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Therapist says I'm not ready for therapy

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So the question she kept bringing up was "what do you want to gain from therapy" and I keep saying "I don't know" and then she says would you be willing to go outside and I said "no" and then she said "I don't think you're ready for therapy" 

I said no because I relapsed into a binge eating cycle a few months ago and I've gained weight and feel depressed, vulnerable and disgusted with myself and therefore I truly don't feel like going outside to engage with the outside world or meet new people. I don't have any friends so yes, it would mean that I have to meet new people. Am I narcissistic for caring so much about my appearance? I don't know. I've spent my entire life knowing what it's like to be abused for being overweight - came over my clinical obesity during early-late teens through restricting and dieting. What can I say? I don't know what to say, but the session has ended a while ago and I'm ruminating over all of this and feel like yes, everything is my fault. Ok it's my fault I must not want to get better because I'm not willing to go outside. Thank you. 

 

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It might be less about the specific not being willing to go outside and more about the not being sure what you want to get out of therapy. And not because there's anything wrong with you or that it's your fault for that you're not wanting to get better.

It's more that it's difficult to do therapy without a goal or two in mind.

For example, you say that it's hard to want to go outside feeling how you feel about your body and the trauma history that goes with it. Would there be a possible goal in all that somewhere? Like body acceptance? Trauma resolution? Developing healthier attitudes toward weight and food?

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Did you explain what you wrote in the second paragraph to her? It's tough because therapy requires us to do things that are uncomfortable, but everyone will need different amounts of time and need to take different steps to make changes. A good therapist should be able to look at the fact that you say your not ready to go outside, and then work backward with you on what will make you able to go outside and then create a plan to work on those things. Being depressed can also make it look like you're not willing to engage in therapy, because at least for me when I'm depressed everything seems too hard and pointless, so I end up shooting down every idea. Maybe really try to communicate with her that it's not that you're unwilling to try, but that you need some help figuring out how to start, and that you need to start somewhere simpler than going outside because that feels like too much right now. 

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I was approved for therapy earlier this week, but I'm not so sure I even want to go through with it. I am so deeply, severely depressed, that just leaving the house is a massive effort. Then, when I'm out, I can't really deal with people well. I can barely hold a simple conversation. I feel like I can't ever smile or laugh. Everything is just so hard to do. When I was in my assessment for therapy, I could barely string two sentences together. I'm having trouble just making this post. It's so hard to think and concentrate, that I'm not sure therapy wold even be useful at this point. Sometimes I wonder if I'm one of the most severe cases of depression out there. I think about suicide daily, but I can't get myself to do it.

I don't know. I guess I just feel like you need some minimal level of functioning in order for therapy to be effective. Right now, I don't think I'm there and I don't know if I'll ever get there. I've been so severely depressed for so many years that it feels impossible to get out of it. It's literally been around 7 years and it seems to get worse each year. I definitely can't work. I struggle just to make it through the days. Meds don't work, although I'm currently on 10 mg of Trintellix. If 20 mg doesn't work, and I can't help but feel that it probably won't, I think I'm going to go in for ECT - although just the thought of going into a hospital for 2-3 weeks is scary as hell.

I kind of got off topic here, so sorry for that, but it just came out. Good luck to the OP. 

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38 minutes ago, DopamineSick said:

I was approved for therapy earlier this week, but I'm not so sure I even want to go through with it. I am so deeply, severely depressed, that just leaving the house is a massive effort. Then, when I'm out, I can't really deal with people well. I can barely hold a simple conversation. I feel like I can't ever smile or laugh. Everything is just so hard to do. When I was in my assessment for therapy, I could barely string two sentences together. I'm having trouble just making this post. It's so hard to think and concentrate, that I'm not sure therapy wold even be useful at this point. Sometimes I wonder if I'm one of the most severe cases of depression out there. I think about suicide daily, but I can't get myself to do it.

I don't know. I guess I just feel like you need some minimal level of functioning in order for therapy to be effective. Right now, I don't think I'm there and I don't know if I'll ever get there. I've been so severely depressed for so many years that it feels impossible to get out of it. It's literally been around 7 years and it seems to get worse each year. I definitely can't work. I struggle just to make it through the days. Meds don't work, although I'm currently on 10 mg of Trintellix. If 20 mg doesn't work, and I can't help but feel that it probably won't, I think I'm going to go in for ECT - although just the thought of going into a hospital for 2-3 weeks is scary as hell.

I kind of got off topic here, so sorry for that, but it just came out. Good luck to the OP. 

