Psychotherapy for Depression and Shame

Many people who suffer from depression also struggle with intense feelings of shame. This week, we are talking with Dr. Jane Rubin about psychotherapy for depression and what patients need to know about depression and shame when seeking out treatment.

What Do You Think People Need to Know about Depression and Shame?

I think it’s really important for people to recognize how often shame accompanies depression. Many people feel ashamed of being depressed. They think that being depressed means that there’s something wrong with them. In addition, shame can also be a cause of depression. If you think there’s something fundamentally wrong with you and you don’t know how to fix it, you can feel hopeless and helpless. Hopelessness and helpless are both feelings that go along with being depressed.

What Qualities Should People Look For in a Therapist?

One thing that often keeps people who are depressed from seeking therapy is the fear that the therapy itself will be a shaming experience. They worry that their therapist will see what’s wrong with them and judge them negatively for it.

If you’re someone who’s prone to feeling shame, you probably experience it in many interpersonal situations. It’s highly likely that you’ll experience it in therapy, as well—not because your therapist is trying to shame you, but because you’re highly sensitive to feeling shame.

It’s crucial that you find a therapist who is sensitive to these issues. If you worry that your therapist is judging you negatively, it’s very important that you be able to talk with him or her about this issue. You should feel that your therapist is genuinely interested in how you feel and doesn’t try to dismiss your feelings or make you wrong in some way. Therapy should be a place where you can feel safe talking about painful issues.

Do You Have an Example of a Patient Who Struggled with Shame and Depression?

I have many. I have a patient whose mother had a fairly severe mental illness. The mother was extremely sensitive to anything that could negatively affect her mood. This included even very minor actions, like my patient’s crossing her legs while she was talking to her mother or setting the table in a way the mother thought was wrong.

My patient grew up feeling that she had to be hypervigilant about every encounter she had with other people. She was afraid that everyone else was as fragile as her mother. For example, whenever she received a less than enthusiastic response to an email she wrote, she was convinced that she must have said something wrong and that her relationship to the other person was endangered. These situations would send her into a depressive tailspin in which she became convinced that there was something fundamentally wrong with her that would undermine her ability to have positive relationships with other people.

What Psychotherapy for Depression Treatments Would You Recommend?

In the area of depression treatment, one size doesn’t fit all. Cognitive behavioral therapy is very popular these days and some people get good results from it. One of its limitations, however, is that it doesn’t address the feelings of shame that are often the most painful part of the experience of being depressed. I would encourage people who are depressed, and who suspect that shame is contributing to their depression, to seek out psychodynamic therapies that specifically address shame as part of the treatment.

What Advice Would You Give to Patients?

Most treatments don’t have immediate results, so it’s important to have patience with your therapy.  At the same time, I always encourage patients to voice any concerns they have about their therapy. Tell me if they think I’m not being helpful. This, of course, is especially difficult for patients who experience a lot of shame. They blame themselves if things aren’t going as well as they feel they should. But it’s crucial that patients advocate for themselves to make sure they’re getting what they need.

It Sounds like Patients Need to be Active Participants in this Process?

Absolutely! This can be difficult for people to do. And, of course, your therapist has to welcome your active participation in order for you to feel safe enough to voice your concerns. Patients often imagine that their therapists have all the answers. But therapy is a highly collaborative process. The more permission you feel to be an active participant, the more you’ll gain from your therapy experience.

Click here to learn more about treatment for depression with Dr. Jane Rubin.

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.