I went into therapy Monday evening with an updated version of my depression map. I originally created it late last summer, to help E. understand what was going on with me. If we are just talking, I tend to minimize things and then feel hurt because she doesn’t notice how bad I’m feeling. In fact, when I first showed it to her, she was surprised.

At the start of the session, I pulled out the new version, then showed her a copy of the older version for comparison. I reminded her how to read it. “Remember, the things lower down on the map are things that come up when I’m doing worse. And see, I used two colors last spring to show improvement between the spring and the summer.”

“Now here is the new one. I used reddish diamonds for November/December, and blue circles for how I feel since I started back to work on January 4. And obviously I don’t feel these things all the time. But in January, I feel them part of the time most days. I can feel okay and be busy doing things, but then I drop for a while. And I don’t necessarily stay there for very long, maybe half an hour or a few hours. But sometimes it can be several times in a day.”

She read over the new one thoughtfully. “Thank you for bringing this in. It’s very helpful. So of these symptoms that are showing up again, which ones are bothering you?”

I paused. This is always hard for me to talk about, even with her. “I guess the urge to harm myself. I mean, I’m managing it. I mostly cope by postponing it, telling myself I can still do it later if I need to. Or I distract myself with a movie or a book. I haven’t actually done it.”

“Does it help,” she asked me, “if you think about it, not as something terrible you shouldn’t do but rather as an adaptive strategy?”

“That is how I think about it. I know it’s a coping mechanism.”

“What do you think you use it to cope with?”

“Feelings. I don’t know what they are. I just know they are intense. I’ll feel like I don’t have any skin, just raw nerves exposed, and it hurts. It’s agitation. It’s, I don’t know, I can never explain it. And I don’t necessarily know why I’m feeling it. I know it’s associated with stress but it’s not all the time when I am stressed. It’s confusing.”

We talked a bit about other coping mechanisms I had, many of which I use pretty regularly. But you know how it is when you talk about something in therapy that is familiar, you have talked about it before, and yet it doesn’t feel like the right thing? That was my reaction. I have had the conversation about alternative coping mechanism a hundred times.

“You know,” I told her. “All the coping mechanisms are about making the feelings go away. Distraction, burning, meditating, yoga, exercising. I use all of those to chase the feelings away. But maybe that’s not the right approach. Maybe I need to sit with them, just let myself feel them.”

“Hm, you may be right,” E. said. “Maybe you had to distract yourself or chase the feelings away for a long time, but now you are ready to feel them. You are strong enough now. Let’s think about what that might look like. Do you know when you feel the urge to harm yourself?”

This was hard to answer. I realized that I fixate on not wanting to feel that way, and so I am not very observant of myself. I had to think a while, and then I said (looking at the wall, not at her, as I do when talking about things that also embarrass me, “I’m not sure exactly. In terms of work, I think maybe it’s when things feel overwhelming with too many things moving at the same time, all over the place. Maybe it’s when a lot is being expected from me, right now, at this moment, and it’s not at my pace, and it’s not my choice. It all feels out of control, and I feel that here, in my chest. Maybe it constricts my breathing. And burning myself would pull all that dispersed energy that is all over the place and pull it down and ground it in the part of myself that I burn. So then it feels less out of control.”

Her response was, as usual, interested but not judgmental. “So what I heard that I think is very important there was ‘not my pace, not my choice.’ It would make sense to me that this is triggering for you, at a very primitive level. You had things happen to you very early on that were overwhelming and out of your control, and that provokes a lot of fear in the girl. If we go back to your commitment to believing the girl, you know what she experienced. And then as a young woman in your first marriage, you also felt things were out of your control…”

After that, I can’t remember exactly what she said. It was something about telling the girl, with no judgment, that you understand why she feels like that. At the same time, you can assure her she is safe now; it’s not the same situation anymore. You can take care of the situations in front of you now, and you will protect her.

This is all a little fuzzy in my head. I don’t exactly remember or understand what she said. What I do remember is that we agreed I would try this week to step back and observe when I have these feelings, where I feel them in my body, and anything else that would help us better understand what is really going on.

And over the last day or two, I have noticed that some of the “I’m so bad” thinking or the urges to hurt myself tend to come up when I feel my time and energy is all going to be diverted from what I want to work on to things I “have to do.” And they are especially powerful when I feel I am not going to be able to meet someone’s expectations.

This sort of surprises me, because I believed I had come to a point of accepting that it’s impossible to make everyone happy, and my real job is to set priorities according to what I most want to accomplish (of course, in line with the mission of our organization). I genuinely thought I had that down. But perhaps it’s another one of those lessons that is solid in my head but hasn’t yet been integrated in my heart.