StayOnTop: Depression

Tomorrow I am going to formally leave the discussion group – not an online but a real-life group – I participated in for the last half year. It is one of the groups that our local mental health care organization offers to clients (patients, if that is what you prefer). This group, labeled “structure group”, is for men only and meets every week with two professional coaches supervising the discussion. In a general sense, the goal is to improve structure, in other words, to give people a better grip on their own lives. To that end, during a typical session in random order each of the participants relates what he did in the past week. Sometimes, one or two of the others ask a few questions, but critical comments are very rare. The coach usually reacts with an encouraging remark (“Well done! I understand how difficult it was for you to go out shopping, but at least it’s good you gave it a try!”) and then it’s the next one’s turn. At the end, all participants are asked to briefly state their plans or intentions for next week. That’s all.

    I guess I may be a difficult and exacting client, but right from the beginning I found this formula very deficient. After trying to adapt and trying to make sense of it for several months, in the past weeks I tried to express my criticism and to formulate some concrete proposals for change. As a result, in hindsight a predictable result, both the coaches and some participants suggested I might better leave the group. You might say they kicked me out for disturbing the peace. So what were the problems I tried to address?

    The main thing was of course that (except for my recent critical notes) nothing at all ever happened in this group. Every session was almost like an exact repetition of the previous one. The core reason of this was that in spite of its name, this group lacked any guiding vision of structure: structure in the group’s own discussions, structure in people’s thoughts, structure in people’s lives. Worse, in spite of the presence of professional coaches the group lacked any specific goals: no short-term session goals, no long-term orientation goals, no shared goals, no individual goals were ever clearly laid out. Questions like in what respect one wanted to make progress, and how one would want to attain such a personal goal, and in what time frame, just were not asked. In a typical session no one made a critical remark, as if both the participants and the coaches were afraid that the other might be hurt by any form of instructive comment.

    Consequently, as far as I can see, no one was ever really helped by taking part in this group. So why did people put up with it? Had they all given up on themselves and on any notion of progress? Was the real function of this group to just give them some kind of safe haven, some easy and undisputable client identity? I was really shocked when one of the men, wanting to defend the group routine against my objections, almost proudly told he had participated in this same group for 15 years and was very happy with it. Apparently, the idea of trying to change something played no role for him whatsoever.

    And this is – I have to admit it – where I got a little angry. Angry not with the other clients, but with the group coaches. By not planning anything, by never giving anyone some kind of homework or challenge, by not setting goals, by not giving any fundamental suggestions, by never discussing people’s errors and mistakes, by just leaving it at being nice and friendly and understanding, they did in fact take no one of us seriously. They gave no one a chance to actually learn something. So why didn’t they try to do what they (at least in my book) were supposed to do?

    Right now I will not discuss all possible reasons for their passive attitude. But I do want to tell that even I, while not at all a professional in coaching people with psychical problems, could clearly see how some of the other participants might be helped to begin doing something about their own condition. For example, there was one client who obviously needed to develop more self-confidence; there was another one focusing on nothing but his own feelings who needed to break free from his narcissism; there was myself needing various things such as improving my bad self-discipline; and so on. A pragmatic mix of homework tasks, just using some simple tricks drawn from various approaches like Mindfulness (non-religious meditative concentration) or NLP (Neurolinguistic Programming, a bombastically misnamed but practical set of learning techniques) might have helped most of us to make some small but significant changes.

Changes? I fear this was the problem. I fear that most of the men in this group did not really want to change anything: that most of them had given up on themselves years ago. I fear that for most of them, being A Psychiatric Patient had become an essential part of their identity: a part they would not dare to change because changing it might leave them with nothing but a confusing mess. To illustrate this, some of them were in the habit of visiting lectures given especially for patients, or frequenting a coffee house dedicated exclusively to serving psychiatric patients. Yes, such things may be of value, but not when they become dominant. These men had become what I would call professional patients. Any change to this status was probably felt to be threatening. And the coaches? I suspect that in order to keep things safe and stable and predictable and easy for themselves, they simply accepted the participants’ resistance-to-change.

    So in all respects this group was locked in a Room With No View. From the first time, it struck me that there was no apparent view of what should be done in this group and how it should be coached. But much more creepy is the feeling that most of the group members had no clear view of their own capacities for improvement: no view of a future, in fact. And the worst thing of all is that the coaches did not even try to open some windows, did not even try to give them a glimpse of a more promising view.

    In the next weeks, I will try and see if I can convince some people in the same mental health care organization to experiment with an alternative discussion group: one that is focused on initiating and supporting personal change. So maybe I will get back to my group adventures in one of my later posts!

• tip: Whatever your depression- or other psychiatric problems, try to not become a “professional patient”: there always remains also another part of you with promises and possibilities. That other part of you is the window on your future. Never let that view fade out of sight.

 
Author: Henk van Setten