I have a tendency to move my decisions from nice, logical decision trees into an underground network of convoluted root balls. Aboveground, choices are determined based on simple, bifurcating factors. Underground, no such rules exist.
Sometimes my decision root balls are so confusing that they’re also wrapped up in other trees’ roots. Those aren’t even my trees! When this happens, it feels like there’s just so much to think about that I can’t consider all of it at once. I’m left with a horribly overwhelming feeling that makes me want to say “no” to everything. It’s like going a million miles an hour and coming to a sudden stop, somehow at the same time.
Overthinking Decisions
I’m a habitual overthinker. I feel compelled to organize all possible plans and outcomes before even considering making a choice. The anxiety stems from the powerful feeling that I have to make the “right” decision, or else. The “or else” is vague and in most cases, probably entirely fictional.
And yet, often, I don’t have a specific worst-case scenario in mind. It’s just a sudden feeling of doom. Once I get myself to slow down and think through the choice in actual words, the real overthinking happens. The pros and cons of each choice are easier to hold onto, but they go straight into the center of a decision root ball. Then they get tumbled around for a while before I get frustrated enough to make the decision.
Untangling a Decision Root Ball
I’m learning that, for slightly longer-term choices, I do better when I force myself to not try to make a decision right away, but to instead let it sit for a day or two so as to avoid my immediate reaction. Of course, I can’t always stop myself from thinking about it all the time and being anxious, but I can reduce the pressure a little.
When I succeed at this strategy for overthinking, I’m much better at choosing the option that’s scary but leads to more growth. The positives start to outweigh the anxiety. The decision root ball starts to become a little less constricted.
For shorter-term decisions, I’ve found that I have to do the opposite of the long-term strategy. If I let myself waffle too much, I become paralyzed and am overwhelmingly likely to pick whichever option involves the least uncertainty.
To illustrate this with a mundane example, imagine me considering the benefits and drawbacks of various food court establishments. If I’m overwhelmed by attempting to balance the benefits and drawbacks, I will pick the option with the least uncertainty and go home empty-handed. And by benefits and drawbacks, I mean things like the length of the line, how harried the employees look, the likelihood that I’ll have to shout to be heard, and how chaotic the space around the line is. I mean, seriously. Sometimes, I’m deterred by not knowing what sizing system they use for their cups. It’s a wonder I can function at all.
Maybe someday I’ll progress to making decisions on the spot with minimal anxiety, but that sounds like an expert-level endeavor. For now, I’ll stick to gradually pruning my decision root balls and trying to say “yes” to some things.
Having anxiety about therapy doesn’t mean that therapy isn’t “for” you or that you can’t benefit from it. Instead, it might be a fear you can change by adjusting the way you approach your sessions.
We often focus on the role of the therapist and how well we connect with them when talking about how to feel comfortable opening up in therapy, but we don’t often examine our expectations of ourselves. Self-criticism and high expectations had me feeling anxious about therapy until I changed the way I thought about myself as a client.
When I decided to start going to therapy in college, I was apprehensive about having to do the classic back-and-forth discussion with my chosen therapist. In fact, I’m still not always keen on it. But the expectation that I held for myself – that I would sit down and spill my guts and cry and reach some kind of catharsis every week – did not pan out. The more accurate picture was (and sometimes still is) one of me sitting down, saying I’m okay, shrugging a lot, and forcing my therapist to sit in silence with me while I wrestle with my thoughts.
I thought for a long time that I was bad at therapy. I was very critical of myself for inadvertently shutting down. Sometimes, I still feel guilty because I perceive my excruciating quietness as a waste of my therapist’s time.
Shifting My Perspective on Myself in Therapy
The longer I’ve stuck with it, the more I can see that this perspective of myself as something like a student who is expected to achieve success is preventing me from recognizing the progress I’ve made. As a perfectionist, I’m prone to thinking that no amount of improvement is good enough, and if I’m not meeting my own expectations, I must be failing. Perhaps even more importantly, my anxiety about therapy gets in the way of me focusing on what I can get out of the process despite and because of my difficulty with certain topics.
