For five years, I've been going through phases of depression. I get tired and sometimes don't want to get out of bed. I used to be very outgoing and loved being around people, but now I'm more and more fearful of social situations. I sit in a corner and avoid everyone, waiting until we can leave. I go for walks with headphones on so I won't get trapped into having to talk to anyone. After I get to know people, I cling to them and feel violated if anyone comes between us. Nothing "bad" is going on in my life. In fact, my life has never been better. I've seen three therapists, but they see me for a few months and then decide that I'm fine and reduce my sessions to once a month. Why bother? I've spoken with my doctor, but no one seems to think that anything is wrong with me. Am I just losing it?

J.T.

I can't say definitively what's going on with you, and what might help, without talking with you personally. But it does sound as if something is adversely affecting you. If your physician has indicated (after an appropriately thorough evaluation) that there's no physical or medical reason for your fatigue, depression and social withdrawal, it stands to reason that there are psychological causes for your problems.

If that's the case, perhaps any pertinent issues or factors did not emerge in your therapy because your treatment was relatively brief, and there was probably little or no continuity among the three therapy experiences. One of the first things that came to my mind was a question about the model under which you saw those different therapists, and whether that approach to therapy allowed enough time for the true nature of your problem to become known.

My suspicion is that you saw those therapists through a health maintenance organization (HMO) or managed care organization (MCO), or some other such agency in which short-term therapy was emphasized. In such settings or arrangements, therapists are encouraged to focus only on immediate problems or symptoms in their clients' lives, and to reduce or stop therapy once those immediate problems have been resolved (or whenever the therapist is unable to justify to the HMO or MCO the need for further therapy). There is little support for a client's being allowed the time he or she may need to feel comfortable enough in therapy, and with the therapist, to become aware of (or reveal) whatever might truly be going on with him or her. Some people who have difficulty with social interactions or emotional intimacy can take a year or more of regular (usually weekly) psychotherapy contact before that happens.

If you think that might be the case for you, I'd recommend finding a therapist (paying for it yourself if necessary) who is knowledgeable about longer-term psychotherapy. That may mean finding a psychologist or counselor whose formal training was more than a decade ago, as the brief therapy model seems to have permeated many contemporary training programs in an attempt to help new professionals survive in the current MCO-driven mental health system. The advantage to working with a therapist outside of an insurance/managed care arrangement is that you and he or she are completely in charge of your therapy. I'd initially discuss with your new therapist not only the problems you've been experiencing, when and how they started, and your current life situation (even though you say it's never been better), but also how your shrinking from social interactions might manifest in the therapy relationship itself. You might also consider finding a really good therapy group in which you can process your social fears (which, of course, you would at least initially be experiencing in the group itself). Some people benefit from engaging in both individual and group therapy at the same time.

I don't think what you're experiencing necessarily means you're "losing it," but I DO think your distress warrants further examination -- perhaps more than has been available to you thus far. I hope you'll consider another go at psychotherapy, but this time planning on (and discussing with your therapist) a longer time frame to provide space for exploration that may need to go slower and deeper than your previous experiences.