|What's the REAL destination?|
One of the great problems with clinical depression is that it attracts almost all of a person’s attention and energy. The temptation is to focus exclusively on the ailment and its resolution.
As a consequence, many people find that most of their time gets taken up with depression management strategies. Their days involve appointments with physicians and therapists, consulting with other healthcare professionals, taking naps, planning graduated exercises to get out of the house, figuring out what to eat, trying to detect negative thoughts, and so on.
Many of these activities are quite helpful. But they run the risk of making the person’s life all about depression and not at all about recovery or “normality.” All thoughts about “what will I do when I’m better” are put aside until that day dawns.
But the handing of control over one’s daily life to the illness sometimes serves to make it more powerful. And the relinquishment of all one’s regular routines, pleasurable events, and goals for the future may feed the very dragon we are trying to tame.
Consequently, I often invite depressed clients to imagine that we had an instant and utterly effective cure for the depression – a magic pill, or the waving of a wand. “So imagine for a moment that it’s gone. This whole thing is over. If that happened, what would you do? What would you want in your life?”
In other words, if your energy was back to normal and you didn’t have to spend every ounce of it fighting the depression, where would you like to allocate it?
I try to get as long a list as I can from the person. Some of the items may not be practical right away, such as “I’d return to work full-time.”
We can, however, usually identify a few activities the person could start doing without waiting for the wand to have its effect. “I’d see more movies” can become part of the therapy, as can “Take up my hobby/sport/avocation again” or “See friends more often.”
The intent is to jump past the depression to the desired outcome, and then spend at least part of our efforts aiming straight at the destination rather than focusing exclusively on the barrier that seems to sit in the way.
I like to do this kind of work at least twice in the course of therapy for depression.
The first time is when we first embark on the journey. “What if, a few weeks or months down the road, the depression is completely gone? We follow you around with a video camera for a week. We can’t see what you are feeling or thinking, but we can see what you are doing. What would we see?” This enables us to make the reclaiming of at least part of this “well life” an early task of therapy.
I like to revisit the question once the person has made some real progress. Their energy is better, and their ability to envision a fulfilling life is likely to be greatly enhanced. “So you’re doing pretty well. Imagine you take this pill (jelly bean) and it’s completely over. You don’t have to focus on the near horizon of depression recovery any more. What do you want to include in your life?”
Most people imagine that they will recover in sequence: They will begin feeling a bit better. Then their motivation will begin to return. Then they can begin to take on the elements of a better life.
The sequence is perfect, but backward. “First you will begin living at least a bit of the life you would like to have if you were not depressed. Then your motivation will return. Then the mood will lift.”
We need to leapfrog past the depression to the real destination. Then we need to make that destination at least a part of the therapy - in addition to the symptomatic and stabilization work we may be doing.