In therapy and out, there is perhaps no more talked about emotional malady than depression, and no form of therapy more prevalent than depression therapy. Everyone experiences depression in some way, some much more than others. (Major Depression and Dysthymic Disorder or Dysthymia are other terms given to specific varieties of depression.) Depression therapy is often what people think of when they think of therapy, period.
Yet in providing therapy for depression, there is a paradox: It seems clear that what everyone is experiencing–what everyone means when they refer to depression in therapy couldn’t possible be the same thing. Depression means so many different things. And yet we rarely question just what is meant by depression, in our ordinary conversations in the world and in the high-stakes conversations that take place in depression therapy. Here are a few examples one might here walking down the the street in New York City or if you listened in on a session for depression therapy:
“I’ve been really depressed since I lost my job.”
“I have struggled with depression my whole life.”
“I find my job really depressing.”
“My depression has been really terrible lately.”
“My mother has been depressed since my father passed away.”
What’s so important about recognizing the multiplicity of meanings expressed with the word depression?
To start with, it has a great deal of impact on how we approach depression therapy to help someone who’s struggling with depression. We can’t begin depression therapy with the assumption that we know what one another are talking about. Doing so would imply some sort of cookie cutter approach to helping. It would be bad therapy.
Depressed? Depression therapy can help you create a less depressing life.
There’s a sort of catch-22 in depression therapy, and it’s a painful one to work through, both for the patient and the therapist. After some time of struggling with depression, a patient in depression therapy may find herself with a fairly depressing life. At the same time, of course, it is the circumstances of a depressing life, past and present, which produced and sustained the depression that brought her to therapy.
Here are some of the ways we think about tackling depression in therapy:
Depression therapy with or without meds?
It’s hard not to talk about depression therapy without talking about anti-depressants. Many people find them remarkable helpful. Others have an insignificant or even disastrous experiences with them. We’re pretty neutral on the subject of psychiatric medications in general–if they’re helpful, if you’re open to their help and you can tolerate the side-effects, great. Plenty of our patients in depression therapy take medication, others do not. In some instances we raise it in depression therapy as a topic of interest but never do we push the issue.
Fighting depression in therapy is about more than feeling better
I am a big fan of feeling better. I’ve had my share of miserable times, and I wouldn’t wish for anyone to stay stuck in depression. The hard part is that you can’t take on depression in therapy without looking at the overall task of creating your life. What makes this so challenging is that you’ve got to create a less depressing life even as you’re feeling (perhaps incredibly) depressed! As impossible as it may seem, getting out of depression involves getting up, getting showered and dressed, making plans, being in touch, going on dates, finding a better job–in short, it involves doing all of those things that seem impossible for the very reason that you’re depressed!
It seems impossible, I know. But it isn’t. It may hurt like hell for a while. It may seem terrifying. But you’ve got to do it anyway. Our job, in depression therapy, is to work like hell to help make it possible for you to put one foot in front of the other.