Third session with my Therapist. I asked them before I left, is there some sort of diagnosis or something ( because I work best with labels). They said no, it is only our third session and right now, I cannot say you have a mental illness. There is distress (self esteem, confidence and putting other people first vs yourself) which causes you anxiety, depression and also unrelated phobia but nothing to say you're ill and we will work through this with what is best for you, rather than a label.

So now I'm confused and conflicted? Why am I so sad all the time if I'm not "actually" depressed. What's the explanation? Is it just my personality that's really bad? I feel like I'm wasting resources of this is the case.


I shouldn't have asked the question.

Hi Wonderlands

Feeling sad is not the same as feeling depressed, and feeling depressed is not the same as suffering with clinical depression. I am not a medical practitioner so I am not going to try to explain the intricacies of diagnosis, but from what I understand one has to be chronically depressed over a period of time to warrant that level of diagnosis.

I think you should feel elated that your therapist is more interested to help you work through what is bothering you than you just categorize you with a label. Where labels may make it easier for some of us to understand why we are the way we are (usually with the assistance of Dr Google) often placing a label on someone can be more harmful than beneficial.

I think it is a matter of magnitude. To me: sad is to depressed; as happy is to euphoric, overjoyed, and jubilant. Feeling sad, even if for a longer than usual period of time, is normal.

I hope my perspective on this has brought you a different way of interpreting where you find yourself. But, if you continue to feel really really sad, please don't hesitate to reach out and talk to someone. Lifeline and the bb hotlines are always available... even if you just want to say 'hello'.

My best to you, and please post again.

SB

Hi Wonderlands, and thanks for posting your comment.

Your therapist has said you don't have a mental illness, however, sadness can last a few days, maybe a week, but you can still function, whereas with depression is a sadness that continues on and on, it doesn't allow you to do anything at all, in fact there's no interest in doing anything.

If your self-esteem, confidence and distress is causing anxiety and depression and making you sad all the time, then perhaps it might be worth seeing someone else but can I say that I'm not qualified to diagnose you.

Remember your doctor has referred you onto this therapist for a reason, but I would visit your doctor again.

Can I ask you that you've had your third session, so how long have you been feeling this way.

Geoff.

Hi Wonderlands

I believe I understand where you're coming from. Typically, a label is given in order to help pinpoint a specific course of action. So, if no label then we can be left wondering 'What's the specific course of action? What exactly is the specialist treating?' No label can leave us feeling a little up in the air without direction.

Not sure if this helps but the following may offer another way of looking at things. A few years back, a friend of mine was treated for a lump in her breast that was acknowledged as being pre-cancerous. Treatment: The lump was removed and she underwent some radiotherapy sessions. Problem solved based on this course of action. With yourself, perhaps it could make sense to say that you are in a possible pre-depression stage or pre-anxiety stage. If you are not treated now, who is not to say you won't eventually face full-blown depression and anxiety. You're at a vital point of investigation and treatment.

A specific label must apply to a specific condition or behaviour (of the brain and/or body) in order for the best course of action to be determined. Clinical depression, for example, is complex; it involves evidence of particular thought patterns, particular changes in chemistry etc. Depression can be a life altering condition that impacts just about every area in life. It can impact not only our level of happiness and self-esteem, it can also impact our level of energy and motivation, our ability to manage emotions, our ability to experience healthy relationships, our sense of connection to life itself as well as so many other things. I experienced depression for some years in the earlier part of my life and it is intensely different to the self-esteem and sometimes deeply challenging emotional issues that can present in my life these days. I personally found depression to be overwhelming and debilitating. I wish I'd received help in the stages leading up to my depression.

The brain is a complex thing. We don't necessarily need labels in order to navigate such complexity; sometimes support and guidance can be positively life-changing.

Take care Wonderlands

By the way, as far as therapists go, some are quite happy to hand out labels and meds without too much initial investigation whereas others are very careful in how they diagnose their clients (which can pay off in the long run). As your therapist gets to know you a bit better, as you open up a bit more, their diagnosis or course of action may change.

Thank you both for responding.

This is definitely not short term feelings. This is long term, years. Years of not enjoying things I used to enjoy or I know I like (I can't muster up the motivation to even begin the activity, instead I'll procrastinate or zone out). Years of not being able to enjoy times with friends if I even get the motivation or courage to go out with them.Otherwise it's excuse upon excuse to avoid Years of having to drag myself out of bed to go to work or the day ahead.
I hate it.

I saw another psychologist in my home town two years ago for the same thing but stopped going because I didn't really like their method. I couldn't go back to my doctor to find someone else because I was afraid to explain why.

Just because I might have one good day once in a while does that discount the other "negative" feelings I get the rest of the time? That's unfair.
I'm just so confused.

I have 4 more sessions before I go back to my doctor. So I guess I'll see then.

Thank you for replying as well therising.

I need to think about this much more it seems.

For some reason I just feel now, it's going to be so much harder to treat because it's just /me/ being a bad person or my personality rather than a chemically thing. I don't even know.

Hello Wonderlands, having a label can be very comforting, because it can provide us with some clarity and an explanation for why things are the way they are.

But also too, it can potentially block us from making changes that we may need to make in our lives. Now none of this means that you are a bad person or have a defective personality. Modern life is complex, and if we've been painted into a corner over years and years, sometimes it can take a while to sort through the weeds and find a way out again. It could be that your psychologist is wanting to focus on the issues in your life rather than giving you a label, which can be a distraction from focusing on what's actually happening.

