Support
Another essential element is emotional engagement and support. The patient does not usually communicate the depth of his pain and fear to those closest to him. It may be that he wants to protect them, it may be that he fears they will reject him; regardless, he “stuffs” his feelings, to borrow an AA term. He bites back on his feelings and tries to pretend they aren’t there. If he shows them at all, he usually gets advice from those around him that is less than helpful. Others are quick to give advice because they, like the patient, are afraid of the need and pain. The good therapist, at this stage, doesn’t give advice. He shows by example that the feelings are not to be feared; in fact, he probes and goes deeper. He lets the patient know that depression is a process that has a life of its own, that there is good reason for hope because depression does end, but that feelings are important. Sometimes all the therapist can do is hold the patient’s hand, as it were, while they wait together for the medication to work. Often there is no one else in the patient’s life who can do this.
Once trust and support are relatively stable, the healing work of psychotherapy can begin. Many aspects of the individual’s functioning can change with treatment. I have grouped these into five major areas: how emotions are experienced; patterns of behavior; thought processes; relationships with others; and how the patient feels about himself. Each of these aspects is explored in depth in the coming chapters, but here is a brief overview.