Are you feeling down but don’t know why? Do you feel hopeless even though, on the surface, everything in your life seems to be going well? Have you read self-help books, or even tried a texting therapy program, and found no relief?
Some issues can’t be resolved on your own. This is especially true if you have a vague but persistent feeling of dissatisfaction that you can’t easily attribute to an external cause, like a bad job or a difficult relationship. In this post, Jane Rubin, PhD., talks about how a therapy relationship can give you what a book or a text can’t– the experience that your life matters.
What have you learned about clients who really don’t know why they are deeply unhappy?
I think it's really easy to understand why people who had abusive parents might become depressed. They’ve internalized years of criticism and so they put themselves down in the same ways their parents did. Even if they don’t connect their self-critical behavior to their critical parent, they do, at least, recognize their tendency to get down on themselves and the way that contributes to their negative mood.
But people whose parents were not critical or abusive, but were, instead, disinterested and neglectful, often struggle to understand their depression. They know that their parents let them do pretty much anything they wanted to do, so why are they unhappy? It feels mysterious to them, and it feels like it means that there must be something wrong with them, though they struggle to identify what that could possibly be.
What does that look like as you try to work with them?
Often, these clients are extremely vague about what's going on with them. Not only can they not pinpoint any causes for their dissatisfaction; it’s often difficult for them to tell a coherent story about why they’re seeking help. They throw out ideas, but none of them seem to gain any traction in our conversations.
Some therapists get very confused by this. They feel that, if their patient can’t identify something specific to work on, they’re not going to be able to help them. But I think there’s actually a lot going on at times when it seems like nothing is happening. Without being aware of it, these clients are communicating in ways that can make it difficult to connect with them. Because they’re not being specific about anything, it can be hard to know what questions to ask. And because they’re not expressing strong emotions, it can be difficult to attune to them. All of this behavior serves as a test of whether I (or anyone) will care enough about them to hang in with them even when they’re not giving me much to work with.
Why is your relationship with them so important?
I think the relationship is, by far, the most important element of any therapy. But, with patients who feel like they don’t matter to anyone, it’s absolutely crucial. These patients are so used to being ignored that they believe lack of attention is just the way things are. They don’t expect anything else, but they long for something else, and this longing can show up in very subtle ways.
For example, I once had a patient who very rarely looked at me when she was talking. She just looked down at the floor. However, everyone once in a while, she would look up at me. It was crucial that I meet her gaze at the exact moment she sought it. I believe that doing so was what allowed her, over time, to be able to begin to talk about the things that were troubling her. It wasn’t that she was incapable of it before. In fact, once she began to talk about what was going on, I found her to be an exceptionally articulate person. But she needed to feel that I was paying attention and that I cared before it felt safe enough for her to talk about what really was bothering her.
Not all of these patients are quiet, of course. Many will talk almost non-stop at the beginning of therapy. But they don’t begin to talk about things that are meaningful to them, and they don’t allow much interaction until they have the sense that they matter to me. That experience doesn’t come from me telling them they matter. It comes from me showing that they matter in ways that mean something to them.
What's the primary takeaway for you as you help these clients?
I think the most important takeaway is that having a relationship with an actual therapist is absolutely essential. A book isn’t going to respond to you in ways that make you feel that your life is important. A text can’t adequately convey tone of voice, and it certainly can’t provide you with facial expressions and other non-verbal signs that you make a difference. Only another human being can do that. So, especially if you’re suffering from a sense of dissatisfaction with your life that you don’t understand, the most important thing is to seek therapy with someone who can help you feel that you matter.
Are you struggling with a vague, pervasive sense of hopelessness or unhappiness?
Please 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.
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