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Tuesday, January 10, 2012

On Psychotherapy

I have a psychotherapy appointment this week.  I suppose this should be seen as an event that will add hope toward remission of my symptoms.  Sadly, at the time of this writing I see it as another tiny step in an infinitely long process.  I hope to change this before my appointment.

I have been seeing the same therapist since 1996 on and off.  I see her usually when I'm coming down from a manic episode or in a long-term depression, like I am now.

When things are going well I find there is no reason for therapy.  However, in the last 14 months or so I have been battling the big bad moods of depression.  I am at a time where I continue to need psychotherapy.

A typical session with her goes like this:
  1. Update.  I give a brief update on the major things in my life.  For example, I assure her I'm taking my meds as prescribed, tell her I am still sober, and inform her of any major life events that have happened.
  2. Reflection.  I reflect on things going on in my life.  As I do this hopelessness, guilt, and sadness towards things in my life occur.  
  3. Analysis.  I then work with her to understand these underlying feelings associated with the things in my life.  By talking about my emotions I am actually releasing built up tension and inner turmoil.
  4. Strategy.  The last thing we do is create a strategy for moving forward.  This stems from the results of the prior reflection and analysis.  This part creates hope out of hopelessness.
The therapy I use most often is cognitive behavioral therapy (CBT).  CBT is the process of analyzing and reevaluating erroneous thought processes.  These are thoughts that I say to myself about myself and the world that are in reality not true.  Not only are they false, they are also damaging.

For example, let's say I feel guilty about the DUI I got the last time I was manic.  I am saying to myself what a bad person I was for getting the DUI.  I'm a failure.

Using CBT I am able to better "see" the event in the context of which it happened.  It happened when I was not myself and not in complete control of my behavior.  I was full-blown manic!

Instead, I need to realize that the offense was done in a state-of-mind that I had little or no control over.  I didn't make a rational choice to become manic and start drinking again. Yes it was irresponsible but it not something the responsible and thoughtful me would not have done this.  The me I am now would have made better decisions.

So I replace the negative thought of "I am a failure" with a more realistic thought of "I did something out of character while I was manic."  The replacement thought is both (a) more accurate a depiction of what happened and (b) keeps me from dwelling on the negative and beating myself up over it.

I find the best thing you can do to improve your therapy is to be an active participant.  Sitting (or lying) there waiting for the therapist to ask questions about your life works okay but is not really efficient.  What is better is to try and figure out before your appointment what some of your issues are.

It's even better if you can actually spend time reflecting on them, looking for insight and answers.  If you do this you will be able to address deeper, more elusive feelings associated with a particular problem.  The goal is to have a clear and realistic look at yourself.

If you can't do are having trouble identifying problem area it's okay.  Therapy will reveal your troubles.  If you are in some sort of therapy I hope it is going well for you.  If you are not participating in psychotherapy, then perhaps it is something you should try?

A helpful article reviews bipolar depression treatment using psychotherapeutic techniques to augment your psych meds.


  1. Hi Jeff,

    Since I am studying to become a clinical psychologist, I am a huge supporter of therapy. Drugs can help to level the brain, but they can't heal the wounds that our illnesses make or help us figure out how to manage the changes to our identities and our lives. This post really highlights that.

  2. Yes, I agree drugs only go so far. It is a challenge navigating the hickups in life experienced while depressed. Usually these are best managed by addressing the situation and coming to some sort of resolution. For that I turn to my friends and family as well as my therapist.