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The two most common presenting problems in therapy are depression and anxiety. In fact, I rarely see any psychological issue that does not contain aspects of depression or anxiety. Depression and anxiety are human reactions to psychological distress.

Although anxious and depressive feelings are common, there are unique ways of arriving at them. Two people may be depressed but for entirely different reasons. Person One may be depressed because they recently ended a relationship and worry that they will be alone forever. Person Two may be depressed because they are intensely self-critical and find fault with everything they do. These reasons are not incidental – they are the pathway.  In therapy, it important to explore the pathway into distress so we can chart a path out. If we focus just on the symptoms of depression – like low energy – the relief is usually short-term. Telling a depressed person to take a daily walk may provide an immediate boost. However, it rarely addresses the parts of the person’s psychology that led to depression/anxiety in the first place. Furthermore, most people have tried self-care techniques before speaking to a professional. If dealing with depression and anxiety were as simple as following a list of tips, no one would ever need therapy.

There is no one-size-fits-all when it comes to psychology. A therapist could be treating two people for depression using totally different interventions. In the example above, research has shown that Person One may need a different approach than Person Two. It goes without saying that no two people are alike; no two therapies should be, either.

Blatt, S. J. (2004). Experiences of depression: Theoretical, clinical, and research perspectives. American Psychological Association. 

Shedler, J. (2021). The personality syndromes. In R. Feinstein (Ed.), A Primer on Personality Disorders: Multi-Theoretical Viewpoints. Oxford: Oxford University Press.

My clients usually tell me about the symptoms first:

“I can’t sleep.”

“I worry all of the time.”

“I can’t focus.”

The symptoms are certainly important. They tell me about what is happening in the here and now. They tell me something about the client’s everyday life. However, the symptoms are not the story. The story may have started recently, or a long time ago. The symptoms represent a turning point in the story, and that old coping mechanisms are no longer working. The clients arrive at the end of their rope, feeling overwhelmed and out of ideas.

The first task of counselling is to slow things down. We need to take a step back from the symptoms and see what exists around them. This is the story. The problems that people experience are embedded in a complex history that contains memories, thought patterns, habits, and ways of relating to others. This goes far beyond the symptoms, and usually reveals the client’s background and enduring ways of relating to the world (the personality). By slowing down, we can examine personality patterns of acting and reacting. This acting and reacting is often automatic and outside of conscious awareness. This is why people feel that the same things always happen to them –  over and over again. By slowing down and examining the story, the automatic moves into conscious awareness. From there, we can work towards establishing new patterns and making different choices.

A good outcome is defined by the client. It usually involves the alleviation of symptoms, but most people want something more. The research indicates that when counselling focuses just on symptom relief, clients might experience short-term improvement but often relapse (and usually pretty quickly). Most researchers suspect this is because the enduring patterns (the personality) were not addressed in the first place. These enduring patterns often prevent people from living the life they truly want. Although every client has a different aim for therapy, the most common goals are: 1) A strong sense of self-worth and identity; 2) To improve the quality of relationships, and; 3) To understand their own feelings and behavior. Obviously, goals like these require a trusting relationship with a counsellor and a commitment to change. 

There are many people who want to change, but there are obstacles in the way. Cost. Waiting lists.  Difficulty accessing services. The Psychologists’ Association of Alberta is currently advocating for increased funding and public support for mental health services: (https://psychologistsassociation.ab.ca/about-paa/).

We believe that all Albertans, regardless of income, should have access to psychological services. To protect the public, we believe that psychotherapy should only be provided by a regulated health professional (e.g., Registered Psychologist; Psychiatrist). I am hopeful that our advocacy efforts will improve the lives of all Albertans and make accessing psychotherapy much easier. All Albertans deserve a chance to make positive change, supported by a regulated professional committed to ethics and competence. As it stands, it is far too difficult for most people to share their story. Many Albertans do not have the extra money to establish a trusting relationship with a psychologist. They feel rushed because they have finite resources or a limited benefits program. In psychotherapy, this has been referred to as the “tyranny of time” (Shedler & Gnaulati, 2020). In fifteen years of practice, I have yet to meet anyone who wants to be hustled through their story. We need to give people a real shot at change and connection. 

References:

Lambert, M.J., Hansen, N.B., Finch, A.E. (2001). Patient-Focused Research: Using Patient Outcome Data to Enhance Treatment Effects. Journal of Consulting and Clinical Psychology, 69, 1590-172.

Shedler, J., &  Gnanulati, E. The Tyranny of Time: How long does effective therapy really take? (Psychotherapy Networker, March/April 2020).

Anxiety may be described as a feeling of worry, unease, or apprehension. As with all human emotions, anxiety is to be expected and can be helpful. It is there to keep us alert and prepared. However, anxiety can be problematic when the feelings of worry are: a) Out of proportion to what is actually going on and, b) We feel unable to control our worry. A panic attack is the quick onset of intense fear and can include sweating, heart palpitations, dizziness, and shortness of breath.

I would encourage anyone with concerns about anxiety and/or panic attacks to speak to a physician or a mental health professional. In the meantime, here are some strategies to help cope with anxiety and panic:

1. Abdominal Breathing – A key feature of relaxed breathing is the stomach rising and falling. This is in contrast to anxious breathing, where the chest is rising and falling and people are gasping for air. Place your hand on your abdomen and breathe in through your nose and out through your mouth ten times. I encourage people to practice this several times a day.
2. Grounding – A feature of panic is losing touch with reality. Thus, it is important to ‘ground’ yourself back into this time and place. Find a chair and place both feet firmly on the ground. Act as though you are trying to push through the floor. If possible, grab the arms of the air and hold on tightly. The purpose of this exercise is to focus on the feel of the chair and the floor, and remind yourself of the here and now.
3. Five/Five/Five – Look around the room and notice five things that you See, Hear, and Feel (Touch). An example: “I see the clock, the pen, the wall, the window, and the coffee cup. I hear voices, cars passing by, the music, footsteps, and the clock ticking. I feel the ground beneath my feet, the chair at my hands, the shirt on my back, the watch on my wrist, and the phone on my lap.”

Practice these exercises a few times each day so that you will be familiar with them. You may choose to use all three or to select the one that works best for you. The good news is that anxiety is very manageable. With proper support and a good toolbox of techniques, worry is something that can be well-controlled.