I started this post, and it was intended to just be one post, but as I wrote, I realised that it was going to be a little endless if I did that, so instead I thought I would make it a series. I intend to get this series out in the not too distant future, in the next couple of months as an absolute maximum! But without further ado, let us drive right in.
I mentioned very briefly in my last post that I had recently finished CBT (cognitive behavioural therapy). I thought that this would be a good opportunity to talk a little about the things I did with my therapist, and the things that I found most useful. Obviously I wont be sharing *too* many personal details because well, they are super personal, but I will share some examples, and helpfully lots of the worksheets my therapists use are available online, so I can share those with you too!
This is obviously not meant to replace any therapy in any way, or to be used remotely for therapy, but it may have little tricks or tips that might help some people. Or you might just find it interesting to know how I found therapy and what I found helpful.
As these things go, the first couple of sessions were heavily introduction and assessment based, the therapist, let’s call her Lacey, getting to know me, and the problems I was having. The main reason I was referred to her was for depression.
Optional aside: As I have mentioned previously, I was very unwell six months ago, and only didn’t attempt to commit suicide because my best friend stopped me – so unsurprisingly several doctors’ appointments followed (after three weeks of crisis services) and eventually (mostly because this took so long because I moved across the country) I ended up at CBT.
We talked about my problem definition which is basically a thing where you try and put the issues you are having into words – which is far far harder than it sounds. For me, I ended up writing down the things that my depression causes me to do rather than how my depression makes me feel, probably because I find it easier to look at objective things rather than emotive or subjective things. So, I included things about not responding to friends, and not looking after myself (eating, drinking, getting dressed), but I did also include some things about thoughts, such as how I feel about not being at university and not progressing with my life, and my negative thoughts about myself e.g. “I can’t do anything right”. We scored how much this upset me, and how much it interfered with my life – I’m not going to lie, It was a lot.
We also talked about treatment goals. These are meant to be SMART objectives, which stands for:
The point being that these treatment goals are important to reflect on later in the treatment so they have have have to be things that you can achieve in the time period, etc. Mine were things like eating right, documenting my feelings, replying to friends within 24h – obviously written as SMART goals (e.g. to eat three relative healthy meals a day, with minimal snacking).
I really felt like Lacey understood what I was telling her (which I suppose is her job but that’s not the point), and that we actually got on really well – in another life I think we could have actually been friends, that or she’s incredibly good at her job. I think a good relationship with your therapist is so important. Several years ago, I had some counselling which was awful. That lady was very pushy when I didn’t want to talk about things; to the point she said if I wasn’t going to talk about a specific thing, there was nothing she could do. I actually ended up having panic attacks both in sessions and before I went because I didn’t want to talk about this event – in short she made me much worse, and I only kept going because I wanted my doctor to take what was going on seriously. Due to this, I was so relieved that Lacey was understanding, she didn’t push me about things unless it was really necessary, but more than that, she made me feel as though I could open up to her about anything. It was bizarre because I’m not the most trusting person in the world!
For CBT, you often get homework, because the therapy, as it says in the name, is behavioural based! The first ‘proper’ homework I had, was a thoughts diary (worksheet available here). This was basically recording the negative thoughts I was having, when they were occurring, what my mood was, and the intensity of this mood, any physical sensations and what I did or how I reacted to those thoughts. The idea being to get to understand how my problems affected my day-to-day life, so that It was possible to choose the correct treatment plan for me. I’ll talk thought one of the ones I recorded:
Date/Time: 22.08.17; 1300
Situation or trigger: It took me a lot longer to do a task than I thought it should have.
Emotions or mood (including intensity): Sad – 80%, irritable/annoyed at self – 90%
Physical sensations: Shaky, heavy chest
Thoughts or images: Why am I so useless? I can’t do anything right. I’m a useless person. No-one will ever love me because I’m so useless.
Behaviour: Got angry and frustrated at myself and had to take a time out to calm down.
That may sound like a huge over-reaction to the situation, but that’s the entire point. Depression had brought my self-esteem so low, and made me think so little of myself, that when one tiny thing went wrong, I punished myself for it, and felt well, horrific. I think that can be really hard for some people to understand, or to empathise with, because you would never have that sort of thought about another person who was taking a little extra time to do something. But, my depression caused me to have those thoughts about myself.
This was a wonderful for looking at reaction behaviours (often going off on my own and getting angry), which were often unhelpful in the long term. Just the idea of writing it down, and almost admitting to myself that that was how I was reacting, made me take a little second longer to think about my reaction – to think ‘Am I reacting proportionally?’ ‘Is getting annoyed at myself or whoever actually going to help, or am I going to feel worse later?’ – allowed me to chill out my behaviours the tiniest bit. These sort of things, in later sessions became bigger experiments and a more important part of treatment. But just from recording things, writing things down, I started to click that my behaviours weren’t always helpful, and my thoughts weren’t always rational. So, if you can relate to that at all, I suggest trying it, just for a couple of days to start with – write down all your negative thoughts and what you do (obviously, you’re welcome to use the worksheet above), and ask yourself a couple of questions about it.
I think I’m going to leave it there for now. These posts are going to be fairly emotive and at times difficult for me to write, so I don’t want to tax myself too much. I really hope you found this helpful, but for now,
Thanks for reading, keep smiling, keep planning. Until next time, bye!