A Case Example of Depression Treatment in Two Sessions
Treatment & Care ›› Depression Treatment
It should read...
By Tim Desmond
Self esteem, self accpetance and a sense of self-worth are vital to feeling happy. When we lose the sense that we are worthy or loveable, it is easy to become depressed. In this example we find that a woman's depression is rooted in both seeing herself as worthless, and in wanting to avoid engaging with the world. We also find that in discovering her hidden purposes for being depressed, they are no longer compelling and she quickly recovers.
Mary, a social worker from Portland, OR, had been unable to work for three months prior to calling me because of severe depression. In our first session she shared about her strongly negative self-talk. She had a powerful inner-critic and try as she might, she had been unable to stop thinking this way.
I wondered why her self-talk was so unkind, so I asked her to imagine what it would be like to really know that she was a good person and deserved love. She tried, but could not even imagine what it would be like. She said, "I just can't go there. It's just not real." I sat with her for a minute or so just connecting with what it must be like to be unable to even imagine seeing yourself as a good person. Then I asked her to try saying, "I am unwilling to even imagine seeing myself as a good person because..." and to finish that sentence without pre-thinking the ending.
That made sense to me, because I still didn't understand exactly why she would feel bad about herself when other people were uncaring to her, as opposed to getting angry, trying to please them, or any of the other possible responses people have. I find that it is important to discover the sense to all of these questions for the deepest kind of change to happen.
I asked her to imagine herself when she would first become depressed, and I asked how old she was. She was seven, and I asked Mary if she could try to become that little girl for a while so I could talk to her. When she was ready I said hello and asked the little girl if she gets depressed. She said she does because her mom is really mean and calls her names. I told her I was sorry that her mom did that. Then I asked if she knows grown-up Mary, and she said she did. I asked her to tell grown-up Mary what she should do when people are mean to her. She said, "What should she do when people aren being mean to her?" and fell silent for a few moments. She said, "If you get depressed, you don't have to do anything." and paused a long time. She continued, "If you get depressed, you can just sit around and you don't have to do anything." Judging by her tone of voice and the long drawn out pauses, I knew that she was in a deep place and I let her have as much time there as she needed. We spend the rest of the session saying those sentences and letting them feel true. When we ended, she thought she would need a month to process what had happened. However, she called a few days prior to her appointment and cancelled saying that she had fully recovered and was working again.
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Tim Desmond