A frequent web visitor commented on a blogger who said that the propensity to feel depressed or anxious never really leaves a person. He asked if I agreed with this.
Here’s the answer. I am convinced that being flawed and having moments of irritability, depression, anxiety, and so forth is an inherent part of the human condition, at least for most of us, and probably everybody. It is not possible to be happy all the time, nor is this a realistic or useful goal–at least that’s my take on it.
We all fall into these black holes of self-doubt or anger from time to time. What I do is to create a ladder for each patient, so you can quickly climb out of the black hole whenever you fall in. That’s why the psychotherapy homework is so vital—so you can practice and learn these tools, so you can use them in the future whenever you need them. It is like riding a bicycle. The skill never really leaves you once you’ve learned how, but you won’t develop the right “brain muscles” without the written practice between sessions, using tools like the Daily Mood Log, the Relationship Journal, and so forth.
There are two goals in TEAM-CBT: Feeling better and getting better. Feeling better is the initial recovery, when the symptoms of depression and anxiety completely disappear, and you feel fantastic. This is a tremendous experience for the patient and for the therapist as well. The recovery usually happens suddenly during a session, and with the new TEAM-CBT techniques, if often happens very early in the treatment.In my experience, it often happens in the first session, assuming I can work with the patient for two hours or so if needed.
Getting better means that you have the tools to deal with the inevitable “relapses” that affect all human beings. To me, I define a “relapse” as one minute or more of feeling lousy. Given that definitions, we all “relapse” all the time! But it does not have to be a problem if you know exactly how to deal with it.
One minute of feeling upset is okay. Or an hour, a day, or a week. But I don’t want my patients to have to struggle with weeks, months, years or decades of misery.
I always tell my patients that we are all entitled to five happy days per week. If you aren’t having your five happy days, you need a little mental “tune-up!” But if you’re having more than five happy days per week, that could be a problem, and we may have to put you on lithium!
I will edit and post a partially completed blog on Relapse Prevention Training (RPT) before too long. RPT is fairly easy and only takes about 30 minutes in most cases. However, if the therapist fails to do RPT, the patient may be shocked, overwhelmed and devastated when the negative thoughts and feelings return. But if you have prepared the patient properly, he or she will know exactly what to do, and the “relapse” will be short-lived.
As an aside, my thinking is consistent with the thinking of the late Dr. Albert Ellis, the New York psychologist who founded a school of therapy call REBT (Rational Emotive Behavior Therapy). Dr. Ellis once wrote a paper on “The Impossibility of Maintaining Consistently Good Mental Healthy,” or some such title. He was making the same point, that we are flawed, and cannot achieve perfection.
Dr. Ellis pioneered much of the thinking that triggered the development of CBT (Cognitive Behavior Therapy), and now TEAM-CBT, although he approached treatment in a radially different manner. Those who still remember him, and attended one or more of his wild workshops or talks, or his $5 admission fee Friday night live therapy demonstrations at his center in NY, will know what I mean!
Dr. Ellis was quite the character, very controversial, but his contributions were tremendous, and he had a great sense of integrity. He did not steal from others, as some in our profession have done, but always gave credit where credit was due. That was one of the main reasons I became a fan of his!
david