For me, life has gotten progressively worse through my teenage years up until my adult years. I'm 20 years old, and I have no life. There is nothing. I can't pick up from where I left off because I never left anything meaningful. I have no friends. I live with family, but isolate myself from them because I dislike my parents and my sister. Interacting is exhausting. I have nothing. Yes, I am so afraid of dying that I am scared of living... I have anxiety because I think this is it for me. Will this be how my life will play out until my death? Then, I'll be in eternal darkness and without consciousness. I feel like I'm drowning when I lie down and close my eyes. I feel like everything is chaos. I feel like there are so many emotions and thoughts in my head that I cannot drown them out anymore because I can't even cry anymore. I'm exhausted and vulnerable. 

 

My head feels as if everyone I have ever encountered in my life who said my name is saying my name all at the same time in every way possible. I want to break everything or hurt myself just to get rid of this feeling. I feel dirty, depressed, and hopeless. I want peace and to be at peace.

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It can be hard for those of us who started having symptoms at a young age because we don't really know what life without mental illness is like. I know it doesn't necessarily feel like it, but you are still pretty young and have plenty of time to build a meaningful life. Try to give your therapist another shot and emphasize that you do want help, but going outside right now feels way too hard and you need to work up to it somehow.

 

Getting on an antidepressant will likely make things easier. I know you've mentioned that this is scary because of potential weight gain. I don't have much experience with eating disorders, so I'm not really in too much of a position to address this. I do know, however, that I've actually lost weight on medications that usually result in weight gain because by not being depressed, I'm more able to exercise regularly. 

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36 minutes ago, thunder said:

It can be hard for those of us who started having symptoms at a young age because we don't really know what life without mental illness is like. I know it doesn't necessarily feel like it, but you are still pretty young and have plenty of time to build a meaningful life. Try to give your therapist another shot and emphasize that you do want help, but going outside right now feels way too hard and you need to work up to it somehow.

 

Getting on an antidepressant will likely make things easier. I know you've mentioned that this is scary because of potential weight gain. I don't have much experience with eating disorders, so I'm not really in too much of a position to address this. I do know, however, that I've actually lost weight on medications that usually result in weight gain because by not being depressed, I'm more able to exercise regularly. 

I live in the U.K, and I don't have health insurance. I'm seeing a private therapist and paying out of pocket for each session: it costs £150 per session. I'm unemployed and using the money I receive from benefits to pay for these courses, but it's still not enough money as I have to pay my phone bill and two credit card bills. I've maxed out two credit cards because of my poor control, and my debit card is always in overdraft. I can't remember the last time when I didn't owe money. 

I have emphasised to my therapist that I want help, but she says she cannot help me if I am not willing to engage with the outside world. I know my limits and realistically speaking, there is just no way I will voluntarily go outside to "socialise" or work because of my appearance and from experience, it could take until the end of winter to be comfortable enough even to attend doctor appointments or go for a walk around my neighbourhood. Did I mention our sessions are over Skype? Would she be able to help me assess my thinking patterns and undo them without needing me to go outside? Part of many coping strategies implemented by therapists is to go out and engage with the world. I genuinely have no real life friends and no work experience, and I dropped out of school during A Levels (They're something like APs and equivalent to SAT II to enter university? I'm not sure.) 

There are weight neutral antidepressants I've been on, and I'm going to start Cymbalta again, so I'm not avoiding them, it just took a while to get any new medication prescribed.

I have been forcing myself out of bed every day to exercise, mainly jogging/walking on my treadmill for 30 minutes; while this is impressive I hardly find it rewarding as exercise is now a chore, and losing weight isn't fun anymore. Anyway, 30 minutes is nothing compared to the hours I spend doing nothing in bed or on my computer chair. It feels cancelled out because I spend more time being inactive. However, I've drastically cut my calories to match my inactive lifestyle. I'm looking to increase my activity levels by adding another 30-40 minutes of exercise. But I'm paranoid to use the equipment in my garden because I have nosy neighbours and yes, they will see me and think "he let himself go" and I will feel their stares, and feel ashamed because I let both of us down. Again. 

The harsh reality is that it's going to take months of exercising and dieting to regain the confidence and I'm afraid therapy would just be a waste of money because of what I'm asking - to go outside and socialise again. My therapist will encourage me to do it right now; then I'd explain why I don't want to, and then she'll identify my explanation as being "problematic thinking." She is free to make this assessment because I can also determine my way of thinking as being unhelpful or dysfunctional. But will it change anything? No. She cannot magically click her fingers and reverse time and the effects of my relapse into my binge eating disorder. 

