Anxiety, depression and therapy

You may already know that to suffer either of these conditions can be totally debilitating in its own, very different way.

Anxiety can leave us with a constant nervous energy, always alert, feeling an energetic sensation tingling or banging around in our bodies, whilst simultaneously holding a weight of something ‘not good’. Always with the sense that there is something to be done, or felt, or understood, but rarely knowing what, or how to deal with it. Just existing day to day can feel dreadful and exhausting.

Depression can be like ‘living weighed down by wet clothes’, as a client once described. Everything feels heavy. There is little to no capacity for motivation, drive or interest; your vitality can feel smothered. It’s hard or impossible to respond meaningfully to anything requiring an emotional response. It can feel hard to connect to the world, as though we are in fog or behind glass. As with anxiety, just existing day to day can feel dreadful and exhausting.

Is there always something ‘wrong’ with us?

It is important to acknowledge that there are times when anxiety or depression is a fitting, understandable response to a situation. Other than being really unpleasant and potentially limiting, they are not ‘wrong’ feelings in and of themselves, or necessarily signs that there is something wrong with us. If you've lost a job or partner, or are feeling lonely, it makes sense that depression might be there too. It can be part of a normal grieving process. If we lean into that process, depression can resolve in its own way.

Equally, if you are awaiting news of a potential diagnosis, or are worried for a loved one, anxiety might reasonably be there too. It makes sense that there might be a worried energy that something bad could be coming your way, and yet there is nothing you can do about it in the present moment. That would be understandably anxiety-provoking.

In these cases, it isn’t the anxiety or the depression that needs to be ‘got rid of’, they are understandable responses to unpleasant, outer world experiences that are asking for their own resolution.

We can still turn kindly towards ourselves in these experiences, or ask for friends, family or a therapist to be with us. The crux of inner world healing and resolving is relationship. More on that later.

Depression and anxiety as defences

In psychotherapy, we work with the idea of defences. If there is something internally difficult for us to engage with – perhaps a potentially scary, strong feeling, or a feeling we learned when we were young that was in some way wrong, not allowed, or threatening to us or our caregiver – then our psyche creates a defence to stop us from experiencing that dangerous feeling.

These defences serve as protections or distractions from the actual feeling that is hidden away in the unconscious, waiting – wanting – to be felt. At the time when our unconscious mind created the defence, it was to keep us emotionally safe and able to remain connected to our caregiver and family, given what was acceptable to or manageable for them.

In evolutionary terms, a defence is a brilliantly effective, life-saving strategy. We can, and ought to, thank ourselves for creating effective defences. But once we’re independent adults, they might be getting in the way more than they are protecting us.

Defences come in all varieties, of which depression or anxiety could (aren’t always) be two. For example, an intellectualising defence might mean that rather than feeling the feeling, instead, we veer off into our heads and talk endlessly about the feeling and all the reasons for and circumstances around it. A physical symptom defence might mean that instead of feeling the feeling, we suddenly get tired, or feel sick, or get a headache. Some of these physical manifestations can become chronic.

Depression as a defence

Here, it’s like a heavy blanket is laid over all feeling, so that we definitely can’t feel the thing that we mustn’t feel. The really debilitating problem with this defence is that in our psyches, it isn’t possible to stop feeling one type of feeling. It’s all or nothing. So by (de)pressing that feeling down and out of our awareness, we press all other feelings out of our awareness too. Meaning that we don’t feel anything. It requires a lot of energy to press all that feeling down; no wonder it is such a tiring defence.

Anxiety as a defence

What if you can’t push the sensations of a feeling fully out of your awareness, as in depression, but you still learned that it was in some way dangerous to engage with them? Your unconscious mind might instead block the process of connecting with the feelings. But the feelings that you mustn’t feel still happen in your body; you just don’t have a way of processing them.

The physical sensations are there – temperature variations, heart racing or slowing, stomach tying in knots, skin prickling, etc – but the defence of not connecting to them stops you from being able to give curious, caring, processing attention to them. So it might be that what is called ‘anxiety’ is actually other feelings, unnamed, and unprocessed, such as fear, anger, sadness, jealousy, irritation, excitement, etc, that we can’t ‘look at’.

So how can therapy help?

Both of these defences are about not feeling feelings that are natural for you to feel. In therapy, the creation of a safe, trusting relationship can allow you to feel, name, and express the feelings that were not permitted in your formative years, that you’ve been defending against. This might seem really scary or difficult at first, and sometimes the defence can increase initially because of that. So we go really gently, at a pace that feels safe.

It might be hard to know what has been ‘done’ each session, but it’s actually not about ‘doing’ at all. It is about gradually building a trusting relationship with another person who warmly offers unconditional positive regard, congruence and empathy. Perhaps these weren’t consistent experiences you had in important relationships growing up. This allows your unconscious to gently release some of those defences, and to feel the feelings you have been defending against.

It might be difficult

When we were little, some of these feelings really were too big and scary to manage. At those young ages, we didn’t have the skills or capacity to soothe our tears or fears on our own. And if we lacked the reliable, capacious soothing of a caregiver, it is understandable that we pushed the feelings away, or built defences against them, for the overwhelming fear we might otherwise have been destroyed.

Still now, some feelings – and the thoughts that accompany them – might feel too outrageous (‘I hate my Mum’), or dangerous (‘if I get angry I could destroy everything’), or scary (‘if I start crying I’ll never stop’) to risk feeling.

In counselling, permission is given to speak the unspeakable and feel the unfeelable, and have it witnessed and held with empathy, without shame or judgement. Maybe for the first time, we can let ourselves cry, and with a calm, empathic adult sitting with us, we find out that we both can survive your tears.

The hope

Therapy offers a safe relationship in which you can gradually turn towards the feelings themselves and learn that you can survive them. Once the therapist has modelled this to you over time, you continue to be that calm, non-judgemental presence for yourself over your own feelings.

In this way, it is possible that depression can lift. And it is possible that anxiety can subside. Feeling more of our feelings – the big ones, the scary ones, the ‘bad’ ones, the ‘not allowed’ ones – leads us into much greater self-trust, capacity for all kinds of experience, and an altogether fuller life.

References

• Freud, A.; The Ego and the Mechanisms of Defence (revised ed.) International Universities Press, (1966)
• Rogers, C.; On Becoming A Person; HarperOne (1995)