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What To Do When Therapy Isn’t An Option

What To Do When Therapy Isn’t An Option

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It’s no surprise that we are big advocates of therapy here at Connecte. Therapy can help us manage stress and anxiety, improve our mood and well-being, and cope with life’s ups and downs. It can also be a powerful tool to help us meet our personal and professional goals and reach our potential. Above all, therapy provides a way to feel seen, heard, and understood.

That said, we’re also aware that therapy isn’t always a realistic option. It can take a financial toll, especially when money is tight and insurance coverage is limited. In the public sector, there are often long waiting lists. Therapy also involves a substantial commitment of our time and energy (contrary to expectations, therapy isn’t “just talking’ and it can be hard work!). And sometimes, we’re just not in a place where we’re ready to face past experiences or discuss the things that are weighing heavily on us.

There may come a point when you feel like you could benefit from taking matters into your own hands and taking ownership of your mental health and well-being. Whether you’ve been in therapy before, plan on trying it out for the first time, or are just looking for some strategies you can use to help you cope and maximize your potential, read on to learn how you can move forward when therapy isn’t an option with a few tips from some of the psychologists here at Connecte.

1. Develop a self-care routine

Self-care isn’t selfish, and it isn’t a passing trend or fad. At Connecte, we’re always striving to find ways to incorporate little acts of self-care into daily life and encourage our clients to do the same. It’s a great way to practice #lifetherapy. Coming up with a sustainable self-care routine can help us cope with distress and improve the overall quality of our lives.

One of my favorite ways to help clients come up with a personalized self-care plan is to brainstorm priorities and activities across different domains, including our physical health (e.g., walking outside, attending a yoga class, coming up with a bedtime routine, eating regular, nourishing meals), our emotional well-being (e.g., mindfulness, meditation, journaling), our need for human connection (e.g., seeing friends and family, appreciating small interactions with strangers), and our thirst for creativity (e.g., painting, drawing, reading, interior design). Maryann Joseph also highlights the importance of pursuing creativity: “Take your pain, take your feelings, and make something with them. Channel them into something creative: write, play music, do some wild, cathartic bedroom dancing, plant something, grow something, build something, repair something, make a fiery tomato sauce.”

Self-care ultimately allows us to learn about ourselves, lead a more fulfilling life, and take care of our basic needs and values. Finding ways to incorporate it into your routine can therefore give you a head start for therapy if or when you’re ready.  

2. Create your personal library

Self-help books and resources that guide us through specific therapeutic exercises or approaches can be really helpful. Like anything, this works best when we actually stick with it. If being consistent is a struggle, it can help to set aside a time each week to check in with yourself and catch up on some reading material or exercises. You can even check in with yourself at the same time each week, much like the way you would in therapy. Finding a therapist who can support and guide you through your own self-help exercises can also be extremely beneficial. Luckily, there are so many great resources available, both online and in print. Some of our favorites include Mind Over Mood and Self-Esteem. Danit Nitka also recommends Reinventing Your Life, which is a schema-therapy based read that is aimed at self-guided change. Online, AnxietyBC and the Centre for Clinical Interventions have many helpful handouts and worksheets for coping with anxiety and depression, building assertiveness, cultivating self-compassion, and targeting self-critical views of ourselves and bodies.  Looking for more? You can always find some of our other favorite resources here.

3. Turn to technology

There seems to be an app for everything these days. And while this can make it easier to incorporate things like relaxation and mindfulness into our routines, it also means putting in the time to find the right apps that will work for you. With the increasing evidence that mindful breathing and relaxation are helpful for treating depression, it really is worth it. Some of our favorites include breethe, Headspace, InsightTimer, and Simply Being. Expectful is another resource to guide you through struggles related to fertility, pregnancy, and motherhood. There are also apps and online resources to help you make new friends and expand your support system, including Meetup, MeetMe, Bumble BFF and Peanut (for new mothers).

At the same time, it’s a careful balance. And sometimes it helps to remember to “disconnect to reconnect”. Making an active effort to check our phones, e-mails, and social media less often, or to unfollow accounts, blogs, or posts that may be triggering for a variety of reasons can do wonders for our mental state and our ability to focus on the things that truly fulfill us in the long run.

