A friend recently asked me what, exactly, about counseling was so helpful to me.

I thought for a minute and then said, “I go in there with a mess of problems. I’m entangled in them. I’m overwhelmed. I don’t see a way out. She helps me to sort out or separate the different problems–to disentangle one strand of difficulties at a time–so I’m not so disabled by the obstacles.”

Last therapy session, I started telling her everything that was wrong. I was jumping from one problem to the next. I don’t think I was making any sense. In tears, I expressed the sadness and anxiety that was all consuming, that I didn’t see a way out.

As usual, she had jotted down some of things I had said.

“Okay, we’ve got several challenges here,” she said. “Let’s take them one at a time.” As a detective, she had narrowed down a few difficulties that were contributing to my feeling of helplessness, a few situations that may have triggered–or at least compounded–my present state of sadness.

(Not to say that depressive episodes of bipolar disorder are ALWAYS triggered by a specific episode or situation, because, as I said in my video about the crying days, sometimes it comes over you like a thunderstorm.) However, this is the purpose of therapy: to identify POSSIBLE triggers of depression so that I can avoid them in the future.

For every problem I identified, my therapist help me come up with a plan of action, so I wasn’t just wallowing in the problem.

Problem #1: The depression may very well be crash from my hypomania, or the result of my Zoloft being lowered.

Most of the time I think you have to start with the medical history, because a depressive who is suicidal or extremely depressed will have a very difficult time trying to identify her problems and try to solve them creativity. The only thing I was able to do for a very long time was to make it through the day. So I always start here.

What’s going on medically? Any changes?

Yes. I was very definitely hypomanic in April, and then in May and Dr. Smith decreased my Zoloft both times. It could be that I need a higher level to be therapeutic.

Plan of Action:

I have met with Dr. Smith, and she has recently upped my Zoloft again. I will stay in touch with her and keep her abreast of any changes in mood. And I will continue to see her every other week until I am feeling more stable.

Problem #2: I am having vision problems.

My health has been further complicated lately by some vision problems. I’m seeing spots like you do after someone snaps a picture with a flash. I’m dizzy when getting up from a seated position or turning my head. This could very well be a symptom of something going on with my pituitary tumor. My endocrinologist always checks my vision. It could also be a side effect from my psych meds.

Plan of Action:

I have called my endocrinologist and have spoken with a nurse there, who is sending me a form to get a special vision test. Once I have done that, I need to schedule a follow-up with my endocrinologist. My mom, who has been diagnosed with a neurological disorder called Blephoraspasm, an involuntary closure of the eye, has warned me that stress can very definitely affect your vision. (Maybe I should invest in a dog right now.)

Problem #3: Eric and I are stressed out. We are crabby, and snapping at each other and the kids. I’m totally grumpy. So is he, and the kids pick up on that.

Why am I more stressed out than I have been before? In May and June, I tried to take on an ongoing writing assignment that was supposed to take five to ten hours a week. However, two weeks into it, I was investing more like 15 hours a week. And this is 15 hours on top of an already-packed schedule. It would have been a great resume piece, and I let ambition get in the way of my health. Our summer schedule doesn’t give us as much time to ourselves, and both of us have had to juggle work around the kids’ schedules. Every day is different, and the lack of consistency is confusing not only to us, but also to the kids.

Plan of Action:

I dumped the writing assignment and have decided not to pursue any freelance projects, or any cool ideas (radio shows, etc.) until I get more time. No book proposals, no articles other than the column I write Catholic News Service and this blog. Everytime someone mentions an interesting project that they want me to consider, I will have exercise the same caution that I do when offered a drink of alcohol. Because even though it’s new and exciting–like a drug–it can’t “cure” me of my sadness and anxiety, and will only contribute to my state of exhaustion.

Furthermore, I will force mental-health activities for myself such as bike rides, kayaking, walking, and spiritual reading. I will try to meditate for 15 minutes a day. And Eric and I have decided we need to do something fun at least once a week. Today we are having lunch. Tomorrow we are going to try to kayak. In order to make more time to do this, I am going to try to find more sitters, and worry less about our retirement. Because we need to keep our marriage alive and happy over stashing away funds for our retirement.

Problem #4: I am worried about David’s anxiety and mental condition.

I feel like I am not addressing this in the way I need to. I’m worried that he suffers like I did when I was a child, and by not having him evaluated by a pediatric psychiatrist I am not doing everything I can for him. On the other hand, I don’t want to worry prematurely or irrationally. I seem to think the problem is more severe than Eric does. Which one of us is right? What do I do? What should our next steps be?

Plan of Action:

I did get the name of a very conservative pediatric psychiatrist who uses meds as a last resort.

But before I schedule an appointment with her, which I will do in January 2009 after I have done the following:

• Read these five books, which have been recommended by my therapist, my doctor, and a pediatric behavioral specialist we saw:

• “Understanding Your Child’s Puzzling Behavior: A Guide for Parents with Behavioral, Social, and Learning Challenges” by Steve E. Curtis;
• “The Highly Sensitive Child: Helping our Children Thrive When the World Overwhelms Them” by Elaine Aron;
• “The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder” by Carol Stock Kranowitz
• “The No-Cry Discipline Solution: Gentle Ways to Encourage Good Behavior Without Whining, Tantrums, and Tear” by Elizabeth Pantley;
• “Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries, and Phobias” by Tamar E. Chansky.

• Spend at least two hours of individual time with David: playing baseball, kayaking, or reading together. I will either work less during the week or try to get a sitter for Katherine, so we can spend this time together. Again, bye bye retirement money. See you next life.

• Use the worksheets provided in “Understanding Your Child’s Puzzling Behavior” to log David’s behavior and such contributing factors as diet, fatigue, and other issues (including my moods) so that when I schedule an appointment in January (if I still feel like that’s the best route), then I will have all of kinds of supporting data with which to present to the doctor. I will also have Eric read through the logs to see whether he agrees or not with the assessment, and how environmental factors and diet affects David’s behavior and mood.

• Spend two hours a week on logging his behavior and/or reading the resources so that I feel like I’m moving toward a solution, and don’t feel guilty and anxious about the situation. If I can’t fit this into my work time, then I will try to get a sitter so that I can work on this just as I would if I were doing a research project.

* Be stricter and more consistent with regard to discipline.

As you can see, I have my work cut out for me. But this exercising of teasing out the specific problems and coming up with a definite plan of action is very empowering. It makes me think I do have control over some of it. If I make my goals small enough and specific enough, I can meet them. 

That’s what therapy does for me: provides me an objective view to the big picture, so that I can zoom in on certain areas that need addressing, and a person to keep me accountable to my action toward a solution.

To read more Beyond Blue, go to www.beliefnet.com/beyondblue, and to get to Group Beyond Blue, a support group at Beliefnet Community, click here.