How do you treat a client who tells you this? Long-term depression leads an individual to accept depression as a normal state of mind, especially if it begins in childhood. The therapist must show the client how to pursue a different path. As an initial step, the therapist may ask the client to respond to three different models of depression.
Model 1: Anger directed against oneself
As children we may feel unable to express anger towards a much more powerful figure, such as a parent. So instead we may redirect that anger against ourselves, in effect battering ourselves into a depressed state.
Model 2: Hopelessness
In a celebrated experiment, Martin Seligman placed a dog in a cage with a barrier separating its two halves. A dog experiencing a mild electric shock would learn to jump over the barrier to safety on the other side. In the second phase of the experiment, electric shocks were given on both sides of the barrier. The dog learned the pointlessness of jumping and just remained unhappily on one side of the cage, a state referred to as “learned helplessness.” The third phase of the experiment replicated the first phase. The cog could jump over the barrier to safety on the other side, but the dog, once having learned helplessness during the second phase, refuses to recognize the changed circumstances and remains motionless in one corner.
Model 3: Grieving
One typically grieves the death of a loved one but one can also grieve other forms of loss. The loss of employment may feel like the death of one's identity. Rejection may seem like the death of one's social self. One may mourn the loss of self, the loss of what might have been, the loss of dreams. Prolonged grief can lead to depression.
Sometimes clients will identify one of these models as the best description of their depression. Often they will identify several models contributing to their depression in varying proportions and the therapy variations accordingly. In the first model, we find the source of the anger and help clients deal with it appropriately. In the second model, we urge clients to try jumping over that barrier-the circumstances may have changed. In the third model, we help clients through the mourning and deal with the trauma of loss.
The first step in dealing with depression of any kind is to get the client moving. If the client has been able to come to the therapist's office that is already better than depressed clients unable to get out of bed. Typically a depressed person has been fairly inactive, so I ask such clients wherever they are willing to try walking (or swimming) for twenty or thirty minutes three times a week. I promise that at the end of two or three weeks we will evaluate whether the exercise has bought any benefit. I urge clients to reward themselves for any steps that they have been able to take in a positive direction, and to avoid beating themselves up if they have not carried out the program perfectly.
Next we address the reminder of “the basics”: getting enough sleep; eating healthily; making contact with other people. As before, I present this as an experiment: if you do not eat breakfast, figure out what you might find palatable and then, after two or three weeks, decide if this has been beneficial. (Maybe a green smoothie?)
Next we have the client assemble a first-aid kit containing a dozen items capable of arresting the descendant into a depressed state or of lifting one from depression. Having struggled with depression in my own life, I share items from my own persona list, such as going for a run, going to a movie, eating chocolate or ice cream (or chocolate ice cream!), Listening to a favorite piece of music , talking with a friend, etc.
Usually people suffering from depression can recognize when they are beginning to slide down that slope leading to the depressed state. I encourage such clients to take measures to “self-arrest,” much the way a mountaineer might use an ice ax to stop sliding down a glacier. Items from the “first-aid kit,” breathing exercises, or the EMDR “Safe Place,” if engaged soon enough, may help to halt the descent into depression and restore a sense of balance.
In cases of severe depression, medication prescribed by a physician may be required before a client can even participate in these exercises.
Once these preliminary steps have been undertaken, we can proceed to identify the underlying causes of a client's depression, often traumatic experiences that can be addressed using EMDR (Eye Movement Desensitization and Reprocessing). Depression need not be regarded as a life sentence. The plasticity of the brain permits rewiring the pathways to depression, enabling clients to follow a path towards hope and happiness.