Fear of Scheduling

When I am working with someone with depressive symptoms, one of the main tools I use is scheduling. I usually explain that the purpose of Depression Recovery Scheduling is not to make people behave and do what they are supposed to do, to obediently check off tasks. It is meant to help the client begin to relax by acknowledging where they are right now. To rouse their curiosity. To bring some focus to a chaotic world. And to do it in the kindest of ways. 

In the case of depression, scheduling is used to begin to loosen the ties that bind one to the point of breathlessness.  Most often people with depression are in Survival Mode. Their attention is limited to this day, this hour, perhaps this moment. People will describe simply having the goal of making it through the day.  The Survival Mode is the first tie.

A doctor I worked with referred to what he called the “amnesia of depression.“ A cruel aspect of depression, related to sense of time and space, is that when mired in active symptoms, it is often difficult if not impossible to remember what it is like to feel well. It feels as if one has always been depressed and always will be depressed. 

The fog and pain of depression makes the world feel as if it is moving too fast and is an unsafe place. Clients have described that things can actually feel blurry, where events bleed into each other and nothing is ever complete, sharp, clear. This is related to the deep sense of disconnection that comes with depression, and the memory and concentration effects of depression.  An urgency and helplessness can ensue; an impossibility of “keeping up.” 

The final tie that is cinched to the point of pain is the cognitive aspect, the relentless rushing of negative thoughts about oneself. At the core of these thoughts is a fundamental sense of “I am bad, fundamentally bad.”

Put all of that together and imagine a therapist suggesting scheduling.  Survival mode, amnesia of depression, a too fast and unsafe world, and the sense that one is basically bad. 

The mere mention of scheduling can cause clients to recoil. Many hear the invitation to schedule as yet another impossible demand. They often already have a sense of failure about not being able to do the most basic things. Writing down what they plan to do in the week to come feels overwhelming. In the midst of depression a written event in a time frame can feel do or die. Even as it is written down many feel a sense of failure then and there. 

They frequently have well intentioned but poorly informed family and friends who have made all kinds suggestions for “feeling better.” Some I have worked with have referred to it as the “If you would only” Syndrome. Internally the depressed person’s response is “if I could do those things, I wouldn’t be depressed!”

So why in the world would I pursue this treacherous territory?  Again it is a medicine that can begin to expand space.

Schedule as Recovery Tool 

Here are the rawest of the raw materials that we have: space and time.

When you are struggling with a mood disorder and particularly depressive symptoms, space and time are distorted. It can simultaneously feel like there is not enough time and that there is absolutely too much time where you don’t know what to do with yourself.

These may be some of the qualities of distorted time and space.

Survival mode: a mind set of getting through the day, toughing it out, waiting for the day to end.

Task focus: getting tasks done in a mechanical way as a means of getting by, not getting “caught,” or not getting too far behind.

Success or failure: all or nothing thinking in assessing the value of one’s life and activity usually leaning toward the assessment of not good enough.

Stressed by external demands: feeling required to show up and finding that stressful.

Default activity: difficulty deciding what to do with oneself and one’s time, so defaulting to an activity where you can exit: tv, food, computer surfing, sleep. The quality of the activity is that it makes time pass without having to choose a direction. Deciding not to decide. Avoiding. Usually not very satisfying; may engender feelings of guilt and/or self loathing.

Activities bleed into one another: underlying worry about what is next and whether you will be able to meet expectations. Difficult to do what you are doing wholeheartedly. No matter what you are doing, vague guilt that you should be doing something else.

Struggle: this is one of the most common descriptions of depression that I hear. There is a quality of everything being effortful. Walking into a store, getting out of bed, doing laundry. You look at others and wonder, “How do they do it?”

You probably know many of the lifestyle prescriptions for depression. Healthy diet, good sleep, get up at the same time every day, exercise. In a word: Routine. The real question is HOW do you incorporate any of that into your life when you are depressed?

Schedule can be a place to begin

Yes, schedule. Okay, so before any freak out here, stay with me as I redefine schedule.

Schedule as mirror

When you are depressed thinking and self assessment are off. One of the most common distortions associated with depression is discounting the positive. When people try to recall their week mentally, they do not tend to remember positive events.

