The Depression Equation
I am a big believer in the equation that insight + practice = transformation. In fact, in an earlier post on anxiety I shared the same equation, highlighting Angela Duckworth’s work on the concept of deliberate practice in her work. In her book Grit: The Power of Passion and Perseverance, she writes the following:
“Deliberate practice is a behavior, and flow is an experience.”
Probably a newer equation for me is reframe + insight + deliberate practice = transformation. I believe that this formula is ideal in helping people work through their struggle with depression, and it’s this equation that I would like to focus particular attention to in this post. And as I cover these specific elements that make up the equation, I would like to shine a light on some of the tools and best practices that I have found particularly helpful in navigating depression.
Unpacking the Equation
First, what is reframing?
As I discussed in an earlier post, reframing is simply the ability to look at a situation and find some helpful, new possibilities in it. In the case of depression, I am asking someone to look at their depression and to reframe it as an opportunity for growth. When you can reframe depression as an opportunity for growth, then you are able to ask helpful questions of it that can lead to positive transformation.
Helpful tools for reframing.
In terms of reframing depression, one of my favorite tools is externalizing and interviewing depression. I discussed this as well in a previous post, but would like to mention a few key aspects of this technique.
One, if you want to help someone externalize their depression I find it particularly helpful for them to have a conversation with their depression as if it’s an inanimate object. The counselor can take the position of depression itself and the person can ask questions of it. The counselor can choose to respond or not respond. Another way to help a person externalize their depression is to ask them to keep a journal about what they are experiencing when depressed.
Two, They can then bring the journal into the counseling setting (whatever that setting may be), and the counselor, pastoral counselor, friend, etc., can read the journal entry and interview the person about their depression. When someone hears their experience of depression read back to them, or put into an interview format, it can be particularly helpful in aiding in insight. I find that there is no right way to do this, so don’t get stuck on or worry about specifics, but utilize what is best for you in terms of externalizing and interviewing.
Three, as a Restoration Therapy therapist, I always draw up someone’s pain cycle in session, putting their depression into their coping behavior, and connecting their underlying feelings to it. When someone sees that visualize mapping of their depression, and when it’s mapped out on a large piece of sticky note hanging on my office wall, I find that will automatically create an externalizing affect for them. Something really powerful happens when a person sits on my couch or stands up in my office and looks at their depression visually. It often automatically makes them realize that they are not depression itself, but depression is something they do. And that realization can be life changing for them.
Second, what is insight?
Insight is simply the ability of a person to gain a deep understanding of one’s self, and hopefully other people. Insight is often gained through looking back at one’s past experiences and how they have shaped them, as well as working on observing oneself in the present moment and what is transpiring.
Tools for gaining insight.
Insight can be achieved in many ways, but in the context of therapy it is often achieved in several different ways.
One, the use of a family genogram is very helpful in helping a person better understand themselves. A family genogram has the benefit of not only both helping a client externalize their depression (i.e. because they may possibly see the depression in the context of the larger family system, rather than just seeing it as something wrong with themselves), but also helps a client identify possible underlying feelings that developed in their early years, feelings that created and environment where depression was developed as a coping behavior. If you are working with someone who is depressed and you want to have them develop a family genogram, you can send them to several different websites, or you can help your client with the development of a genogram by reading several different books on the subject, or by utilizing any training you have had in this area.
Two, I highly recommend helping someone identify both their Pain Cycle and Peace Cycle in the Restoration Therapy model. There are different ways to do this, but the most simple are passing out a sheet of feelings and coping behaviors, and truths and actions, to help a client identify these cycles.
Three, or you can really focus on the dialogue between yourself and the person you are working with, and pay particular attention to what feelings they are describing and attaching to their depression. This can better help you identify the negative pattern of interaction that creates their depression. As well as listening for the Pain Cycle, you can also listen for a client’s particular strengths and beliefs about themselves, and use them to help construct a Peace Cycle.
Third, what is deliberate practice?
