Depression & Therapy:



To help me, please remember:

(From the depressed to the friends/family)

1. Please be patient while I decide if I can trust you.

2. Let me tell you my story. My whole story. In my own way. In my own time.

3. Please accept that whatever I may have done, whatever I may do is the best I have to offer and seemed right at the time.

4. I am not 'a" person. I am *this* person, unique and special.

5. Don't judge me as right or wrong, bad or good. I am what I am and that is all I have got.

6. Don't assume that your knowledge about me is more accurate than mine. You only know what I have told you. That's only part of me.

7. Don't ever think that you know what I should do - you don't. I may be confused, but I am still the expert about me.

8. Don't place me in a position of living up to your expectations. I have enough trouble with mine.

9. Please hear my feelings, not just my words - accept all of them. If you can't, how can I?

10. Don't save me. I can do it myself. I knew enough to ask for your help, didn't I? Help me to better myself.



To help me help you, please remember:

(From the friends/family to the depressed)

1. I am only HUMAN. As much as I want to help you with, listen to, and understand your problems, I am just human, and have my failings just like you.

2. I cannot offer a miracle cure, I cannot fix your problems, I can only support you through them.

3. The things I say will often be the "wrong" response, and I will probably react in the "wrong" way, but please trust me that I am trying my best

4. I love you and I would NEVER intentionally hurt you. if I am insensitive or say the "wrong" thing, its just because I don’t know how else to show I care.

5. I cannot always be there for you. In the long run, you must stand on your own. I can support you, but I cannot hold you up. However hard I try, I am not strong enough to carry you up as well as me.

6. I cannot, and will not bear your guilt. If you are angry at yourself, please don't turn it back at me, because for me that is the worst thing I can imagine.

7. Although you want me to treat you as 'normal', and although I know I should, sometimes my care for you overrides my sense of right and wrong. It might be wrong to wrap you in cotton wool, but I care about you too much to do otherwise.

8. Likewise, if an argument might end in you blaming me for your depression, I may avoid arguments because I cannot cope with that guilt. Yes it’s wrong to treat you differently in that way, but it’s the only way I can cope with helping you.

9. I do not begrudge you my help and support, I care about you, but please respect that as much as I love you, your problems do take a toll on me, just as they do on you.

10. If I break your confidence its because I love you and am trying to do my best for you. To betray your secret and protect you from yourself will always be more important to me. There is no point me loyally keeping my word if it means you end up dead.

11. I don't presume to know best, or know more than you about how you feel, but I will still have my opinion on what’s going on in your life, and I am willing to stick by it.

12. Just remember...we are all only human.



- The above lists are taken from the BUS forums



The “Do”s of talking to we who are depressed:

1. Do offer to listen, even if you don’t know what to say. A lot of the time, venting is more helpful than any advice that anyone could offer.

2. Do show us random acts of kindness: send us a funny card, give us a hug, call us up just to talk, ask us to come do things with you (movies, sports, getting ice cream, “hanging out” etc). We may not reciprocate, but we’ll notice and appreciate it.

3. Do accept our feelings and perceptions as valid, even if they disagree with yours.

4. Do distract us if that’s what we need.

5. Do offer to just keep us company if we don’t want to talk. We might prefer to be alone, but we’ll appreciate the offer. And there’s a decent chance we’ll take you up on it.

6. Do stay realistic if we’re being unrealistically pessimistic. Blind optimism won’t help; realism will.

7. Do make yourself available when we need you, and make sure we know you’re available.

8. Do accept that we need some time alone, and that it’s not personal if we would rather be alone for a while than be around others (including you).

9. Do accept that we will sometimes choose to go to someone else rather than to you. It’s not personal, so please don’t take it as such.

10. Do let us know what your limits are. If you can’t listen to suicidalness, or self-injury, or starvation, let us know. If you can only take crisis calls before 10 PM, tell us. We don’t expect you to be superhuman, and we’d rather find out your limits by being told rather than by trial and error.



The “Don’t”s of talking to we who are depressed:

1. Don’t say that we shouldn’t feel a certain way. If we feel a certain way, it’s for a reason, even if we don’t know that reason. Accept that and try to help us cope with it.

2. Don’t interrupt us in the middle of a rant; just listen and let us talk.

3. Don’t tell us to “get over it already,” or “that’s in the past, focus on the future.” If we could do that, we would.

4. Don’t tell us to “turn it over to God.”

5. Don’t yell at us. It will only make us feel worse.

6. Don’t accuse us of being “attention-seekers,” “fakers,” “wanna-be’s,” or of “trying to manipulate you.” Our depression isn’t about you, or about the rest of the world. It’s about us.