One of the first things I ask clients to do is to keep a log for a week, to simply write down what they do as best they can. This does several things:

*You are establishing a clearer relationship with space and time simply by making note of it. Writing it down makes it an object to look at rather than being stuck in your head. For example, if you can look back on Monday and Tuesday when you are feeling poorly on Wednesday that is more spacious than barely being able to stand the next moment.

*It brings space between the person and their activity. It is a way to reality test. There is often a sense of surprise when schedule is reviewed, that so much is forgotten. It is not unusual for someone to come in for a session. I ask them how they have been doing. When depressed they will often make a very negative assessment of how they spent their week. Then when we review schedule together they are amazed at how they painted the week totally dark with a very broad brush, as they find moments of pleasure or peace.

*It is a record to begin to notice patterns that usually have little to do with success or failure. You can start to look at activities in relationship to one another. People often notice if they can get out of the house to do one thing they can tack on another more easily. Maybe dropping the kids at school is non negotiable so packing working out clothes or hiking shoes for after drop off can be a strategy.

The magic of a week

I also work with people who have TBI, traumatic brain injuries. Memory difficulty will often be a significant aspect of the injury. I noticed over time that when a client with TBI could hold the sense of a week, eg, truly remember that they met with me last week and here they are again today a week later, their recovery would take a leap. It was an emphatic demonstration of the magic of a week. There is something to be said for a more expansive sense of time in contrast to Survival Mode.

I ask clients to work with a format where they can see a full week. Day at a time calendars invite Survival Mode thinking. Monthly calendars are not focused enough. I sometimes refer to “the basket of the week.” It is a container that is large enough to arrange things properly. Rather than carry around an endless list of to do’s, when you schedule a week you can see where things fit in relationship to one another.

Interestingly enough, I find this to be a body based practice as well. For example, a client may earnestly schedule themselves for going to the gym 5 days a week, often when they have not been going to the gym at all, and often when they do not particularly like going to the gym. They may try to please me and fool themselves the first time I ask.  If I ask again, encouraging them to see what their body says. They most often find a definite yes or no.

The medicine of beginning, middle and end

By scheduling activity in the basket of the week and being realistic about what is appropriate for the week, events can begin to come in to clearer focus and regain their integrity of having a beginning, middle and end. A dear colleague and friend worked with preschoolers. As they would begin to ask her about what was next or if they were going to do this or that today, her gentle reply would be do what you’re doing. Do what you are doing. It’s quite a satisfying feeling. One thing at a time, fully.

Activities having a beginning, middle and end also suggests scheduling transition time. Allowing time for travel, a snack, a trip to the bathroom. I regularly suggest that clients arrive a few minutes early for their appointment so that they have time to gather themselves, I remind them to turn off their cell phones, and I suggest a short five minute walk after a session.

Schedule as shield

As I mentioned earlier, when you are depressed, time is distorted. There is often a feeling of overwhelm. So when you are on the phone or out in the world and requests are made, you may find yourself making decisions and commitments impulsively and out of context.

Schedule as shield means that you take the time and make the time to see if and where activities fit in the basket of a week. Schedule as shield means you become more comfortable making requests and offering counter proposals.

This may require telling others, “let me think about it, I’ll get back to you.” Buy a little time to see where and if the proposed activity fits and works for you.

Schedule as Dynamic

I think one the reasons people cringe at the word schedule is that they associate it as something rigid and unchanging. Not so. Life will always have a percentage of the unexpected in any given week. Seasons change. We experience different stages of the life cycle.

We are not trying to create a static schedule because it simply does not work. Life is dynamic we are dynamic. We cannot move unless we make a relationship with right where we are.

Every week we arrange a new basket. Some elements may be included for some time. But at the end of each week we are reflecting and seeing if the basket was satisfyingly arranged and how we might fine tune it for the next week.

Weaving, Clustering, Elegance

As we arrange our basket of a week, time after time, we begin to notice that we are developing arranging skills. We begin to recognize what the anchors are in our week. Maybe bed by 10:30 and Wednesday morning yoga. We begin to notice when our energy is strongest for which activity and quit trying to push ourselves so hard to do everything all of the time. We think more about balance, beauty and satisfaction.

Rather than thinking of schedule as empty boxes to be filled dutifully, we begin to see schedule as an elegant art form that can move our lives forward.

For more info about depression please visit my website SupportforDepression.com