Editor’s Note: Noel McDermott is a psychotherapist based in the United Kingdom. He has more than fifteen years of experience helping people overcome anxiety, depression, trauma, recovery in addiction and mental illness, loss, loneliness, childhood trauma and abuse. He offers talking oriented methods of psychotherapy and counselling and also non-verbal and creative arts approaches. You can learn more about McDermott on his website.
Depression can be very devastating but can respond very positively to appropriate help.
Depression has a number of sources and indeed many levels of severity. It is probably best thought of as being a spectrum or constellation of experiences. It can have many causes and triggers and this may indicate one method of help over another.
But it can creep up slowly or have been around for so long we don’t notice it. The first step in dealing with depression is spotting it in our selves or in others.
Spotting The Problem
Here is a quick guide given to me by a General Practitioner but it should not be used as an alternative to visiting your doctor! Always seek professional help for a diagnosis.
Ask yourself if you have experienced any of the symptoms from the list below in the last two weeks. Rank each answer on a scale of 0, 1, 2, 3, (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day).
A. Little interest or pleasure in doing things.
B. Feeling down, depressed, or hopeless.
C. Trouble falling or staying asleep, or sleeping too much.
D. Feeling tired or having little energy.
D. Poor appetite or overeating.
D. Feeling bad about yourself – or that you are a failure or have let yourself or your family down.
E. Trouble concentrating on things, such as reading the newspaper or watching television.
F. Moving or speaking so slowly that other people could have noticed? Or the opposite –being so fidgety or restless that you have been moving around a lot more than usual.
G. Thoughts that you were better off dead or of hurting yourself in some way.
So the scores for your depression would rank something like this
1-4 Minimal Depression
5-9 Mild Depression
10-14 Moderate Depression
15-19 Moderately Severe Depression
20-27 Severe Depression
Then decide if the problems you have identified have made it difficult for you to work, take care of things at home or get on with people; i) not at all ii) fairly difficult iii) very difficult iv) extremely difficult
This is a rough guide and in no way should replace a proper consultation! But if you are bothered by these symptoms, do not ignore them. Depression, if caught quickly and if it is not complicated by other factors such as childhood trauma, has a high likelihood of responding to modern pharmaceuticals and talking therapy.
CBT (Cognitive Behavioral Therapy) or solution Focussed Therapy (SFT) are forms of talking therapy that utilize key concepts of reframing thoughts and setting goals, changing behavior. They differ from in depth psychology approaches in that the focus is on the presenting issue and develop responses to that without linking to any underlying cause, which is why CBT/SFT work well when there is no underlying cause for depression such as childhood trauma. Talking therapy, in combination with medication such as anti-depressants, can help you to successfully manage your symptoms.
Typically sessions will happen once or twice a week and will look at thought patterns linked to depression such as negative thoughts about self, about the world, or about the future. The negative thoughts will be identified. For example: I’m no good (negative to self) others are better than I am (negative to world) no one can help me (negative to future/world).
These thoughts will be logged on a worksheet and looked at for patterns such as times of day and linked activity to see if the negativity is linked to actual times and events in the world.
The therapist will work with you to reframe the thoughts where possible. The thought, “no one can help me” might be reframed as “there are plenty of techniques and treatments for feeling low, I have to work at finding the ones that work for me”.
Activity monitoring may help you to realize how adding pleasurable activities might lift your mood. Additionally it can help to reframe negative thinking about current activities that though once meaningful and pleasurable might be currently experienced as not pleasurable because of the depression.
For example if prior to the depression you found cycling fun but now find it not so pleasurable, you might say to the therapist, “I don’t enjoy cycling anymore”.
That way of thinking contributes to your low mood and discourages you from engaging in physical exercise which is known to be a mood enhancer.
The reframe with the therapist might be to compare the low feeling of cycling to the low feeling of being at home alone and bringing us to an understanding that in comparison cycling is more pleasurable than isolating at home and therefore worth doing.
