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Dear Dr. Saltzman,

I have been receiving psychodynamic counselling for the last 4 of my 42 years of life. I have found it a painful process but very helpful.

I have also been taking citalopram for this period and still am.


It takes a lot for me to share my feelings and experiences and that is why I have found the process (therapy) so uncomfortable. 

I am not sure if I am over reacting. It is also possible that I am transferring my feelings onto my therapist.

 

Even though my confidence, development of my “self” and difficulty dealing with conflict have improved enormously I found myself struggling a little with a difficult situation at work.

 

Over the period of time October 2007 to February 2008 I became irritable (very out of character); my insomnia worsened considerably, I virtually stopped reading, walking etc and found it extremely difficult to get myself to do anything. I am an extremely determined person and do not tolerate weakness in myself so was still able to function in my job and my private life.

 

From February till June the situation worsted considerably.

I found it nearly impossible to accomplish anything unless in a very structured environment. I was only managing to get to sleep at about 4 every morning. On the weekends I only managed to drag myself out of bed at about 3 in the afternoon - I wished I could just remain asleep. I would burst into tears at the drop of a hat – even at totally inappropriate times, at work. I had some experiences where I felt uncoordinated and as if I was looking at everything through a tunnel.

 


I started have suicidal thoughts (brief and no planning) and had one incident (the first ever) where I made a half hearted attempt to cut myself – I believe I would have inflicted more than a few scratches if I had had a blade.

 

I plucked up the courage and told my therapist of both the thoughts and the cutting incident. She asked if I had made suicide plans but other than that made no real comment.

 

As soon as I was out of the negative environment (end of June) the darkness started lifting quite quickly. I told my therapist that, in retrospect, I believed that I had been mildly depressed. She said that she thought that was a very strong claim, that depression is a serious mental illness and that feeling depressed is different to being depressed. I left it at that but it did not leave my mind.

 

A few weeks ago I did some research on line, looked up the difference between being and feeling depressed and did 5 different on line self tests (answering the questions as I had felt not how I was feeling at the time of doing the test). All came out that I may have been moderately to severely depressed.

 

I was not totally hopeless at the time as I had made plans to leave and thought that the situation would end. I was desperately trying to survive until I could leave. I did not loose all of my confidence. I have, however, been severely depressed more than once prior to this and believe that I am able to recognise the feeling.

 

I printed off 2 of the tests and excerpts of the information I found and took them in and showed her. She once again said that being depressed is a very serious condition and then suggested that I thought being depressed made me interesting. She warned me about pop psychology and said that one needs to take a person’s personality into account. I pointed out that I was not trying to put myself in a box but rather was trying to express the way I knew I had felt.

 

I looked up the DSM4 criteria and did some more research.

 

I know that I generally appear very composed. I used to be barely able to identify how I felt, let alone share it with others. I had thought that I was now expressing how I was feeling and was asking for help but think I may still not be doing it very effectively.

I do, however, wonder at the response I received to my telling her that I had had suicidal thoughts.

 

It has tapped into my feelings of not being understood. I also feel like I have been asking for attention and therefore feel a little foolish.

 

Have I distorted the situation - is all of this likely to be about my inability to affectively ask for help and affectively share my feelings?

   

I truly appreciate the opportunity to get an honest opinion from an expert.

Your site provides a wonderful and much needed service.

 

Best wishes and many thanks,

 

Kim

London






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Hello, Kim--

Thanks for your appreciation of my website. I am glad to be able to provide this forum for people who are interested in psychology, psychotherapy, philosophical awareness, and spiritual unfoldment. I understand also that my views, coming as they do from an anonymous and disinterested source who profits in no material way from this work, often are helpful to people who are struggling with life problems such as yours. Further, since I have time to see only a very few clients in my personal therapy work, providing this forum seems a good way to extend the reach and benefits of the training I have been fortunate enough to receive.

Questions such as yours always put me in a difficult position. I do not know your therapist and would not like to criticize the work of that person unfairly. Also, I have only your version of events, and you could be mistaken in some of your impressions. On the other hand, psychotherapists are working from a position of great power and authority, and we know from Lord Acton that, "power tends to corrupt." Accordingly, some workers in the field have an unfortunate tendency to come on a bit too imperious or overbearing when questioned by their patients.





