Depression is a “whole-body” illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away.

People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression. The symptoms of depression may vary from person to person, and also depend on the severity of the depression.

Depression causes changes in thinking, feeling, behavior, and physical well-being. * Changes in Thinking – You may experience problems with concentration and decision making. Some people report difficulty with short term memory, forgetting things all the time. Negative thoughts and thinking are characteristic of depression. Pessimism, poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during a more serious depression.

* Changes in Feelings – You may feel sad for no reason at all. Some people report that they no longer enjoy activities that they once found pleasurable. You might lack motivation, and become more apathetic. You might feel “slowed down” and tired all the time. Sometimes irritability is a problem, and you may have more difficulty controlling your temper. In the extreme, depression is characterized by feelings of helplessness and hopelessness. * Changes in Behavior – Changes in behavior during depression are reflective of the negative emotions being experienced. You might act more apathetic, because that’s how you feel. Some people do not feel comfortable with other people, so social withdrawal is common. You may experience a dramatic change in appetite, either eating more or less. Because of the chronic sadness, excessive crying is common. Some people complain about everything, and act out their anger with temper outbursts. Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal appearance, even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity and household responsibilities suffer.

Some people even have trouble getting out of bed. * Changes in Physical Well-being – We already talked about the negative emotional feelings experienced during depression, but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping, is common. Some people can’t sleep, or don’t sleep soundly. These individuals lay awake for hours, or awaken many times during the night, and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose their appetite, feel slowed down by depression, and complain of many aches and pains. Others are restless, and can’t sit still. Now imagine these symptoms lasting for weeks or even months. Imagine feeling this way almost all of the time. Depression is present if you experience many of these symptoms for at least several weeks. Of course, it’s not a good idea to diagnose yourself. If you think that you might be depressed, see a psychologist as soon as possible. A psychologist can assess whether you are depressed, or just under a lot of stress and feeling sad. Remember, depression is treatable. Instead of worrying about whether you are depressed, do something about it. Even if you don’t feel like it right now.

The main purpose of therapy is to facilitate your problem solving and personal growth. This occurs when you begin to acknowledge your freedom to change, accept the responsibility to make those changes, and then take action.

Therapy is a process by which you can make positive life changes. The word “process,” according to Webster’s Dictionary, is a natural phenomenon marked by gradual changes that lead toward a particular result, e.g., the process of growth. The implied message in this definition is that major changes take time. These major changes are an accumulation of smaller changes directed at a desired result. Don’t expect quick fixes.

In therapy you will learn to identify, label and process your feelings and thoughts. You will also evaluate your behavior. Most unwanted feelings, thoughts, and behaviors can be changed with work. Therapy is work. It is not something your therapist will do to you, but instead something you will be guided through. It is important to remember that in therapy you will be encouraged to make well thought-out choices. If you have difficulty making choices, your therapist will teach you decision making skills. It is also important to remember that if you choose not to work in and/or out of the therapy setting, you will probably not achieve your desired results. The days and hours between sessions will be the time when most of your work will be done. In the first stage of therapy, time is spent discussing concerns and getting to know each other. It is important to develop a trusting relationship in the early stages of therapy. A trusting relationship is necessary to the therapeutic process. Often people enter therapy because they have difficulty forming positive relationships with others. This is an indication this person has difficulty trusting others. Your therapist will be very patient and encouraging if this is a problem for you. Much attention and time will be devoted to your needs in this area.
As trust is developed, it becomes easier to discuss feelings and needs. The result is a better understanding of yourself and the development of plans for making changes. Realistic goals can be set and choices can be explored. Active involvement by you, both during the therapy session and outside therapy, is required in order for changes and growth to occur. You will usually be given suggestions at the end of your therapy session to be carried out before your next session. Many times these suggestions will be generated from your own ideas for “homework” assignments since you are more aware of your time restraints, abilities, interests, etc. Again, it is your choice to work outside the therapy setting, but try to remember you have come to a professional who is knowledgeable about the necessary steps in the process of change. It is very important in goal setting to evaluate your progress and modify goals at appropriate times. Therefore, part of your session will be devoted to discussing the previous week’s assignment.
Therapy has three phases. A beginning that begins with the first session, a middle that can begin and end at any time, and an end that begins two to three sessions before the final session. When you are ready to bring a close to the therapy process, it is your responsibility to make this known to your therapist. Closure on therapy occurs for various reasons including the accomplishment of goals, moving out of town, need to focus attention elsewhere, or dissatisfaction with your therapist. Whatever the reason for ending therapy, schedule a final session and discuss your leaving with your therapist. Not showing up for your session or just “disappearing” is a very unhealthy way to deal with good-byes and conflicts.

Personal commitment to therapy is crucial for success. If you must cancel your appointment or come late for an appointment you are expected to notify your therapist. Payment is due at the beginning of each session. Valid methods of payment are: cash or check. Please inform your therapist of any insurance changes. Therapists often work late hours, attend out of town conferences, and have hospital emergencies that make them difficult to reach. Twenty-four hours notice usually will insure your therapist gets your message. Also, this gives others an opportunity to schedule their session in your time period.

Please be on time for your sessions. They will last only 50 minutes.
Equally important are the responsibilities you have to be an active, open and honest client with your therapist. Your most important responsibility, however, is to work toward the goals you and the therapist have agreed upon. Seeing a therapist for 50 minutes per week will be of little benefit without additional effort outside the therapy office. This work can include thinking about the material covered in your sessions, making yourself aware of the behaviors you want to change, or working on specific assignments made by your therapist. Examples of a specific assignment might be keeping a journal, reading a specific book or article, or practicing a new skill. Therapy is what happens between sessions.