I have been trying to shift my perspective on my role in therapy to be more like that of an explorer or some kind of self-ethnographer. I go to therapy, I do my best to talk, and I observe whatever happens. I’m there to be curious, and if talking about something is suddenly challenging, that in itself is interesting information.
Why Go to Therapy if It’s So Uncomfortable?
I learned early on in my experience with therapy that although talking about myself is deeply uncomfortable, it feels worthwhile. I have always been quiet and reserved, and I tell myself that it’s a preference. But, finding myself unable to answer personal questions in therapy taught me that I have less control over it than I wanted to believe.
To Challenge Myself
When pushed to discuss something I’m uncomfortable talking about, I simply clam up. It frustrates me because it does not feel like a voluntary reaction. Obviously, I go to therapy to talk about myself – why can’t I override my tendency to shut down? It’s like a drawbridge lifts in front of me, and I can no longer get my words across the gulf between myself and my therapist.
To Practice Being Vulnerable
Ultimately, therapy led me to the realization that while staying quiet is comfortable for me, it is also lonely. I don’t intend to change my natural tendency to be reserved, but I do hope that by practicing being open about difficult things, I can allow my reservation to be a choice, not a barrier.
Everyone has secrets, and it’s perfectly okay to keep them private. But there are times when it’s good to share personal information, especially if it’s going to help you overcome a challenge in your life. Holding secrets out of an inability to put them down can be a deeply isolating experience.
Finding Ways Around My Anxiety About Therapy
I’ve gotten better at talking about myself in therapy, but it’s still hard. I still have sessions where I can’t seem to find the lever to lower the drawbridge and let the words out, and that’s okay. My therapist knows that I stay quiet not out of disinterest in the process but because it’s hard for me to engage in it.
On days when I don’t say much, I go home and write her an email with all of the words I couldn’t set free. It gives us somewhere to start the next time and lets me communicate in a way that’s easier for me. I still challenge myself to talk, but I know that I have a backup line of communication if I need it.
Whether I choose to discuss something or not is up to me, of course. My therapist is there to guide me, even push me a little, but ultimately, I decide what to talk about or not. If I want to set aside a more difficult subject in favor of discussing something easier but still meaningful, I can do that.
Considering the Therapeutic Relationship
I have found that for me, viewing a therapist’s role as that of a knowledgeable partner rather than an authority figure helps me stay intrinsically motivated and makes me more willing to push myself. We’re exploring my brain together, and I know that if I don’t accomplish something I set out to do, I won’t be “in trouble” with my therapist the way I would think I were if our relationship were less equal.
It’s a strange relationship to navigate — one that is inherently unequal in more than one way. You go to a therapist for help because they have knowledge and a perspective you don’t. You pay them, and you probably defer to their expertise. They are in a position to set expectations and try to interpret the implications of what you say or don’t say. It’s easy to start seeing your therapist as someone to impress, especially if, like me, you’re a chronic people-pleaser.
At the same time, clients have the option to stop going, the freedom to ask for adjustments in their treatment, and the potential to view themselves as indispensable experts on their own experiences. It can be motivating to think of therapy as something you get to take part in with your therapist rather than something you have to go to. Ultimately, I think the dynamic of a partnership makes me less likely to fear that my therapist might disapprove of or be disappointed in me for not achieving something or even for not talking enough.
I’m still trying to let go of my self-imposed pressure to be a wonderfully verbose client. I go to therapy to work on my depression and anxiety, and part of that involves being less critical of myself. I used to think I was a bad client because of my anxiety about therapy. Now, I think I struggle to talk about myself, and that’s part of why I’m in therapy.
My therapist has been encouraging me to track my depression and various contributing factors for years. I’ve tried several apps, journals, and charts, but I always drop the practice after a little while. Eventually, I identified why those tools never worked for me and used that information to make my own system.
