Therapy seems to happen in a vacuum

How do I take what I learn outside the soundproof room?


Cary Tennis
April 6, 2006 2:09PM (UTC)

Dear Cary,

I've been in and out of therapy for chronic depression for around two years now. My therapist is a very lovely woman, and our sessions are helpful, to a point. In her office I can cry; I can truly express my feelings of confusion, fright, etc. But once I'm out of the room, it's like nothing has changed. It's as if the session occurs in a vacuum. Whatever progress I manage to make in that period of time doesn't seem to carry over into my life. In the office, it's easy for me to see the "light at the end of tunnel," but outside of it, I feel utterly hopeless. Don't get me wrong -- I'm very grateful that I have these moments of relief, but I wonder what this means for me for the future.

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As it stands now, I'll have to leave therapy in a few months. This is because I met my doctor through my university's psych services center, and when summer comes I'm planning to return to my hometown. I have only a few more credits to go until my degree is completed, but I'm not planning to return to university after the end of this semester because I just got out of an abusive relationship, and the consensus all around has been that my best course of action would be to move home permanently. The problem is I don't have health insurance outside of what I qualify for at school. I know that moving home is a good idea; it's a place where I can feel protected and safe in a way that I haven't been for a long time now. But, I worry that my depression will eclipse these positives without a weekly therapy session to keep me somewhat in check. This is a contradiction to what I said above, I know, but I worry nonetheless.

My depression isn't a result of the relationship; it was there before I ever met my boyfriend. While the relationship did indeed exacerbate it (to the point where I had my first real contemplations of suicide), just being far away from harm isn't going to solve everything.

And so I guess my question is, how can I take care of myself? As hopeless as I feel away from my therapist's office, going there gets me through the week on a basic level. It helps me force myself to take a shower and get dressed in the morning. It helps me do the dishes. These are mundane tasks, but if I complete them, I breathe a whole lot easier. I don't want to lose this, but without therapy I think I might. Also, I don't want the ability to do chores to be the only progress I make before lapsing again into some deep depression. I used to be a person who loved school, someone who could be very productive. Nowadays, I can barely make it through my readings, let alone sit down and write 15-page papers. I have a long way to go before any of this can come to fruition, but without professional help I'm not sure if I'll ever get there.

Looking for Help Outside of the Doctor's Office

Dear Looking for Help Outside,

I suggest you tell your very lovely therapist that you have a plan. Tell her you would like to spend your remaining sessions preparing for life after therapy, working to identify sources of support and coping mechanisms that you can use once you leave.

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Insist that this work be concrete and goal-oriented. Think of it as though you were packing for a long trip. Assess your needs. Are there medications you take? Where will they come from? Who will write the prescription? Gather that information and put it in your suitcase. Do you need to be able to call someone from time to time when you feel fearful or depressed or anxious? Who will you call when you are living at home? Put that name and number in your suitcase.

And how will you replace these weekly meetings in which you are free to explore and express emotions? You cannot just let this practice lapse. Consider it a given that you will have to maintain some kind of weekly protocol to treat your depression. First, thoroughly scour your local area for free or low-cost psychotherapy for depression. If none can be found, and if there is no way to afford individual therapy, then identify a group to attend. If there is no group, then find some helping function that occurs weekly and commit to attending it, whether it be church or perhaps some 12-step group. Do not fantasize that you will simply meet with a friend every week and talk about your feelings. That won't do. It must be something formal that occurs without your volition, something that you can join, somewhere where you will be missed if you do not show up. You are looking for support, not entrepreneurial opportunities. You are looking for a regular setting where your depression can be a shared artifact of concern.

I would also ask your therapist what techniques and tools are in use to help a client take therapeutic insights and progress out of the room and into the world. There must be enterprising therapists who have written about that very thing. Unfortunately I'm not trained in therapy and at the moment am woefully restricted in my access to research. So I suggest you ask your therapist about that.

While I do wish to emphasize these practical measures, I cannot resist speculating on the larger issues. Your observation that therapy seems to occur in a vacuum could be just your individual psychology talking. But it also hinted that your outside world may be particularly hostile to the idea of psychotherapy.

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It's something to think about, as it relates to returning to that world and living in it as a person with manageable depression: Do you share your struggles with friends and family? Does your depression come up in conversation? Or is it mainly your private struggle?

Since this depression came on while you were away at school, you may not have had a chance yet to find out how those in your hometown will respond to it. But you have been through a lot and you are now a changed person, that much is clear. It's safe to say that, like all those who go away and return, you will find that the world to which you return largely expects you to be as you were, to take your accustomed place at the table just like before.

To the extent that you do not do that or you deviate from it, you may find yourself in conflict. Your family members may feel they don't know you anymore, or that in having cast off old behaviors and adopted new ones you are repudiating them.

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You cannot go home again, as they say. Prepare to be disappointed by your family. Concentrate on treating your depression. That is the most important thing right now. Indeed, paradoxically, explore with your therapist the possibility that living at home might bring on a deeper depression. Deal with possible pitfalls now, while you have professional support. Do not wait until you are in the grip of depression.

My main wish for you is that you use this time to strengthen the sociological infrastructure, as it were, of your own mental health. Then you can go home knowing you have a good support structure. In short, consider these few months as a period of preparation for a new phase of life.

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