Short-Term Psychodynamic Psychotherapies for Depression

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Yvonne had never felt very confident. When she was a child, her older brother, Leo, excelled at school and at sports. He was also good-looking and charming, so he had many friends. Both parents, particularly the father, doted on Leo and constantly pointed out his accomplishments to anyone who would listen.

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Yvonne was quiet and not as outgoing. She loved Leo but often felt unloved and unwanted. She coped with her feelings by spending most of her day at school or at friends’ houses. This worked until she tried to go to university but was not accepted. She had wanted to be a lawyer like her father, but this goal now seemed out of reach.

Yvonne became less and less confident, and more and more listless and uninterested in going out and doing anything.

Her family doctor suggested that Yvonne see a psychiatrist. The parents were sceptical but finally agreed. The psychiatrist felt that Yvonne’s depression and lack of interest were related to her feelings of inadequacy throughout child¬hood. He encouraged her to work on resolving those feelings, and assured her that she was a valuable and likable person, even though she was not as extroverted as her brother.

Psychodynamic therapies can treat depression, but they are not for depression alone. The therapist works from theories based on psychoanalytic principles originally developed by Sigmund Freud, and altered since then by other psychoana¬lysts, based on their experience with patients. The therapist assumes that events from your past are affecting the way you see and act in the present, although you may not be fully aware of how you are being affected. The experiences are buried in your unconscious mind, and the goal of this therapy is to remember and unravel the experiences and the ways they are now influencing you. When you become more aware of how the past affects you, you will be better able to decide how you want to live and act now.

People who are prone to depression often live their lives for some ‘dominant other’. They feel that if they can only be what the more powerful person wants them to be, they’ll gain love and care. When they don’t receive that love and care, depression results; they feel that they are a failure because they can’t satisfy the other person. However, their disappointment is based on a false premise. We all have to live for ourselves. When we become comfortable with our own feelings, good and bad, we are free to live lives that are truly our own.

In Freud’s classic 1917 paper ‘Mourning and Melan¬cholia’, he compared depression to grief. Although the depressed person does not actually lose a loved person, as in bereavement, he does lose the emotional connection with the loved person. The individual blames himself, experiencing guilt, shame, lowered self-esteem and ‘anger turned inward’. He is angry and disappointed in the loved one, but cannot express his rage, for fear of being further rejected by the person whose emotional support he feels is necessary for his survival. The short-term psychoanalytic therapist works from these premises when seeing you.

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