Saturday, August 27, 2011

Is it really that easy to Just Do It?

Today's email brought news of another study about the impact of exercise on depression. This one was conducted by the University of Texas, seems very well-designed, and the upshot is that exercise works just as effectively as a second medication for folks with long-term depression. The trend among prescribers is to add something like Abilify to a current SSRI (Paxil, Prozac, etc.) for their patients who have depression that's not responding to just one med. This study shows that there is another way for many people to have the same result, without an extra med. Around half of the people who added regular exercise to their SSRI improved significantly.

So, you say, why don't I just tell all my clients to exercise?

The answer, as always, is that it's just not that simple. While I am keenly aware of the benefits of exercise, and try try try to add it into my lifestyle (No, really, I try!), it's not as easy as simply suggesting it to someone as though they've never heard that idea before. Can you imagine that there's someone left in the U.S. who hasn't dealt with a daily barrage of messages about their size, their laziness, their lack of motivation, their inability to look like people on TV? This is where my job gets complicated. Again.

The act of fostering change is one that we spend all our time in graduate school trying to figure out. And then we go into practice, and we learn a little more, and we keep trying. We get a dozen years of experience under our belts. And we are faced with a client who, for all we know, would make rapid improvement with exercise. And our years of experience sit there in our heads, mocking us.

While there are some who benefit from the boot camp approach, I'm guessing that many of them aren't overcoming serious depression, or a life of parental shaming, or a daily battle with body image. Screaming at my clients to "just do it" might benefit a couple of them, and damage my relationship with the rest. Mine is not really to urge, or cajole, but to join with my client in a process of discovery - how do I really feel when I resist exercise? What are some thoughts about my body that I might want to choose not to believe anymore? Is there a gentle experiment I can do, one without a failure component, that will let me try something new in a safe way?

Unlike the trainer at the gym, my job isn't to goad you into getting your workout done, no matter how positive the results may be. My job is to help you realize that no matter where you want to go, you've got to start just exactly where you are today. Judgment doesn't change that. Then I work with you to help you find about yourself, figure out what might be in the way, and to stand by and support you as you try out some new behaviors. If those behaviors don't "take," that's just as successful an experiment because we've learned more about the problem. I'm happy to help hold my clients accountable, if they want, by asking them to exercise, and I'm hoping that they'll have a few experiences that show them there's a better way.

There are therapists who will push, and goad, and you can find them by asking if they'll do that for you. In the long run, I've seen my way work more often than not. And, to me, that's reason enough to stick with it.


  1. I agree with your way (from personal experience).

  2. "Is there a gentle experiment I can do, one without a failure component, that will let me try something new in a safe way?"
    That is one of the requirements I have for, well anybody actually. Not just therapists. "Baby steps" FTW.

  3. One of the students I saw was constantly assigning me homework. And usually it was stuff I had no interest in - not the "omg I dun wanna!" that I get when it's something important that I just am not willing to face yet (which is usually someplace important to push) but stuff that really didn't resonate with me.

    Bear in mind, I was seeing her at a time when my depression was at it's deepest and I actually got to the point of being suicidal during this time frame, so my judgement wasn't the best.

    But she sent me home once, just a few minutes into the session, because I hadn't done my homework.

    I can appreciate her purpose in doing so, but at that point in time all that came across was total rejection, from the one person I was supposed to be able to trust.

    So yeah, I like your approach better.

    When it comes to me and exercise, I have found that it really makes a difference what *kind*. Just plain walking? Bores me out of my brain and leaves my mind free to fall into its depressive patterns and can actually send me deeper into a depressive tailspin. The one thing that really works for me is dancing - but dancing can also trigger my body-image issues (which are frighteningly powerful), so I need to be careful with it too.

    Our minds are such strange places...

  4. I meant to comment on this post before now, to say a couple of things. First of all, I like reading your blog because I always feel like I'm getting free little therapeutic tidbits. Something about certain things you say makes me reconsider my own beliefs, and to think about things in a different way.

    Second, this Just Do It column was especially meaningful to me. I am in the process of just doing it, and it's hard work. But good work. The questions you casually posted about body image really made me think, so thanks for that!

  5. Thanks for the comments, folks. I learn from you just as much as you learn from me, for sure.