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As a counsellor in Whitton and Twickenham, I am often asked questions about counselling for depression. Some people are not always sure. They ask what is depression? What are the causes of depression? And how do I identify the symptoms of depression? Depression is a continuous state of mind which locks people into downward spiral of low moods, hopelessness and despair. It is a normal response to human experience, life crises and survival.
However, rather than medicating depression as a permanent solution, counselling and psychotherapy for depression aims to help people suffering from depression to understand their experience and heal the source of the depression. Rather than treat depression as a generalised set of clinical/medical symptoms, we look at depression as part of the human experience. Through a process of developing an awareness of underlying feelings, emotions, thoughts and relationships a person can understand, unravel, and transform depression. Counselling can help people heal and find self-acceptance in order to live a more fulfilling and meaningful life.
Counselling theories, including Freud (1917) view depression as a kind of defence-mechanism, way of coping or self-protection which relies on "shutting down" the integrated neural circuits in order to avoid pain (D, Seigel, 1989). Freud (1916) first proposed that depression may be due to childhood experiences of loss and grief around the death of a loved one, abandonment by a parent or even an emotionally absent parent.
He also realised that childhood experiences of neglect or emotional detachment can also lead to depression in later life, as the adult finds it difficult to form intimate relationships, fearing loss and abandonment. Freud distinguished between actual losses (e.g. death of a caregiver) and later symbolic losses experienced in adulthood (e.g. divorce, loss of a job). Both kinds of losses can produce depressive reaction, by causing the individual to re-experience childhood memories when they experienced loss of affection from a parent.
Whatever the causes behind depression a person’s state of mind can be improved through compassion and empathy in therapy; as well as using a number of counselling techniques to change a person’s frame of mind. Research shows that some people may be more predisposed to develop depression in response to life events. The familial inheritance identified in depression is both genetic and learned. Whether one is predisposed to depression or not, there is a great benefit in addressing the issues by accepting counselling for depression. At counselling Twickenham, Whitton I offer counselling for depression with a human touch. The clinical diagnostic manual for mental disorders (DSM IV) states that the symptoms of depression are: five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning;
1. a depressed mood most of the day
2. diminished interest or pleasure in all, or almost all, activities all day
3. significant weight loss or weight gain, a decrease or increase in appetite
4. sleeping problems or insomnia most days
5. psychomotor agitation or retardation e.g. restlessness or lethargy
6. fatigue or loss of energy most days
7. feelings of worthlessness or excessive guilt (which may be delusional)
8. diminished ability to think or concentrate, or indecisiveness
9. recurrent thoughts of death and recurrent suicidal ideation, or suicide attempt
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Developmental Stages: depression must not be confused with normal grief after the loss of a loved one, although extended grief may lead to depression eventually. Depression is usually developed in childhood as a learned response to poor patterns of attachment between parents and children e.g. as a result of fear, abuse or neglect (M. Klein, 1932). Klein believed that we internalised our parents and caregivers during childhood development and that deficits or failures by the parents to care for led to very painful and traumatic memories being remembered in adulthood - experienced as an episode of depression when the adult experiences loss in later life or a failure to form intimate, long-term attachments. But it can also be developed after prolonged emotional pain or adult trauma.
Bodily Effects: in depression there may be great difficulty with motivation and summoning the energy necessary for even the most basic tasks, such as getting out bed, preparing food, washing or getting dressed. Depression often includes periods of intense fatigue and restlessness. Depression may be experienced physically in the body due to the release of certain hormones; leading to complaints about pain and tension in the neck, back, muscles, nausea and headaches. It may also lead to sudden fits of tearfulness without an identifiable trigger. Alan Schore (1991) believed that children who are not emotionally attuned to by their parents, find it difficult to self-regulate their bodily sensations and emotional states. This can also affect the person's ability to self-care in times of emotional upheaval and crisis.
Depressive Thoughts: depression involves extremely negative thoughts are generated and may persevere with beliefs like “I’m no good,” “I am worthless” “whatever I do is never good enough” “no one cares about me”. People with depression may feel intense shame or guilt. Anxiety and worry persist about seemingly inconsequential matters and are frequently present. In some cases, thinking may be diminished, and suicidal thoughts are common. CBT practitioners like Beck (1967) believed that people suffering from depression appraised themselves and the world in negative schemas. He described a cognitive (thinking) triad in which persons formulated negative thoughts about the Self, world and their future. Beck claimed that depressed individuals tend to create schemas (core self-beliefs), which view themselves as helpless, worthless or inadequate after suffering a series of negative experiences. They interpret events in the world in an unrealistically negative and defeatist way, believing that the world is persecutory or an obstacle to their happiness which cannot be overcome. This leads to a grim view of the future, which they see as totally hopeless because their inadequacy and worthlessness will prevent them being able to improve their lives.
Depressive Feelings: depression includes low moods and feelings of overwhelming sadness or grief and other negative emotions. Emotions may be expressed with tearfulness, anxiety and anger present in severe cases. People may also feel empty, unsure of themselves and completely withdraw from close relationships, friends, family and work. Patruska Clarkson (1998) believed that people who find it hard to moderate or regulate intense emotional states in a crisis without the support of a loved one, can become confused lost and suffer from inner-directed anger.
Relationships: depression interferes with a person’s ability to communicate or express emotion, and to experience appropriate emotions and intimacy in relationships. Depressed people often find it difficult to receive reassurance or comfort from others. They may feel unworthy or that others are being insincere. Lethargy, irritability and anger may make mutually shared expressions of love difficult to bear. Depressed people often feel isolated and withdrawn or completely desperate and dependant on others, accompanied by feelings of neediness. Depression may have passive-aggressive elements that disrupt relationships and lead to sabotaging behaviours. They feel unable to participate in social activities, and may be unable to work due to stress and anxiety. Counselling In Teddington involves helping people gain insight into negative patterns of thought, fearful emotions and avoidance or self-limiting behaviours. It means building a relationship of trust, compassion and empathy between counsellor and client, so that they can move towards a positive pattern of attachment and self-care. But the strategies and coping mechanisms which bring about change, are learned through a collaborative process of working through the client’s issues and dependent on a healing and therapeutic alliance with the counsellor.
Please email or call me Counselling Whitton, Twickenham for further information and guidance on depression and suicidal thinking.