Treating Depression Without Medication - Part Two

Another issue that I often see with depressed clients is a fear of failing and getting it wrong. In considering this, we can turn again to the Gestalt therapy theory concept of ‘creative adjustment’ - how an individual has adapted to cope with a certain situation in their early development, which may no longer fully serve them in the present. What is the function of your depression or depressed feelings? What do you gain from being depressed? These are some of the questions I pose. Often the immediate response is one of denial, disbelief or even anger. My client assures me that they have absolutely no interest in feeling depressed, that they gain nothing from it and are wholeheartedly dedicated to feeling better. Indeed, my question may be experienced as an insult or as ignoring the depth of their pain and distress. I go on to explain that the creative adjustments we may have made are no longer in our awareness. Therefore, we are not intentionally setting out to cause ourselves distress. I invite the client to be open to the idea that the knot they may be tied in is one that was knitted a long time ago. I point out also how the evidence doesn’t stack up. Even though a client may assert vehemently that they 100% do not want to feel depressed, they exhibit ambivalent behaviour like not showing up for therapy, turning up late or avoiding working on the issue in therapy. Most clients have some degree of ambivalence. There is always the part that wants to change and the part that doesn’t want to change.

What can the function of depression be? For some clients, it provides a security. Even though the distress is real and often awful, being depressed minimises the fear and anxiety linked with risking and getting rejected or failing. I ask clients what they would do if they weren’t feeling depressed. Often it is difficult to respond. Even risking telling their therapist about secret hopes and dreams feels too scary, for fear they will be judged. When I probe a little more I may find out about creative talents, passions and interests in the past or present. I ask them what stops them pursuing them in the present or developing them, since they were or still are a source of enjoyment. The critical voice then comes knocking on the door forcefully.  They reply that as soon as they do anything like that their inner critic tells them it is rubbish. The critical voice says that unless what they do is perfect then there is no point in doing it at all. I too would be put off from doing anything which risks exposing myself if I were confronted with those negative thoughts.

When I challenge my depressed client on what would be so bad about failing, they say the failure and resulting self-blame would be unbearable. None of us like failing or feeling rejected or getting something wrong. As humans, we are primed to feel shame and embarrassment. The thing is though that like all other emotions, this changes. We may feel bad for 30 minutes or so but then life carries on. Therefore, even if the feeling feels unbearable, we do in fact bear it. What seems to make it even worse with depressed clients is the critical voice that is there anyway and really goes to town when they get it wrong. From this point of view it makes sense that it is better not to risk and try. The therapeutic work is then about helping the client to look at the unrealistic expectations of the critical voice and how it stops them from doing anything. The work is also about developing enough sense of safety and self-belief so that they can bear the idea of taking a risk and getting something wrong and living to tell the tale.

I hope that you have found this article useful. If so then please share it with someone. If it has stimulated your interest in working with me then feel free to call me or text for an informal chat or to book an assessment session. I also look forward to reading any comments you have.


Warmest wishes,