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Depression and Mutual Need

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“We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence”.

I read this passage from Irvin Yalom’s Book titled The Gift of Therapy and it touched something within me deeply. It was the reason I began my career in social work. The reason was to reach people, to join together to help create change and to help ease some of the burden that lies in being human. A passion was ignited within me at a young age to reach people in all walks of life and to do so in a meaningful and honest way. The truth about being a therapist is that it is not selfless work. There is little in this world that is. Being a therapist is a calling and therefore fills a deep need within those of us who do the work each day. It fills a need to connect and a need to help facilitate change. Just as joy and laughter are a beautiful part of life, so is suffering. Most of us need support on our journey to figuring out what to do with that suffering. I am not immune to that suffering, in fact it is because I have been touched by it that I am where I am today and am able to do the work that I do. The things I am reading in the news every day, the stories I am hearing from people in my community, all speak to the fact that while the dialogue about mental health is catching, it needs constant fuel to ensure that it doesn’t burn out. It is this dialogue that will save lives if we keep it going. But we must keep it going.

Someone asked me the other day if depression is for life. “Is it like addiction? Once you have it, you have it forever?” Depression is often at the forefront of our discussions regarding mental health. The reason is clear: it is so prevalent and relevant. While this is encouraging in that it means the dialogue is opening up surrounding the subject, it is often not being used correctly which is problematic for those suffering from depression. “I’m depressed. It’s just who I am.” Believe it or not I have heard this more than once. My question is always, “what does that mean to you, what is depression to you?” It is shocking how frequently the response is: “I’m not sure”. The word has become a catch all for things not going well in our lives. When this is tied to the stigma that is still woven throughout our society surrounding depression, it creates even more unrest in someone believing themselves to be depressed. The belief is I am depressed therefore I am broken. I can instantly feel the hope drain from the person sitting in front of me as they share this with me. But depression, like all mental health issues, is far from hopeless. Being broken is part of being human, we are born broken and it isn’t until death that we become free from the brokenness. Feeling sad is not depression. We all feel sad sometimes. It is one of our most natural and human emotions. Depression goes deeper than sadness. Depression resides in ones mind and heart like a beast, robbing the world of beauty, light, joy, and hope. The less we talk about it, the greater it grows, the longer it lingers, the more painful it becomes.

Jamie Tworkowski writes in his book If You Feel Too Much, “We all have our past. We all have our pain. We will all know ghosts from time to time. But if our life is like a building, then we should open our doors to let some people see inside. Into our darkest places, into those rooms that hold our fears and dreams.” Depression whispers to stay silent, to stifle your story, to not ask for help. The courage comes in doing the opposite. When I am asked what I do and the type of people I see, my initial reaction is to always respond by saying, “I see people like you. And I listen to their stories.” I am a therapist, but first and foremost I am also a human with my own story and my own pain and my own places that are broken. In the beginning I thought that made me less worthy of helping, listening, supporting, but I know now it actually makes me more capable. Living honestly is one of the greatest challenges we are faced with on a daily basis. We ignore our pain, we push away our discomfort, we hide from depression and anxiety and feelings of insecurity. It is when we step into the light, when we honor the broken parts of ourselves as much as the strong parts, that we become whole. Only then are we able to find true connection, true healing, and true peace.

Mutual need is a concept that rings true not only in my work as a therapist but also in my work as a human. It is when we free ourselves from the fear of being in pain, the fear of being broken, the fear of facing our demons, that we begin to see clearly. We are all in pain at some point in our lives. If we join together in that, the pain lessens, the burden lightens, and the darkness wanes.

The Importance of Validation in Relationships

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I remember when I was a teenager how frequently I felt misunderstood. It was a time in life filled with emotions and unknowns and I was bursting at the seams to “figure it all out”. Looking back I see clearly now that what I was really looking for was just to be understood, to have someone listen to me and say, “I hear what you are saying”. So many of us get stuck emotionally at different times in life and it is easy to revert back to a young place and a young feeling of wanting to be heard and needing to be understood. How many times have you talked to a friend, acquaintance, or family member and had them offer advice or had them tell you their story in response to yours? It can leave you feeling angry and even more confused than when you started out. The reason being, you weren’t looking for a solution. Most of us understand that it is up to us to solve our problems. What we are looking for in connection, in relationships, in life, is just to have someone listen and validate what we are feeling.

This holds true in therapy as it does in the rest of our intimate relationships. People come to me to share their story . Whether these stories are heartbreaking, tragic, pathological, or just about a bad day, it is not up to me to place judgment on them. It is up to me to not only hear the story but hear the emotion behind the story. What most of my patients are looking for, whether it be because they have been starved of it their entire lives, or because they just need to hear it coming from an unbiased and professional perspective, is validation. I see you. I hear you. I understand the difficulty of the emotions you are experiencing right now.

