As a gay therapist in Los Angeles for the past 27 years, I have found that Depression is the single most-common diagnosis and presenting problem. This is true for most therapists, from what I hear from colleagues and from my students that I teach in the advanced psychotherapy course at USC.
According to many studies, people overcome depression very often through a combination of psychotherapy and medication. However, there are many clients I encounter who wish to avoid using medication, even though I have seen it work miracles. When a client has questions about medication, or even outright fears of side-effects, we can talk about those – and if they’re interested, I refer to several local gay (or straight-but-gay-affirmative) psychiatrists (MDs) who can prescribe the right medication for that person. But for those who have tried medications in the past and didn’t get benefit from them, or who just want to avoid them for whatever reason, I teach those clients about overcoming (or at least improving) symptoms of depression (“Major Depressive Disorder) without medications, through various forms of psychotherapy, most notably, Cognitive-Behavioral Therapy.
Cognitive-Behavioral Therapy (CBT), founded by Aaron Beck, MD, and refined further currently by his daughter, Judith Beck, Ph.D., among others, basically posits that our thoughts influence our feelings, which influence our behaviors, which creates our subjective experience of life. That’s a simplification, but it works. Within this, Beck described how depression originates through what he called the “Cognitive Triad” – basically, three types of negative thoughts that we harbor in our minds, in our own “inner monologue”, and repeat, over and over, to our detriment. These are negative thoughts about Ourselves, the World around us, and our Future.
For gay men, we get more of this than straight people. Why? Because our minds and our feelings have to cope with an all-too-frequent barrage of negative statements directed at gay people. It’s fairly easy to internalize negative messages about ourselves if we constantly hear anti-gay rhetoric from politicians, religious celebrities, and even some musicians. When we see atrocities in the world, made more accessible by the Internet, social media, and countless sources of news, it’s easy to form a negative opinion of the current global state. When we see the many struggles the LGBT rights movement has faced, and continues to face, it’s easy to allow negative thoughts about the future. More so than straight people, we have to rally a healthy view of ourselves in a gay-positive context, and this takes some mental re-focus and work.
Without realizing it, most people who struggle with depression are in a very bad habit of repeating Beck’s style of negative self-statements to themselves many times a day. When a person really starts to be aware of how often they do this, the realization and epiphany of it can be overwhelming.
Think about what you do. How often do you mess something up, and say to yourself, “I’m such a dummy. How could I mess that up?” In that moment, you have just depressed yourself a little bit. That was a negative self-statement, this time about yourself.
Or, how about this: The clerk gives you the wrong change at the grocery store. You’re out at your car and late to be someplace before you realize it. You don’t bother to go back and correct the clerk; you just say to yourself, “What’s wrong with people these days? Is everyone incompetent anymore?” You’ve just depressed yourself again, with such a global statement about the current state of humanity in the world around you.
Or this: Your book just got rejected by an agent you sent it to. You read the rejection email and you say to yourself, “I don’t know why I even bother. This writing thing is never going to work. My previous successes were just a fluke; and I will never publish anything ever again.” Again, you’ve depressed yourself with that statement because it’s a global negative statement about your own future.
So, what do we do about this? To start, just be aware that there IS a “cognitive triad” – self, world, future – that exists, and that you’re doing it in your own thinking. Just notice it, mindfully, without judgment and without panic, every time you do it – for just one day. Catch yourself having these negative thought statements. Which category – self, world, future – do they fit into?
Now, let’s pretend you’re a copy editor at the New York Times. It’s your job to identify incorrect statements, and replace them with healthier ones. Instead of “I’m such a dummy”, you say, “Oops. I meant to emphasize the benefits of my company’s products in that presentation, not the features. I’ll re-write the presentation tonight and do it better for my new customer tomorrow.” Or, instead of “What’s wrong with people these days? Is everyone incompetent anymore?”, say “That clerk gave me the wrong change. I think she got distracted by the noise for a moment. I’ll cut her a break and let this go, but I’ll speak up next time.” Or, instead of “This writing thing is never going to work,” say, “Many authors had their work rejected many times before it was published. I will keep submitting and persevere, but I will ask my editor if there are any more changes to be made, and I will consult my writing technique books to see if any of my core skills in the book need to be strengthened.”
You see how different the second statements are, compared to the first? The second ones give you “wiggle room”. They are more specific. They avoid big, negative generalizations that don’t give you any room to move. The second statements give you something to work with, a “cognitive flexibility”. They encourage you, not depress you.
The entire process of Cognitive Behavioral Therapy is a lot more involved than this, but all of it contains techniques and concepts that are pretty easy, if you have someone (such as a therapist trained in it) to help you.
Outcomes studies about the effectiveness of psychotherapy (yes, they do those things, and quite often) have shown that medication alone for depression can, indeed, help. So can a combination of medication and therapy. And, so can therapy alone. But you have to actually do it; it won’t work if you don’t try.
If you’re willing to try, I’m willing to help you. Call or text 310-339-5778 or email Ken@GayTherapyLA.com.