Why Motivational Journals and Apps Don’t Work for Me
I understand why a system with lots of elements appeals to some people, but I tend to find them discouraging – the opposite of their intended effect.
My Depression vs. Positivity
Whenever I tried an inspirational/motivational journal, I quickly lost interest. I’d open it up to mark down that I felt like a person-shaped vat of cold, unsalted mashed potatoes. The list of weekly goals I hadn’t met would be staring up at me. Some inspirational quotes would arrive in my brain through the filter of my depression, limp and meaningless. Over time, I began to avoid them, knowing that the initial excitement of setting up a shiny new tracking system would sour.
Apps Aren’t It, Either
Apps have the advantage of offering daily reminders, but if the app is structured like the previously discussed journals, a cheery notification that it’s time to check in only distances me further. I really wanted apps to work for me, and I’ve been consistent with them for two or three weeks at a time, but I always abandon them eventually. They’re too complex, they ask me too many questions, or they document more than what I want to track.
Mood Scales and My Problem with Numbers
Number-based tracking scales usually include too much choice for me and don’t allow for flexible indecisiveness. A 1-to-5 scale just paralyzes me. What if I say “3,” but I’m really a “2?” That would be catastrophic, obviously.
Perfectionism
Maybe it’s a vestige of perfectionistic test anxiety, like I have to choose the “right” answer and be consistent in my interpretation of the scale or else anyone who looks at my data will get an inaccurate sense of my mental health. So instead, I just stop using them. When there’s no data to look at, I didn’t do it wrong!
So in the end, I decided to go with what my therapist suggested in the first place (I must be exasperating when it comes to tracking), and just made my own system to track my mental health.
My Method for Tracking Mental Health Symptoms
I wanted something straightforward, easy to use, and without the frills of a motivational journal. I got a completely blank, unruled journal and a set of stencils. I found these stencils online by searching something like “bullet journal stencils.”
The Mood Tracker
Each hexagon represents a day, which I’ve drawn a line through to depict AM on the top and PM on the bottom. I chose three colors to be “good,” “blah,” and “bad.” This way, I only need to pick a color and fill in the shape. If I can’t decide on a color, I can mix two of them together or shade the shape according to how the day progressed.
I also write small notes every now and then for medication changes, ketamine appointments, and other factors. I like that the bare minimum for this system feels doable for me but isn’t so scant that it’s uninformative.
The Medication Tracker
The medication tracker is similar to the mood tracker in that each section represents a day of a month. The inner row is morning and the outer circle is night. I picked a color for “Yes, I took my meds” and a color for “No, I didn’t take them.” It does help me to see how frequently I’ve missed doses, partly because the perfectionist in me hates to see too much orange.
I keep the journal and the colored pencils in my nightstand so they’re easy to get to and I don’t have the excuse of already being in bed when I remember to track.
How It’s Going
I’ve been consistent with this method for a little over two months, which is probably the longest stretch I’ve ever gone with tracking mental health symptoms. I can’t say that anything groundbreaking has come of it yet, but it is interesting to confirm some of my expectations.
I’ve tried and abandoned so many methods that I don’t think I showed my therapist my journal until I had been using it for a month. I didn’t want it to be yet another dud in a long line of tracking tools. So, I kept it to myself for a little while and am only just starting to assess its usefulness.
Just like with any mental health-tracking method, there are gaps in the data that become evident over time. I’ve been adding symbols to my mood tracker for things like self harm and my period. It’s becoming more complex, but I think the fact that I decide when to add those symbols rather than having a dedicated section for them works well for me.
That said, I’m considering adding a way to track more factors, such as appetite, sleep, and exercise. I don’t want to make it too complex, but I might have the habit established enough to expand my system without abandoning it.
There are tons of ways to track mental health symptoms and factors, and you can find many of them detailed online. What way works best for you?