I don't know. What does fixing mean to me? What do I want to gain out of therapy? I want to get better. What does getting better mean to me? Losing weight is a priority. And then? Removing the excess skin to prevent relapse into binge eating (I think it's obvious how losing weight and having unpleasant excess skin is going to impact my eating disorder and mental health). What is unrelated to my body? Relationships, friendships, education and work. 

 

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Good on you for making some changes already.

There are substantial mental health benefits as well as physical health benefits to even a moderate amount of exercise, particularly for people who are otherwise not moving around much. This is in addition to your goal of weight loss. You're reducing your risk of death from cardiovascular disease and stroke, lowering your blood pressure, getting your body to kick out endorphins as well as enhancing your muscles' ability to utilize the insulin you're producing more efficiently. The metabolic benefits of physical activity last long after (think many hours) you stop the activity. You're also helping to oxygenate your brain and increasing the odds of getting some more restful sleep. Plus you're breaking the inertia that often comes with depression just by doing something different.

If you aren't ready to physically go out and socialize, are there ways you could use your current resources and comfort level (ie internet, skype etc) to help increase your social connections until you're ready to go out? How about taking a free course online to help move you in the direction of education? Just some thoughts I'm sure you've already had.

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49 minutes ago, Wooster said:

Good on you for making some changes already.

There are substantial mental health benefits as well as physical health benefits to even a moderate amount of exercise, particularly for people who are otherwise not moving around much. This is in addition to your goal of weight loss. You're reducing your risk of death from cardiovascular disease and stroke, lowering your blood pressure, getting your body to kick out endorphins as well as enhancing your muscles' ability to utilize the insulin you're producing more efficiently. The metabolic benefits of physical activity last long after (think many hours) you stop the activity. You're also helping to oxygenate your brain and increasing the odds of getting some more restful sleep. Plus you're breaking the inertia that often comes with depression just by doing something different.

If you aren't ready to physically go out and socialize, are there ways you could use your current resources and comfort level (ie internet, skype etc) to help increase your social connections until you're ready to go out? How about taking a free course online to help move you in the direction of education? Just some thoughts I'm sure you've already had.

I do a lot of socialising on the internet. But I don't think this is enough for my therapist. As for educational courses, I would be interested in perhaps taking a writing course, but I don't think I want to pursue a career in that field if you get what I mean? Same with psychology. I am trying to create my clothing brand but it's difficult to brainstorm ideas, it used to be easier.

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I think you sound like you are putting some good practices into action....you  want to lose weight and you are already putting  some action in  place to do this... sounds like good goal setting to me. Can you not get support through the nhs? Just wondering why you have to go private for the therapy? 

 A lot of our negative thinking IS (sorry i know it’s obvious) in our heads, becuase our depression makes us just think shit all the time. So everytime you Spiral down the disgusted with yourself thoughts, try if you can Tom remind yourself ..this is the Depression talking, and I’m making steps to get out of it.

 

it amazes me what we toroture ourselves with, ... i too get disgusted with myself...

my reasons? Not physical, but one reason from a few is I feel i haven’t acheived a career...and now it’s too late...i feel very shamed of this, and my thoughts spiral into self disgust. Just wanted to share that we can spiral on down about all sorts of things. You are still very young and you do have a journey to walk that can lead you to a life you want, it takes time, and patience with yourself, and not to compare yourself with anyone, especially people who don’t have any type or understanding of a mental illness. 

 

Please take care 

 

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43 minutes ago, Brain zaps said:

I think you sound like you are putting some good practices into action....you  want to lose weight and you are already putting  some action in  place to do this... sounds like good goal setting to me. Can you not get support through the nhs? Just wondering why you have to go private for the therapy? 

 A lot of our negative thinking IS (sorry i know it’s obvious) in our heads, becuase our depression makes us just think shit all the time. So everytime you Spiral down the disgusted with yourself thoughts, try if you can Tom remind yourself ..this is the Depression talking, and I’m making steps to get out of it.

 

it amazes me what we toroture ourselves with, ... i too get disgusted with myself...

my reasons? Not physical, but one reason from a few is I feel i haven’t acheived a career...and now it’s too late...i feel very shamed of this, and my thoughts spiral into self disgust. Just wanted to share that we can spiral on down about all sorts of things. You are still very young and you do have a journey to walk that can lead you to a life you want, it takes time, and patience with yourself, and not to compare yourself with anyone, especially people who don’t have any type or understanding of a mental illness. 

 

Please take care 

 

I will cancel my sessions with her and apply for therapy via the NHS again. 

