In The Shadow Of Depression - Anna, 22y

Empty eyes meet mine.

"Everything is blank," she whispered, her voice barely audible, in response to my gentle inquiry about her thoughts.

A long silence ensues, and I notice her eyes welling up with tears, which she discreetly tries to wipe away with her sleeve. I scold myself for forgetting to place some tissues and make a mental note.

I break the silence, as I've come to understand that words don't come easily in this state.

Anna

A year ago, a 22-year-old named Anna sought my help. She was grappling with severe tinnitus, migraines, sensory overload, fatigue, and signs of depression. Medical examinations revealed no physical issues, prompting a referral for psychological support. She had spent six months with a psychologist, but the progress had been minimal."

And that's how she ended up here.

Anna felt helpless, afraid, and cautiously hopeful. I shared that last emotion with her. When people are referred to a specific therapist, they either have high expectations or none at all. If one psychologist couldn't help them, why would another? In their minds, they become the "hopeless cases," those whom no one can assist. Anna fell into the category of high expectations, although she never expressed it explicitly. Even though I had established a framework, set expectations, and explained my approach, I sensed that I had inadvertently burdened myself with that same pressure.

Anna shares how she's been feeling stuck lately. The holiday was hectic and lacked the structure she had clung to over the past year. During an unguarded moment, I feel that her powerlessness, fear, and sadness have overwhelmed me, clouding my thinking. I notice that I'm being swept away by obstructed thoughts. "We've come such a long way, and it seems like we're back to square one. How can this be?" I realize that I need to zoom out for a moment and regain clarity. When you work with the same people for a long time, maintaining that distance and approaching the situation with a fresh, open, yet critical perspective can be challenging.

I regain my composure, think about the progress she has made, and feel hopeful again. I really needed to see the bigger picture for a moment.

How difficult must it be for her to keep on focussing when you're in the midst of the story?

People with mental margin have the space to distance themselves from the situation, their thoughts, feelings, and behaviors. When that margin disappears, it's truly challenging. I catch myself planning an entire treatment plan in my head, eager to share it.

However, I look at Anna and realize that she doesn't want an enthusiastic therapist to provide her with a treatment plan right now. I slow myself down and reconnect.

"What do you need right now?" I ask her.

"I don't know, everything is still blank," she replies.

"Would you like me to guide you today?"

She responds with a gentle nod, tears streaming down once more.

Reflection

After the session, I review my notes, reflect on the session, and consider other paths, words, and exercises that might have led to a better outcome. I catch myself with a hidden agenda: she longs for that enthusiastic, cheerful, energetic Anna she used to be, and I realize that I want nothing more than to help her feel like that Anna again. Patience has never been my strongest suit. Unfortunately, we haven't reached that phase yet, or at least not yet. Because I genuinely believe she will get better. If I didn't believe that, I would consider it my duty to refer her elsewhere, although in this case, that might do more harm than good. But I sincerely believe in her. She has already come a long way: the tinnitus has stopped, the excruciating headaches have ceased, she's not constantly exhausted, she dares to seek help occasionally, she's taken up a hobby, but the cloud is still there, and the joy remains elusive. We're not there yet. Accepting the shadow of who you once were is sometimes the most challenging step.

Depression is a tough opponent... It latches on and seizes every opportunity to take control. It's understandable for a person to feel disheartened and anxious. Unfortunately those happen to be the least functional feelings during a recovery process. They paralyze individuals to the core. Recovery is hard work, and it requires energy, as well as the hope that it can actually get better.

I close my eyes, take a deep breath, and feel immense gratitude wash over me. Grateful that she hasn't given up, grateful that I get to accompany her on this journey, grateful for the mutual trust, and grateful to know that she's not alone. I open my eyes and adjust her assignment for the week, hopeful that it's another step in the right direction.

Note

In my opinion, one of the best videos explaining depression is 'I had a black dog, his name was depression'. I would recommend it to anyone suffering from depression or who's confronted with it.