Around 20% of people will meet DSM criteria for clinical depression in their lifetime.[1] The national average goes up for women, 25% of whom experience at least one depressive episode.[2] It is no surprise, then, that one of the most common reasons people reach out to my practice is that they are feeling depressed.
One of the most painful features of depression is the way it self-perpetuates. When we are depressed, we often engage in patterns of thinking, feeling, and behaving that separate ourselves from the things we love and the people that support us, calcifying our depressive feelings and making those painful emotions harder to get out of. Effective therapy for depression involves identifying these patterns and the deep causes that sustain them and figuring out how to break that cycle.
The Heterogeneity of “Depression”
In part because there are over 200 possible ways to meet the symptom criteria for major depressive disorder but also because people are affected by life events in radically different ways, depression can look very different for different people. While some people come my practice reporting that they haven't been happy in years or that one decision they made a long time ago has ruined everything, at least as often people report not feeling anything at all or that a partner or a friend has noticed a change in them that they haven't and urged them to get help.
People are very good at convincing themselves that they are "fine" or that feeling "this way" is normal - even deserved - when they are in profound pain. All of us are are invested in maintaining the systems that we have developed, far past the point where they have become maladaptive. If you grew up learning that you were valued when you could make other people happy you might become an adult who is extremely people-pleasing but who is chronically overlooked and undercared for; though it may feel terrible to be in that position, even then you may not want to give up making people happy as that is the only tool you have to be told you matter. As a result, depression can occur in people who seem the happy without friends or family ever noticing.
Therapy for Depression and Psychotherapeutic Integration
Because depression has such diverse manifestations – and often overlaps with anxiety, grief, and trauma – it is crucial that treatment be flexible to address the various issues that arise in the course of therapy. This can sometimes be difficult because depression combats its own treatment; the very things that can help – getting out of bed, meeting friends, making plans, going to work/school, finding a better job – are the things that feel the hardest to do. As a result, effective treatment for therapy often requires a psychotherapist trained in multiple methods – known as psychotherapeutic integrationism[3] – and capable of approaching the many ways depression sustains itself. Although we want to make tomorrow feel better than today, exclusively focusing on symptom reduction won’t provide any insight into what is generating these painful feelings. On the other hand, solely focusing on the deep causes of depression won’t give you actionable tools to combat those feelings when they do arise. The integrative therapy that I utilize joins these approaches in order to address both the immediate and more long term elements of depression.
[1] Hasin, D. S., Sarvet, A. L., Meyers, J. L., et al. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336-346. [2] World Health Organization. (2002). The World Health Report 2002: Reducing Risks, Promoting Healthy Life. 2002.
[3] Wakefield, J. C., Baer, J. C., & Conrad, J. A. (2020). Levels of meaning, and the need for psychotherapy integration. Clinical Social Work Journal, 48, 236-256.
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