Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (17 page)

I am here waiting for you. But I can’t do it without you. Keep going. Stick with the therapy. Things will be better.

I’ll see you in five years.

With love and compassion,

Sandra, 2019

I have read such incredibly powerful and moving letters from people who have done this. Try it and you will too, I suspect.

Here is another future letter, this one with a little different tone.

Dear Joe,

I am writing this letter to you from your future. I am you in the future and I wanted to reach out to you to tell you something.

Hang in there. You will make it out the other side, buddy.

But I also want to kick your ass a little. You did make it out, but you could have done it a little faster if you had just gotten your ass out of bed every day and walked around the block.

I know it feels impossible, but here I am in the future telling you that anything worth doing feels hard and takes effort. I know you can do it because you
did
ultimately start walking, then running, and that is part of how you got out of the hole you were in.

If I were there right now, I would tell you that after you are finished reading this, without thinking about it, immediately get up and get out of bed, out of the house, and start moving.

You tend to get stuck in your head, in your thoughts. Most of those thoughts are just bullshit, buddy. Don’t listen to them. They are coming right from depression. They are not real, just a temporary glitch in the brain hardware. The more you listen to those thoughts and believe them, the more discouraged you will be, so just let them be there and don’t give them any weight or credibility.

Okay, I’ll end this now. I’ll see you in five years. Life is better. You are better. I’ll be waiting. Now, put this letter down, get up, put on some clothes and shoes, and get out there!

Your future self and best buddy,

Joe

P.S. Go. Why are you still reading, you putz?

Again, of course, some depressed people will just not want to or be able to do this exercise. No worries. That’s why there are many other methods of Future Pull and many other strategies. Don’t force it.

Starting Therapy From a Post-Depression Perspective

Another Future Pull method is to start the therapy process by asking what life will be like when therapy is done and successful. This turns the usual therapist inquiry, which focuses on the past roots and experiences of depression or the current experience of depression, on its head.

William Styron wrote, “It is of crucial importance that those who are suffering a siege, perhaps for the first time, be told—be convinced, rather—that the illness will run its course and that they will pull through.” (2008, p. 139). So, instead of asking about your client’s history of depression or whether any of his relatives suffered from depression, start in the future and presume he will get to a better place.

I travel a lot for my work (I teach workshops around the world) and have taken my fair share of taxis. Imagine if I got into a taxi when I arrived in a new city, exhausted and just wanting to get to my hotel to unpack and get ready for the workshop I would teach the next day. What if, as I got into the cab, I told the taxi driver, “I’m going to the Hilton downtown,” but instead of moving the cab, she turned around and said, “Where are you coming from?”

I might answer politely, “Santa Fe, New Mexico.”

“Were your parents from there?” she might then ask.

“No, they were from the Midwest, where I grew up.”

Still the taxi hasn’t started moving, and I might be getting a bit antsy at this point.

“Did you get along with your parents?” the cabbie might ask.

Now I would be getting a bit annoyed. “Yeah, pretty well. Can we get going?”

“What is your hurry? You seem anxious and stressed. Are you usually so stressed?”

At this point I would probably be wondering how I could get out of this cab and find another, less curious and less intrusive taxi driver who would help me get to the hotel much more quickly.

It’s a crude analogy, but depressed people, like most psychotherapy clients, are suffering and want relief. By starting therapy with a focus on where they want to go rather than where they have been, you can offer them a little relief right at the beginning of therapy. Starting with the future and presuming that therapy will be successful creates an atmosphere of possibility and hope and invites the person out of the mire of depression.

The late solution-focused therapist Steve de Shazer had a funny way of doing this. He would ask the client in the first few minutes of therapy, “How will we know we’re supposed to stop meeting like this?” (personal communication, 1986). I do it in other ways: “If we could wave a magic wand and everything was better in your life, what would be happening?”
Or, “If we could take a time machine to the time when we’re done with our work here and you are no longer depressed, what will you be doing?”

Using metaphorical devices or frames may help the depressed person get out of his current discouraged frame of mind and into imagining a time beyond or after the depression has lifted. Other metaphorical devices might be a crystal ball, a miracle, a magic pill, or whatever creative idea you can come up with. For example, you could ask an artistic client to make an image of himself in a future where therapy is over and things are better.

Here are some questions you can use to start therapy from a post-depression perspective:

“If I could wave a magic wand and your depression was gone, what would be happening?”

“If your depression disappeared overnight, what would be the first thing you would notice that was different tomorrow as you started your day?”

“If we could take a time machine to the future after you’ve gotten through this time, what would I see you doing in your day-to-day life that’s different from what you’ve been doing recently?”

“If you could have a different future than the one your depression is pointing you toward, what would it be?”

“What is your fondest dream for the future? What would you do or focus on as you left this office [or treatment center] that would make it possible or even likely that that better future would come true?”

“What part of that future do you think you could start doing right now?”

“Could you write yourself a letter from your future self that has gotten through all this trouble and tell yourself what that future is like and how you got there? What advice would your future self give your present self in that letter?”

“If your problem disappeared, what would be different in your daily actions? What about in your relationships? In your work? In your thinking? That others would notice? What part of that future without a problem could you start doing right away?”

“How much better would you have to feel to get a sense that you could probably make it the rest of the way without the help of therapy?”

“What will be the first sign that you’re feeling better? What will let you know that you’re all the way better?”

“What will your spouse [partner, mother, father, best friend, roommate] notice when you are all the way better?”

