Thursday, June 21, 2012

Chronic depression and discerning what I want

Claude Monet, "Weeping Willow."

When my therapist and I do the CBASP therapy (Cognitive Behavioral Analysis of Systems Psychotherapy) for chronic depression, one of the key points in the session is to pinpoint my desired outcome of the specific interpersonal interaction we’re discussing.
Those specific interactions are what the therapy is built around. Every week I bring in an example—positive, negative, or a little of both—of an interaction with another person, and we analyze it in a systematic way.
There are two types of outcomes we discuss.
The actual outcome is based on what actually happened. It’s the last thing I did or said during the interaction.
The desired outcome is the best possible outcome given the circumstances.
That’s where I’m having the most trouble, deciding what the desired outcome should, or could, be.
Sometimes I literally draw a blank when my therapist asks me, “What did you want to happen during this interaction?”
It’s not unusual, my therapist said, for people with chronic depression to not know what they want.
In my mind, I view “the right thing” or “the best thing” in opposition to “what I want.” I tend to think of “what I want” as the selfish thing.

What I want?

I don’t mean I have trouble deciding what flavor ice cream I want, or which outfit I should wear.
I mean decisions about what I want out of life: what is good for me and what is not, when to speak up and when to be quiet, how I want to spend my time, what I should be doing with my life, what my purpose is—the big but basic wants.

Effects of depression

Depression can suck the energy right out of me. Sometimes I feel dull and lifeless and all I want to do is sleep. I don’t want to do the things that I usually enjoy, like reading or cross stitch. The thought of doing anything overwhelms me, so I don’t spend a lot of time thinking about what I want. I don’t care.
I also sometimes have a difficult time knowing if I’m making a decision based on my depression or on an understanding of what I want in life.
And the hallmark of chronic depression is a sense of hopelessness. So to consider what one wants begs the question, what does it matter?

So how can I help myself?
At this point, it’s important for me to consider what I want—something novel to me—and then consider whether or not it’s the right thing.
There are some ways that help me decide what I want. Most of them involve quiet activity:
*Writing helps me sort through my thoughts. Often while writing a post, I will figure out what message I’m trying to convey only after I write it.
I can relate to the writer Joan Didion, who said, “I write to find out what I’m thinking, what I’m looking at, what I see, and what it means.”
With better thinking, I can gain better self-understanding.
*Quieting my mind helps me to focus. The best way for me to slow down my thoughts is to sit quietly in meditation, listening to my breath and the other sounds around me, imagining my thoughts passing through my mind.
As the frenetic pace of the thoughts slows, I can pay better attention to what’s going on now.
I have found that if I meditate regularly, I am calmer and better able to attend to now. The key is regular meditation.
*Nature helps me. Sitting by the river and listening to the water, talking a walk, and biking through fields and trees soothes me and calms me.

It’s a process. I’m still having a difficult time discerning what I want out of an interaction. But I’m working on it.

  Do you ever feel that what you want is in conflict with what is right? How do you resolve that conflict? And how do you discern what it is that you want?


  1. A very challenging post Tina!
    I often have huge inner conflicts when it comes to what I want in life. Whether that is with interactions or the way people treat me, or what I have accomplished in life or even when it comes to my worldly possessions.
    I can never ask anything for myself because then the thought comes that there are always people that are worse off or treated worse then I am. So then it feels like a terrible sin that I will be punished for, if I ask for anything better. (the "rich" won't go to Heaven, and in my mind somehow the "happy" ones not either, as that is a kind of richness) And I'm not allowed to judge anyone for anything either, as that feels like a sin too. Doesn't leave much to respond with in an interaction!
    It causes a lot of anger and frustration to build up, but I still do not know how to change these thoughts. But I think a lot of people with OCD have an over active conscience anyway and that plays a large role when it comes to trying to figure out what you really want. It's so difficult to figure out what I really want or what I think I SHOULD want.
    I love doing jigsaw puzzles, they really relax me, and going for walks, and I do a lot of knitting and crochet. And meditation is a great help too.

    1. Klaaske, You're right--the side effects of never considering what we want can be anger and frustration, which can be depressing. I am working on deciding what I want and consolidating that with what is right, but it is so hard. I like to crochet, too, and I am meditating just about everyday--it needs to be everyday!