I am in the same boat as you with careers. I think the more we define careers as being "journeys to a life" the more depressed we get when we think about "success" and "failure" what are these terms? We beat ourselves up because we don't have a job because of the way society has made us think about jobs, self-worth, and purpose. I'm not expert but I think a job isn't a path to finding yourself or getting a life. I think you just feel good because other humans finally stop seeing you as an inferior, lazy human being because of our conditioning and I think a job is vital to stay alive. Doing something you love is difficult in this world... I think doing something I love would make me happier and make it feel less like a job. 

I'm not lazy, I could go and work retail or cleaning tables and serving food, but how would that make my depression any better? 

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On 12/27/2017 at 1:52 PM, protectmepls said:

I'm not lazy, I could go and work retail or cleaning tables and serving food, but how would that make my depression any better? 

I think I would be worse if I didn't work (though getting to a point of being able to work full-time was a process). It has its own stressors, but overall I think it helps. It gives me something else to focus on and forces my body and brain to move

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6 minutes ago, Ion said:

I think I would be worse if I didn't work (though getting to a point of being able to work full-time was a process). It has its own stressors, but overall I think it helps. It gives me something else to focus on and forces my body and brain to move

I can't go outside until June (eating disorder) (recovering from the physical appearance changes from months of binge eating) so here I am stuck here.

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Just to gently challenge your thinking a bit, is it TRULY that you cannot go outside until June? Are you physically (not mentally or emotionally)stuck?

or is it more the case that you prefer to not go outside because you fear others’ judgments?

these are different challenges that require different types of solutions.

if I understood you correctly, you feel unable to go outside until your body weighs less. And rather than challenge the limiting thoughts, your current plan is to focus on weight first.

thats a perfectly fine plan, though I feel sad you feel so excruciatingly self conscious that you feel stuck inside.

i wanted to point out that your language reflects a common unhelpful way of thinking wherein we mistake feelings for facts.

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40 minutes ago, Wooster said:

Just to gently challenge your thinking a bit, is it TRULY that you cannot go outside until June? Are you physically (not mentally or emotionally)stuck?

or is it more the case that you prefer to not go outside because you fear others’ judgments?

these are different challenges that require different types of solutions.

if I understood you correctly, you feel unable to go outside until your body weighs less. And rather than challenge the limiting thoughts, your current plan is to focus on weight first.

thats a perfectly fine plan, though I feel sad you feel so excruciatingly self conscious that you feel stuck inside.

i wanted to point out that your language reflects a common unhelpful way of thinking wherein we mistake feelings for facts.

I can go outside, except I have no friends and fear judgement. I'd have a nervous/emotional breakdown and become extremely paranoid. I also wouldn't know what to do.

 

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I can go outside, except I have no friends and fear judgement. I'd have a nervous/emotional breakdown and become extremely paranoid. I also wouldn't know what to do.

Those are some solid statements! Nice work there.

Do you see how being more specific starts to indicate ways to actually attack the problem(s) rather than avoid them because it's hopeless?

It sounds like you're choosing not to go outside because you feel more lonely and afraid of other people's judgment. Also afraid that your emotional state and thoughts would become so overwhelming that  you'd be unable to cope effectively. It also sounds like you would feel uncertain about where to go or what to do with your time outside of the house.

It's a lot easier to generate possible responses to test out (think running LOTS and LOTS of tiny experiments about "what happens if I do X?")

If you were in the mood to generate some hypotheses, which one of those do you imagine you might be interested in poking at first?

 

 

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On 09/01/2018 at 11:27 AM, Wooster said:

Those are some solid statements! Nice work there.

Do you see how being more specific starts to indicate ways to actually attack the problem(s) rather than avoid them because it's hopeless?

It sounds like you're choosing not to go outside because you feel more lonely and afraid of other people's judgment. Also afraid that your emotional state and thoughts would become so overwhelming that  you'd be unable to cope effectively. It also sounds like you would feel uncertain about where to go or what to do with your time outside of the house.

It's a lot easier to generate possible responses to test out (think running LOTS and LOTS of tiny experiments about "what happens if I do X?")

If you were in the mood to generate some hypotheses, which one of those do you imagine you might be interested in poking at first?

 

 

I'm fat and ugly right now and therefore I don't want to go outside and go outside itself will not cure those thoughts, reverse them or ease my depression. Especially when I am fat right now and ugly. And I will not embarrass myself. Thanks 

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Right now, it seems like going outside isn't what you want to be focused on. You've already made some changes to try to address the weight gain, which is excellent. While it might be useful to be able to challenge the idea that you can't go outside at your current weight, maybe something else will feel more manageable and enable you to start making progress.