I’ve started bringing my dog to therapy. Does she sit with me and look patiently into my eyes while I cry? No, definitely not. She spends 10 minutes wandering around, smelling the smells of the week with great vigor. She pokes the diffuser with her nose, sticks her whole head in the trash can, and squeeeezes behind my therapist’s chair to not-so-sneakily smell her belongings. Then, she goes back and forth between the window and relaxing on the rug, ears perked up, listening for outside sounds. She comes over to me for pets and cookies every once in a while, but mostly, she’s just nice to have around as my unofficial therapy dog. She’s completely oblivious to my human problems. Looking at her blissful ignorance during therapy is like a brain palate cleanser.
You can’t help but wonder what she thinks of this development. Here we are, in this room we come to sometimes for no discernible reason. Pretty comfy. New smells since last week. 8/10. Would be better if I got second dinner. All that matters to her is that I feed her, walk her, and let her sleep at the foot of my bed. She’s a simple creature – intensely curious and frustratingly smart – but simple in that she really doesn’t need a lot to be happy.
She shares some of that innocent joy with me. She makes me smile every single day. It doesn’t matter how depressed I am – she does something goofy or sweet and has no clue that I find her antics ridiculous. Like how she leads with her face when encountering snowdrifts, or her exasperation at me taking constant photos of her, or the many, many hilarious faces of Sleeping Stella.
Sometimes, when I try to change something in my treatment(s), my depression says, “No, thank you.” Changing my medications has not gone well for me in the past, but I continue to clutch my personal dream of reducing the number of things I pick up from the pharmacy. I recently added a drug which required me to get off of something else, which overall, does not seem to have gone well. The options now are complicated and I don’t particularly like any of them, but I still have Stella! The routine, obligatory outdoor time, and turbo-boosted zoomies have done me immeasurable good. She demands my attention and action, and there’s really no telling her to just go entertain herself. Our walks are sacrosanct to her. No replacements. And no skimping on length, either!
This was part of my goal in adopting her, and it worked in more ways than just the responsibility of it. I thought that it would be healthy for me to be forced to get out of bed and do things, but that the emotional reward of that would come during my good times. I wasn’t expecting my unofficial therapy dog to be able to careen through the fog of my depression and make me smile every single day. A smile or laugh every day certainly doesn’t fix everything, but it’s something to be thankful for.
My mental health has once again taken a turn in a not-fun direction, which I attribute to some recent medication changes. So, instead of sitting here thinking, I should write something. I can’t think of anything to write, and then putting down anything I do write as being the worst drivel ever to appear on my screen, I’m going to take you on a little diversion.
Did you know that an elephant’s sense of smell is twice as strong as that of a bloodhound’s? (C, that documentary led me astray. Google says twice, not four times.) This is what I said to my therapist the other day in one of my many futile attempts to distract from the topic at hand. We’ve also discussed, among other things, a documentary I watched called “Octopus Volcano,” how scallops have eyes, and what “horse” is in ASL. Usually, when I share a fun fact like this, there’s a brief exchange, and then she goes, “Well, that used up about a minute and a half.” And then we’re back where we started, just a little more entertained. This time, I think we probably used up, like, at least three minutes with the elephant fact. It may have been the most productive time-wasting fact I’ve ever pulled out of my sleeve. We got going on a train of thought that I think has some incredible real-world promise.
Just imagine: search and rescue ELEPHANTS. The police force brings out the specially trained sniffer elephants in super-wide trailers. They step down, decked out in vests that say “DO NOT PET. I’M WORKING,” but the vests are really just tarps secured around their bellies with bungee cords because the elephant service vest market just isn’t there yet. Soon, they’re working in airports, sniffing for bombs and drugs. All floors have widened stairs and elephant-safe ramps, and next to the dog relief areas are rooms with piles of dirt for the pachyderms to toss over their backs. Retired sniffer elephants spend their golden years relaxing with their family herd with frequent visits from their old handlers, revered as heroes for their invaluable contributions. I think we’re on to something, here.
“Sir? Sir! This is a service animal. Please don’t feed her the limp lettuce off your hamburger.”
