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Welcome to the Mood Disorders Forum. Questions in this forum are being answered by Peter Forster, MD and topics covered are anxiety, bipolar, depression, panic disorder, post traumatic stress disorder and stress.

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I'm wondering about my options in terms of therapy and general life choices.

I'm not able to access therapy that is likely to benefit me in my region and the hospital is unable to fund therapy elsewhere.  What do I do?

I'm not working so don't have the funds to access private therapy or relocate.  I don't have a huge amount of family support.

My family doctor has been a sounding board over recent years but I'm finding that unhelpful in helping me to move forward.
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Dear Jaquta,

Very nice to hear from you. Let me see if I got the question right - is it something like this -

Given the limitations on accessing the best therapy option for me, what is my best choice for moving forward in my life.

It would be great if I could get a sense of your goals for change and also your sense of what your strengths are (and other sources of support that do exist).
The question is about right.

Goals for change?  What would I like different?  And when?
The when is easy.  Yesterday or as soon a practically possible.

My ability to relate and communicate is probably quite high on the list.  I would like conversations to flow and to be natural.
I would also like to be able to communicate openly and honestly and intelligently.

I would like to be able to persevere with something.  Work towards and achieve a goal instead of trying desperately hard to motivate myself all the time (which often ends in failure and me needing to start from the beginning again).  This has happened in study, work, diet and exercise, etc.
Some of my thinking is unhelpful but the problem seems to lie more in ?committing and investing energy and other resources.  It could be avoidance due to fear of failure or desperation in order to get something done in which case I overdo things and get burnt out).

My whole life needs changing.
Education, employment, relationships, diet, exercise, balance, health, less stress, structure, flexibility.

Strengths?  I'm on a benefit so have time available.  I have limited responsibilities.  Are single and have no dependents.  I would say that my physical strength is my biggest asset.
Strengths (and weaknesses) are that I care and are loyal.  I think that I must be a little bit resilient to have survived what I have through the mhs.

I have a couple of brothers and sisters.  My parents are both alive.  Family are there but I wouldn't call them supportive.  Mum has been undermining my attempts to get mh support and tells me to forget about the past and get a job.  I find the lack of validation and insensitivity difficult to deal with.

I still see my family doctor regularly.  I find having that in place helpful (but unhelpful at the same time).

I don't have friends, I don't have hobbies or interests.

Part of me thinks that I am just a waste of time and space and a financial burden on society.  Part of me thinks that there could be more effective ways to help individuals like myself.  Seems like nobody cares enough to do anything that would be remotely helpful.

Another strength is that part of me still cares.  Albeit a very small part.

I currenly just want to sleep all the time and avoid everything.  I have a lot of thoughts and images from my past which seem to be constantly in my head.
Thanks for your thoughtful response.

A don't have time to give you a reply that is adequate but let me make a few observations and suggestions.

I think that the focus on improving perseverance is a good one. In working with many folks with chronic depression it is my observation that this is probably the most common problem that gets in the way of a sustained recovery from depression - the various ways that the brain tries to convince us that continuing to do the things that are good for us is "too hard."

Since you don't have a therapist to help you stay on track I think that you might want to try to find a peer who you can develop an accountability relationship with. Someone who helps you stay on track with your goals but who is perhaps also working on her or his own goals with your support.

A couple of random thoughts about the process of change - change begins in the "now"... which is why the notion of "making New Year's resolutions" is so often flawed, it is often about fooling yourself into feeling OK with not making a change now by promising to make a change in the future. And change starts with small steps. So the challenge is to think of something small that you can do now that will get you started.

Second, you need to do what you can to recognize the first small steps of change. Because at the beginning change is not associated with visible benefits.

Third, you need to find ways of measuring where you are as you try to make changes. This is to counteract the tendency of the brain to dismiss improvements as "trivial" or negligible. Neatly illustrated by an older woman we have been seeing in the clinic for a couple of years - she came in with a SEVERE depression which led her psychiatrist to recommend ECT as the only option. Her Beck Depression Inventory score was 45, very high. Over the course of our work with her she got down to a Beck score of 8 (not clinically depressed - still very mildly depressed but not at the level of a diagnosis of major depression). However both she and her daughter have repeatedly suggested that she is not benefiting from treatment, and if we did not have repeated measures that clearly show her how she has gotten better I am sure she would have stopped doing the work that allows her to remain relatively well. Measurement is essential.

Finally, sometimes a barrier to change is not wanting to accept things as they are. Many folks I see will say, I would be willing to start doing something (losing weight for instance) but it is too hard to measure where I am right now (weigh myself)... I will do that once I have gotten down to a weight that is closer to what I want to be at... They tend not to make progress until they are able to accept that they are starting the process right here, and permit themselves to notice where they start and thus to notice the early progress they make (instead of always being upset because they aren't where they would like to be).
I responded to your post earlier.

I think the depression bit really hit.  I haven't been thinking in terms of depression (mainly in terms of being very tired and wanting to sleep and not doing anything).

I had an old Depression Inventory Test from when I was in hospital.  I took that and my score was 33/ 39.  Higher than when I was in hospital.

This is pretty bad but I slept the afternoon but I dreamt about a building destroyed in the Christchurch earthquake earlier this year (the Christchurch Cathedral).  Anyway, it made me think that I hadn't really resolved stuff around that.  The raw, unedited coverage on TV with bodies being dragged out, etc that I saw earlier this year and the tour through the red zone when I was down there for my brother's wedding recently.

Your comment or example about weight helped me gain a new insight.
My avoidance regarding working in open employment (going through the process of compiling a CV and attending a job interview) made me realise that that means I have to confront my failures as an individual.  I don't want to have to acknowledge those.

Thank you for you help and I hope you have a Merry Christmas and a Happy New Year.  Thanks for your time.
And a Merry Christmas and a Happy New Year to you as well.

Speedy, our dog, is sick and it looks like we'll have to put her down.
Hopefully the new year will be better.  Today started off better though.

Thanks again.
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