Where To Start?
Since no one seems to really understand depression, everyone feels entitled to an opinion. You have no way of knowing if your physician s advice is any better than your wife’s, your clergyman’s, a mental health professional’s, or the guy on the corners. But the truth is that experienced, open-minded therapists in fact know a great deal about what helps people recover from depression. This “practice wisdom” of therapists rarely filters out to the public, not because it contains trade secrets, but because much of it is tied to theoretical points of view that themselves get in the way of exchanging knowledge and experience.
I want to briefly summarize here how good psychotherapy works with depression to facilitate recovery. The purpose at this point is not to sell psychotherapy, but to use it as a model to explain recovery from depression; how people can learn to stop the self-defeating behavior that seems to them to be the only possible response to their desperate inner state.
One of the essential elements in effective psychotherapy is trust. The patient is open and honest with the therapist in return for an implicit contract that the therapist will use his special knowledge only to help, never to harm, the patient. For many adults, the therapeutic relationship is the only one in which they can let their guard down. Depressed patients are almost always full of guilt and shame. They haven’t lived up to their own standards. They feel like failures. They feel that they’ve let their loved ones down. When the therapist hears the guilty secrets
and doesn’t run screaming from the room in revulsion, or castigate the patient as the moral leper he thinks he is, healing begins. The acceptance of the patient as a worthwhile individual, even though he’s not perfect, is crucial for the patient to overcome his pervasive guilt and shame.