A Relational Approach to Psychotherapy and Counselling for Depression

The relational approach is hot in the therapy world at the moment, but what does it actually mean, and why would those who are not mental health professionals want to know about it? This series of posts will discuss how we do or don’t think relationally about some common mental health issues, and what the implications of this might be.

First we’ll look at one of the most common mental health issues, depression. This is a significant issue in New Zealand, as probably most of us know due to series of education campaigns and some very useful efforts to reduce stigma. Often, however, campaigns to de-stigmatize mental health issues cast those issues in a medical light, presumably because we tend to feel little shame over other medical issues such as a broken leg or a heart condition. When taken to the extreme, this can lead to thinking that equates depression with chemical imbalances in the brain that are really only the responsibility of our doctor to deal with. Just like I wouldn’t advise a neurosurgeon on how to operate on me, coming from this perspective, I might sit back and wait for the medication prescribed by the expert to do its work on my depression.

I’m not advising anyone against anti-depressants, but I am suggesting that there’s more to the picture of depression than this. Two subtypes of depression involve relationships of abandonment/grief, and of intense self-criticism.

If I am suffering the first subtype, that of abandonment, I may be experienced in relationship as very difficult to reach and connect with, and my (sometimes unconscious) expectation of others is that they will readily abandon me. Others, whether recently or in my childhood may actually have abandoned me. Furthermore, I may now act in ways that sustain this pattern, by for instance, retreating from others into a depressive isolation. From this relational perspective, my depression isn’t only a chemical imbalance in the brain, it is a state of sustained and often unacknowledged grief, loss, and appropriately to this, sadness. If I'm depressed and doing therapy from this perspective, therapy isn’t just about kickstarting my brain's chemistry, but about helping me to grieve, and bringing me back into relationship – often starting with a relationship with a warm, reliable, and empathic therapist.

If I am suffering from the second subtype, that of self criticism, it may be extremely painful for others to witness just how much I disappoint myself. Though others may accept me, and I may even long to accept myself in the same way, it is as if an invisible wall exists to stop any of this acceptance easing my pain. A criticising relationship with myself has been internalised. In order for me to break with my loyalty to this self-criticism, in therapy I may need to explore with my therapist where it came from. What were the earlier relationships in my life in which I was criticised or invalidated, and was this criticism valid? Were the standards or the purposes of this earlier criticism compassionate and guiding, or punishing and unrealistic?

In a nutshell, that’s my brief introduction to a different, more relational, and hopefully more human way of viewing depression. Please let me know in e-mail or comments what you think about this. Check in again soon for the next post in this series: a relational approach to borderline personality disorder.

Post by Michael Apathy at Lucid Psychotherapy and Counselling.