7. Don’t walk on egg shells. Be honest with us; just don’t be insensitive about it.

8. Don’t blame yourself for our problems. You didn’t cause them, and it only makes us feel guilty.

9. Don’t blame us for our problems. We blame ourselves enough already, there’s no need to add to that.

10. Don’t tell us that there are others who are worse off than we are. We know that. Just because others may be worse doesn’t mean that we’re okay.



Overall, the most importiant thing to remember is that everyone is different. These are basic guidelines, not all of them will hold true for everyone. Print the list out and show it to those involved (whether you're the depressed one or the helper). Talk about what will help and what won't.



How to Find a Good Therapist



I’m writing out this post because a lot of people on this forum have complained about bad therapists, or said that they don’t want to seek therapy because so many therapists suck, couldn’t help, couldn’t understand etc. In fairness, a lot of therapists do suck. But the good ones are worth finding. It’s worth looking through however many it may take, but there are things you can do to narrow down who you might see beforehand so you waste less time searching.



Why should I get therapy?

If you have any sort of problem that causes you significant distress and you’ve been unable to resolve on your own and with the help of those you feel comfortable turning to. This can include depression, anxiety, trauma, mania, irrational fears, relationship difficulties, obsessions or compulsions, hallucinations, frequent memory loss that medical doctors cannot explain, recurrent thoughts of death or suicide, or any other persistent problem. Also, if you just thought “I don’t deserve therapy,” or “It would be selfish of me to get therapy because others need it more,” or “I don’t want to worry my family/friends,” (or anything resembling those) I would strongly recommend seeking therapy. You do deserve it, you won’t be preventing anyone else from getting it, and people who love you would rather be worried than let you suffer alone. It should be noted that periods of depression are common after breakups or the loss of a loved one. If it persists for longer than a month or six months respectively, I would recommend seeking therapy. Or, if you feel the need, earlier.



Is there anything I should try before therapy?

It’s usually a good idea to visit your doctor before seeking therapy and talk to him/her first. What should you expect at your doctor’s office?



First, you should expect your doctor to want to run some physical tests to make sure there isn't something else wrong that's manifesting itself as depression. Some doctors don't do this. If yours doesn't, make sure to ask to be referred to a psychiatrist for diagnosis, or ask your doctor to make sure it isn't something physically wrong. Psychiatrists are the only mental health professionals who are licensed MDs - physicians - and can determine whether or not there is something wrong with you physically vs. neurologically/psychologically. Physical problems need to be ruled out first because therapy and anti-depressants will do little to correct a hypothyroid problem or some other non-psychiatric medical condition.



Once a "General Medical Condition" has been ruled out, you should get referred to either a psychiatrist (if you haven't been already) or a psychologist for diagnosis. They aren't going to know how to help you until they figure out what's wrong. A good diagnosis should take a while, so that they rule out other conditions etc. For example, if you think you're bipolar, there are several other possible explanations for symptoms similar to bipolar (schizophrenia [which is NOT multiple personality], ADHD with depression, Unipolar depression, a personality disorder, etc), and depending on what the problem is, your treatment plan will be different. Diagnosis will probably involve a meeting between you and the psychologist/psychiatrist, a few questionnaires, an examination of your history and your family history relative to psychiatric disorders, etc. This will probably take between one and three sessions, depending on how clear-cut your symptoms are. Once the mental health professional has come to a diagnosis, make sure they explain it to you and that you agree with it. Also, ask them what other, similar conditions are and how they ruled them out.



Once you're diagnosed, and think the diagnosis is reasonable, you can consider treatment options. If you're interested in medication, you should only accept prescriptions from a psychiatrist, and you should ask questions and know what to expect from the medication prior to beginning it. A lot of people are intimidated of this because of the "doctor knows best" theory, and while they probably do know best, you still have a right to know everything they can tell you. And if you know what to expect from a med, things will probably go better with it. Do some online research to find out more than just what your doctor tells you.



The same basic principle holds true for therapy. So learn about your options and find a therapist that’s right for you.



How to find a good therapist

There are many therapists out there. Some are really, really good and they’re worth seeking out. Many are pretty bad though, so it’ll probably take some looking to find a good one…

There are lots of things you can do to minimize the time it takes to look for a good therapist:



1. Decide if you’d prefer a male or female therapist.

2. Check with your insurance company for a list of therapists that they’ll cover. Talk over your financial situation with your parents to see how much they could afford to pay per session beyond the insurance (or, if you’re on your own, figure out how much extra you can pay).

