Depression
Depression is a very common problem for thousands of people in the Vancouver area. There are hundreds of therapists and hundreds of different treatment modalities to choose from and frankly a lot of very partial information about how you can make the best choice.
Adding to the confusion, every person is unique and the genesis of each person’s depression is different. It’s really important to keep in mind that in selecting a certain type of therapy or a particular counsellor, treating only the obvious, external and surface symptoms of depression will likely not be enough to create long term relief.
Rather, in counselling, the client and therapist must work together to untangle the knot, discover how this particular depression is formed and work to release the deadening grip of the depression so that repressed feelings can flow more smoothly. At the end of effective counselling, there is new vitality and a client is empowered to take action in his or her life.
The following is a guide for clients and for readers in Vancouver to understand their depression and learn how to choose effective therapy. If you or someone you know is suffering with depression they may be experiencing debilitating symptoms they desperately need relief from. Recognizing the problem is the first step.
What is Depression?
Depression is a symptom. It is a reaction to, and an attempt to mitigate some form of pain. Usually without knowing it, or intending to, people create depression for themselves when they use the mind to cut themselves off either from frightening or unpleasant feelings, or from compelling calls for action they find too scary, overwhelming or perhaps unfamiliar to handle. The results are extremely painful and unfortunately, a very common problem in this city.
How Depression Feels
Low mood—sadness
Loss of motivation
Loss of enjoyment or pleasure
Procrastination
Excessive guilt or worthlessness
Hopelessness
Social withdrawal
Loss of energy
Hypersomnia or insomnia
Excessive self-criticism
Irritability
Indecisiveness and lack of concentration
Changes in weight
Suicidal ideation and/or thoughts
In addition to treating these symptoms, effective counselling addresses underlying causes of depression, thus uprooting the problem at its source and reducing the chance of relapse. In order to understand how counselling treatment works it is important to first understand what depression is, and how it is formed and maintained. Understanding how one creates their depression, learning about one’s personal process of how depression happens is a critical step in therapy. You can begin with some information.
Clients in Vancouver can do the same thing with action that we know we need to take but are afraid of doing. Sometimes we have very strong drives to live our lives more fully and deeply. We may need to make changes to:
Contribute something to our culture
Create a work of art
Change careers
Leave a relationship
Take more risks
Pursue an interest
Expressive ourselves more fully
Correct a wrong we have done
Stand up for ourselves
Participate in community in Vancouver
Go back to school
Even though we know what we need to do, we are afraid and even blocked from our own inner knowing by our fears. In order to restore some sense of equanimity it is common to split off our knowing, out of consciousness in order to be rid of the related feelings of fear of failure, inadequacy, rejection or what have you. We literally split off our strong internal drive, our need to live a better life and we become divided, fragmented and depressed. This is a very confusing state. One no longer knows what one wants, nor has the felt sense, in some cases, of knowing who one is. The feeling is of being lost. People in this state often, finally, look for counselling, relieved at least that there is hope for a way forward. Then the search begins for effective counselling.
How Depression is Formed and Maintained
Often, instead of feeling raw anger and fear, betrayal, hurt, etc. and allowing oneself to process painful experiences, one elects instead to create a deadening where escape is available from the painful feelings that seem so immediate, intense and terrifying. People often fear that if they allow these feelings there will be no end to them or that the feelings will hurt them in some way. It is important to know that they are just feelings, and they do end. But here’s the rub—the result of deadening is even more pain—the pain of depression that is feeling dull, flat, numb, alienated and disconnected from self.
At some point, the depression becomes so thick and so familiar that people, alienated from their primary feelings, experiences and drives, no longer know why they feel so lost. Often there is an accompanying flood of self-critical thoughts and the depression is compounded. If there is a tendency to blame this state of mind on others, on biology, the rain in Vancouver, life itself, god, and other things we are powerless to change, then the door to the cage closes and we no longer knows how to get out.
How Counselling Works
We’ve all felt the pain of the slings and arrows of love in our families of origin, our peers and in our romantic relationships.
