Mathias’s Story
Kjell Tore
Mathias never liked school, and he dropped out in his teens without completing high school. Now in his mid-thirties, he has been depressed as long as he can remember. For him, it is the normal status quo. After dropping out, he started working to earn money by helping local farmers take care of their animals in the summer and working in the forest in the wintertime harvesting timber. He got his driver’s license at eighteen and bought a car as soon as he had earned enough money.
Tall and overweight, Mathias avoids getting into conversations with neighbors or other people in the rural community where he lives, and offers few facial expressions to let people interpret his mood and intentions. To most people, he seems quite serious and stern, and the local kids are scared of him, although he has never been mean to them. To adults who do not know him, he gives the impression of being intellectually challenged. He contacted a local therapist after his girlfriend of a few years, Anita, had threatened to leave him unless he got help for his depressive condition.
Mathias and Anita live together in a mountainous part of the country with a dog and some chickens, far away from the closest city. The only joy Mathias would talk about with his therapist was taking long drives with his girlfriend to go shopping in the city. He felt safe that no one would recognize them that far away. He had been quite a bully in his youth and was afraid of encountering former classmates in his local community whom he had treated badly in earlier times. The past few years, both he and his girlfriend had been smoking marijuana and drinking alcohol when they had the money for it.
Cognitive testing revealed that Mathias had poor verbal understanding and reasoning skills but quite good visual reasoning skills, meaning he was not so good at small talk or long, intellectual discussions, but very good at practical tasks. He tended to be quite impulsive and had a persistent habit of avoiding any challenging task he was asked to do by saying, “You probably think I am stupid.”
STEP ONE: GET A GRIP. To start with, Mathias needed to work on gaining some control over his impulsiveness and attentional focus. The neuropsychological testing indicated that his attention span was short, so his therapist would see him in short sessions with a single theme or task per visit. They would start every session with a short breathing exercise, to teach Mathias a strategy to delay impulsive urges. Since his verbal abilities are limited, the therapy sessions needed to be structured in a way that takes advantage of his visual reasoning strengths. Short, practical, motivating tasks can be designed for him to solve in order to help him focus his attention when working through the five steps.
Mathias was able to name a problem he wished to work on to address his depressive mood. The problem he formalized was his lifelong sorrow of feeling like a failure. He hadn’t finished high school, and he hadn’t been able to hold on to a job for any meaningful period of time. He is currently unemployed. His relationship is strained, and he is certain his girlfriend is about to leave him.
Working through the emotional underpinnings of his feelings of failure, Mathias recognized that he had never had any support in his formative years to achieve any goal or follow through on any challenging activity he wished to pursue. He had developed a recurrent pattern of impulsive interests that he abandoned at the first sign of difficulty. Giving up became a successful strategy for him to avoid failure, and he automatically applied this strategy whenever he sensed problems on the horizon. His parents had struggled with mental health issues as well, and he had been moved into various foster care homes in his early years. He never achieved mastery of any sport, skill, or ability.
The fact that he was tall and strong from an early age, however, gave him physical prowess that he used in his youth to gain a sense of self-confidence. The result as he became older, however, was that it just pushed everyone away from him. Thinking about this now makes him even more depressed as he now understands the anxiety-inducing effect his behavior has had on others.
STEP TWO: PINPOINT WHAT YOU CAN CONTROL
What couldn’t Mathias control? Mathias realizes there are many things he has little or no control over. He couldn’t control whether or not Anita loves him, if she is faithful to him, or if she ultimately will leave him. Nor could he control the consequences of his earlier bullying. And he is not sure how much his depressive symptoms are the result of a mental condition inherited from his parents, or the result of his difficult upbringing.
What could Mathias control? Thinking through this question, Mathias became aware of many things that he had control over in his everyday life. He could control his daily eating habits, exercise routines, and sleep practices. He does not have any problems falling asleep, but he simply never went to bed until a few hours past midnight. The darkness and stillness of the night seem to calm his fidgety brain. But he could decide to go to bed earlier.
In many areas, he recognized that he could make better decisions for himself to improve his physical and mental health. Moving forward, he can make an effort to treat people fairly and not let his mood and temper get the best of him. Importantly, he recognizes that he can control the way he treats his girlfriend, how he communicates with her, and what activities they can do together to strengthen their relationship. This has become a particular focus for Mathias.
What could he do about the things he couldn’t control? Even though he couldn’t control his girlfriend’s feelings about him, Mathias could control his behavior toward her. He could work to be the best boyfriend he could be. The process would give him self-confidence; the end result is out of his hands. He could be more aware of his tendency to give up quickly, and make an effort to hang in a bit longer when his gut is telling him to give up. And if working through the five steps with a therapist does not relieve his deep symptoms of depression, then he would see a doctor about getting more help.
A serious area of insecurity for Mathias is whether he could actually control his urge to take drugs. He is motivated to stop but realizes that he would have to get help from a specialized mental health professional to control that urge—perhaps having to take medication if needed. He also has the idea to attend couples therapy with his girlfriend to get help communicating better. He realizes that even if he tries to change the way he communicates, many years of misunderstandings might not make it easy for her to understand his new efforts. After all, he is not strong at verbal communication, while that is a strength in Anita. He may have to give her insight into his way of communicating if she is open to learn.