Is this a breakthrough? Did I have a breakthrough in therapy?! Yeah, yeah, it’s not about me, but a striking realization is a striking realization. Elephants are the next sniffer dogs. Maybe they’re not as motivated to please humans, and they do need to eat a tremendous amount of foliage as they travel great distances throughout the day, but I think those problems could be overcome with some creativity. There really is no limit to what you can take away from therapy.
Non-sequitur segue! Other problems that can probably be overcome include my current difficulties with changing my clothes and eating and getting work done and my general depression problems. Titrating down on an antidepressant can be tricky. I’m trying to figure out whether this dip in my mood is because this antidepressant was helping me more than I thought it was, regular old withdrawal, ketamine wearing off, or any number of other variables. I suppose time will tell. Let’s persist in our efforts to overcome wacky, theoretical elephant scenarios and the challenges of living life.
P.S. Good luck to the Google algorithm in trying to figure out what the heck this post is about. 🙂
Sometimes I feel like a bird that can’t figure out how to fly. I periodically get launched out of a cannon (in this metaphor, that’s due to IV ketamine treatment for depression), then flap and flap to no effect. I’m trying to make progress, but gravity is always there. Eventually, I sink lower and lower, just exhausting myself with all that flapping.
That’s how it feels, but I don’t think that’s entirely accurate. Yeah, ketamine wears off eventually, and yeah, my brain has a biochemical problem that means I can’t fix depression just by flapping. But the flapping is doing something. All that work I put into therapy and maintaining a routine and getting exercise must be functioning in tandem with the IV ketamine to push my little bird wings just a smidge farther.
I know this because my mood still dips pretty low sometimes, but on the whole, I’m in a better place than I was a few months ago. Perhaps it’s that I bounce back faster, now. Or maybe it’s just knowing that it won’t last forever.
And now, being able to look back and see that I’m flippity flapping on my own a little makes it just a little bit easier to continue. Chipping away at something day by day is tedious and frustrating, but all of that work adds up. If you can look back at where you were a little while ago, it helps to notice that in working on depression, you have made progress, even if it’s just in the personal growth or a skill you’ve learned or the support you’ve gotten.
Unfortunately for me and my therapist, my ability to write words does not always translate well to being able to speak them. I need time to think through an entire thought before I speak it, and I struggle sometimes to get the words out when the topic is something challenging. And not just for sensitive topics like self-harm or suicide, but even for topics like life goals.
In fact, the word “goals” makes my stomach twist. I feel so much internal pressure when it comes to my ambitions that any discussion of the topic overwhelms me. It’s as if I know that once I start really acting to reach my goals, I’ll have to go all out because I don’t know how to not do something 100%. And that’s overwhelming. And unrealistic. So I try to avoid talking about it or thinking about it beyond my daily sense of guilt for not “doing more.”
It goes without saying that I don’t like this. Goals are important, and they should be exciting, not something you dread. Yes, they often take hard work to reach, but I think the balance of work to reward should be worth it. I don’t want to put in work just to alleviate an unhealthy internal pressure; I’d rather work for something because I want the excitement and fun and pride of achieving the thing. Depression makes this hard. Excitement and fun and pride are not feelings that depression wants around. So, I find myself terrified of adding more to my plate and pursuing my goals, and terrified that I’ll do nothing and fall even more behind my self-imposed schedule. Trapped in between the two, “goals” is a scary word.
Here’s where the code word comes in. Instead of “goals,” my therapist and I talk about “clams.”
It’s groundbreaking, I know.
There’s no significance to clams, it was just the first word my therapist thought of, but it stuck. Much like the Potato Scale of Depression is useful in its humor, “clams” are somehow easier to talk about because of the silliness. It takes away the gravity of having a discussion about goals and replaces it with a lighthearted conversation about a bivalve often eaten with a lemon-butter sauce.
And this is how I want my goals to be. Not so scary. Not so enormous. Just little steps to bigger results, like shucking one clam at a time to make a chowder.
Love, Your Brain 