4. Attend a group

Group therapy can be a really helpful way to work through issues and, in many cases, is often recommended as either an adjunct to or starting point for individual therapy. Maeve O’Leary Barrett and Stéphanie Landry recommend looking into free support groups or workshops that are available through AMI-Quebec, REVIVRE, ANEB (for difficulties related to eating disorders), or the Mont Royal Cemetery (for grief counselling).

Lisa Linardatos also recommends taking part in an extracurricular group and making sure we set aside time for the kind of play that is typically only nurtured in childhood. Whether it’s participating in a team sport or even a bounce class, a creative arts or improv class, a public speaking workshop, or a book club, joining a group activity can be a helpful way to seek out meaningful social interactions, improve our energy and motivation, and build confidence while learning a new skill. Regardless of whether it’s group therapy or simply therapeutic, having an activity outside of the home and feeling socially connected can be so important for our sense of well-being.

5. Open up to close others

Speaking of feeling socially connected, spending time with loved ones, including friends, partners, and family members, is so essential for our mental health. Simcha Samuel says: “Consider sharing your feelings with those you trust. Notice if there are a couple of people in particular with whom you tend to feel especially accepted, understood or supported. Make sure to let them know how much their support means to you and what about their support in particular you have found especially helpful.”. If you’re wondering who to open up to, Jodie Richardson recommends watching this video on the difference between empathy and sympathy. She adds that speaking with a friend can also be a really powerful way to learn how to be a “wise, empathic friend to ourselves and our emotions”.

If you find yourself struggling to find new friends or maintain the friendships you already have, you can always learn more about my work on friendships here. And if calling a friend isn’t a possibility, there are phone lines that offer a listening ear, words of encouragement, or suggestions for social and community level resources.

6. Challenge your assumptions

Sometimes, our resistance to therapy has less to do with practical obstacles and more to do with personal barriers. It’s not uncommon to have biases about what therapy actually looks like or involves. This can be true regardless of whether we have past experiences with therapy.

  • For so many, the thought of entering therapy can feel like a lifelong commitment. In reality, the goal of most therapy experiences is to help you find ways to cope in your everyday life and to essentially become your own therapist. And while every person and experience is different, it’s absolutely possible to make progress in a limited number of sessions.
  • If the cost of therapy is prohibitive, it might help to know that some clinics offer sliding scales (often with an intern therapist) where the fee for each session is based on your financial situation. It’s also not uncommon for therapy to take place every 2 weeks as opposed to every week, especially as things progress.
  • Finally, if you’re concerned about not “clicking” with a therapist, know that it’s all about fit. Research actually suggests that the relationship between a client and therapist actually matters more than the type of therapy that’s practiced! It’s perfectly okay to find someone else with whom you are more at ease and comfortable. Just try to recognize if you might be too quick to give up on a new person or experience.

Challenging some of the assumptions and unhelpful ideas and expectations you have about therapy can ultimately free up space to help you recognize whether you might actually be ready to take the next step of seeing a psychologist or therapist. Until then, focusing on self-care and meaningful connections and using the many resources at your disposal can be an important way to prioritize your health and happiness.


Miriam Kirmayer is a PhD Candidate in the Clinical Psychology program at McGill University in Montreal, Quebec, and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological medicine40, 1943-1957.

Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of behavioral medicine33, 11-21. 

Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38, 357-361.  

Shakya, H. B., & Christakis, N. A. (2017). Association of Facebook use with compromised well-being: a longitudinal study. American journal of epidemiology185, 203-211.

Michael Phelps: Breaking records, smashing stereotypes

Michael Phelps: Breaking records, smashing stereotypes

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Have you ever heard someone suggest that ‘Depressed people are lazy, and they just need to toughen up’? Not only can such statements be extremely hurtful, but evidence flies in the face of such thinking.

Case in point: Olympic athlete Michael Phelps’s battle with depressive symptoms and suicidality. One thing that makes his story so compelling is that he is a record-breaking gold medalist whose training undoubtedly requires tremendous focus and dedication, and who most people would certainly not consider to be ‘weak’ or ‘lazy’.

