One of the stereotypes of therapy is the assumption that depression (and anxiety) are the result of a "bad" childhood. The idea that the depressed person's parents weren't attuned enough, or they were abused, neglected, bullied, or something else. Even clinicians can easily fall into the trap of looking for what was "wrong" in a person's upbringing -- and often there are very relevant events and patterns that can manifest in a depression. But the assumption generally is that some thing(s) "must" have happened, right? Often, yes. But I'm not so sure this is always the case. I have seen quite a number of people in my practice who have had, what I and they would consider to be, a "good" upbringing. The parents were attuned, supportive, and sensitive to their needs, they had fun, enjoyed their siblings (for the most part) experienced many different things, had friends, were social, traveled, etc. Sure, there were times when things weren't great, but as a whole, their upbringing seemed good and happy.
I know, clinical word, right? -- "Sucks". But it does. Depression sucks. I've seen many people in my practice who struggle with depression, and there's nothing easy about it. One day you feel pretty okay, and another day you're suddenly having a hard time getting out of bed again. Or you may feel like you're just going through the daily motions, even if you're out of bed. It can last for days, weeks, months, or years. It is not a fun condition, nor is it something any person should take lightly. People who are depressed tend to share some things in common: They often tend to feel like an outsider, not good enough, not likable, like they are always doing something wrong, like they will fail or be rejected if they try.
Please click on either of the following links if you haven't read part 1 or part 2 of this social anxiety series. With social anxiety, people can get caught up in trying to be agreeable. For example: "That sounds good!", "How nice!", "How neat!", That's really cool!", "That's awesome!", etc. (There are reasons for this agreeability, such as fear of rejection, fear of being negative or critical, or of overtaking the conversation, but we'll save that discussion for another time). While obviously there's nothing wrong with being supportive or validating to another person, these comments generally don't do much to help to open a conversation without adding something with it. Genuine interest in the other person helps creates a more fluid conversation because it adds an element of real curiosity that can open the conversation.
This post is part 2 of a 3 part social anxiety series. Please click here if you'd like to read part 1 before continuing. Otherwise, read on. There is something that I call the "Social Anxiety Window". This is the amount of space and leeway where people feel comfortable when having a social conversation. For example, some people feel that they can engage in light small talk, and prefer to keep the conversation focused on the other person. This keeps the topics on the surface, and avoids bringing oneself (or even both) into the conversation. This is representative of a fairly tight window. For a socially anxious person, having a tight window for acceptable conversation tends to reinforce the anxiety because once the other person has said their part, it leads to conversation jumping. Searching for different topics in a conversation tends to be a more difficult mental exercise, as opposed to expanding a topic into broader conversation. As mentioned in the previous post, what often happens with social anxiety is there is more focus on thinking of the next question to ask to keep the other person talking, rather than trying to find a way in to engage with what is present.
Some people look forward to social situations and seem to thrive off of them. Many others have a more difficult time with social situations, leading people to cancel plans, skip out on social events, or attend, but find themselves uncomfortable and looking for ways out the whole time. In my practice as a psychotherapist and coach, one of the main issues I've seen with social anxiety is that people who are socially anxious tend to overthink what they are going to say in a social situation, and don't spend enough time actively listening. This causes them to miss the cues that can open a broader or deeper conversation (unconsciously, this probably happens out of a fear of connecting on a deeper level, as well as fear of vulnerability, even if there is also a conscious desire to connect -- this topic on its own could generate many books of discussion).
Chronic migraines are life-changing. It is a lonely struggle that family and friends don't tend to understand without experiencing it for themselves (and migraines are a very individual experience, so even those who have had a migraine don't necessarily know the struggle of another). With chronic migraines, the fear of the next attack always looms. In fact, the fear itself can even become debilitating. People have often relied on medical and alternative practices to try to relieve themselves from chronic migraine attacks. These methods can all be helpful, and it's especially important that people have a neurologist following the progression of their migraines. However, what isn't focused on enough is the role mental health plays in chronic migraines, and how much certain types of therapy can help with relieving migraines.
I have to admit, as a therapist with many years of training, and still aiming to improve my work every day, it always frustrates me when I hear people equate the delicate and challenging nature of psychotherapy with talking to a friend. Sure, therapy can at times involve a venting quality, and this is completely welcome as part of the process. However, this isn't the extent of what therapy is about. Therapy isn't simply an ear and a supportive voice, even if listening and support are part of the picture (and sometimes listening and support is what a person needs; and it's also important to hold in mind that not everybody has an ear or a supportive person in their lives).
I posted this a few years ago, however it is always good, as we approach a new year, to improve the ways we approach our relationships. With the New Year, people often take the opportunity to re-evaluate who they are and consider the changes they'd like to make in their lives. This is something people would benefit from doing year round -- reflecting on the choices we make, the way we treat others, and our commitment to self-care. One of the mistakes people often make in their relationships is attempting to change their partner. Eventually, they end up realizing that the more they push their partner to change, the more resistant their partner becomes to that change. One of the secrets of a successful relationship is for each partner to continue to improve, both as a person and as a partner. If each person make the effort to be a good partner, the relationship takes care of itself. You each focus on taking care of each other, rather than worrying about how the other should take care of you.
Based on my previous post about the usefulness and necessity of anger at one's therapist in the treatment -- rather than abandoning the treatment in these moments -- it was brought to my attention that a follow-up could be helpful to explore when switching therapists may be a good decision. It can't be overstated how complicated of an issue this really is. What makes changing therapists so complicated is understanding the greater picture of what's triggering the urge to leave. Is it something the therapist is specifically doing? Is a pattern being re-enacted by the client -- with the therapist --that happens in their own lives outside therapy as well (a very common phenomenon that can actually enhance the treatment)? Is it a dynamic that's triggering past emotional states that could actually be useful to understand in the treatment? Is the client wanting to leave the therapist for actually not being a good therapist, or is it more about the difficulty of facing the negative emotions within an overall good treatment? And so on. Basically, how does a person determine when the therapist is problematic, versus when the difficult emotions of an otherwise positive treatment are triggering a desire to leave?
Fear of flying is a difficult phobia to treat with conventional therapy techniques. Therapists often attempt to treat this phobia with standard cognitive-behavioral techniques, but run into roadblocks because of realistic obstacles. For example, systematic desensitization runs into problems because nowadays a person can only get to security without a ticket. So a person can't just build up steps to the flight the way a person can do with, say, going to the high floor of a building in an elevator. Many therapists also attempt to treat this fear by focusing on relaxation techniques: mindfulness, meditation, etc. These are useful and can be helpful, but are generally not enough on their own when trying to overcome fear of flying. Some airlines try to help this phobia by offering courses to learn about flying, why it's safe, and all of the logical components of this issue. But this is rarely, if ever, enough to overcome this fear. While the professionals referenced above have good intentions, fear of flying is difficult to treat without a multi-faceted approach that specifically focuses on fear of flying itself. In other words, flying phobia requires its own focused approach.