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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5107
Experience:  Dr. Mark is a PhD in psychology in private practice
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I have a friend who is so depressed that OKMH1020100

Resolved Question:

I have a friend who is so depressed that she can't see she's sabotaging her job search. What can I do to help her not reject every ad as "a scam" or "already filled." She's on the verge of homelessness.

Submitted: 9 months ago.
Category: Mental Health
Expert:  Dr. Mark replied 9 months ago.

Dr. Mark :

Hi! I'll be glad to help you with this issue.

Dr. Mark :

It sounds as though your friend may be very depressed well beyond just the job search issue. Is this the case?

Dr. Mark :

Hi, the system says you're standing by but you haven't replied. Do you need more time?

Dr. Mark :

The system is trying to revert to question/answer mode because you haven't replied over the time it allots. I'll try to extend it, but if it reverts, I'll answer in that mode, okay?

Expert:  Dr. Mark replied 9 months ago.

Hi! The system reverted to the question/answer mode so I'll answer you here, okay?


First, let me say your friend is very fortunate to have you there caring about her. I can imagine how worrisome her situation might be. You are very caring and that is beautiful.

Your focus is how to help her with her employment issue. The theory is good: if she can get past this self-sabotaging hurdle, it will give her some confidence, something to build on, and she can move forward with the other parts of her "self" that are depressed.

This is indeed a good theory, but it rarely works with the depressed person. Because the job impasse is the tip of the iceberg for her and she is emotionally "mired", so to speak, way down below the surface with the heavy portions of the iceberg. She can't reach the surface enough to get herself to do the things you're so generously trying to help her with.

It's very likely that professional help will be required. And perhaps medication to give her the boost emotionally to be able to actually follow up on some of the work you're doing on her behalf. I'm concerned, though, that you not become frustrated with her, because you really can't be her therapist. And she may need to go at her own pace with this. We don't know how low she has to fall and it may require a professional's intervention to help her find the "bottom" so she can make her way up.

I'd like to, therefore, paste in for you part of what I have written for people I work with who are depressed in her situation, where they are self sabotaging and just can't get out of the dark hole they feel themselves to be in, okay? My hope is that you might find a way to share it with her and thus not have it be where you are the one who "owns" her getting better. This way you can stay friends even if she isn't able to follow up on your help. You can just give this to her as something you saw that might help her. I know it won't talk about jobs and job searching directly but I don't think that is the level she can get better on. She needs to get an emotional lift in general.

Here goes:

Let's work on a coherent program that includes medications and behavioral treatment. The six components of a total natural care program are: herbal remedies, diet, exercise, motivation, spiritual life, and psychotherapy.

First, medications. I am not for or against medications; they can be helpful and they can be sometimes counterproductive. But, I have found that when a person feels they are in a very dark place in their life, medications can give a boost that can help the person move forward. If you work with the prescribing doctor to make sure this is a temporary boost, then it can be very helpful.

I also want you to know that at the end of the posting I'll paste in for you a technique you can use to help when you are in that dark hole of depression and anxiety. When you are feeling depressed and in a dark hole, this is something you can use to help with some relief and you can use it over and over.

The first stop after medications is herbal remedies: St. John's Wort is the only herbal remedy that has any clinical evidence supporting its effectiveness for depression. Other "products" claim to, but in the psychological literature, this is the only remedy accepted as having significant evidence. IMPORTANT: do not take St. John's Wort with any antidepressants. You're on antidepressants which rules out St. John's Wort. So if you want to try this option, discuss it with your doctor if you are discussing medications; this is important. Any other herbal remedies are going to be a matter of whether you want to try it for the cost. Remember: no "natural" remedy is going to have the quick and powerful effect you will see from the medications--but not the side effects or withdrawal effects either.

Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods.

Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 1,600-3,000 mg daily. Omega 3 is the main supplement. The research on it and depression is conclusive. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.


Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Your doctor will verify the research results showing the benefit.


Motivation: I recommend you apply the principles in the following videos and books. So that you can be yourself with more confidence and share it with others. Coach yourself. Be your own life coach! I want you to get really into motivational videos and books. In other words, accept your past fears, accept your past worries and hurts and traumas. Accept them and focus on becoming who you WANT to be now. Here's a simple YouTube search I put together on "motivational speakers":


http://www.youtube.com/results?search_query=motivational+speakers&aq=f



Some like Tony Robbins are the classic big guys. Some are newer. There are now wonderful women speakers as well. There are now great women speakers as well. Watch them all. Get inspired. Buy a book or two. Here are some possibilities, but they are only suggestions as there are so many good ones.

The first book is the father of all these type of books. How to Win Friends and Influence People by Dale Carnegie. There are classes in these books now! It was written in the 1930s and still has something to say to us today that is very worthwhile.

I think very highly of the second book on my list, which is a real classic: The Seven Habits of Highly Effective People by Stephen Covey. It is the book that has helped more people than probably any other.

The third book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.

Spiritual life: the medical literature is now rather overwhelming about the benefits to so many different areas of physical health of regular religious and spiritual practice. Going to church, meditation, etc. are all shown to produce benefits to the physical body. What about our mental health? Well, you will see that meditation is now a regular part of psychotherapy interventions. I don't know if you're a religious person or not. But if not, this may be a good time in your life to tune up your spiritual life. If you do not believe in G-d, that's not a barrier to your own spiritual life. Just thinking about the meaning of your life, of life in general, and feeling more harmonious with the universe will help with the depression.

Psychotherapy: this requires to have you reorient your thinking about depression and meds and remedies. Medications and remedies only treat the symptoms of depression and that it is important to treat your depression as a HUMAN symptom.

You need to find a psychologist to help you with the underlying CAUSES of these symptoms, who can help with the depression itself. You need to feel comfortable with the psychologist and I don't want you to accept just any therapist. You have the right to interview them until you find one who you feel comfortable with and that you feel will understand your experience!


If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and depression


http://therapists.psychologytoday.com/rms/



If you want someone who isn't as structured as a pure CBT therapist, consider seeing if the therapist also lists humanistic and/or psychodynamic therapy in their orientation. The idea here isn't that these types of therapy are magic. It's that you may want to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions.

I wish you the very best!

Now for the technique: here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you when the anxiety of depression is present is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety and depression, which strengthens the emotion and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 9 months ago.

Hi Dr. Mark - thank you for your reply. Thank you also for acknowledging that I don't want to own her getting better.


 


 


The fact that she's living out of her office and doesn't have the $230 rent even for that makes this problem a little different than the usual, I think. She doesn't have money for any of this.


 


Maybe the question should be, where's the last rung to cling to before she falls through the cracks?


 


This might be a social welfare rather than a psychology question.


 


I will give your answer a good read and see if any of it will be applicable to her financial situation.


 


Thanks.


 

Expert:  Dr. Mark replied 9 months ago.
I'm afraid her financial situation is only one symptom here in the disorder. That was the basis of my answer that I wrote. I hope you agree.


I'm so glad you recognize you can't own her recovery. It's so important. Because that's a downward slope for you as well as her. I was concerned but I'm glad that's not the situation. Good for you.


Where will her bottom be? I can't tell you she won't become a ward of the state and thus be forced to go to residential treatment. I have seen this sometimes in my career. I know that's painful to hear, but sometimes this is the only way that a person can give themselves permission (as strange as it sounds) to actually get some help and get better and move forward.


We of course hope she can pull out of her deep and dark hole of despair before this occurs, but again, I think the financial situation is just a symptom here.


Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5107
Experience: Dr. Mark is a PhD in psychology in private practice
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