“If a miracle occurred tonight while you were sleeping and your depression lifted completely, how would you know tomorrow that you were feeling better? What would be the first thing you would notice when you opened your eyes? What would you notice next? How would your day be different? Who else would notice the change if you didn’t tell them about it, and what would they notice?”

“You told me you are artistic. Can you draw a picture of yourself when the depression is gone and tell or show me how that picture is different from how you are today or how you have been recently?”

Again, make sure you aren’t obnoxiously positive when you do this investigation. You don’t want to alienate a depressed client who just can’t imagine a future without depression or pain. You want to invite him with sympathy and kindness to consider a time after the depression.

Here is a sample dialogue in which the therapist starts therapy with the end in sight:

Therapist:
Now this may seems a little strange, but I always like to set my compass from the start of our work to make sure I’m meeting your needs and going where you want to go rather than where my theories and ideas point. So, can you tell me, as if this were our last session rather than our first and you were coming in to say good-bye and thank me for helping you get better, what kinds of things are going on in your life now that you’re no longer depressed?

Client:
Well, I would be back to work. I would be eating better, more regularly. I would be smiling more. What else? I would be listening to music again.

Therapist:
Okay, that gives me a sense of what we’re shooting for. What will others in your life be saying or noticing about you when you’re better?

Client:
I guess my mother would say I’m less irritable. And that I call her more regularly. And my friends would say I answer my phone now, when I used to avoid them or not call them back.

Therapist:
Again, that is helpful. Any other things that would be very noticeable when you came for your last appointment that would be different from what’s been happening recently for you?

Client:
I might get started on a book I’ve been wanting to write for years. I put it away when things got bad and I need to get back to it.

Therapist:
Is there anything that will be happening when you’re no longer depressed that you’ve noticed you’ve been doing a little more of in the recent past?

Client:
Well, I have been answering calls from my friends more in the past week. I knew I was coming in here, and for some reason that gave me a bit more energy, and I felt bad for having blown them off, so . . .

FETCHING THE FUTURE

Each method in this chapter is about communicating hope and possibility. A Zulu proverb holds that “you have to go fetch the future. It’s not coming towards you; it’s running away.” For the depressed person who is “future challenged,” it takes effort to move from being orientated to the painful present or brooding on the problematic past to the possibility of a brighter future. You can be part of the reorienting process and help the person restore her sense of a future with possibilities.

CHAPTER SEVEN

Strategy #6: Restarting Brain Growth

A new hypothesis is supplanting the old “serotonin deficiency” theory of the neurological causes of depression. This new understanding emerging from recent brain research is called the “neurogenic/neuroatrophy hypothesis.” This new way of thinking about depression holds that stress reduces the growth of both new brain cells and new connections within the brain and that untreated depression can even cause brain lesions and damage. Fortunately, there are ways to restart brain growth, but they are rarely used with depressed people. This chapter will describe the scientific evidence supporting this new hypothesis and give you ways to convince depressed people that becoming more physically active can be a way to alleviate and, ultimately, possibly eliminate depression.

As a child, I wasn’t very athletic. I liked to swim, but for the most part I preferred less active pursuits. I liked reading and music. I became even more inclined to indoor sports as an adult, such as writing (this is my thirty-sixth book) and, since my profession is psychotherapy, sitting down and talking with people. But one thing I have always treasured is learning. I like to learn. When a friend said she considered herself a “lifelong learner,” I decided that that phrase fit for me as well.

So, a few years ago when I read a book called
The Brain That Changes Itself
by psychiatrist and neurologist Norman Doidge, I was both energized and depressed by one of the book’s conclusions: that one of the best ways to keep our ability to keep learning alive as we age is to be physically active. It turns out that the brain can grow new brain cells all through life, but only if we encourage it to do so by being physically active, which leads to the birth of new neurons, and making sure we don’t clog the blood vessels to our brains with bad foods and inactivity, which can lead to brain cell death.

At around the same time, I fell in love with my now fiancée Helen, who was a triathlete. She ran, biked, and swam and reveled in physical activity. She both encouraged me to become more active and helped guide me to be so. She told me one of her favorite books for learning the basics of better exercise and self-care was
Younger Next Year
(Crowley & Lodge, 2007), a dialogue between an aging man who wants to become more fit and his physician. It is a fun, funny, engaging, and informative book, and reading it eased me into a more active life.

I did just a little at first, knowing that if I tried to push too hard (I was out of breath after just minutes at a mild pace on the treadmill), I would become too discouraged and stop. I began slowly and built up to fifty minutes of brisk walking on the treadmill.

Then one day, Helen invited me to take a run with her. I declined initially; I knew she was in such better shape that I wouldn’t be able to keep up with her. But she insisted she would go at whatever pace I wanted and stop whenever I asked. Being a guy, however, and in the bloom of a new relationship, I ended up running at a mild pace for forty-five minutes. I was out of breath, but I had done it: run steadily, if slowly, for three-quarters of an hour. I had never done this in my life, and if you had asked me, I would have told you it would never happen. I didn’t have the discipline or the willingness to push myself that much.

The next day we went for another run, again for forty-five minutes. Like anything, the more you do it, the easier it gets. Within weeks, I was no longer huffing and puffy in major discomfort at this level of activity. Now, many years later, I routinely run for forty-five to fifty minutes. And I began this habit, I discovered that this is what most experts recommend as best for heart health and brain growth.

I tell you all this to prepare you for learning this last strategy, which is all about restarting brain growth in depression. And, as you will learn, one of the best ways to restart brain growth (or reverse some of the brain-damaging effects of depression) is to become physically active.