Back to the Q&A this week. Before I answer the questions, I talk about a recent psychiatric hospitalization that I had to do with the hope of helping you understand that it’s not a purely black and white situation.
How do you build a support system when you have depression and do not have close friends to lean on? It’s extremely difficult for me to open up and trust people, and I feel the strong urge to withdraw very quickly. I’ve had depression from a very young age. It caused me to neglect a lot of relationships, push people away, and isolate myself. Although I have acquaintances, I don’t have anyone I could call a close friend, and my relationship with my family is not on good terms because of past abuse. I’m currently in a romantic relationship, which has been the only constant for me over the last 5 years, but it’s been clear for a while now that it is not going to work and is unhealthy (probably for both of us). I know I should leave but I’m so terrified of being completely alone and not having any support as I go through with it. Any advice would be greatly appreciated!
Thank you for this question. It’s a good one and you are certainly not alone in this struggle. It can be tough to make friends as an adult in general and especially hard when you have depression sapping your motivation and also making you feel that you are not worthy of friendship etc. Obviously the first thing that I will suggest is making sure that you are getting therapy or going to groups. Of course this is different from friendships, but that can be a good thing. You will have a built in space to share your feelings and get help with problematic thinking patterns and things of the sort, which can actually help you feel like you are not burdening your friends with all of it. Nothing wrong with being honest and sharing yourself with your friends but it can help to have an outside source to mitigate that guilt you might feel. Having a therapist WHILE you try to make some friends could also be a great thing because I’m sure it will be a bit of a challenge for you and you can use therapy as a space to get help working through the things that usually cause you to escape or become distant. I appreciate that you are not simply running back to family since you have a history of abuse with them. It can be hard to establish boundaries like that, but it may be entirely appropriate. I’ve said it before but family is just family. You don’t get to choose them. With some work and effort, you are in a position now to bring people into your life that can be beneficial and fill you up instead of draining you constantly.
One of the best ways to make connections and establish friendships is to get involved with something. When you are working or are in school, you can have a sort of built in community that does the work for you. If you don’t have that or you work with a bad group of people, it gets a little more tricky. What are you interested in? Start there. I asked for some examples on Facebook and Twitter and got lots of great responses about how people were able to make friends outside of work and school. One example that I really liked was joining local Facebook groups. Local groups based around one of your interests such as photography or D&D. Volunteering is a classic example. If you drink, breweries and wineries are a great place to meet people. Taking classes or workshops… there are plenty of different options.
Understand that there are different levels of friendship and that’s okay. You don’t need to have someone fulfill all of your emotional needs as a friend. That may be unrealistic. Start with just having casual friends and move forward from there. It can take time and shared experiences for a deep friendship to develop. There are also online communities that can help to bridge that gap and make you feel not completely alone (might I suggest the Hardcore Self Help Facebook group?). In this day and age, the difference between online and face to face friendships is much more blurred. It’s totally possible to make great friends through the internet (obviously you’ll want to exercise appropriate caution in sharing personal details etc.).
So the bottom line is that you are going to need to be a little proactive, which can take some work when you are depressed. You may need to do some self-help or therapy to help you get to the point where you are able to pursue these things. Once you get the ball rolling, you will hopefully realize that there are so many different options and opportunities. The other thing is that when you start doing some of this behavioral activation work (getting yourself active and enjoying things again), you will probably have an improvement to your mood, which can positively impact the relationships that you might end up building.
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I have a good deal of anxiety and stress after being stalked and several concussions. My therapist is very keen on me avoiding stressors. She says there is actually still something to fear (there is an “actual lion walking about”) in terms of having to avoid stressful reactions. Too high stress levels for too long a time. She pleads me to be very cautious in exposing myself to work, social situations and the like. How does this sound to you? Can there be situations where that advice holds true?
VERY good question! So you’re basically asking when is avoidance and being vigilant actually a good idea? I know that I talk a lot about the importance of exposure, avoiding avoidance, practicing small acts of courage and all of that, but there ARE some circumstances where that isn’t the most important thing for you to focus on.
First off, let’s talk about the concussions. I don’t know the details of your concussions – when they happened, how severe they were, if you have post-concussive symptoms etc. So let me explain a little bit about concussions in general. Concussions are a mild traumatic brain injury where your brain collides with your skull – think of when you are in a car and you need to slam on the breaks. You keep moving and the car stops, which causes you to slam forward and if you didn’t have a seat belt, you would probably smash your head on the steering wheel or dashboard. In this analogy, you are the brain and the car is the skull. Concussions can happen from a blow to the head or violent shaking. There is a range of severity. From a mild concussion, you may have very few effects from it. As you get more severe, you start to have symptoms like confusion, feeling dazed, headaches, sensitivity to light, nausea, etc. Some people also get post-concussion syndrome, which is when the effects persist over time. You continue to have headaches, sensitivity, and all of that, but you can also get significant emotional changes, thinking difficulties etc. It’s no fun. When someone has postconcussion syndrome or suffered a more severe brain injury, one of the most important things to do is rest. Both physical rest and cognitive rest is called for. However, this is a short term intervention. Your doctor should be the one to advise you on how long is appropriate. So if you are in a postconcussive phase, it may make a lot of sense for you to avoid undue stress and really focusing on rest so that your brain can recover as well as possible.