For example, years of not enjoying things you used to enjoy or "know" you like. Is there another explanation? Have your interests changed? Are you feeling some grief or a sense of loss around this? Those things you used to love doing, what was it exactly you used to love about doing them? How did they make you feel, and what has changed? With your work, are you doing what really matters to you? If you knew that today was the last day you had on earth, would you be living the life you are now, or would you be doing something different?

These are all big big questions I know, but when depression has set in over many years as you describe, they are not temporary feelings and it is worth asking the big questions to go with the big feelings.

Hi Wonderlands, thanks for getting back to us.

There is no shame in telling your doctor that the therapist doesn't suit you, I've done this a few times, so they find someone else, and what I'm worried about is having the rest of these 10 sessions not being happy with the outcome.

Your health is more important than seeing a therapist who doesn't connect with you, it's a waste of time trying to improve your health, and remember you have to go back to your doctors.

You can have a good day if you're struggling with depression, but when you 're by yourself once again, back you go, you can also laugh and be social for a day, no problem but your depression hasn't been solved.

Geoff.

Hi Wonderlands,

I see that you've gotten some great support here already so hope you don't mind me adding my two cents.

It sounds like you were pretty disappointed by the comment your therapist made, so I want to share my interpretation of it. What if he/she were to say "given that I've only seen you for three sessions, I don't think I have a full picture of you just yet to consider all of your symptoms and how they're impacting your life. You seem to have symptoms of both a depressive disorder and an anxiety disorder but right now I don't think it completely aligns with the diagnosis provided by the DSM. Yet, because I'm still getting to know you this is something I'm looking at, but I don't want you to focus on the diagnosis and instead focus on our work together". Does this change anything for you?

While it's true that there are significant chemical changes in depression, there are also chemical changes in sadness. The difference is often just the intensity. Sometimes the cause of depression seems to be a chemical imbalance, and sometimes it appears to be external (like work, study, relationships, life experiences). The chemicals that we talk about in depression (like serotonin) naturally fluctuate day to day anyway. So I would understand if yours were low. It's not a reflection of you or your personality.

With all that said though, the 'treatment' for depression is much the same - diagnosis or not. There is no specific 'eligibility' in terms of a therapy. You can still receive the same treatment, and still go on medication (if you choose to), regardless of whether you meet a criteria.

I hope this provides some insight.

Hi Wonderlands

Please don't be so hard on yourself in describing yourself/your personality. You're an incredibly tough and amazing person, to be navigating the challenges you describe and for such a long period of time. And yes, what others say is spot on, you can have the occasional good day but that doesn't mean things aren't all that bad. One of the things I despised most about the state of depression I was in was its tricky nature: 'Oh, I'm feeling better these days!' and then BAM, all of a sudden it was in full force again, leading me to wonder if it was ever going to end.

Wonderlands, I have to tell you that one of the things about labels is they can be deceptive. During my 15 year battle with depression, I was helped in a number of ways yet none of that help made any long term significant difference for me. I would never have imagined in a million years that it would be, of all things, post natal depression group therapy that would be the thing to make all the difference. After a great health centre sister recommended this to me, I can remember thinking 'I'm dealing with that same black dog that's been barking for years. How is PND group therapy going to take me out of this place I've been in for so long?!' Here I was judging the 'PND' label as being wrongly suited to me and my situation (even though I'd just had a baby 8 weeks before).

My experience: It's not the label that makes the difference, it's the result that's important and whether the therapy offered to you is having a positive impact in any way. Personally, if I had relied on a label to define the state I was in, I would never have attended that PND group and therefor would have perhaps never found my way out of depression.

Perhaps give your current therapist a bit more of a chance if you can see the potential for positive progress. As Geoff mentioned, if you're just not connecting with this person, continue your quest for a therapist you click with. Remember, health professionals should be working to serve you, you shouldn't be working to please them.

Take care Wonderlands

Hi Wonderlands,

You have inspired a great discussion here on the beyondblue forum. Having a diagnosis versus not having one is something that people, both clinicians and people experiencing symptoms, can have quite different opinions on. This can be based on their experience in how a diagnosis has impacted themselves or if they are a clinician, how they have been trained.

For example, I am a mental health nurse that was employed in child and adolescent mental health settings in the early years of my career and most young people did not get labelled with a standard diagnosis where I was employed unless it was really clear. Everything focused on 'symptoms' or 'traits'. This has shaped me as a practitioner today so I rarely focus on a diagnosis (unless it is helpful) but rather focus on symptoms and strategies to improve symptoms to gain a sustainable recovery. The other side of the coin is that a diagnosis can be very helpful in many ways for clarity around a cluster of symptoms you are experiencing, gaining funding, explaining your symptoms to people in a short succinct way and like in therising's example, finding support structures that work for you. It would be quite hard to find a support group by listing the symptoms of what you are experiencing on say google but at the same time, if you are diagnosed incorrectly, then you might exclude yourself from a support that might be just right

What I emphasise to people is to do what is right for you, right now. As a practitioner, this is what is referred to as a 'person centred approach' and keeps you in the centre of care so that caregivers, like your therapist, work with you and support you in the decisions you make in your treatment planning. If you are a person that feels comfort in knowing what your symptoms cluster is pointing to right now, then revisit this with you therapist and explain that a diagnosis, is important to you. If you change your mind and prefer to not use the diagnosis and rather describe your symptoms as say 'a period in your life that was challenging', then this is your choice too.

I have found this link for your interest on the SANE Australia website about some of the upsides and downsides to diagnosis that you might find interesting. https://www.sane.org/the-sane-blog/managing-symptoms/what-use-is-a-diagnosis

Wishing you the best possible outcome,

Nurse Jenn