Tony White

In those instances where a person has a psychological basis for depressive symptoms there are often a collection of common clinical features that lead to some treatment possibilities.

If a person is very depressed then counselling will be of little use as the person is so ‘down’ they can participate very little in the counselling. As a result, not uncommonly clients who are being counselled for depression can at the same time be taking antidepressants. This can at times work well but sometimes the client may need to try a number of different antidepressants.



From what I have seen over the years sometimes a particular antidepressant can be a ‘wonder drug’ and make a great difference, but at other times they can make the person feel worse. So there may need to be some trial and error with this type of medication. The other difficulty is that antidepressants can make people emotionally flat. The depression subsides but so do all the other emotions and this can hinder counselling, as counselling often requires the expression of emotion. This is particularly true for anger in the depressed client, but also can be a problem for showing emotions like sadness in instances such as a bereaved client who is depressed.

Inward turned emotion.
Depression is a sodden emotion. It is an emotionally inactive emotion and an inward turned emotion. The antithesis of this is anger. It is an active emotion. When people get angry often something happens or changes, this is not the case with depression. People do not tend to sit with their anger. If they do then it starts to turn into depression. This is a important point because it means people cannot be angry and depressed at the same time. Angry people are mobile and active. Depressed people are immobile and inactive.

However sometimes depressed people are angry but they turn the anger in on self as the diagram shows.



This indicates some counselling options. The diagram on the left shows how the depressive will tend to direct their anger at self and this commonly manifests in the person doing negative self talk. This can be a self directed angry act. One option is for the person to identify a ’thing or person’ out there who they are angry at. Then begin to express that anger at ‘it’ and this can result in a reduction of the depressive feelings. However it must be guilt free anger expression. If the person expresses the anger and then feels guilty or bad about it the point of the exercise is lost.


Action and anger commonly go together



Passive behaviour
Because of the ‘stuck’ quality of depression it lends it self well to being a passive behaviour. (Often a secondary gain discovered by the depressed person) Children can learn in childhood that: “If I am sad enough for long enough then ‘X’ will do ‘Y’”. Mother will give me attention, father stops being angry at me, and so forth.
Thus we have a situation where the depressive does nothing, then someone else does something and thus we have a psychological symbiosis. If you stay very depressed for a long time then you cannot look after yourself and eventually the state will intervene and become the Parent and Adult ego state. So depression lends itself well to being used as the fourth passive behaviour of incapacitation.



Thus treatment revolves around breaking the current symbioses in the depressed person’s life. Often there is also a historical symbiosis to be dealt with as well.

Strokes
Some people are depressed simply because they are stroke deprived. This is common in socially isolated individuals, they simply do not get enough strokes. Indeed some who develop depression will then become socially isolated and thus the stroke deprivation increases the depression.

In this case the treatment looks at the stroking patterns in the person’s life, how they filter positive strokes and so forth. Sometimes such depressed people will be very resistant to acknowledging and accepting positive strokes from others. In such instances I often switch to plan B. The client then contracts to find and give others positive strokes. This is kind of a back door way of getting the person to begin looking for positives in the world rather than the negatives.

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