STEP THREE: PUSH INTO MOTION. To start with, Mathias has to find internal motivation to change and work on strategies to get in a more positive frame of mind and practice more constructive behaviors. He is motivated to change, but being positive is unfamiliar territory for him. Yoga and meditation are not his thing, and even the simple act of putting a smile on his face is a challenge. It may take a long time for him to effect change in his way of thinking and to make it automatic. But he can work on his smiles (smiling to people he passes by on his walks) and his comments (complimenting his girlfriend and his neighbors if he dares approach them), to name a few areas of practice.
Mathias divided the specific actions he needs to carry out to counter his depressive mood into Easy Actions and Tough Actions. He made a list of actions he could start working on immediately and actions he would have to work on over time. One thing he can start practicing every morning just before eating breakfast is to take one very deep breath, giving attention to how it fills up his lungs and abdomen, and then follow it up with four long, deep breaths. He also has a list of daily routines he can follow. He recognizes that he will need to ask for help to carry out most of the Tough Actions.
One of his biggest challenges due to his impulsive nature is to learn to apply an internal filter to his thoughts, words, and behaviors when interacting with his girlfriend. An important skill is practicing to delay reacting to emotionally laden comments. When she texts him that she misses him, he will refrain from texting her that he misses their dog. He will stop and take a deep breath—or five—before he responds. In talking with him, the therapist understood that Mathias thought this was funny, but his girlfriend did not see it that way. Working on understanding her perspective will be a long process for Mathias, but it is a necessary step, not only to help the relationship with his girlfriend but also to help him get out of his self-absorbed bubble. The simple process of thinking about how words and actions will affect the person on the receiving end would represent a significant change in his daily interactions with the people in his environment. In particular, his girlfriend.
When it comes to his girlfriend, his focus will not be on “improving the relationship,” but on his own actions that will make him a better partner and the habits and behavior that will make his everyday life as healthy and enjoyable as possible.
STEP FOUR: PULL BACK. Mathias realizes that a key prerequisite to establishing a better relationship with Anita is to take better care of himself. The best way Mathias can be kind to himself is for him to stop his habit of criticizing himself for everything he does. He realizes that saying that he is dumb in all contexts in which he is facing a difficult task is an unhealthy defense strategy. He decides to learn new phrases that he can use to build confidence every time he gives his best effort.
Every time he feels the motivation to make changes to his thought and reaction patterns Mathias tends to have a flashback about what a miserable life he has had. All the bad feelings of his past come crashing down on this big man, and it makes him feel like a little boy being smacked down by one of his parents. He decides to take a larger view of his life when this happens. Instead of diving into those feelings of humiliation, he will take a bird’s eye view of his life. This will help him see that then was then and now is now. He does not have control of the “then,” but he does have control over the “now.”
He has also spent time reflecting on the effect that taking drugs and alcohol had on his ability to control or influence his future in any real way. He has come to understand how his parents lost the war to their own cravings, and he saw how a similar tendency was working to destroy his life and the lives of those close to him. He realizes that he will need help to change some of those destructive behaviors that have become automatic and seemingly impossible for him to control, but he is motivated to choose a future different from the one his parents chose. This new future will be his.
STEP FIVE: HOLD ON AND LET GO. Recalling the traits of his youth, Mathias found that loyalty and an easygoing nature are two qualities from his past that he intends to cultivate. These are qualities he admires, and he sees that they are part of him. He feels they are qualities he can be proud of, and he will use them in his commitment to improve his relationship with his girlfriend. He has gained a belief that every effort he makes toward this goal would give him pride and purpose and affect his mood in a positive direction. He cannot expect these qualities in his girlfriend, but he can commit to exhibiting these qualities in himself in all areas.
He understands the term loyalty to mean following through on the promises and agreements he makes. To act on his easygoing nature, he will let go of reacting in an aggressive way when his girlfriend does things that he normally reacts to. Here he will hold on to the new skills of breathing and applying his internal filter to delay his impulsive response pattern. If there are serious issues, such as her taking drugs or alcohol, he can learn to bring them up in conversation in a supportive way. But first and foremost, he can be loyal to his promise to not take drugs himself and in this way be an example for his girlfriend to follow.
Mathias has also always had a fair sense of justice and of what is right and wrong. Even as a young bully, he never preyed on the children who were not able to fend for themselves; he only bullied the children who were unfair to others. At least, this is the way he remembers that part of his life. And if it gives him pride to feel that he can have that role of being on the side of fairness and justice, then this will be an important quality to hold on to in the years ahead. He decides to tap into his strength and sense of fairness to help those in the community less able to fend for themselves when they are treated unfairly.
Mathias decides he will work on letting go of his anger about missed opportunities in his past. He has a chance to work on feeling in control of his life now, so the feelings of loss of control of his life in his past can be placed back in the past where they belong. He also decides to accept his past and let go of his tendency to constantly revisit the shortcomings of his parents. He recognizes that their substance abuse prevented them from being the parents they wanted to be. It’s not an excuse, but he decides there is no reason for him to let these feelings hold him back, so he lets them go. He can learn from their mistakes and cultivate a positive attitude of control over his urges to fall into the same trap by instead channeling those urges into positive actions.
Finally, Mathias will need to set up a plan to monitor the progress of his actions on a regular basis with or without his therapist. He has needed help in setting up a program to get him going in the right direction, but in time he will need to put in place his own routines for monitoring how his thoughts, feelings, and behaviors will be aligned with guardrails for him to thrive and grow moving forward.