Now if we are no longer in that postconcussive phase and you are fully recovered the story changes a bit. Are there cases where you may want to avoid undue stress? Sure. You don’t want to have yourself in a constant state of high alert if that is going to stop you from functioning appropriately. However, if what you said is true, that you are being asked to avoid work, social situations etc. That may be a bit much. Again, unless you are in that postconcussive phase where you need your brain to heal, you don’t want to completely avoid the world. If work is a crazy big stressor, sure take some time off. If you are constantly having PTSD triggered be being in a certain place, sure avoid that place for now if it’s stopping your functioning. But you also need practice at being in the world and operating the way that you would like to.
SO basically if your level of stress is an extreme burden on you that keeps you from functioning or if you are being held back from doing the work that you need to do in therapy etc due to the amount of anxiety that you feel from everyday activities, you might want to be cautious and aware of what sort of situations you put yourself into. Otherwise, I encourage you to not be black and white about it and evaluate each individual situation separately in terms of your current coping abilities and the kind of life that you are working toward.
Hi Duff, I have recently discovered your podcast and it has been an instant favorite of mine. I have a few questions that I would love to have you answer. As an aspiring future mental health counselor (LPC), what advice would you give someone going into the field? What do you wish you would have known? And last, do you have any training on positive psychology? What do you think about it? (If you have answered these before, please refer me to the episode and I would love to give it a listen!) Take care.
Thanks for writing in! To clarify, an LPC is a licensed professional counselor, which is a master’s level certification that allows someone to provide therapy or work in a treatment setting like a drug rehab. Surprisingly for as many talks as I’ve given to classes and things of the sort, I haven’t thought about the questions that you asked very much.
I suppose one thing that I wish I would have known is that many training programs tend to focus on clinical skills and other important course work, but really neglect to give you proper guidance on things like business strategies, establishing a private practice, and “real life” topics of the sort. Never be afraid to ask questions or be the one that is annoyingly engaged in class. That’s how you get what you need out of a program. On that note, you can get what you need out of most programs if you are willing to advocate for yourself. If there’s a certain type of experience that you would like to get more exposure to, talk to your advisor or the program director, and often you can work something out. I will also say that it takes a lot of work to be a full time therapist. One of the biggest benefits in my professional career has been establishing multiple sources of income. That has allowed me to avoid falling in what I like to call the “private practice trap” where you need to jam out as many clients as you can back to back each day to make sure you are making a good living. Always be on the look out for ways that you can use the skills that you are learning or capitalize on your unique personality to do something a little different than the rest of the crowd.
You will have ups and downs. You will have times when you are inspired and on your game and other weeks where you feel like a total phony and you have no right to be helping other people. Just know that’s all part of the process and you have a very long time to become the best therapist that you can possibly be. When you feel that way, remember that it’s because you actually give a shit.
On that note, you will find people who don’t give a shit in the field. People who are jaded or people that make you wonder why they ever got into the field in the first place. This is your opportunity to be different and genuinely care about what you do. The work can be heavy at times, but it can also be super gratifying and fulfilling. On the hard days, there’s nothing wrong with leaning on your supports and/or getting therapy yourself. Be aware of your needs. It’s easy to try to be a fixer and put other’s needs above yours all the time. You are human too. This is a long game and you need to be able to help people for many years, so make sure that you take good care of yourself too.
In terms of positive psychology – I’ve had coursework on it and I’m certain familiar with the approach, but I wouldn’t say it is a central component to what I do. Positive psychology is the study of what makes life worth living. Rather than focusing primarily on treating mental illnesses, interventions more tend to help people promote the areas of their life in which they feel fulfilled, happy, grateful, etc. You might do acts of kindness, writing gratitude letters, increasing awareness of positive life experiences etc. What I feel about it is that it’s a great aspect to be aware of and try to integrate into your work, but unless you live and breathe positive psych, I’m not the biggest fan of it in terms of a primary approach. It takes a certain personality on the part of the therapist and on the part of the client to really make that work. I like taking a strength-based look at things, not trying to over pathologize someone, and all of that, but someone with severe agoraphobia or suicidality is not going to be cured by keeping a gratitude journal. It’s an important movement because it brings some balance to the field of psychology, which can be a little to focused on symptoms, diagnoses, and “fixing” people, but it definitely has its limitations when it comes to real-life therapeutic practice.