3. Check with any of your friends/family members who see or have seen therapists for recommendations on who to see or who to avoid. (Note: Everyone has different preferences for therapists; if you’ve already talked to one and s/he seemed good, but a friend says they sucked, don’t necessarily cross them off.)

4. Decide what type of therapy would be best for you – there are a lot of options. Would Cognitive-Behavioral Therapy work best, Rational-Emotive Therapy , Dialectical Behavioral Therapy , Gestalt Therapy , Psycho****ysis , or humanistic therapy work best for you? These are not the only options by any means, just some of the more common “organized/formalized” therapies that have been shown to work. Make sure the therapist is licensed to give the type of therapy that they use. (Note: In practice, therapists usually end up mixing these therapies together to whatever best suits you, but they will focus most on the area that they specialize in.)



From the list your insurance company gave you, you should then make a phone call to any therapists that look good (i.e. anyone who specializes in what you’re seeking help for). Start with somewhere around five. You’ll probably get a message machine, so just leave your name and number and tell them you’re interested in possibly starting therapy with them. When they call back, you should:



1. Make sure your therapist has experience with whatever problems you’ve identified (depression, anxiety, self-injury, eating disorders, etc). You should ask about their success rate with clients who’ve had similar problems to you, and how many they’ve seen.

2. Discuss their treatment methods with them. What type of therapy do they do? If you have any ideas on what would help you most, talk to them about that and see how flexible they are. For example, if they’re going to treat self-injury as a suicide attempt, though you made it clear that it wasn’t, it’s usually a good idea to move on.

3. Ask how long they’ve been practicing for, what degrees they have, where they got them from, their licensure information, etc. Their degrees and licensure information generally don’t play a huge role in how good a therapist they are, but if they’re not willing to answer or get insulted by any questions you have about their education and licensure, it’s usually an indication to move on. (Information on what degrees mean what can be found in a later section of this post.)

4. Ask them about their fees, and compare that with what your insurance will cover. If money will be a problem, talk to them about potentially reducing the charge (many therapists will do this).

5. Do not set up an appointment right away. Tell them you’re shopping around trying to find a good therapist and that you’re going to check with a few others before making a decision. If you think you may want to see them, tell them that, but don’t set up an appointment until you’ve evaluated things a bit.



At the end of the call, think about whether or not they made you feel comfortable (as much so as is possible), or if you felt anything else during the call. If they might be okay, keep them on the list, if they seemed particularly good, star them, and if they sucked, cross them off. If you get any stars within the first few therapists, set up an appointment with whichever you’d prefer. If not, call some more. If you’ve called quite a few, and still have no stars, consider setting up an appointment with one whom you hadn’t crossed off, though it would be better to keep looking.



In your first appointment, there’re several things to look for, both minor and major:



1. Who do they introduce themselves as? It’s usually best if they use their first name (i.e. Mark instead of Doctor Smith). If they don’t use their first name, that doesn’t necessarily mean that they’re going to be bad, but can be a good first indicator.

2. Do they take notes? A few notes are fine (unless it bothers you, in which case you should tell them and they should stop), but if you have to pause for them to copy stuff down and they won’t stop taking notes, it might be a good idea to find another therapist.

3. It’s not too uncommon for therapists to have you fill out a short questionnaire about the reason you decided to seek therapy and a bit about your past. That’s not necessarily a bad thing, but a lack of it isn’t necessarily bad either.

4. Very importantly: Does the therapist make you feel comfortable? It’s usually a good idea to give them until the end of the session for this, and if you’re still not really sure then, try a second time. If you don’t feel like they’re reasonably easy to talk to you should terminate therapy with them. There’s no need to waste time and money.

5. Very importantly: Do you feel like the therapist is actively listening to you and focusing on your problems, or do they just ramble about what you need to do to get better? If the therapist doesn’t listen well, you aren’t going to get anything out of the therapy. Again, this can be hard to tell first session, especially if you’re like me - slow to warm up to new people and therefore not talking a lot. Even if you don’t talk a lot though, try to notice if they ask questions frequently or rarely. The more questions the better, usually. Again, if they refuse to listen well, you should terminate therapy. (Note: If you are barely talking, which is common if when you first start therapy, they may talk a fair amount to fill in the gap. This is different from rambling on and preventing you from talking, and shouldn’t necessarily be used to rule them out.)



The most important thing about a therapist is that you like them. If you don’t like your therapist, you won’t gain anything from seeing them. It’s normal to get mad at and have disagreements with your therapist from time to time, but most of the time you should get along well.