Past traumas
Disappointments
Interpersonal attacks
Unhealthy family dynamics
Loss of relationships or loved ones
Bullying
Family of origin issues
So, often, our response to these experiences is to close down, feel less, love less, live life less. In effective counselling one can process past experiences like these ones, while allowing the attendant feelings to move through the body, freeing up tremendous amounts energy that was previously trapped in the fight against one’s own impulses and feelings.
The client and counsellor work together to understand the situation with clarity and integrate the experience with compassion. Once a client has learned how he/she constructed a depression, she can learn to move forward as a free and active agent in her own life instead of being controlled by chronic, psychic pain, which was generated in the past and maintained in the present.
But here’s the thing, in recognizing how the depression is constructed, client and counselor must also recognize that the depression is right in a sense, or at least it has its own logic and its own set of priorities… Life does throw outrageous fortune our way. The experiences some of us have been through are horrifying and sad. People can be unkind; the world is polluted; something is wrong in our life; the destruction of nature and building of strip malls is ugly and to refer again to our favorite bard, something is rotten in the state of Denmark!
Depression can be a protest in the face of ugliness, cruelty, chaos and/or a protest against personal but urgent concerns such as a meaningless job or mistreatment by others. Sometimes depression is a protest against a situation we could accept and ultimately choose to allow in our lives.
Counselling requires incredible compassion and attendance to what is troubling. Depression can be a demand for love, beauty, meaning, intimacy, care and deep and tender witness to pain that has never been properly listened to or even felt.
Equally important is learning to hear and attend to callings from the future. Working with a counsellor, a client can allow himself to move forward because he has learned to listen to intuitions about what to move toward. In counselling, clients can learn skills and methods to help them consistently act, in spite of fear, from their deepest desires and most profound values, a calling that is not fleeting, shallow and changeable, but more meaningful and more inclusive of the needs and concerns of others and the world. At the conclusion of this kind of psychotherapy clients can choose to live a more purposeful life with more energy, vitality and meaning.
A Good Counsellor…
A good counsellor will understand how to identify and work with depression. The right counsellor for you will be someone you feel comfortable with, someone you connect to, and someone who you feel is honest with you, while also being empathetic. Studies prove that the most important ingredient determining successful outcomes to therapy is a good relationship between client and counsellor so choose someone you feel you can trust.
There have been countless studies proving that Counselling is effective for treating depression. For those people living in the Vancouver area who have depression, the dullness, apathy and low mood are a heavy kind of suffering for which there is an alternative. Counselling offers another way, through the feelings, towards the clarity of increased consciousness and the exhilaration of an audacious life.
*Seasonal Affective Disorder (SAD) is a depression that is caused by hormonal changes in the body due to the lack of light in fall and winter months. Some people living in Vancouver may be affected by this condition. Counselling can be effective in treating SAD.
Anxiety
What is anxiety and how can we root it out in counselling? In therapy we aim not just to manage or control it, but actually settle into calmer more grounded state where we feel more consistently confident. Essentially anxiety is a symptom, not a feeling. It is an agitated state that one enters when one feels threatened. Usually the threat is either an external threat, or stemming from an internal conflict.
Once you can feel fear instead of anxiety, allowing yourself the full felt experience of fear, without giving in to letting it rule your actions, you will be through the anxious state.
Counselling can be very helpful to people struggling with anxiety because fear needs to be handled carefully. If we are too hasty, fear can overwhelm and result in increased symptoms.
Fear and How We Cope With It
Fear is an incredibly uncomfortable state many of us will avoid at all costs. Our vulnerability in the face of the realities of life is a very painful recognition, one that can cause significant physical, emotional and mental agitation. In response, we develop all kinds of strategies, otherwise known as defense mechanisms to avoid or control this basic and ultimately unavoidable experience. Learning what defenses you tend to use, can be invaluable in understanding how you shape your experience.
And yet it is possible to walk so closely with your own fear in counselling that you discover your ability to ride it out, to launch into the unknown with relative confidence, to actually learn to enjoy the ride. As this calm develops, and anxiety begins to lessen, clients will relinquish defense mechanisms as they become both conscious and unnecessary.