In recent years, he has opened up about his experiences (1, 2). Let’s take a look at what he has shared, and how this might relate to mental health more broadly:

1. He cited social support as an important factor which helped him realize that suicide was not a good solution.  My clinical experience has shown me that people with depression often tend to isolate themselves. Low mood seems to say ‘just stay in bed, cocoon yourself under the warm covers, things will seem quieter and safer there, and you won’t have to struggle to expend energy interacting with people or doing activities.’  Sometimes people feel like they would be burdening others with their problems, or that others won’t understand what they are going through. But the reality is that isolating ourselves from the people who truly care about us can contribute to further worsening our mood, resulting in a vicious cycle where low mood makes us want to isolate ourselves, which in turn can contribute to further lowering of our mood. And ironically, sometimes the periods when our mood is lowest and our inclination to confide or socialize is plummeting can actually be among the most important times to do the opposite and reach out.

2. He reported having been critical or disappointed with himself when he did not beat a certain world record. This suggests that he may have had a focus on outcome goals, where the motivation is tied to the result (e.g. winning a competition), as opposed to process goals where the focus is on the steps involved (e.g. hard work, love of learning) (3). This may have left him feeling like a failure when he did not achieve his desired outcome. Indeed, some research has found that process goals can have certain advantages, including more enjoyment (4). I’ve often heard clients say things like ‘I’ll be happy when I achieve x goal / when I hit x milestone / when x is over’, but as clinical sports psychologist Kristen Keim noted, it is important to take pleasure in the process and in the moment (5).

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3. He reported that his sense of self-worth declined after he retired from swimming. Sports psychologist Dr. Goldman noted that equating identity with sport can lead some athletes to lose their sense of self (5). It can be very risky to put all of your eggs in one basket by linking your sense of self-worth to any one area of life (be it academic performance, romantic relationships, or physical appearance) because of the negative ramifications for mood and/or self-esteem when we don’t perform as well as we would have liked in that area, or when our involvement in that area diminishes. As such, some therapies encourage clients to develop and value multiple domains of life (6).

4. He noted that he had not reflected on his accomplishments along the way. Perhaps it is surprising that someone who has won so many gold medals during his career would not have already reflected on his successes. But many of us can relate to being focused on getting things done; it can feel like we are running on a treadmill that is going so fast that we struggle to keep up and to catch our breath, making it a real challenge to focus on the present moment and to practice mindfulness. See my colleague Natsumi’s blogpost to learn more about mindful awareness and how you can begin to incorporate it (7).

5. He was initially reluctant to get help, and anxious about the idea of change. Some people think – if you’re not doing well, you should jump at the chance to feel better, right? In reality, things often aren’t that simple. In many ways, we are creatures of habit, and we often find comfort in familiarity, even if that familiarity isn’t ideal. The idea of some unknown change can feel risky or scary, and people may wonder if they are capable of change, if that change will be sustainable, or if they will be fundamentally different people when their depressive symptoms have improved. These are all valid questions; make sure to raise them with your therapist if they are of concern to you.

6. Having benefitted from treatment, he went on to raise awareness and develop a foundation aimed at promoting stress management for youth. Although not everyone will have their own foundation, some people are eventually able to make meaning or see the silver lining in their experience, for instance, by noting that their own struggles have improved their ability to empathize with others and to demonstrate self-compassion.

Bottom line: Struggling with depression does not make someone weak or lazy. And the wide variety of people coming forward about their own experiences demonstrates that very accomplished, hard-working and motivated individuals can struggle with mental health problems. Michael Phelps’s experience illustrates this point well, as well as the importance of factors like social support, motivation, self-worth, and mindfulness in mental health.


Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

  1. http://www.cnn.com/2018/01/19/health/michael-phelps-depression/index.html
  2. https://www.cnn.com/2017/07/03/sport/olympics-michael-phelps-swimming-mental-health/index.html
  3. Qu, Y.., Pomerantz, E. M., & Deng, C. (2016). Mothers’ goals for adolescents in the United States and China: Content and transmission, J Res Adolesc., 26, 126-141.
  4. Wilson, K. & Brookfield, D. (2009). Effect of goal setting on motivation and adherence in a six-week exercise program. International Journal of Sport and Exercise Psychology, 6, 89-100.
  5. https://www.theatlantic.com/health/archive/2016/08/post-olympic-depression/496244/
  6. Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. New York, NY: The Guilford Press. 
  7. https://connectepsychology.com/blog/2016/1/11/3-simple-mindfulness-practices-for-coping-with-difficult-experiences-and-emotions-in-day-to-day-life