Breaking the Cycle of Depression

Bill O'Hanlon on the "Marbling" Technique for Working with Depressed Clients

Bill O'Hanlon

When I was a psychology student, I learned about a phenomenon called “state-dependent learning,” based on the idea that our brains associate certain memories with specific environments, sensory experiences (smells, tastes, sounds, etc.), and internal experiences (emotions, thoughts, images, etc.). For example, if you study in a blue room, you’re likely to recall the studied material better if you take the test in a blue room or with something blue nearby. If music is playing when you fall in love, hearing that music again will take you back to those memories. The brain works by association, and certain associations bring up other associations.

This extends to emotions as well. If you’re happy, you’ll more easily recall happy memories. Thus it follows that if you’re depressed, it’ll probably be more difficult for you to recall happier memories. So, when you’re feeling helpless and resourceless, it’s harder to get in touch with resources.

And what happens when a depressed person seeks help from a mental health professional? Most of us therapists tend to ask our clients to talk in detail about their depression. Now, of course, that’s part of our task: to assess the level and history of depression. But an inadvertent side effect can be a deepening of the depressive experience as we bring it to the foreground. Indeed, a recent study shows that extensive discussions of problems, encouragement of ‘‘problem talk,’’ rehashing the details of problems, speculating about problems, and dwelling on negative affect lead to a significant increase in the stress hormone cortisol, which predicts increased depression and anxiety over time.

To counter this effect, I like to use a method that I call “marbling.” My father owned several meat-packing plants, and early on I learned that marbling refers to the fat streaks embedded in the leaner meat in a cut of steak. It gives the steak more flavor. In a similar way, but with less cholesterol, in therapy I suggest marbling discussions and evocation of non-depressed times and experiences in with discussion of depressed times and experiences. This way, we don’t just evoke and deepen the depression, and we avoid losing contact with the depressed person by listening to her and being careful not to invalidate or minimize her suffering. By going back and forth between investigations of depressed and non-depressed experiences and times, the person who’s been depressed is reminded of resources and different experiences, and often begins to feel better during the conversation.

One of the first ways I suggest implementing marbling is to discover, with the depressed person, a map of her depressed times, thoughts, actions, and experiences, as well as a map of her non-depressed times, thoughts, actions, and experiences. This is like asking the person to join you as a co-anthropologist of her life so that she can help you not only learn about the contours and geography of her suffering, but also about her competence and better moments.

Let me give you an example. While traveling to do a workshop in another city, I was asked to do a consultation with a woman, Cindy, who was spinning her wheels in therapy. Cindy would get stuck in severe depressions regularly and would basically stop functioning, quit her job, and become dependent on her therapist, whom she’d call many nights during the week in the depths of despondency and desperate for help.

I began my conversation with Cindy by asking what had brought her to therapy. She said she’d be fine, feeling confident and competent, and then she’d get depressed, losing her sense of confidence and sleeping until noon. I asked Cindy to compare and contrast her more confident and competent times with her depressed times, and the following picture began to emerge.

During her depressed times, Cindy:

  • Stayed in bed until noon
  • Got up, but stayed in her night clothes
  • Sat in her living room
  • Ate breakfast cereals all day
  • Did nothing
  • Talked only to her therapist and one male friend (who was also depressed)
  • If working and beginning to feel depressed, went to lunch alone
  • Thought about how she was getting worse and how she might have to move in with her father and stepmother if she couldn’t care for herself, or even be committed to a psychiatric institution if they couldn’t care for her or got tired of her
  • Took her shower and got dressed in the evening

During her confident and competent times, Cindy:

  • Got up, showered, and dressed before 9 a.m.
  • Went to work or met a friend for breakfast
  • Did art or played music
  • Spent time with her girlfriends
  • Met a girlfriend for lunch if she was still working
  • Gave herself credit for small or big accomplishments in the recent past (e.g., getting a paper and looking for a job, finishing an art project)

As we talked about this, Cindy began smiling at times, even while discussing her depressive experience. I told her that I wanted to learn the Cindy way of doing a "good depression," and this phrase seemed to tickle her. She also got a kick out of my naming her depressive experiences “Depresso-land,” and contrasting it with “Confidence/Competent-land.”

We often talk about “depression” as if it were a uniform experience, but although many depressed experiences share common features, they always occur in specific and particular ways for the person in front of us. The non-depressed features are also very particular and specific. But we’re so often focused on the suffering of depressed clients that we neglect to investigate and discover other experiences that don’t fit with their depression. I’m interested in discovering and detailing non-depressed experiences, actions, thoughts, and experiences. That way, I learn about the person’s abilities, competence, and good feelings as well as get a sense of her suffering.

This blog is excerpted from "Out of the Tunnel." Check out the full issue on Depression Unmasked. Or read more FREE content on Depression/Anxiety.

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Topic: Anxiety/Depression

Tags: antidepressant | antidepressants | Anxiety | Bill O'Hanlon | clinical depression | coping with depression | curing depression | depressed | Depression & Grief | free depression resources | Milton Erickson

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