  2. Wow, those are some meaty questions!

    It seems to me that we have the impulsive "wants" (I want chocolate! Now!) that may or may not be what is right. However, the deeper wants, the wants of our souls, are always right and worth protecting. It's not always easy, because we women are conditioned to be nice, to be accommodating, to put our needs aside for others -- and when we do something different because it is what we want AND what is right, we may get backlash from others who feel inconvenienced.

    I have found in my recovery that often doing the things that are most meaningful to me seemed selfish at first. Now, I see the difference in me when I am true to that deeper part of my being, and I can't go back to doing anything else.

    I get my clarity on the yoga mat and on walks. Walking, for me, is almost magical in its ability to help me sort out the deeper wants from the shoulds and from seeking momentary pleasure just to "feel better."

    1. Nadine, Some good stuff in your comment--thank you! I know what you mean by women being somewhat conditioned to put others' needs first. And I had a mother who told me that to do what I wanted was selfish.

      I like what you said about "the wants of our souls" that are right and worth protecting. That speaks to me.

      Walking clarifies things for me, too, and getting my mind to quiet down.

  3. Yeah, this was a really heavy one for me. I read it late last night and needed to think more before I commented. I am not anymore prepared this afternoon though. I think I do have a clear picture of what I want and desire..but if it is "right" is where it gets tricky. When my children were growing up I felt this quandary more so than now. I hit a point in my life where my (Navy) husband was deployed often, for 6-12 months at a time. Oh, and we moved every 2-3 years. I wanted to go back to school and I wanted to work. But it was difficult because I also wanted to be there for my kids and dad couldn't attend school functions or baseball games so I felt the want and need to put them first but I also wanted to take care of myself and be the best I could be. I had these other desires pulling at me and didn't want regrets later was complicated. I was really conflicted.
    I think I always try to find a balance and though I look back and I would do a couple things differently, I have come to the conclusion that in our particular situation I could not have it all. Others may be able to do that, but I could not. I have no regrets, I was with my children when they were small, got schooling in later in life & worked at some really cool jobs. Maybe I could have it all...just not all at once.
    Believe me I stress out, a lot, but lately I try to keep in mind that there are lots of do-overs, most of the time (not always, I realize) we can change our minds or do something again and do it differently.
    But your post goes way beyond that realm of thought and it is keeping my brain busy today.

    1. Krystal, I can't imagine trying to juggle all the things you had to juggle while your children were growing up and your husband was in the military. You hit the nail on the head, I think, when you said maybe you could have it all, just not all at once.

      Finding a balance is hard for me, because I'm not sure what balanced it. Not sure if I've ever lived a balanced life, but it's something I'm trying to do now.

      You're right--there are chances for do-overs or to do things differently, and to change our minds. We should remember that!

  4. As an INFP, I'm an idealist, so I always trend towards what's right, even if it isn't what I want. I can't help myself. This has, however, gotten me in trouble once in a previous job, when I felt like something I was being asked to do was unethical. It didn't go over well w/ the boss that I refused to do what she wanted. And another time, I had to turn someone I liked in (even though I liked him - we all did so it was shocking!) but it was the right thing to do, because he had abused a minor.

    1. I'm an INFJ--similar to you! I don't have a difficult time deciding to do the right thing morally or ethically. It's the other bits of life--did I say the right thing, should I assert myself now, etc. that get me.

  5. Oh, I have found writing to be so helpful as well. I never realized how writing could be so therapeutic. Lots of times I will start to write a post and then it comes out completely different than I thought it would be, but then I've ended up learning something about myself.

    I'm sorry you struggle with decisions. Sometimes it can be difficult to know what the best decision is for everyone, including ourselves.

    1. Writing helps me, too. I'll start out thinking a post is about one thing, and it ends up being quite different. I learn from that, too.

      Decisionmaking about some things is not easy for me, but I am working on it!

  6. Many of your tools are also tools that I use.

    The times I have been depressed in my life are so scary with the fatigue, lifelessness, inability to make decisions etc. I hate all those feelings and I am so sorry you have to suffer thru those things so often.

    1. Thank you for your empathy, Elizabeth. I appreciate it.

  7. Very interesting post Tina!!
    I never know what I want. I usually avoid even thinking about what I want so that I don't need to change anything in my daily routine.I don't have interest in anything


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