Depression – a process of coping
Depression, together with anxiety, is a very common psychological difficulty. In this article, I will first briefly describe the similarity and difference between depression and anxiety. Then I will explain one way of making sense of depression and how this way of thinking can be applied in psychotherapy sessions.
Depression – the similarity and difference from anxiety
Feelings of anxiety are often associated with fight or flight strategies. It is particularly so if the object of anxiety is a specific situation or a thing. When the specific features of anxiety become more general, the anxious feeling starts to affect the person more broadly. Anxiety may result in the person showing more global symptoms. This is where the anxiety may cross over to depression.
With depression, the strategy occasionally changes into freeze or fragment. This is the case even when the person maintains high functioning. It will impact many profiles of a person including emotional, cognitive and physical.
As symptoms, depression and anxiety appear to be distinct; people who suffer from anxiety often avoid death whereas people with severe depression occasionally harbour the idea of death as an escape from painful experiences in life. On the other hand, depression and anxiety as life experiences are often continuous; people who suffer from either depression or anxiety often have the other.
When reflecting on depression, keep in mind where the person’s deepest wound may lie. It could be the sense of safety which is compromised, resulting in constant feelings of danger. Or perhaps needs of others take precedence with one’s own needs put on hold. Sometimes people suffer as a result of repeated boundary violation where others cross the lines without consent. The wound may be deepest in the area of self-esteem due to painful experience of humiliation. Alternatively a person may feel severely curtailed in the process of free choice due to numerous occasions of feeling defeated.
All the above points of psychological injuries are related; a kink at one point requires adjustments at other points. On the other hand, if you see each element as a theme for growth, any human being will revisit some of the themes every now and then during the course of life.
Depression and psychological coping
Psychological coping is originally a natural reaction to stimuli. We all use various psychological methods to cope with life. It is an attempt to protect the wound. For instance you might have shut yourself down to create a sense of distance from a dangerous environment. Furthermore a person often keeps on trying if things do not change. Using the previous example, if the dangerous situation has not improved, you may not only keep yourself shut down but also strengthen the coping by prioritising others needs over yours in order to keep the danger at bay. In this way extra layers of coping will be built on top of the original.
As previously mentioned, the kink in one node causes adjustments in other nodal points. If the extra coping does not produce a life-enhancing outcome and further coping is not successful, it will eventually become elaborate layers of entrenched coping.
The more distress you experience, the more frequently and fervently the attempt to heal the wound. Often there are patterns in the way people deal with the wound. The pattern most likely operates unconsciously and they tend to create a certain interpersonal dynamics. The original coping was created to protect and heal the wound. So long as the deepest wound is aching, patterned dynamics continue within you and with others.
‘Then what can I do?’
This is a fair question which many of you may have asked yourselves. It is especially so for a person who has tried numerous things without much success. You will be surprised to hear that the answer often lies in you. It is often hidden under the layers of coping.
Psychotherapists who are properly trained and well experienced will not usually tell you what to do. A sensitive practitioner thinks that it is important for any human being to be able to choose when making a decision on important issues.
Perhaps it is time to look for alternative coping options instead of those which you have been unconsciously using. You can explore why you have given up on those options to start with. You can reflect on new options, try out some of them and see what the outcomes are like together with your therapist. Whatever the outcome, it will create a point of reference to evaluate the effectiveness of the alternatives which you chose. For this process to happen, you need time and space to anchor yourself. In order for you to be replenished anew and to sail off in a different way, it is vital that you create time and space for yourself with somebody who can psychologically hold you. This can be your psychotherapist.
One of the subtle things psychotherapists do during your sessions is to facilitate the process of creating many feasible options with you. Life lived with reflection, self-compassion and decision is life well lived.
If you want to know more, a programme which is titled All in the Mind on BBC Radio 4 could be informative. Do check their iPlayer.
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About Mari Yamamoto
I have been offering psychotherapy and counselling over the past ten and a half years in Ealing W5. I am a psychotherapist registered with the UKCP and hold a Masters degree in Integrative Psychotherapy. Away from my private practice in Ealing, I also work at the King's College Hospital in London. I welcome diversity in my practice.