You say that you don't know what you would do if you were to go out right now. Maybe start there, so that when you are ready to consider going outside, you have some ideas of what to do and how to do it. 

I don't know what goes into creating a clothing brand, but is there something you can do there on your own, from home? You also mention being interested in writing and psychology. Is there a reason you couldn't do an online course in one of those? This could potentially give you a start towards connecting with others in person when you are ready. For example, if you take a writing course, you could later look into whether there is a local writers group you could join. Maybe you'll find after taking a class that you want to continue studying a particular subject, which is great. Otherwise, you'll learn some new information and gain some insight into what does and doesn't interest you so you can try again with something new. 

 

 

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7 hours ago, thunder said:

Right now, it seems like going outside isn't what you want to be focused on. You've already made some changes to try to address the weight gain, which is excellent. While it might be useful to be able to challenge the idea that you can't go outside at your current weight, maybe something else will feel more manageable and enable you to start making progress.

You say that you don't know what you would do if you were to go out right now. Maybe start there, so that when you are ready to consider going outside, you have some ideas of what to do and how to do it. 

I don't know what goes into creating a clothing brand, but is there something you can do there on your own, from home? You also mention being interested in writing and psychology. Is there a reason you couldn't do an online course in one of those? This could potentially give you a start towards connecting with others in person when you are ready. For example, if you take a writing course, you could later look into whether there is a local writers group you could join. Maybe you'll find after taking a class that you want to continue studying a particular subject, which is great. Otherwise, you'll learn some new information and gain some insight into what does and doesn't interest you so you can try again with something new. 

WEEK ONE

Thursday 14th December – 30 minutes on the treadmill

Friday 15th December – 30 minutes on the treadmill

Saturday 16th December – 30 minutes on the treadmill

Sunday 17th December – 30 minutes on the treadmill

Monday 18th December – 30 minutes on the treadmill

Tuesday 19th December – 30 minutes on the treadmill

Wednesday 20th December – 30 minutes on the treadmill

 

WEEK TWO

Thursday 21st December – 30 minutes on the treadmill

Friday 22nd December – 30 minutes on the treadmill

Saturday 23rd December – 30 minutes on the treadmill

Sunday 24th December – 30 minutes on the treadmill

Monday 25th December – 15 minutes weightlifting, 30 minutes on the treadmill

Tuesday 26th December – 30 minutes on the treadmill

Wednesday 27th December – 15 minutes weightlifting, 30 minutes on the treadmill

 

WEEK THREE

Thursday 28th December – 30 minutes on the treadmill

Friday 29th December – 30 minutes on the treadmill

Saturday 30th December – 15 minutes weightlifting, 30 minutes on the treadmill

Sunday 31st December – 60 minutes on the treadmill

Monday 1st January – 15 minutes weightlifting, 60 minutes on the treadmill

Tuesday 2nd January – 60 minutes on the treadmill 

Wednesday 3rd January – 20 minutes weightlifting, 60 minutes on the treadmill

 

WEEK FOUR

Thursday 4th January – 60 minutes on the treadmill

Friday 5th January – 30 minutes weightlifting, 40 minutes on the treadmill

Saturday 6th January – 30 minutes on the treadmill

Sunday 7th January – 40 minutes on the treadmill

Monday 8th January – 50 minutes weightlifting, 30 minutes on the treadmill

Tuesday 9th January – 40 minutes on the treadmill

Wednesday 10th January – 1 hour 5 minutes weightlifting, 30 minutes on the treadmill

 

WEEK FIVE

Thursday 11th January – 60 minutes on the treadmill

Friday 12th January –

Saturday 13th January –

Sunday 14th January –

Monday 15th January –

Tuesday 16th January –

Wednesday 17th January –

 

 

 

WEEK SIX

Thursday 18th January –

Friday 19th January –

Saturday 20th January –

Sunday 21st January –

Monday 22nd January –

Tuesday 23rd January –

Wednesday 24th January –

 

WEEK SEVEN

Thursday 25th January –

Friday 26th January –

Saturday 27th January –

Sunday 29th January –

Monday 30th January –

Tuesday 31st January –

Wednesday 1st February –

 

WEEK EIGHT

Thursday 2nd February –

Friday 3rd February –

Saturday 4th February –

Sunday 5th February –

Monday 6th February –

Tuesday 7th February –

Wednesday 8th February –

 

WEEK NINE

 

 

 

 

 

  

 

 

 

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protectmepls, keeping track of an exercise schedule is really better off in a blog setup, where you can easily refer back to it, rather than having it as part of a thread on the Depression Forum.

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