Dysthymia - A short client profile
A couple of years ago I started working with a client who stated her doctor thought she had Dysthymia. I had heard of the condition, however did not know much about it other than it's symptoms are similar to that of depression.
I decided to read up about Dysthymia to ensure I was providing the best possible counselling service I could for my client taking into account her GP diagnosis.
I discovered that the condition combines a mood disorder with chronic depression and has long lasting symptoms (more than two years for adults). This was true for my client as she stated she had been ‘moody’ for years and was starting to believe it was her personality.
Her parents would say to her “why can’t you be happy and cheerful like your friends”. My client, let’s call her Alison, would feel further inhibited by these comments and a spiral of low mood would continue.
It wasn’t until Alison was in her late 20’s that she became fed up with feeling low and sad on a regular basis. Colleagues would always ask her “are you alright?” even when Alison thought she was having a ‘good’ day. She visited her doctor who prescribed a small dose of anti depressants and recommended counselling, which is how she came to be a client of mine.
Alison’s symptoms when I first met her included overeating and using food as a comfort. She was slightly overweight and stated she had struggled with her weight since early teens. This factor had contributed to low self esteem and confidence issues, particularly in school and it wasn’t until she was 15/16 that she established a couple of close friends.
Alison seemed like a successful career person however and was beginning to question whether she should just ‘put up with’ how she felt all of the time, seemingly for no reason. Colleagues would tell her to “cheer up”, but then didn’t bother after a while as they became used to Alison seeming down in the dumps.
Aside from symptoms Alison described, I noticed her presentation was, at times, unkempt. Her hair was dishevelled as though she had tied it back before going to bed and hadn’t bothered to redo her hair the following day. She never wore makeup and rarely smiled, although she did have a unique sense of humour which was quite dry.
I quickly noticed that Alison complained a lot about colleagues and management, yet lacked a desire, or perhaps energy, to solve issues she had with them. The counselling was slow work and we spent quite a few weeks building rapport and a therapeutic relationship. Alison began to feel more comfortable within the counselling setting and I saw her personality, or at least another side to her personality, emerge.
She would smile and at times laugh about something that had happened which would catch her by surprise. After about four months of counselling, Alison began to report social outings she had been on and I noticed subtle changes in presentation, such as a new pair of shoes or a bit of mascara. She complained less. Alison was getting to know herself and as a consequence, her world outside the counselling room was slowly changing, peoples responses to her were more friendly… people began to notice her and were no longer avoiding her in the canteen at work.
Her mood was lifting, however I felt great responsibility to ensure this happened at a slow and manageable pace otherwise Alison was in danger of feeling unsafe, that her world was becoming unfamiliar which could rock the foundations of her coping structure. As an adult she had not known feeling anything other than ‘down’ for much of the time.
Sure enough, Alison hit a point whereby she just cried for the whole session. She felt as though she didn’t know herself and seemed scared of change. With lots of listening, reassurance and reflections of her achievements in recent weeks, this low point was temporary however I believe may have been grief/loss for what she had known for so long, even though how she felt before was simply “just sad” as she described it.
A few months later, Alison felt ready to end the counselling. She was still on anti depressants but was attending three monthly reviews with her doctor. I am confident that Alison had broken away from the attachment of Dysthymia. She now knew she had the ability and another element to her coping structure to maintain a sense of positive wellbeing, however she was grounded enough to know that there would be days when things were more challenging.
One thing was for sure, she no longer fell into the diagnosis of Dysthymia as she had experienced more good days than bad for a substantial period of time. I really hope this continued for Alison and I also hope her story can offer you hope if you have had a diagnosis of Dysthymia or depression of any kind and are worried that you are now stuck with it for life.
I have provided a snippet of a presentation for someone who has Dysthymia. Diagnosis is complex and symptoms vary. Please see your GP if you feel you may have the condition or are experiencing similar symptoms.
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