Overcoming Resistance in Therapy

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auggie bdayChanging our habits is one of the most conscientious things we do in our lives. It’s more than training yourself to drink eight glasses of water, or to exercise for an hour each day. Changing our habits means retraining our mindset, and not just our bodies. In how we process events, think about ourselves, and our self image. We know these are good things for us, but why do we resist suggestions to change? Are there strategies for overcoming our fixed reactions and coping skills that don’t serve us well?

Only to Just Begin.

When I was living through my postpartum depression, I was seeing my psychiatrist for medication prescription, and my mental health counselor, Susan, who worked with me, (heavy emphasis on work). Susan taught me through application examples, of how I had become who I told myself I was. She explained the tendency to resist cognitive therapy when we don’t see ourselves as being capable of getting better. I had to learn new skills if  I wanted to succeed, and I had to start seeing myself as someone who would recover.

I learned that a barrier to behavioral therapy, is lack of genuine introspection. Therapy was going to be work, and I had to be honest with myself and acknowledge what my challenges were. This meant examining issues about myself, not something flattering to do, that’s for sure. I had to admit that I was a pessimist, and I felt doomed at the start of any homework before I even gave it a try. For us to even bore an inch into my stubborn persistent negative self image, I had to be painfully honest. I had to face my dysfunctional emotions, maladaptive behaviors and cognitive processes. In Susan’s words, “To change a behavior, change an action.” This was beyond the petty advice given by friends and family of “mind over matter,” or “cheer up!”

I didn’t like this part of therapy.

Who likes to think of themselves as dysfunctional and negative? Yet, that’s the truth that I had to accept. With plenty of reading from books that Susan recommended, and from months of honest answers to questions in therapy, I began to turn my self concept around and talk to myself in a positive way.

I thought twice before saying, “Not me.”
I didn’t automatically begin to think, “That’ll never work.”
I stopped myself from saying, “Yeah, but…”

“Yeah, but” was the biggest obstacle we had to overcome together. “Yeah, but, I tried that,” and “Yeah, but, that didn’t work before,” and “Yeah, but, I’ve tried everything.” Self-condemning was the biggest road block to possible improvement. Without the door to my mind and trained thoughts even open a crack, what light would ever get in?

We resist when someone asks or tells us to do something because our self talk makes us lose the war before we even march onto the field. The thing is, without change, there will be no change. Doing things my way hadn’t been working for me… so why did I persist with pessimistic negative thought patterns?

I know I didn’t want to be that way, but I had trained myself over a lifetime. The cost of continuing in that way was becoming evident. We lose friendships, without understanding why. We exhaust family members, unclear why they have no patience. Our marriages barely hang on by a thread from the emotional fatigue of supporting a person who never has hope and is always down.

My question to anyone “stuck” and wanting to change, is this. Examine the impasse. Do you need to find a more pro-active physician? Is there a therapist that’s been recommended to you, but you haven’t sought out yet? Have you resisted suggestions of medication, or continued talk therapy? Work with your medical team and be open to their suggestions for change. Our trained minds are stubborn. My default setting of pessimism was stubborn enough to not even consider suggestions by my therapist. I would think, Why try? Nothing ever works anyhow. Susan taught me how to change the way I view and experience events, ideas, concepts and emotions to find more positive alternatives.

Over a lifetime of negative thought patterns and reactions, our default is set. In my case, comfortably, to see myself as always being anxious, depressed, low energy, and being that one in a thousand who will never get better. The thing is, we can get better. Postpartum depression and anxiety are mental health disorders, but with treatment, people with PPD and PPA  do recover. But as in anything, work and commitment are required to deconstruct ingrained and automatic behaviors.

I once saw myself as eternally depressed. I once saw myself as that one with postpartum depression and anxiety that would never get better. After 11 months of weekly therapy sessions, I began to improve. I saw success and that made me try again, and try harder. It wasn’t an overnight process, and it wasn’t an easy process. It was work, and it’s still not my nature to be hopeful, but through honest dialogue with myself, I had a starting point of recognition and awareness of this about myself.

I had to begin, with difficult questions. By asking others to support and help me. I had to put my ego aside, and ask myself how I talked to myself. I asked trusted friends to be patient with me while I grew in a new, beneficial direction. I had to listen when my therapist told me that I was allowing no room for positivity, or change.

None of this was fun, but all of it was life saving. This work made me feel uneasy, vulnerable, raw. It was hard. I felt shaky, as a new me began to battle with the old me. Much of the time, my new thoughts didn’t feel like mine, so unfamiliar that triumph was hard to imagine — I was not a positive person, remember? But with time, and repetition, as my new thoughts grew to become my own thoughts, I felt capable and stronger. And I began to feel that victory was possible.

My self concept now is of someone who has overcome things that she thought she never would. And it began, by beginning.

