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[britmom]

I've just started seeing a psychologist in response to a bad episode of postnatal depression. During the treatment for this, it's come about that there's an underlying psychiatric condition for which I'm now taking medication. Anyway, this whole therapy lark feels a bit strange to me. Perhaps it's my British reserve coming out: it's telling me it's undignified to talk about your feelings. On the other hand, I've got a (probably stereotypical) view that half of America is in therapy at any one time. (OK, that's a bit of an exaggeration, but you get my point.) I think there's also the problem that I find it hard to be told that the way I've behaved is basically down to the way I think. Perhaps it's because, as an academic, I feel that it's my job to think? I don't know, but I find the whole concept of challenging the way I think difficult to accept.

So...I suppose I'm looking for positive accounts of how such treatment has helped. Also, any suggestions for how to maximise its effectiveness would be useful. (I'm aware that #1 is to keep an open mind, which is what I'm trying to do.)

My biggest issue is with CBT, which seems to be the most commonly used approach here in the UK. I find that the way I think about things changes completely, depending on my mood. When I've been at my lowest points, I've been able to make a completely rational (in my mind) argument for suicide. When I'm well I find it pretty much impossible to understand how I could ever think that way. It feels like a completely separate way of thinking that I can not access unless I'm depressed. How on earth will I be able to re-think the way I react to feeling depressed if I can not understand it?

Right, I hope that's fairly clear, and that I haven't complicated my post with too many questions. Is anyone willing to help me with this?

[qrypt]

CBT might not be the whole answer, but it really could be a big part of the answer for you.  It would be hard to have an appreciation of it at this very early stage.  The point would be to learn it, to develop the facility of invoking it; only then would you be in a position of knowing for yourself whether it can help you.  So, it's natural to be skeptical about it now, but I wouldn't use that reaction as a basis for rejecting it. 

What you say about how things look from different vantage points makes sense.  When you're not down, you don't understand how you can get so down -- so it's not obvious (when you're not down) how CBT could help you get back up.  A big part of the point of CBT is to train yourself to do precisely that.  But again it would be hard to appreciate at this stage how it would work in practice. 

If you want to read, David Burns is a well-known author, for this book.  It's annoying to buy mass-market books with bright yellow covers like that -- but it's reasonably sophisticated, not at all fluffy.

[neutralname]

I recently did some CBT.  I found it hard to suppress my dismissive attitudes: my therapist explained how thoughts, feelings, and behavior are all interconnected, and how by working on some of these, we could help with the whole package.  Yadda, yadda, yadda, tell me something new.  It was also the first time I have been given homework in therapy, and I've been in and out of therapy for coming up to 25 years now.  (It's also the first time that I've been older than my therapist.  And I'm also older than the British Prime Minister.  Damn.  But I digress.)

So the ideas of CBT are blindingly obvious in theory, but hard work in practice.  I found that I could not identity any missteps in my reasoning at first, because I am so smart, and I have it all worked out.  Academics are good candidates for CBT because we buy into ideas of rationality, but probably challenging in other ways because we are so good at rationalizing.  I found that a particularly useful part of the process was in identifying my automatic reactions and labels for myself and others -- jerk, loser, failure, screw-up, f***-up, b*tch, nutjob -- and toning them down, giving people more credit, and being more generous.  The hard work is in working through the process and keeping it going, remaining conscious of one's reactions, finding different ways to react, and establishing new patterns.  Quite often I think of it in very neuronal ways: laying down new pathways in my brain.  It's not an overnight process. 

As with any therapy, it is important to find a therapist you work well with.  That's not necessarily the same as liking your therapist, but you do need to respect them. 

Good luck!

[britmom]

Thanks, qrypt and neutralname. I'm actually not 100% sure that CBT will be the approach taken, but it seems by far the most popular choice here in the NHS. (For what it's worth, I don't get to choose my therapist. This is on the NHS so, whilst I have the benefit that it doesn't cost anything, I also get what who I'm given. She's a clinical psychologist, and, thankfully, I think she's very good at her job.)

I'll do my best to keep an open mind. Neutralname's post reminded me that another problem I have with this whole process is that I can already understand a lot of what went wrong, and how my thinking made things worse. However, understanding something rationally does not necessarily make me feel that way. For example, I understand the reasons why I suffered from terrible guilt at being a working mother. The depression made me believe I was a bad mother, and that guilt fed the thoughts that working=neglecting your children. I internalized the messages I received from the media and other sources that say working mothers are destroying their children's futures.  I understand that. I can place the entire dialogue over working mothers into a social, political and cultural context. I'm a historian; I know that these arguments are nothing new. However, understanding that doesn't necessarily take the gut feeling away when I'm depressed that I'm not worthy of my children. The two things seem quite separate. My feelings are not necessarily a direct product of my thoughts.