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That said, the inquiry you put to me deserves a reply, and I will try to provide one with the understanding that I am relying on solely upon the accuracy of your account. Please understand also that, not knowing either of you, I am not able to judge the relationship between you two, to know the ins and outs of your therapeutic alliance, or to know the direction of the work your therapist is trying to accomplish.

If you had not mentioned your therapist, but simply had related the feelings and events in your own life as put forth your letter, I would immediately begin to suspect that you had been suffering from depression. Without a personal interview, one cannot make a firm diagnosis, but several details in your account are, to me, highly suggestive of a serious level of depression. You mention difficulty in sleeping, which is a classic telltale sign of depression. You speak of suicidal ideation, another telltale. You write of bursting into tears suddenly and inappropriately, yet another sign of depression. You refer to a history of depression, which is still another indicator that your worries about depression ought to be taken seriously. And there is more: feeling as if you would just like to remain asleep, and the cutting incident. After all of this, your suspicion of depression should not be shrugged off as just having been influenced by "pop psychology."

Reading between the lines of your letter, I imagine that one of your issues in therapy involves early narcissistic wounds and your subsequent embarrassment and shame in wanting attention, so it is possible that your therapist's apparent resistance to the idea that you could be depressed involves some technique she is using to work with those issues. It would be interesting and helpful to know about that, but I imagine I never will. Nevertheless, her statement (if you have reported it correctly) that, "depression is a serious mental illness and that feeling depressed is different to being depressed," makes no sense to me whatsoever. To begin with, "depression" is not just a mental illness, not just one illness, but rather a collection of illnesses. The term, "depression," in other words, is really a kind of wastebasket term which comprises many different states of mind, and may include any of several different mood problems--ranging from mild to severe--which could require different approaches to treatment, including psychodynamic treatment. A psychodynamic approach to depression--one that does more than just dose the sufferer with medication, that is--requires circumambulating the experience of the patient to determine what the patient feels, what the patient thinks, and what the patient fears. If the patient reports feeling depressed, the therapist, in my experience, needs to begin an intensive exploration of those feelings, which certainly will not be facilitated by prematurely drawing a distinction between "feeling depressed and being depressed." In my view, as a working hypothesis, if one feels depressed, one is depressed.





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Now, as I said, there are various kinds and levels of depression, and one can even be depressed without feeling depressed, but I see no reason to tell someone who reports feeling depressed that she is simply seeking attention. If she is, I would give her the attention she is seeking. I might also want to discuss the issue of seeking attention, but I would not belittle her depressed feelings by implying that they fail to qualify as "serious," or that they are simply a manifestation of "personality." If your therapist had wanted to draw a distinction between feeling sad and suffering from an illness called "depression," I would be able more easily to understand and agree, but as you put the matter, I find myself not inclined at all to agree with her rather dismissive approach to your request for understanding, empathy, and assistance.

You seem to suggest that one of the issues for which you have sought therapy involves difficulty in sharing your feelings and in asking for help with them, but I don't hear that difficulty in your letter to me—after all, you have asked me for help, and have made me understand how you feel. If a therapy is worthwhile and effective, and if the therapist is doing right by the patient, the patient ought to be able to share at least as much with her therapist as you have shared with me in this letter--including doubts about the therapy and the therapist's opinions--and the therapist should be able to see, hear, and understand the patient without making her feel ashamed of her fears, concerns, and needs for attention to them.

I suggest you keep at this, and don't take no for an answer. You have a four year investment in this work, and your complaints deserve a fair and complete hearing. Furthermore, a good therapeutic alliance can only be improved by that kind of struggle. If necessary, and if you think it advisable, perhaps you will want to share your letter and my reply with your doctor as a starting point for deeper investigation of this impasse in communication.

Sometimes therapists can get so wrapped up in their pet theories and favorite points of view that they fail to see the full human reality of the person sitting across from them.

Be well.









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page last modified November 11, 2008



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