*If you’d like to explore more, these are the books that Susan had me read. My therapy wasn’t based solely on positive thought, but together with medication and talk therapy, challenging my self concept was an integral part of my treatment plan. Once my therapist and I worked on (it took a year!) helping me see that recovery was possible, hope set in. Before then, I was resistant. Medication helped, talk therapy helped, eating sleeping exercise support and friendships helped, but it wasn’t until I changed my inner talk, that things began to look hopeful.

Learned Optimism: How to Change Your Mind and Your Life by Martin E. P. Seligman
Optimal Thinking: How to Be Your Best Self by Rosalene Glickman
Optimism: Learn the Power of Positive Thinking. Our Thoughts Shape our Attitudes  by Abe Kass

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Depression setback or just a bad day?

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raindrops on a window with traffic in the backgroundMany people who have experienced depression (of any sort) know what it feels like when you start slipping. That’s how I’ve always described it – it generally isn’t really one giant, fell-swoop sort of crash, but more like that feeling you get when you’re sitting in your car and you realize the parking brake isn’t on and you’ve taken your foot off the brake and you’re rolling. For one split second you think, “ACK!” Except of course in the car scenario you can just put your foot back on the brake or yank the parking brake up and hopefully prevent any serious damage.

That’s not always the case when depression starts to take over.

To be fair, sometimes it is. Sometimes catching it early enough makes it possible to reverse the backwards slide enough that depression doesn’t take hold. And sometimes, you’re actually not slipping at all. Sometimes it’s just a bad day.

How to know if it’s just a bad day

Learning to recognize when it’s a bad day versus an ongoing issue was one of the hardest lessons for me to learn. At any sign of my usual symptoms I used to panic. I’d think ahead to the next few weeks or months and what I had on the go and assume that none of them were going to happen and wonder why me and let in that little bit of self-loathing that seems to always come along with a new bout of depression. It took wise and experienced friends and supporters asking the same question over and over for me to start asking it of myself: “Is this really a sign of a problem or is it just a bad day?”

When I was really caught in the up-and-down of recovery from PPD, it was actually “just” a bad day relatively often. Not always, of course, and that’s not to say that a bad day doesn’t really and truly suck. But recognizing a bad day is such a huge part of managing depression and not letting it throw you into the deep, dark spiral.

I was talking to a friend about this the other day. “I feel like I’m sliding backwards,” she said. I knew the feeling well, but also knew enough to poke a bit. “Do you think it’s just a bad day,” I asked, “or something more?”

Let me be clear: Answering that question isn’t always easy. Sometimes it’s really hard to be objective enough about our own mental health to be able to realize that it’s a bad day and tomorrow might very well be better. But sometimes it really is as simple as asking that one basic question. And if the question makes you think about specific things — a disastrous morning getting the kids out the door to school, a medication change, being overtired thanks to a child who decided Wednesday night was a good one to test mom’s fortitude — chances are you’re in the Bad Day Zone and needn’t worry about the backwards slide.

That was the case for my friend in our recent conversation. She thought one particular thing might have triggered it, “but it’s definitely a bad day,” she said. “I’m going to try to start over tomorrow.” Sometimes it’s the simple strategies that are the best ones of all.

 

photo credit: Unsplash

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Warrior Moms Are Key to Fighting Stigma

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Susan and Tiny BeanI had the thrill and honor recently to attend the recent Special Legislative Commission on PPD meeting with Representative Ellen Story this month.  My new friend (and fierce advocate and mental health professional) Mara Acel-Green extended an invitation to the open meeting – and upon walking in, I was floored by the feeling that Postpartum Progress belonged in the room.

The Commission invited Deborah Wachenheim to speak about her sister Cindy, whose story was featured in The New York Times earlier this year. Listening to Deb speak about the events leading up to her sister’s postpartum psychosis and death, I was struck by the genuine interest and concern of the room.  This was a meeting full of top tier mental health and birth professionals, legislators, and non-profit leaders.  Their heartfelt appreciation for Deb’s willingness to share something so personal (and freshly raw) and thoughtful questions gave me hope that the meeting was not just government lip service.

As the meeting progressed, organizations checked in with progress reports, included MCPAP for Moms, the Department of Public Health and the Community Health Center pilot programs.  Throughout each of their discussions, time and time again, the question that kept resurfacing was “How do we make sure screened mothers are being supported after their diagnosis?”

What these doctors are really concerned about is How do we get moms to follow through with their diagnosis and treatment?  The Commission has been focused up until this point primarily on training primary care physicians, pediatricians, and birth care workers on screening for postpartum mood and anxiety disorders.  But as any survivor can tell you, screening and diagnosis (though absolutely essential) are only the first of many hurdles on the path to wellness.  As suggestions were shared, I noticed that their solutions all focused on actionable items for healthcare workers.  And it seemed to me they were missing a piece of the puzzle.