I was eating dinner at a restaurant the other night with my husband. In the midst of our dinner I couldn’t help but overhear the conversation two women eating near us were having. One said to the other “I just don’t understand why she wouldn’t just end it, it’s ridiculous. All she does is complain about him but she doesn’t do anything to change it!” My interpretation of this is that one of these women’s friends is in an unhealthy relationship that she talks about often to her girlfriends yet she does nothing to change her situation. This story sounds familiar to so many of us. The question can always be asked in a situation like this: is that friend talking to her girlfriends about her relationship for them to change it or just to have them hear what she is saying and to hear what she is feeling? The latter is always true. Understanding that we as humans need to be emotionally validated comes with another important lesson, we all have stages of motivation to change that we go through. This unknown woman in the unhealthy relationship that just “won’t end it” is clearly not ready to end it. I don’t know this woman, I don’t know the relationship, but I can guarantee this is the case. She is emotionally stuck. While it is easy for an outsider to judge this and look at her as being “crazy” for not ending it, if we validate her feelings and understand she isn’t ready to end it yet, we might provide her with exactly what she is looking for.

Change is uncomfortable and can be painful and challenging. We cannot expect people to change overnight, and we cannot expect it to be easy. Often times change pertaining to difficult emotional relationships and situations in life means untangling patterns and behaviors that have been present for ones’ entire life. That takes time, patience, motivation, and professional help. When your car needs a repair to run properly you don’t think twice in taking it to an auto mechanic. The same should be true when you need an emotional tuneup. None of us are free from the need for help every once in a while in getting unstuck.

The next time someone you love is talking to you, practice active listening and validation. Active listening means not only hearing the words the person is saying but also recognizing the feelings that come with those words. When they are finished, fight the urge to give them advice or to relate what they have said to something you have been through. Validate what they are saying, allow them the space to be supported by your understanding, and then if you feel you have something to offer–ask if they are open to hearing it before you speak. If you practice this in your relationships I promise they will become richer. And while you will be giving more, you will also end up getting much, much more.

Self Harm as a Way of Coping with Buried Rage

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Self harm, also known as self injurious behavior, is a topic that frightens many and is not talked about enough, particularly when discussing young adults and adolescents. Self harm manifests in many ways including cutting, burning, scratching, hitting, punching, head banging, sticking objects into the skin, or even swallowing dangerous substances. Some common misconceptions about self harm are that the people who do it want to die, they are trying to get attention, or they are dangerous. While finding out someone you love is engaging in self destructive behavior can be devastating and frightening, there is hope. Self harm usually is not a suicidal gesture. Those struggling with this behavior are seeking to escape the intense emotions they are experiencing. This seems like an oxymoron to many people. Why would someone want to inflict physical pain to avoid emotional pain? The truth is that self harming behaviors actually provide a temporary sense of relief due to the endorphins that are released in the body after cutting, burning, or other self injurious behavior. When our bodies are injured the natural biological response is for the body to release chemical endorphins. This creates a feeling of calm and temporarily soothes a hurting soul. The problem is that this temporary relief does not last very long and in fact creates even more emotional pain. It doesn’t address the underlying issue.

The first response I have to someone who is engaging in self injurious behavior is to find out what feelings they are trying to escape from. It is imperative that therapeutic work is done to get to the core of what they are self soothing. What happened in the past that is so painful and emotionally scarring that the only relief comes from hurting oneself physically? Generally the answer always comes back to buried rage. We learn at an early age that anger is socially unacceptable. Anger equates to fighting, violence, pain, suffering, even death. The misconception is that anger equals action. This is entirely untrue. Anger is a feeling just like any other. Even more important is the understanding that anger is a secondary emotion. It stems from some other feeling first such as hurt, pain, vulnerability, betrayal, loss, etc. In order to understand the rage we need to look back and discover where it was born. There is too much of what I call “bandaid therapy” in treatment these days. Learning new behaviors and practicing different coping skills accompanied by self esteem boosters and thought changing cognitive work. These practices are not entirely ineffective, but they lack the long term results that one hopes to get when they seek professional support for emotional difficulties. Learning new skills is incredibly beneficial after the core issue is understood and addressed. In order to see lasting change, one has to look deep into the psyche to uncover where the damage started and then begin to unravel it and heal old wounds. The therapeutic relationship is the perfect place to start doing just that.

My approach to self harm is to first create a trusting and solid therapeutic relationship in which to build a foundation for wellness. Once this is accomplished we will begin to uncover what has been buried so that we can begin to heal old wounds. The message anyone who self harms needs to hear is that they do not deserve to suffer any more than they already have. In therapy peace and understanding can be found that eliminates the need to self soothe through self harm.

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