How Can Talking to a Therapist Help my Depression?

Depressed? You aren’t alone. 1 in 13 Americans will have a depressive episode this year. 1 in 5 of us at some point in our lives. So how will talking to a therapist help?

First of all, DEPRESSED PEOPLE! You are the reason we went into this profession. If most therapists were to condense their passion for mental health treatment into a sentence, it might be: to help people be happy. 

WARNING: This article is long. REASON: Therapists use far more angles to treat depression than most people realize. If you don't finish this article, that's okay. I just want you to walk away knowing there are many more ways therapy can help than you might imagine.

Your therapist is curious how you talk to yourself about your depression. Is your narrative one of self-loathing and judgment and plagued with guilt? Or are you angry with God, the world in general, or specific others that have brought you to this point? Have you fallen into the all-too-common trap of learned helplessness? This is when you have made many efforts to ameliorate your symptoms but nothing has worked and you fear your depression is here for good.  

Your therapist wants you to learn that your self-talk is a powerful force to perpetuate depression or fight against it. He might challenge beliefs that you have come to hold true such as: you are unlikeable, other humans can’t be trusted, life is cruel and pain and disappointment should be expected. These beliefs cement depressing feelings of sadness, despair, anger, fear. They leave no room for hope. 

He will point out an unhelpful automatic strategy our brain has to continue these beliefs which we call confirmation bias. If you believe you are unlikeable but you have one friend, your brain quickly labels that friend as an exception. When a coworker doesn’t like you it affirms your belief. When a stranger scowls at you in passing, it confirms how repellent you are. But when the boss compliments you, she was just being nice. When a church member asks you to join their Bible study, they do that for everyone. We hold tight to our beliefs, whether they are true or not. 

Your therapist doesn’t want you to recite uplifting platitudes. It won’t help to insist the sky is orange if you know it’s blue. Rather, your perspective must shift from negative to honest. The truth is that there are bad things in the world and a whole lot of good too. Your therapist wants you to see them both and be grateful for the good. Having depression is like wearing sunglasses. You are looking at the same people, places, and situations but through a negative lens. Darker. Distorted. Your therapist is sitting with you looking at the same picture but without the depression tint. He will ask you to accept that your view is distorted and remind you of the colors you will see again when your depression shades are lifted.  

Your therapist also knows that depression is an illness. He wants you to care for yourself the same way you would if you had a physical illness. No one functions well when they are sick. It’s hard to concentrate and we don’t have much energy. We accept when we have a virus and give ourselves some grace that those days are not going to be very productive. Or fun. Most humans are willing to rest, go to the doctor, take medicine, and whatever else they need to get better quickly. With depression, we just keep going and feel guilty that we are not the best version of ourselves. We don’t internalize our shortcomings when we are ill, we blame it on the illness! We don’t tell ourselves that we are no good or feel ashamed of getting the flu. Everyone gets sick. But the depressed internalize their depression particularly when it is long-lasting. It becomes part of them. A flaw. Something to hide from public view. Something to be ashamed of. A weakness. 

Your therapist will also be prescriptive in you changing some behaviors – either starting or stopping a behavior. He may discourage you from drinking while working on your depression. He may suggest you exercise. He's going to look at what habits perpetuate your symptoms and what actions might help relieve them. As the old adage goes, doing the same thing and expecting a different outcome is the definition of insanity. He will ask you to change. 

Speaking of our behaviors perpetuating our depression, your therapist knows that making these changes is a fight. Unfortunately, depression makes us want to do things that keep us depressed. We are tired and don’t feel like exercising. We don’t feel like going to the party or calling a loved one. We crave some dopamine when selecting food, often opting for high fat and high salt junk that can make us feel worse. We may want to drink or use drugs to dull how we are feeling or at least feel something different for a moment in time. Imagine someone who is severely depressed. What does she look like? She is in the fetal position in bed. She is crying and not doing anything to help herself. Possibly not doing anything at all.  

Your therapist will point out that this is natural and must be fought against. We can't allow ourselves to lean into depression if we're trying to climb out of it. Your therapist may ask that you consider what behaviors you would be doing if you were not depressed. Would you be biking, making supper, smiling, going to work, prioritizing the gym? These are the steps toward walking out of a depression pit. And it’s often not easy.  