Anyway, I'm waffling. I suppose the right thing to do would be to bring all this up with the psych when I see her next. My OP was prompted by her asking me to consider what I would like to gain from psychology, and that's what's driving all of this reflection

[neutralname]

Yes, Britmom, I have similar experiences in the disconnection between understanding and feeling.  My depression is often not expressed in thoughts at all, but in bodily feelings and a sense of despair.  The approach of CBT will be to uncover the thoughts that prop up the feelings, and to get you to articulate the feelings.  At first my response to it all was that it was missing the point, and I knew all the right things intellectually, so I didn't need to work on that. 

It's the automatic thoughts and immediate reactions that I need to work on: the ones that come first, before the more considered and reasonable ones take over.  The claim of the CBT approach is that if you look hard enough, you will find them and that you can change them by becoming more conscious of them and then reformulating them.  I don't know if it is always right, but it does have some empirical backing. 

I found daily journal writing was a useful way to explore this stuff. 

[87735501111]

Best of luck with the counseling. This might not help, but you might also look into progesterone cream to help you balance out the hormones too. I know that might sound hokey, but it might be worth a try, since hormones do relate to mood, and progesterone apparently crashes after pregnancy. But do this together with your doctor/OB-gyn.

[msparticularity]

My experience with CBT has been that it is not a bit useful when I am down in the depths. What it does do, however, is to help me recognize when one of my (periodic) descents begins, and to take steps to address it before I plunge into the depths again. My (literally) decades of experience with a range of therapies has taught me to take emergency measures first (whatever meds are needed to feel better fast), followed by learning CBT for better self-management. It's kind of very scary to say this, but I've been quite stable now for well over a decade. I believe this is due to a combination of baseline management that includes St. John's Wort and fish oil daily, moderate exercise, good diet, and CBT to recognize and head off episodes as they begin. 

[voxprincipalis]

However, understanding something rationally does not necessarily make me feel that way.

Yes, this is quite true. However, the unexamined assumption in what you wrote is that it is necessary to have emotional/"feeling"-based confirmation of a state of mind in order to feel comfortable in it. You prioritize feelings over rational thoughts. (This is something I fight against as well.)

It is not necessary to "feel" that a certain behavioral/thought choice will bring good results in order to do it. When you check for a "feeling" confirmation you are trying to project future emotions, which is never more than wishful thinking under the best of circumstances. Your feelings do not have to be in line with your rational behavior choices.

This is a super-hard thing to accept if you are someone who has always been ruled by emotions and feelings (like I am).

You may find other modalities helpful to complement your CBT work. Bodywork has always been great for me, including the tactile version of EMDR, reiki, and other physical modalities. There are also some modalities I've tried that have been further off the beaten path, and many of them have worked well. My current therapist is a CBT person, and she was recommended to me by my psych specifically because I have often been resistant to CBT in the past. The combination is indeed good for me.

Good luck!

VP

[msparticularity]

You may find other modalities helpful to complement your CBT work. Bodywork has always been great for me, including the tactile version of EMDR, reiki, and other physical modalities. There are also some modalities I've tried that have been further off the beaten path, and many of them have worked well.

I have also found bodywork and some traditional therapies very helpful--most notably SER (somatic emotional release work), Maitri Breathwork (I trained with its developers) and the American Indian sweatlodge. I don't know whether these are things that would be available in Britain, although I know there are Maitri practitioners on the Continent--especially in the Prague area.

[britmom]

You may find other modalities helpful to complement your CBT work. Bodywork has always been great for me, including the tactile version of EMDR, reiki, and other physical modalities. There are also some modalities I've tried that have been further off the beaten path, and many of them have worked well.

I have also found bodywork and some traditional therapies very helpful--most notably SER (somatic emotional release work), Maitri Breathwork (I trained with its developers) and the American Indian sweatlodge. I don't know whether these are things that would be available in Britain, although I know there are Maitri practitioners on the Continent--especially in the Prague area.

Thank you for these suggestions, although I must confess I don't understand a word of it. I'll be back once I've googled them.

[britmom]

Sorry! I managed to post the same message twice.

[neutralname]

Britmom, I'm pretty sure you won't be able to get bodywork on the NHS.  But you might find some ads for people who do that sort of thing in your local yoga studio, and that's becoming more popular in the UK. 

[merinoblue]

A CBT approach kept me sane while going through my PhD and dealing with acute grief and a prolonged midlife crisis that swamped me. I could not have managed otherwise. I had a wonderful therapist who "got" my sense of humour, and was very skilled at what she called "reframing" my experiences. She was able to situate my experiences against generational and age experiences, as well as what I would clumsily call expected psychological developmental through the decades. As one example of how valuable her skill was to me, she helped me to understand that the profound sense of social disconnect and alienation I was experiencing had a great deal to do with making career and life choices that were out of sync with what most people of my age were doing with their lives. Over 6 years we talked about every aspect of my life circumstances that was challenging and made sense of them. It was the making sense part that was so valuable to me, as well as her challenging my rigid expectations for how my life should unfold. (We talked quite a bit about the stranglehold that using "ought" and "should" language in talking to ourselves creates).

[msparticularity]

(We talked quite a bit about the stranglehold that using "ought" and "should" language in talking to ourselves creates).

One very good therapist (a licensed clinical social worker) that MrP and I worked with used to say, "Don't should on yourself."