How Anxiety Feels
Anxiety manifests in extreme physical sensations that can feel overwhelming. Just as fear can escalate to the fear of fear, and fear of fear of fear, anxiety symptoms may escalate as well to panic attacks, avoidance and phobias.
In fact, many people experience anxiety symptoms such as above as well as many other possible symptoms. Essentially, anxiety is an unmistakable, pressing feeling of nervousness. It is associated with tension, stress and agitation prompting activity. We have all experienced this feeling at one time or another, but sometimes for some people anxiety is repetitive, persistent and to varying degrees, debilitating.
Some Anxiety Symptoms
Feeling apprehensive
Feeling powerless
Sense of impending danger, panic or doom
Increased heart rate
Breathing rapidly
Sweating
Trembling
Feeling weak or tired
Stomach problems—nausea and/or diarrhea
Problems sleeping
Excessive worries
Irrational thinking
Fear and Anxiety are Part of Life
Life can be frightening. The very fact that we are alive, we have the freedom to make choices and decide how we will respond to our circumstances is in itself daunting. In counselling, clients learn that allowing their vulnerability and moving through whatever fears or discomforts come to the surface is a much more resilient and effective approach than trying to create ‘strength’ by imposing control over themselves and their environment. In this sense, vulnerability is actually the seat of our strength.
By learning to take action toward their deepest wishes and desires, by learning to stay open and embrace life instead of tightening up and shutting down, by allowing inner sensations and emotions to flow through the body, Vancouver clients can learn to live fully and deeply thus effectively addressing this type of existential anxiety.
Eventually a new acceptance comes: time is passing and we are aging, but I am living well.
Anxiety from External Threat
Sometimes anxiety arises in the face of real, external threat. The stress and rush of everyday life in a modern world can overload our nervous systems making fear and anxiety an even greater probability.
Peeling back the layers, in therapy, gradually we arrive at the fear of the specific external threat itself. If we can stay with it, attend to it, witness and hold it, the fear dissipates and the anxious mood is relieved. Learning to experience fear, respond to it and also act in spite of it is an aim of anxiety counselling that can generate increased confidence and a more satisfying life experience. Learning to contact their fear and be with it until it simply subsides, clients can experience significant relaxation and calm compared to the relentless agitation and despair that comes with being imprisoned by anxiety.
Anxiety from Internal Conflict
In counselling, my clients tell me they don’t understand where their anxiety comes from. They no longer know why they are anxious or what they are afraid of. Sometimes anxiety arises from some form internal conflict, for example someone who wants to live a more authentic existence connected to real, deeper human values. The urge to let go and live more freely is experienced as a very real threat, inner conflict is created and anxiety results. In counselling people can learn to integrate these apparently opposing concerns. Fear once faced and held can dissipate and one can then consider the real implications as well as the likely benefits of allowing a change.
The process is of learning to be compassionate and inclusive with ourselves rather than judgmental and critical especially in regards to oneself.
Anxiety can have many different causes and manifests in a variety of different forms. Some of the more severe forms are described as anxiety disorders with different disorders having markedly different characteristics. Anxiety and depression are often experienced together.
Types of Anxiety Disorders
Panic Disorder/Agoraphobia
Specific Phobias
Social Anxiety and/or Phobia
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder
Generalized Anxiety Disorder
If you believe you have an anxiety disorder it is important to seek treatment so that your condition doesn’t worsen unnecessarily.
In effective counselling client and counsellor should work together to discover the cause of the anxiety and replace ineffective coping and defenses with new strategies, insights and behavior changes. Counsellors can be helpful by guiding the client gently toward what is deeply unsettling so it can be integrated, and clients can achieve the best results possible by actively engaging and exploring their own interior depths while attempting bold but gradual behavioural changes. This journey, undertaken with courage and commitment can produce much needed relief from the strain and constriction of anxiety.
Relationship
Relationships trigger our hurt and stuck spots. Relationship turmoil where our oldest wounds are repeatedly exposed is is a very painful experience associated with psychological pain and distress.
