Working with the depressed person

This is not a statement on how to treat depression but some things which are often factors in counselling the depressed person.

Stroke deprivation. Depressive like symptoms can result from a person experiencing stroke deprivation. They are not getting enough strokes (positive or negative) so as to satisfy the Free Child. The Free Child can put up with such deprivation for only so long before it starts to psychologically deteriorate. If the level of strokes is quite low then the rate of deterioration can be quite rapid

Put another way, we all have our own level of relational needs. We have to get “X” number of relational units met each day. We have to feel and be involved in relational contact with another person reasonably regularly. However it seems the level required can vary quite considerably from person to person. For some the number of units of relational needs required are quite low and for others it is quite high.

Childhood depression is an interesting phenomena

However if they are not met then depression can result. Whilst the treatment of this seems clear, that is to have more relational contact, for some that is a most difficult thing to do as the schizoid personality will tell you. If it was easy to do they would have already done it and would not need to come to counselling to deal with it. In addition establishing a social life is not an easy thing to do. It takes time and sustained effort. 

If one is socially isolated making ongoing friendships is not that easy. People have busy lives and if a new person enters into your social world that means one other must drop out because there is only a certain number of hours in the day.

High Critical Parent. This is common in the depressed person. If the person drinks alcohol ask them if they feel the depression lift when they first feel the effects of the alcohol. If it does then you know a high CP plays a role in this persons depression. As I discuss in my book - Working with alcohol and drug users - alcohol quickly and effectively blocks out the CP. This can make drinking appealing to the depressed person because it gives them temporary relief from what can be a very savage and relentless internal critic inside their head. However this can result in a drinking problem.

Also what happens most often is the depressed person will keep drinking and then the personality is effected in other ways, the person gets drunk and then they end up worse off and feeling even more depressed. Whilst there is an initial positive outcome by turning off the CP if they continue to drink then this positive is lost amongst more negatives that result from the continued drinking.

Repressed emotion especially anger. Depression can result because the person has emotions they are not expressing and then releasing. This is especially so with any anger that is not being expressed. Instead it sits like a sore in the persons psyche slowly but surely pulling them down into depression. This again is a problem for the FC, as stroke deprivation is. A basic FC need is not being met and over time the person will psychologically deteriorate as I mentioned above.

The repression of emotion can occur in a number of ways

1. Don’t feel

2. Don’t feel x, feel y

3. Don’t express your feelings

4. Feel x, but express y.

In number 1 the person is not even aware they are having a feeling When the FC is that repressed or detached the person may not even be aware they are feeling angry, sad or scared. If they are not aware of it, they certainly are not going to express it in a productive and healthy way.

In number 2 the person becomes aware they are experiencing a feeling but it is a substituted feeling. Typically women do this when they feel anger and they substitute it for sadness. Typically men when they feel sad they substitute it for anger. Either way there is not the possibility of a healthy expression of the feeling such that depression can result.

Number 3 highlights the difference between the experience of a feeling and actually expressing a feeling. Two quite different psychological processes. Some people are aware of the feeling they have and it is an appropriate feeling but have an inhibition against the expression of the feeling.

In number 4 the person feels the right feeling but expresses a different one. When the woman who get angry starts crying which is more appropriate for sadness. Or the man who feels sad and all of a sudden he is showing anger.

In any of these depression can result because feelings are not being expressed in a psychologically healthy way.

Response to trauma not been worked through. This is similar to the one just mentioned but entails much more than just the expression of emotion. In this instance the person can see that the  timing of depression is related to an event. The person may have been in a bad car accident or been assaulted. They do not work through the trauma and hence depression can result.

Secondary gains. All of us have what is sometimes called normal person depression. We all experience depression to some degree from time to time. But it is not bad enough to be debilitating and we struggle through it and come out the other side without too much difficulty.

As with any neurotic state there is always the possibility of secondary gains forming. The woman who feels starved of love starts to feel a bit depressed and she tells a few of her friends and husband. She discovers that as a result of her disclosure all of a sudden she finds people being loving and caring of her because she is ‘ill’. A secondary gain has formed that meets her need to feel loved hence the depression can persist and magnify in intensity, often this is out of her awareness.

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