Exercise is the antidote to depression (though not 100% effective) and your therapist knows it. Any increased movement is good but a significantly therapeutic dose of exercise is sustained cardio for 30+ minutes a few days per week. Cardiovascular exercise does not mean running on a treadmill. It is any activity that causes your heart rate and your respirations to go up. Simple as that. If you are huffing and puffing and your heart is pounding in your chest, you are doing it. Yoga, swimming, lifting weights, playing a sport. Your therapist has worked with enough humans to know that if you see exercise as a chore, it will never become integrated into your life. 

Finding joy in movement is your therapist’s desire. Once you find the Zumba class or volleyball game that you enjoy, then you will incorporate it into your life more seamlessly. Your therapist knows: if you hate exercise, you are doing it wrong. 

Your therapist may ask your interest and comfort level with treating depression with medication. She knows that therapy is effective for depression, medication is effective for depression, and doing both is more effective than either alone. As a psychiatric medication prescriber, I can attest that there are a multitude of ill-advised reasons that keep people from considering medications. Let me start with the most inaccurate: I’m not that sick. Of all the psychiatric medication we prescribe, antidepressants tend to be low risk / high reward. Antidepressants generally provide good efficacy which brings improved quality of life at a low cost in terms of side effects. Put more bluntly: antidepressants are generally much safer than most people realize.

There are rare exceptions of course, but there are risks to not treating depression as well. Like losing your job, your husband, your life to suicide. Many accurately have heard of the common side effect of our frontline antidepressants causing sexual dysfunction. It’s true! But what they don’t know is there are other older and some newer medications that are just as effective that can avoid that side effect. Others fear weight gain or sedation that were more common in previous drug classes and that can be avoided with present day antidepressants, as well. More than 1 out of 10 Americans are on antidepressants at any given time (partially because they are equally effective for anxiety) and yet, no one talks about it. It’s normal to be depressed and it’s a smart idea to treat it so it doesn’t get worse. 

For our retired or not working clients, your therapist knows that boredom breeds depression. Many of the aforementioned busy people dream of retirement (when they likely just need a vacation and a reduced work schedule). This doesn’t mean that you should work, but you need to do something. For some it is solitary activities, such as home hobbies (e.g. gardening, crafting, painting). For others, it is helping others. This can mean volunteering or visiting loved ones in nursing homes or supporting an animal non-profit. Still, others need to contribute. Some people have found identity in working and do not adjust to being static. They prefer to work or at least help out by mowing the neighbor’s lawn or doing handyman work for family members. Entertainment and rest is an important part of life, but it’s pretty depressing if it’s all you have.  

It is not uncommon for a human to stray down the wrong path in life and then become depressed with how life has turned out. For you, your therapist will encourage writing a whole new chapter. Whether this means sobriety, forgiveness of yourself or others, or changing how you treat others. Your therapist will show you that you have an untapped opportunity to start over. Quit drudging down the same miserable road and change direction.  

Happiness is not found in chaos. Your therapist may highlight the erratic decisions you make, the drama in relationships that follows you, or the lack of foresight in terms of what your current actions have on your future self’s mental health. Living in mayhem can be a distraction. Eliciting intense reactions from others can take our mind off of our own hurts. It can be like living in a play. More accurate, a soap opera. If havoc and turmoil follow you in life, at some point your therapist has to ask what purpose this has. He knows you can’t be happy on that roller-coaster of life. He also knows it may be all you know.  

Finally, your therapist may agree with me that it is hard to be alone and happy. We weren’t made to be solitary creatures. Some struggle with intense anxiety that leads them to fear leaving the nest and thus cut off interactions with the world. Some are simply not socially skilled. It’s harder to connect with others or be able to read them. When someone has low self-esteem or, even worse, self-loathing, you do not get picky with relationships and will often settle for those that either treat you poorly or don’t fill your cup. They may have people in their lives but are the loneliest people on earth. We need people in our life, but nobody is often better than a harmful somebody. Your therapist will assess your social skills and social circle, as this is a common barrier to happiness.  

Just as there are many causes of depression, there are also many angles at getting you well. Let your therapist in so she can see the whole picture. Talking about it will help!

Feel better, y’all!