Deconstructing Depression


Deconstructing Depression

A Therapeutic Road Map for Effective Treatment

By Margaret Wehrenberg

November/December 2010


Psychotherapists probably see more cases of depression than anything else in their practices, but it remains one of the most challenging conditions to accurately assess and treat. Part of the problem, no doubt, is that "depression" is a broad, poorly defined diagnostic category, which embraces a daunting range of symptoms, including cognitive and physical lethargy, mental rumination, loss of concentration, chronic negativity and pessimism, feelings of worthlessness, and unremitting sadness. Furthermore, the symptoms themselves can block response to treatment. Lethargy, hopelessness, negative thought patterns, and refractory negative mood all interfere with useful interventions. To get beyond or around the powerful drag of inertia in depression, therapy needs to quickly nudge clients into action, help them take charge of their cognitive habits, instill hope, and reduce negative mood.

Rather than seeing depression as some kind of monolith, I've found it useful to see depressive symptoms as falling into four basic clusters, each reflecting a different underlying cause‚ÄĒneurobiological, traumatic, situational, and attachment related. By immediately addressing the attitudes and distinctive vulnerabilities that lie at the core of each cluster, treatment can begin to bring about a shift in brain function that makes longer term work easier. In what follows, you'll find a brief description of how to begin treatment with each cluster, with a particular emphasis on how to…

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