Not Always Depression

Hilary Jacobs Hendel published an articlein the New York Times recently that beautifully captured the healing process of a client with what the medical establishment would call “treatment-resistant depression”. She describes the steps of Accelerated Experiential Dynamic Psychotherapy, an approach based on psychodynamic and Gestalt frameworks. AEDP rests on the latest in brain research that explores how our natural emotional responses get “stuck” in the body, playing a role in psychological “disorders”. AEDP also unfolds from decades of studies on the kind of helping relationships that can get things unstuck. In Hendel’s story, her client has learned over the years to protect himself from abuse by entering into a state of profound disconnection, from other people and from his own inner world. He struggles to talk at all, let alone talk about his feelings, leaving him cut off from others and his own experience. 

I have participated in the AEDP intensive week-long training, as well as years of training and mentorship in an allied form of Gestalt therapy which focuses on the quality of the therapeutic relationship and the mindful exploration of emotional experience in the body in the present moment. Reading this story reminded me of a client of mine , “John”, who struggles with depression and alcohol use. AEDP would frame many of John’s difficulties as side-effects of the ways he learned as a child to repress, numb out, intellectualize, or otherwise avoid engaging painful core emotions. After experiencing significant relief and support in his sobriety from a first, very tearful, session, the client brought up in his second session a conversation he had had with his mother about the kind of child he had been: charming, undemanding, but noticeably quiet and withdrawn when upset. Not necessarily because of abuse or parental failure - in fact his parents were basically present and supportive, if rather emotionally unavailable and dealing with their own substance use issues - John had learned to cope independently with normal emotional signals of pain and distress, signals that would typically compel a child to reach for their caregiver. As Hendel points out, this process tends to leave the client with compromised capacities for emotional regulation, but also an all-pervasive legacy of shame. As psychoanalysts observed decades ago, a child left alone to take care of their needs would rather believe that they are bad or somehow deserving of their loneliness, than that their world is unsafe. Functioning as an inhibitor of core feelings and driving us away from supportive loved ones, shame is a barrier to treatment success in many conditions, and needs to be identified and addressed proactively in therapy. The inhibiting effect of shame was made concrete when John told me in a firm tone of voice, his eyes bright, about a glimmer of happiness and hope that he was experiencing. Almost immediately he teared up and looked away, saying “There’s still a part of me that truly believes I’m a piece of shit and it’s all my fault”. Experiencing the actual bodily feeling of shame, identifying and sharing it while in contact with another human being, while exploring the role that this “shamer” part playing in the cycle of his addiction, is giving John more ammunition in the fight for sobriety. It is also building his capacity to experience underlying core emotions with his girlfriend and other supports, rather than engaging in his typical false optimism or turning to alcohol to shut them down. 

Check out the AEDP approach to emotional healing by reading Hilary Jacobs Hendel’s book, It’s Not Always Depression, or contact me if you would like to get to work on issues like this with a supportive therapist.