If you find after several appointments that a therapist isn’t helping at all, you should consider finding a new therapist. It should be noted that several appointments usually isn’t enough for you to be “all better,” but you should feel like it’s helping a little.



What are the risks that I’ll get put in a mental hospital?

Because of the way insurance works nowadays, hospitalization is pretty rare, and is generally reserved for when there really is no other option. Insurance companies will usually only cover two to three weeks of hospitalization at a time, so it’s very rare to stay in an inpatient facility for longer than a few weeks.



How does medication fit into therapy?

If you are over 13, no one can legally force you to take medication that you don’t want to take. However, medication can be very helpful in treating many conditions. Recovery rates for most disorders are highest when therapy is combined with medication.



I would suggest learning all you can about a medication before taking it. What does it do? What are its side effects? How much will it cost? How long will it take to start working? What other medications are available and why is the recommended medication the best one to start with?



In most cases, it’s best to wait a few months after starting therapy before starting on medication. Mis-medication can be very damaging, so it’s best to let your therapist get to know you a bit so that they can determine with some accuracy which medication would be best for you.



What do the different degrees and titles mean?

There are so many different titles and degrees that therapists use: psychiatrist, psychologist, councilor, social worker, etc. The following section will explain each degree, how much and what sort of training is involved in attaining it, and what abilities the holder has.



Psychiatrist - Psychiatrists have an M.D. and are medical doctors with a specialization in psychiatry. As a result of this, psychiatrists are the only mental health professionals with the ability to prescribe medications. They can also give psychiatric evaluations. Their training includes four years of normal med school (with one or two psychiatry electives included), one year of internship as a normal doctor, and three years of internship during which they focus on psychiatry (this may vary, but it’s the “norm”). Most psychiatrists training is geared towards psychopharmacology (prescribing medication), with varying amounts of training in therapy.

As such, most Psychiatrists function as prescribing doctors rather than therapists. For psychiatric medications, they are worth seeing, as regular physicians do not have the training to properly monitor psychiatric meds (yes, even basic antidepressants). Some psychiatrists do give therapy, but I would suggest being careful when considering them for therapists. In my experience, a much lower percentage of psychiatrists are skilled at therapy compared to other mental health professionals. Psychiatrists receive licensure through the American Psychiatric Association (http://www.psych.org).



Psychologist - Psychologists hold a doctorate in psychology. The most common degree is a Ph.D. in clinical psychology, but both a Psy.D. or an Ed.D. can also be licensed psychologists. Psychologists can give psychiatric evaluations, but cannot prescribe medication (Except in New Mexico; and there is a movement to allow psychologists to prescribe meds everywhere in the US after receiving additional training in psychopharmacology; I do not know about other countries). Their training includes four years of graduate school, and at several years of post doc work (equivalent of internships for medical school). Psy.D.’s receive the greatest amount of training toward clinical psychology (more built in experience in their curriculum), with Ph.D.’s in second and Ed.D.’s in third.

In my experience, Psy.D.’s tend to be the best at therapy. There are certainly bad therapists with Psy.D.’s, but they seem to have the largest percentage of skilled therapists out of all the degrees (not just psychologists). Ph.D.’s vary quite a bit. I have not heard anything about therapists with Ed.D’s. Psychologists receive licensure from the American Psychology Association (www.apa.org).



Counselor - Licensed counselors have some sort of masters degree, usually an M.A., sometimes an M.S. The requirements for licensure vary heavily from state to state. In Ohio, the term is LPC (Licensed Personal Counselor). Usually, counselors have one to two years of graduate school training in counseling, and many have strong areas of specialization (i.e. eating disorders, substance abuse, relationships, etc). They cannot prescribe or administer psychological testing. I am unsure if they have a post degree training period similar to an internship or post doc.

Counselors, in my experience, vary tremendously in their skill at giving therapy. Some are really, really bad, and some are wonderful. Most are in between.



Social Workers - Licensed clinical social workers hold a masters degree in social work (M.S.W.). Many school guidance counselors have M.S.W.’s, but most are not licensed. They usually have one to two years of graduate school training in social work. They cannot prescribe medication or administer psychological testing. I am unsure if they have a post degree training period similar to an internship or post doc. The MSW is the most “accepted” masters level degree for mental health professionals to hold. They receive licensure (LCSW) from each state individually, like counselors.

Social workers tend to vary similarly to counselors, though I haven’t heard nearly as much about them.



Insurance companies usually cover psychiatrists most, psychologists second most, and counselors/social workers third. However, the cost of therapy usually increases along with the insurance coverage.