Depression

Are you familiar with…

• Feeling sad nearly every day
• Feelings of hopelessness or lack of worth
• Loss of energy
• Lack of interest in activities that used to be pleasurable 
• Sleeping too little or too much 
• Feeling like this might never change

This is what depression can look like. 

Let me start with an important distinction. We’re not saying that you shouldn’t be sad sometimes, especially if difficult things are happening in your life. But that’s different from depression, which makes it so much harder to handle life’s difficult moments, and can stop you from enjoying life’s easy ones.

Depression is a lot more prevalent than you might think. In the U.S., a 2017 study estimated that 17.3 million adults in the United States had at least one major depressive episode (lasting more than two weeks) over the course of the year.

Here’s the first piece of good news I have for you: 

You’re already ahead of the game, just by reading these words. 

You’ve taken the step of asking and researching about what you might do to overcome your depression.

That’s where a therapist comes in. I work actively with you to beat depression and help you feel better. We’ll take a look at how depression actually works, what factors contribute to it, and the strategies you can use to reduce the bad feelings and bring back your ability to feel good.  And we’ll do this in ways that make sense to you — without confusing jargon or unclear goals.

This approach to therapy for depression isn’t just about you talking and me listening. We’re going to take active steps, from the first session, to give you tools that you can start using right away. We’re going to take advantage of techniques that have been proven in multiple studies over decades to reduce or eliminate depression.

Cognitive-Behavioral Therapy (CBT) focuses much more on the present and the future than on the past. Rather than spend time figuring out where a pattern came from, we’re going to concentrate on what you can do about depression right now. 

Here’s the basic idea:

Three central elements of human experience are thoughts, feelings and behavior. You don’t need me to tell you that depression is a painful feeling, and it’s not hard to notice that when we’re hurting, our thoughts and behaviors change too (for example, noticing only negatives or avoiding activities that used to be enjoyable).

CBT helps us recognize that if you change any one of those three elements, the other two will respond in kind. So we’ll find ways in which you can consciously behave differently and adjust your thinking, and put these changes into action, because they’re proven to help lift depression.

In CBT work, we want you to have the most effective tools against depression whenever you need them. So we’ll go over the techniques in session, then have you concentrate on taking these skills into your life. And in the next session we’ll identify which techniques have worked best for you, and how to make them part of your regular routine.

As you practice these tools and notice that they work, they become easier — and your skill in reducing depression improves.

But I’m feeling sad and hopeless for reasons. Painful things have happened to me. Are you telling me that I should never feel bad?

Not at all. Let me make a distinction between sadness and depression. Of course there are things that happen to us in life that a person would naturally feel sad about, and it’s emotionally healthy and appropriate (though not pleasant) to have those feelings. But actual depression is different.

Let me ask you this. When you feel down:

1) Can you identify why you’re feeling down, in that moment?

2) Is the level of “down” you feel in proportion to the circumstances?

If the answer either of these questions is No, then you might be moving beyond expected sadness into depression. 

But let me say this: Dealing with difficult or sad situations gets much easier when we’re not depressed. Because then we’re not battling feelings of hopelessness along with the actual pain and challenge of the situation. 

My depression feels so much worse than what you’re talking about. And I’ve had it for so long. How can CBT skills help something this big?

This is one of the great ironies of depression. When we’re depressed, so many parts of our life feel hopeless — including the prospect of depression getting better. I know how tough it can be to begin therapy work when we feel this hopeless about it. So let’s keep a close eye on results. Once you’re clear that our work is helping depression lift, you’ll gain the confidence that we can continue to improve your mood.

But isn’t focusing on the past important? Isn’t that what therapy is supposed to be all about?

Understanding where a problem came from is often enlightening, but that’s not the same thing as positive change. We might gain some insight into experiences or patterns that led to your depression, but we want to prioritize actually reducing it. We’ll identify what’s proven to help you feel better, so that you can experience improvements now and make sure that they endure.

What about medication? People have been telling me that I should take anti-depression meds.

We can talk about it. I can’t prescribe medication, but we can discuss whether it might make sense for you to consult with a doctor about a possible prescription. As with any type of treatment, there would be both upsides and downsides to anti-depressant meds. It’ll be your decision whether you want to explore a medication strategy. Before that, though, we’ll work on the available tools that help reduce depression. 

How long does this process take? I don’t want to be in therapy forever.

I agree! Let’s get you feeling better and skilled at fighting depression as efficiently as we can.

Each client’s situation is unique, so I can’t accurately predict length of treatment. But I can tell you that standard CBT protocols and skills for depression are designed to be taught and practiced in 8-15 sessions, and that the essential goal is for you to get good enough at this work that you no longer need the help of a therapist.

I’ve been using Cognitive-Behavioral Therapy for 15 years to achieve positive results for many clients, and I’ve been teaching these techniques to student and early-career therapists. Together, we can help you feel better now, without spending years doing therapy.

Paul Silverman, MFT LPCC

Email me: paul@sfcounseling.net
Call: 415/820-1590

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