Cheryl is not the only client who has undergone long term psychotherapy or counselling for a few years elsewhere including other parts of the world before coming to see me for depression and anxiety treatment. Most of them saw their counsellors or psychologists once a week or once a fortnight.
Cheryl is able to explicate in details her symptoms of depression and anxiety, and more noteworthy, the historical origins of her mood disturbance. She was brought up by a "critical mother", who always told her that she had never done enough. Cheryl internalized the voice of her mother so that she now criticises herself constantly even though she earned a Master degree in IT, has a fulfilling career, married a nice guy and has two kids. She described that the "voice" in her head acts like putting her down in front of an imaginary audience, which include her parents, her schoolmates and her co-workers, whom she seems to have never measured up to. Her experiences of being sexually violated when she was young also brought about a heavy sense of guilt given her Catholic background, which associates with her continual attempts to “prove” that she is heterosexual. She ran into "wrong" guys easily and ended up having two divorces over the years. Now she is working in HK, and feels a strong sense of captivity in face of the tightening COVID restrictions.
Cheryl described how she acts like a kid, where she seeks approval and recognition from other people, and becomes anxious and depressed if she cannot. She feels that she has been stuck in the past and cannot free herself from these historical chains, even though she knows that she has no "rational" reasons or "objective evidence" to support her depressogenic thoughts that she is a failure and no one is proud of her.
I asked her what she actually did when she was stuck. What did she do when she was in the worrying loop during the sleepless nights? How did she respond to her feeling of inertia when she thought that she was a failure after her husband had snapped her for not understanding politics? What else did she do with the critical voice in her head besides succumbing to it?
She was stunned by my questions without an answer. She told me that she talked about her problems repeatedly with the counsellors and psychologists she saw in the past, but they never asked her how to cope with them. She thought that having insight about the historical origins of her problems and talked about them would help her come out of the black hole.
The representations of our ideas, feelings, somatic states, memories, behavioural inclination, etc., are interconnected in our brain like a web. The more we think/talk/practice/recall all or some of them, the stronger the connections among them. The more we go over the worries whenever we wake up in the middle of the night, be it seemingly automatic to start with, the more we wake up at a similar time having similar active state of mind in the forthcoming nights. Whenever we give in to the procrastination in reaction to the anxiety about failing a job assignment, the stronger the relationships among giving-in, fear, avoidance, and sense of failure. In other words, when we are repeating the chain of negative thoughts, undesirable behaviour, the bad feelings and the memories stored in our mind and body, the harder we feel we can change it because it has become a habit, or a chain-lock, after millions of repetitions over the years.
To change a habit, practice the new behaviour/thinking/bodily states. To begin with, you need to make an intentional move, with tremendous attentional resources putting on it. New feelings, new behaviour and new somatic responses do not occur out of the blue, or by repeating yourself in the old maze.
Cheryl learns to set aside a problem-solving time during the day to draw out a contingency plan for all the bad consequences she could imagine that constitute her worries. She learns to focus on breathing and relaxing herself when she is awakened in the middle of the night so as to set a better condition for falling asleep again. She quickly identifies the script of the voice in her mind, and learns how to confront it. Through accessing her feelings associated with her mother, she learns to develop a self-soothing voice with compassion whenever the critical voice comes up again. She creates an imagery self to show empathy, understanding and permission about her struggle at sexual orientation. She tries out many more tactics because no one alone but only a combination of all these strategies works. These strategies are not easy to start, but practice makes near perfect.