The cycling example includes the behavior bit of cognitive behavioral therapy. behavior itself can change our depressive symptoms if we are persistent. A common experience in depression is to lose motivation and to isolate; this in turn makes us more depressed as we suffer from lack of activity and social contact.
By continuing to engage in our normal routines while suffering from depression it will help us come out of the illness. Going through the motions can help bring us out of our depressive shell.
Get planned, organized and engaged in your healing.
It is worth having this type of action plan ready in case you become ill, like planning for the unlikely event of a fire in your home. Knowing your fire drill in a fire can save your life. Knowing your action plan in the event of mental illness can help get you better quicker.
• Be aware of the symptoms of depression in oneself and also in others.
• Seek help.
• Use medication if advised by your doctor.
• Give your symptoms the double whammy of a dose of talking therapy.
• Stay engaged in activities and life as much as you can bear (and then a little bit more).
Going Deeper Than An Action Plan For The Emergency
This action plan may not always be enough if there are revealed underlying issues during the depressive episode.
But don’t get anxious.
The techniques you have learned above will keep you on an even keel. You may need to extend the period you use medication for and you may need to continue the self-help exercises learned from your CBT or other related therapies. But you may also need to go deeper and resolve some of the conflicts that have opened up for you internally.
This is where depth approaches such as psychodynamic psychotherapy may be beneficial. Psychodynamic psychotherapy has evolved from psychoanalytic traditions in that the primary focus is to reveal issues we may be unaware of and which the depressive or anxious feelings are used as a defense against our becoming aware of.
It relies on the interpersonal relationship between client and therapist more than other forms of depth psychology. It tends to be more eclectic than others, taking techniques from a variety of sources, rather than relying on a single system of intervention.
Typically one would see a psychotherapist once a week for a period of two or three years to be able to work through the internal conflicts, face fears hidden in the depressive symptoms and engage in ones emotional and interpersonal life in a more complex, whole and complete manner.
Psychodynamic therapists will be integrative/eclectic and may well be cognitive behavioral practitioners as well. The difference is the opening up of the past and linking it to current behavior and symptoms. But this does not create conflict with cognitive techniques if the practitioner is skilled at identifying those thoughts and feelings that need management via CBT/SFT and those that need to be opened up and integrated via more dynamic and depth work.
Typically the psychodynamic therapist will understand that we have become maladaptive to our current life’s circumstances because of hidden fears, shames, events and traumas. By bringing these to light and sharing them with a compassionate, kind and skilled person we can integrate the emotional experience of these events and thereby overcome them.
There should be no reason why this work would stop one from continuing to engage in life, work and family etc. In fact if one becomes unable to cope emotionally then it is probable that the work is progressing at too swift a pace and needs to slow down.
Moving Beyond Illness
This leads to the arts therapies, which can be considered as depth approaches. Arts therapists practice in all the arts modalities: Art Therapy, Music Therapy, Dramatherapy and Dance-Movement Therapy.
They draw from their creative artistic roots and also from psychological theory and blend the two. Becoming creative is understood as healing in its own right and this would be encouraged in clients.
In Dramatherapy (my modality) the therapist draws upon play, theater, role-play, script, narrative and story to work with a client to understand and develop a different (creative) relationship to their problems. Also it enables a client to learn new practical skills via rehearsal in the drama, developing a fuller role repertoire in their lives and so on.
In Dramatherapy we draw upon common human themes from myth and story across cultures and times enabling a client to link in to a sense that they are connected with human experience. This is particularly powerful in depression where the sense of becoming an ‘island’ unto oneself can be devastating.
With depression that may have been used as a defense against acknowledging childhood trauma and abuse, drama therapy can be useful in containing the trauma within a myth, enabling the client to maintain a connection with human experience while acknowledging the depth of the pain they feel. This containment can make it a uniquely safe way of exploring difficult life experiences.