Postpartum Progress doesn’t just “drop kick despair.”  It kicks stigma in the teeth.

After my own diagnosis, 5 months postpartum, I continued to struggle for almost 6 months with treatment compliance.  It wasn’t that I refused treatment, but instead that I was still struggling with so much shame that I just couldn’t comply.  Depression and anxiety rob a person of their sense of truth and rationality.  Psychosis steals reality itself.  How anyone could expect me to take responsibility for my own mental health treatment in 2009 still leaves me in disbelief.

I attended therapy regularly but fought against taking medications.  And though I knew the right answers to my therapist’s questions and believed them on some level, deep down I still carried such stigma about mental illness that I couldn’t separate myself from my disorders.  Not until I found Postpartum Progress.

Reading stories of other mothers just like me, I found my own courage reflected back to me.  Here were women who had battled the same terrible thoughts, who had raged at their babies, and who had felt worthless in their roles as mothers – and I looked up to every. single. one.  Postpartum Progress doesn’t just “drop kick despair.”  It kicks stigma in the teeth.

This is why I credit Postpartum Progress and #PPDCHAT with saving my life.  Not because Katherine Stone or Lauren Hale treated my anxiety and depression, but because they showed me I was worth saving – that I could and would get better.

This is what legislators, healthcare professionals, and non-profit organizations need to know: the key to getting mothers to follow through with treatment?  Is to disintegrate the stigma.  No one does that better than the Warrior Moms.

I’ll be meeting with the Commission staff and other Massachusetts organizations in the coming months to make sure Postpartum Progress is a part of the important conversations they are having about treating and supporting mothers during and after pregnancy – because the patient community?  Is that final piece of the puzzle.

 

Author’s Note: Postpartum Progress recently collected survey data from its Warrior Mom community and FaceBook fan page.  75% of respondents indicated that Postpartum Progress increased their likelihood to seek professional help for their condition.  You can read the entire report HERE.

photo credit: Susan Petcher

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WTFP?!: Why Access To Women’s Healthcare Matters

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Recently, on a Thursday, I went to have my annual physical exam. I was completely shocked when, during the breast exam, my gynecologist found a lump. Just a few days later, on Tuesday, I had a diagnostic mammogram. I was sure they’d come in the room right after the mammogram and say all was well, but after looking at the mammogram results the radiologist decided to immediately give me an ultrasound. I was sure he’d come in after the ultrasound and say all was well, but instead he told me I needed a biopsy. Two days after that, on Thursday, I underwent a core biopsy on my right breast. And the next day, Friday, I received the results. I have a benign fibroadenoma. In a little more than a week I was able to get several different exams and find out what was going on inside my body and have a plan for moving forward. And THAT, my friends, is how women’s health should go all the time. We should all have access to the information we need. The tests we need. The trained and competent physicians we need. The supplies we need. The support we need. And all in a timely fashion.

It’s not like that in most places of course. Women don’t have access to even the most basic things like contraception. And it’s not just a few million here and there that don’t have access. It’s 220 MILLION women in developing countries who want access and can’t get it. When you take away that access, you take away the power a woman has to make plans, to design her own life and decide what she wants to do and when. If she has no way of getting her hands on any sort of birth control then she can’t decide whether and when to have children.

I got to spend some time recently hearing from EngenderHealth, an organization dedicated to training healthcare providers around the world in order to help ensure family planning and reproductive health services are available to more women in more places. I appreciate their work and I know it’s important. I was able to plan my own family — my husband and I were married eight years before we decided to have children. We were financially and emotionally prepared and ready to welcome what ended up being our amazing son and, four-and-a-half years later, our fabulous daughter into the world. It was access to contraception and good women’s healthcare that allowed us to make those plans and have a family exactly the way we wanted to. I think other women, other parents, should be afforded that same access.

But because of cost, gender inequality, the huge distance it often takes to travel to a place that might or might not have contraceptive supplies, and lack of trained providers, among many other barriers, millions of women don’t have access to contraception. EngenderHealth is working to change that. And we can help them this fall by raising our voices and taking small actions as part of their WTFP?!  (Where’s the Family Planning) campaign that will lead to more women getting the healthcare they need exactly when they need it.

If you think women should be able to decide when and if they have children, join in. If you think being able to survive childbirth and have healthier babies is important, join in. And if you think women should have the ability to stay in school or build some type of business or career that gives them financial stability before they have a family, if they choose, join in. Because family planning and contraception contributes to all of these things. Join in. Let’s all ask: #WheresTheFP

Find out more by clicking here and be sure to follow EngenderHealth on FacebookTwitterLinkedIn and YouTube.

What does convenient and safe access to contraceptives mean to you? Answer in the comments below for a chance to win a Social Good Goodies bag.

 

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