It’s not uncommon to feel “stuck” in your life. Maybe you’re unsure which way to go in your career or your personal life isn’t what you’d like it to be. Most people who feel stuck aren’t suffering from clinical depression, but some are. Dr. Jane Rubin talks about two kinds of clinical depression and how therapy can help you find relief from them.
What Do You Mean by Clinical Depression?
In my experience, clinical depression can take two forms. Many people have physical symptoms of depression, such as difficulty sleeping or concentrating, as well as emotional symptoms like feeling hopeless. When these people come to therapy, they’re looking for relief from these physical and emotional symptoms.
Sometimes people need medication, as well as therapy, to get better. But research has demonstrated that medication combined with therapy is more helpful than medication by itself. So, therapy, along with medication, if needed, is a very effective treatment for clinical depression.
But there’s another kind of clinical depression that can only be helped by therapy. It’s what I think of as a kind of “defensive” depression. This kind of depression is a defense against feeling better. In fact, people often experience it just when they’re starting to feel more hopeful. This kind of depression can’t be treated with medication because it’s not biologically based. It’s purely psychological.
Do You Have an Example?
I do. I’ve had many patients who have felt very hopeless about their lives. Some of them didn’t have satisfying work, while others didn’t have satisfying relationships. All of them were convinced that they would never be able to have these things they so desperately wanted.
Over time, as we worked together, these patients began to feel more hopeful that the lives they wanted were within their reach. But just as they were on the verge of having the work or the relationship they wanted, they would convince themselves that it couldn’t happen. They would put up all kinds of roadblocks just as they were nearing their destination.
This is what I’m calling defensive depression. It’s a defense against having the kind of life you want. And it’s a kind of clinical depression that therapy is uniquely suited to help.
What Are the Root Causes Of Defensive Depression?
One very common cause is that it’s a form of self-protection. If you’ve felt hopeless for a long time, letting yourself have hope can feel like taking a tremendous risk. What if things don’t work out? Will you then feel humiliated that you let yourself believe that your life could be better? In these situations, maintaining the status quo can feel safer than running the risk of defeat.
Another very common cause is the feeling that you don’t deserve to have a better life. People can feel this for many reasons. Maybe they feel guilty about having a better life than a parent. Or, they feel that there’s something fundamentally wrong with them. The good news is that, whatever it is, therapy can help you identify the root causes and begin to loosen their hold on you.
How Difficult is This to Treat?
I don’t think it’s difficult to treat if we recognize what we’re treating. It’s really important to be able to recognize when a patient is suffering from the defensive kind of clinical depression. In other words, to identify when they’re defending themselves against feeling better. If we recognize when that’s happening, we can begin to help people explore why they’re preventing themselves from feeling better. We can help them to get to the point where taking unfamiliar risks feels better than holding onto their familiar suffering.
Why Not Talk About These Issues from the Start?
It’s really not possible. People don’t experience defensive depression until the depression that brought them into therapy begins to lift. When someone begins to experience defensive depression, it’s actually a sign that therapy is working. Patients have more hope. That’s when they begin to put up roadblocks against it.
Do You Have Any Recommendations?
My recommendation is always that anyone who feels they might be clinically depressed seeks professional help. A good therapist will be able to refer you for medication if that’s warranted. And, whether you need medication or not, therapy is an essential tool for relief from clinical depression.
Click to learn more about depression therapy and treatment with Jane Rubin, Ph.D.
Jane Rubin, Ph.D., is a clinical psychologist in Berkeley, California. She works with individuals in Berkeley, Oakland, the East Bay and the greater San Francisco Bay Area who are struggling with depression and anxiety. She also specializes in working with people who are trying to find meaning and direction in their lives.