Disclosure: I have not mentioned any identifying information of past or current clients.
A few of the main issues I typically see as a university counselor are depression and anxiety. This is what some refer to as “the common cold” of mental health in general and specifically with college students. Probably about 75% of my clients come in wanting help for depression and anxiety. In the first session, we go over the client’s background. Family experience growing up, traumatic events the client may have gone through, significant events throughout the client’s life, presenting problem, history of the presenting problem, what the client has done to help this issue, etc. One question I typically ask clients in this first session is “how will we know when we are done with therapy?” “What will that look like and feel like?” “What will be different?” though these questions allow for deep thought, it is pretty common that I get the response “I just want to be happy.”
Heck yeah! I don’t blame you at all. I like being happy too! We can definitely work on this! However, some people seem to not understand that a life without depression and anxiety is not realistic. Yes, clinical depression and anxiety are disorders and are considered “abnormal ” (I have a love/hate relationship with the word abnormal and, also, the word pathology. This is how we refer to things that need clinical focus, but I feel it further stigmatizes mental health issues. To be honest, majority of people experience depression and/or anxiety at some point in their lives, so experiencing these should be considered normal!) This type of depression and anxiety are, indeed, a huge factor in a person’s functioning and does need to be worked on. I am not minimizing that in any shape or form.
What I am referring to is normal depression and anxiety. Some of my clients come in thinking depression and anxiety only present in one form–pathological. They think they are somehow less of a person for experiencing it. This is false. Depression and anxiety are NORMAL emotions. These are emotions that we are supposed to experience–same as happiness, sadness, and excitement. All of these emotions are messengers, they are trying to tell you something. Anxiety (future based) warns you of potential danger and things that you are not comfortable with. Fear/ nervousness (present based, often used interchangeably with anxiety–though they are not the same) tells you what you are scared of, what is important to you, and how you would like a situation to unfold. Depression warns you of things you do not like, things you are not comfortable with, things that make you feel less of a person, and that a change may be needed. This does not mean you are less of a person, it just means these things make you feel this way. The only time depression and anxiety are considered “pathological” is when, in the words of my professor from undergrad, “the volume is turned up.” It significantly impacts your life. You have a hard time getting out of bed, feeling happy, being motivated, concentrating, keeping up your grades, etc. Or, with anxiety, you find yourself isolating from other people, you fear many different things as opposed to just one, it causes problems such as exhaustion, inability to engage in social conversation, and reduced ability to relax. This is what we can work on in counseling. But, is it realistic to say we can “cure” these disorders?
In my opinion, it is not realistic. I would say the odds of going from experiencing a depression and/or anxiety disorder to being fully cured and never having it again is slim to none. Depressing (pun intended)? Yes. Realistic? Definitely. Once we experience depression and anxiety disorders, our brain chemistry has changed. The levels of “happy chemicals” in our brain are altered. They become unbalanced. While I am not a psychiatrist, neuropsychologist, or any other type of profession that studies brain neurons for a living, I have been taught in school about them. My guess is that once these chemicals become unbalanced, it is hard to get them balanced again. And once they are balanced, it is difficult to maintain that balance. Especially with the many ups, downs, twists, and turns of life. Hence, why many people try antidepressants and why some choose to stay on them for life. This helps them try to maintain this balance to help prevent severe future episodes of depression and anxiety.
Why would I say this? Why write a blog about such a depressing topic? Well…I think part of treatment for psychological issues–particularly chronic ones–is being honest with ourselves and our clients. This does not mean that the person is forever doomed. Absolutely not! This means that while treatment may focus on reducing the intensity or frequency of depression or anxiety episodes, we need to be honest with ourselves that these states will come and go. And that’s okay.
I’d like to use myself as an example. For as long as I can remember, I have always HATED speaking in front of people. HATE HATE HATE it. In high school I took speech in summer school so that I only had to do three speeches as opposed to the normal seven. In a history class, I remember telling my teacher that I was not going to get up and speak in front of the class–but I would do the PowerPoint. She gave me a 70. In undergrad, I got lucky with not being required to take a speech class. I get incredibly nervous, and sometimes panic, thinking:
“What if my voice shakes?
“What if I lose train of thought?”
“What if they notice that I’m nervous?”
I thought I could avoid speaking in front of people by choosing a profession that typically met with just one person to a few people. Little did I know that my current job, and part of my passion in this field, would include speaking in front of others.
At my current job as a university counselor, I occasionally speak to classes about different topics. One class I talked about our counseling services on campus. Another class (careers in psychology), I talked about the counseling profession–education, internships, licensure exam and process, different types of licensure you can qualify for with a masters degree in counseling, different types of therapy models and treatment options (sandtray and art therapy), typical issues I see as a university counselor, and what I love about being a counselor. In the near future, I will be presenting to a multicultural psychology class about how I incorporate multicultural aspects into counseling. These presentations have made me realize that I love presenting. I don’t particularly love the talking in front of people part, but I love sharing knowledge and helping others–even if it is not directly through counseling.
So, how do I deal with my intense anxiety and fear related to speaking in front of people? Well, the long answer is that I employ several different techniques. A big one is some cognitive-behavioral therapy interventions. Another is an intervention typically associated with Acceptance and Commitment Therapy model. This model is big on accepting whatever it is you experience and committing to doing what you can about the situation while remaining committed to your values. I value sharing knowledge and helping others, so I accept that I will feel anxiety prior to the event, and nervousness in the moment when speaking in front of people. But I also commit to doing my best. This includes: CBT interventions in my thoughts. Rather than thinking “what if’s” I think:
“It’s okay if my voice shakes.”
“It’s okay to be nervous.”
“It’s okay if they notice I’m nervous.”
“I’m more judgmental of my speaking than they ever would be.”
The other thing I do to help my anxiety/fear? I accept that I will probably always experience this before speaking. Yes, I too once tried really hard to get to where I felt no anxiety or fear at all. That would be ideal, wouldn’t it? But it’s probably never going to happen. And that’s okay. I can still be a good presenter despite my anxiety/fear. I can still make a difference. You can too.
You can live a fulfilling life, despite your chronic mental illness.
You can be happy.
You can achieve all your goals.
You, too, can do it.
You do not need your mental illness to entirely disappear before you begin to live.