Diagnosed with major depression by a psychiatrist when I was forty years old, I had to find a therapist who could help me. The physical side of the illness pounded me: sleeplessness, fatigue, and the inability to concentrate and be productive at my job as a lawyer. But also the psychological dimension: feelings of low self-worth, chronic sadness, and negative thoughts about my ability to recover and be happy again.
A friend recommended me to the man who would become my therapist for the next twenty years. Jerry was a psychology professor at a local university. From the Bronx, he has a wonderful, salty sense of humor. Not only was he brilliant, but he was also warm and engaging. I felt at home, and we quickly bonded.
During this dark time in my life, I felt isolated. More often than not, I felt lonely and didn’t know anyone with depression that could understand what I was going through. Jerry did. He became my closest ally, who was with me every step of the way as I dug my way out of the dark cellar of depression. It took time. And patience that was tough to come by as I slogged through depression for years. But his strong and kind presence saw me through. He gave me insight into what depression was and the ruminative, distorted thinking that the disease would churn out. Jerry called this “crooked thinking.” I learned to recognize such thoughts as not part of who I truly was but as part of the illness. It gave me a distance from them and made it easier not to identify with them. This opened up the possibility – and hope – that I could let go of these destructive thoughts and embrace more realistic, positive ones.
Is therapy really effective?
A recent article in The New York Times explored whether therapy, based on the most current research, really works. What the studies show, and this has been both my experience and hundreds of others I’ve been privileged to meet over the years who struggle, is that it’s the combination of a good therapist and antidepressant medication that is the most effective treatment. In my case, I have been on Cymbalta (an antidepressant) and Lamictal (a mood stabilizer) for the past fifteen years. The meds quieted the physical symptoms enough so that I could benefit from my therapy with Jerry. Without the medications, I found that my time with Jerry was not as effective because his insights could not penetrate the hard shell of the physical side of depression that my brain was generating.
Some have told me I was lucky to find a therapist as good as Jerry. Others have said that they’ve had therapists who have been real duds or ineffective. As The Times article points out, it’s not always the educational background that matters (Jerry had a Ph.D., but many other therapists have M.S.W.), but, interestingly, if a patient emotionally bonds with a therapist. Bonding, and its relationship to the efficacy of the therapy, was challenging to measure in all the studies that were reviewed for the piece. The article reviewed some research that suggests how therapists react to the negativity of a patient that matters. For example, while this was not the case with Jerry and me, many patients can and do, blame their therapists for they find the therapy not helping. Sometimes, they outright say this to them. If a therapist responds with empathy rather than being defensive, that is the key.
Advice if your new to therapy or considering switching.
Before Jerry, I had a few other therapists. Each lasted about six months. The therapy helped me regain some footing, but at some point, it became clear that it was not, in the long run, going to help me get to the bottom of it all and make lasting changes. So, if you’re a person in therapy for depression, listen to yourself. Do you have an emotional bond with the therapist? After giving it a fair chance, do you feel it’s really helping you? If not, I’ve learned that it’s time to change therapists.
Whether you’re in this boat or thinking of going into therapy for the first time, an issue for many is finding a good therapist that might give you the best chance of establishing a bond and recovering from depression. While there are no easy answers, a few places to start might include your family doctor or a trusted friend. The family doctor might be a good bet because, in the U.S., over ninety percent of antidepressants are prescribed by them. If cost is a consideration, getting a list from your insurance provider about what therapists in your community accept your particular insurance would be helpful. When you are new to counseling, I suggest “interviewing” a therapist to see if you’re a good match. Often, I tell folks to put together a list of three therapists and make an appointment with all three. If your talk with the first one you go to is a great fit, you need to look no further. If it isn’t, interview the next two.
Summary & Resources.
In summary, you don’t have to go through depression alone. As I have often said, one of the worst aspects of depression is loneliness. Much of my ongoing recovery is working on having deep connections with others. This has been through many avenues, such as regularly attending depression support for lawyers (check out the Lawyers Depression Project, or if your not a lawyer, check out “The Six Best Online Support Groups for Depression”), volunteering in my community, and being more open with those I love when struggling. Talk therapy is more than talk, and it’s a critical part of learning to cope with and manage depression.
By Daniel T. Lukasik, Esq.