However, relationships can be our greatest teachers. Relationship counselling offers an invaluable opportunity to investigate unhealed wounds and undeveloped parts. Nothing reveals what needs to be worked on as well as repeated interactions with those who know us well.
Attachment
Human beings are emotionally and physically built to bond. In fact we bond so easily and so much with others, particularly when we are sexually involved, that a great deal of effective relationship becomes about struggling to hold on to one’s autonomy and independence while still staying close and connected to our loved one.
This is the dance of relationship, staying close while remaining distinctly ourselves. The problem is many people, and all of us at times, use unhealthy ways of establishing closeness and also of establishing individuality.
Afraid of losing closeness, we attempt to control our partner; afraid of being engulfed by them we distance, withdraw and coldly shut them out.
Our habits and preferences for maintaining closeness and autonomy usually begin when we are very young and can be very deeply rooted.
Emotional Intimacy
In real emotional intimacy we are revealed to our partner. With true closeness, we are most ourselves and we share who we are in our depths. It is through this sharing of the deeply personal that two people can create a beautiful and intimate interpersonal relationship. Real intimacy may look like vulnerably asking your partner to connect with you or it may mean sharing with them that you need solitude for a little while.
Relationships Are a System
However, as we have all experienced, relationships are not always intimate. We don’t feel we can be ourselves. We feel pushed and pulled and don’t know how to manage our needs. We may fall into conflict or into detached apathy. Relationships have patterns and cycles, and relationships in conflict have particularly rigid, repetitive patterns and cycles which can be very hard to break because generally the pattern or cycle reinforces itself. A skilled therapist as a third party can be invaluable in helping a couple or an individual identify the system and find new ways of engaging without further entrenching the negative pattern.
In therapy, the partners learn to identify and look at the entire cycle, they can then begin to find ways to break the pattern. Counselling helps the couple to create awareness about how the cycle is created and then clients and counsellor can practice breaking the cycle and try engaging in new ways.
Cycles of Engagement
Some of the most common patterns in a stressed relationship are:
Attack/Withdraw
Pursue/Withdraw or
Attack/Attack and
Withdraw/Withdraw
Attachment Styles
There are a limited set of attachment styles. People tend to have the following attachment styles:
Secure
Anxious
Avoidant
Fearful/Avoidant or Disorganized
Anxious attachment is characterized by nervous preoccupation with securing engagement with the partner, while avoidance is pretty much the opposite. Avoidant partners mitigate rejection fears by withdrawing from the loved one and finding some form of distraction. The fourth category, Fearful/Avoidant or Disorganized is marked by fluctuation between the two previous styles.
Enmeshment
When we sacrifice our personal autonomy too much we can become too involved in our relationship. We’ve probably all felt it, often in the beginning of a relationship and sometimes throughout. We give up our usual activities, we spend all our time with our partner, we lose friends, we stop speaking up about what we really think, we look after our partner’s feelings too much or we sacrifice our own goals and dreams for the comfort and security of being with the person we love. We lose a sense of where we end and our partner begins. Suddenly we are not the fascinating, engaged, attractive person we used to be. Our partner may even find themselves bored with us, or us with them.
Learning to maintain boundaries in a relationship is one of the most effective ways counselling can help create a healthier relationship and a more satisfying life.
Disengagement
Sometimes a couple will navigate enmeshment, arriving, reactively at a stage where they are more able to maintain autonomy. However, this can go too far too with each person maintaining individuality, but at the cost of emotional intimacy and connection in the relationship. This may end in a break up or sometimes, a couple stays together noticing less conflict and feeling, in a certain sense, safer, however many couples at this stage feel there is something missing. Connection has been sacrificed and intimacy is not achieved. Therapy can help a couple learn to create more emotional connection through honest sharing and deep listening and responding.
Goals of Therapy
Different couples may have different goals for where they would like to end up in therapy, however much of couples therapy and relationship counselling centers around exploring the dance of autonomy/intimacy to arrive at a successful marriage of the two, where both people are autonomous, and intimacy is also enjoyed.