful stretch, the one I’m winding up with now, the main thing I’ve gotten is understanding and accepting that depression is a lifelong condition for me, and learning how to manage it. Until recently, I’d always thought of my depression as situational, something that cropped up now and then when times were rough, but not something I needed to worry about or even think about the rest of the time. In this stretch of therapy, I’ve accepted that depression has come and gone my whole life and will probably always do so, and I’ve learned what to do about it — what kinds of life events tend to trigger it, how to recognize the warning signs, what specific actions to take when an episode is coming on, what to do when I’m deep in the middle of an episode or am starting to pull out of it.

The common theme among all of these? Going into therapy, I had no idea about any of them. If you’d asked me what my goals for therapy were… well, the first two times, I would have said “I’m unhappy and am not handling it well.” I was unhappy about relationships or work, I didn’t know what to do or even how to decide, and my unhappiness was taking over my life. The third time, I went into therapy because my dad was dying, and I knew I should be in therapy when he died. As therapy proceeded, my goals changed.

I agree with Miri that it’s a good idea, if possible, to have goals going into therapy. And a case could be made that what I wound up getting out of therapy did meet my original goals. Learning how to identify my emotions, how to let myself feel my emotions, and how to manage depression, were the tools I needed for my original goals of not having my life be completely screwed-up by my unhappiness, and figuring out what decisions I needed to make. I’m just saying: For me, therapy is often surprising. When it goes well, so far it’s always been surprising. It takes me places I couldn’t have predicted, and helps me solve problems I couldn’t have named and didn’t even know I had.