Deliberate practice is intentional and thoughtful repetition of a certain skill. In my practice I like to talk about deliberate practice as being those moments when someone intentionally experiments with the insight they have gained in therapy. In her book Grit, Duckworth says this about deliberate practice:
“Make it a habit. Figure out when and where you’re most comfortable doing deliberate practice. Once you’ve made your selection, do deliberate practice then and there every day. Why? Because routines are a godsend when it comes to doing something hard. A mountain of research studies show that when you have a habit of practicing at the same time and in the same place every day, you hardly have to think abut getting started. You just do.”
Tools for deliberate practice.
One, the most important tool that I use in my work to help people with depression (and all issues for that matter), is the practice of the 4 Steps in the Pain Cycle and Peace Cycle in the Restoration Therapy model. In fact, the 4 Steps is a great example of combining both insight and practice. The four steps are created due to the insight of the client and therapist, and then that insight is put into the practice in the form of walking through some steps that can be said out loud verbally, as well as out loud in one’s own head.
For example, when a client first comes into my office to do work with me, I spend a fair amount of time helping them identify their four steps (insight), and we will continue to use that insight in the form of 4 steps as our foundational piece throughout therapy:
Step 1: Say what you feel… This step is part of the Pain Cycle and it’s identified by helping a person discover how they feel in certain situations such as conflict, distress, etc. In step 1, I help someone identify their core underlying feelings.
Step 2: Say what you normally do… This step is also a part of the Pain Cycle and it’s identified by helping a person discover their coping behavior in situations such as conflict, distress, etc. From my experience this is often an easier step for people to identify. People seem to be much more aware of their behavior, then what the underlying feelings are that trigger it.
Step 3: Say your truth… This step is the beginning of the Peace Cycle and it’s one of the hardest to identify in my experience. Also, in my experience, working with Christians can be challenging when we get to this step, because many are quick to give a truth that feels cliche (i.e. a Christian answer that they feel they have to give to be a “good” Christian), and it often takes a lot of work to help someone identify a truth that resonates with them and their experience when they are emotionally regulated. In the Restoration Therapy model, truth can be identified from three different sources: a) self; b) others; c) God.
Let me pause here for a second to say something about these steps and why they are important. When a person is in their Pain Cycle they are emotionally dysregulated. That is to say, their emotional response is triggered by their underlying feeling in the Pain Cycle and they automatically respond to that feeling typically in an unhealthy way. In this moment they are reacting, rather than choosing to respond in a healthy way. In the Pain Cycle people are emotionally dysregulated, and the Peace Cycle is the beginning of emotional regulation. When a person identifies their truth and practices that, they are learning to emotionally regulate themselves and respond to themself and others in non-reactive ways.
Step 4: Say what you will do differently (and do it)…This step is also part of the Peace Cycle, and is the healthy response that one chooses when they are emotionally regulated and operating out of their truth.
These 4 steps are something that I deliberately practice multiple times a day, even when I’m emotionally regulated. And I encourage clients I work with to make it into a habit, and to intentionally and deliberately walk through the 4 steps multiple times a day. Walk through the steps when they are emotionally dysregulated, and walk through them when they are emotionally regulated. I compare it to a fire drill, in that the more I practice it when I’m not in conflict, the more readily I will be able to put into action what I have been practicing.
Though I find the 4 steps to make up the bulk and most significant portion of the tools that I help clients access when struggling with anxiety, I want to mention a few other that I have found to be absolutely instrumental in my own life around depression, and the lives of my client’s working through depression.
Two, the practice of self-care is probably one of the most important things I have clients do in my first meeting with them (along with helping them identify their Pain Cycle), is to go over how they are taking care of themselves physically, emotionally, mentally, and spiritually. I find that one’s ability to care for themselves is often connected to their ability to emotionally regulate themselves and especially their depression. So I will often focus on making sure that clients are paying attention to taking care of their exercise, diet and sleep (physical). I will make sure they are paying attention to connecting with others like friends and spouses as well as tuning into their interior life (emotional). I will make sure they are paying attention to doing things that stimulate their intellect (mental). And finally, I will make sure they pay attention to doing things that help them connect spiritually to God, or their version of a higher power (spiritual). These are important categories to help reduce and manage depression.
Three, I find that the setting up little experiments for people to practice are very helpful, and give them real time experience in learning to put tools to use and navigate through depression. I think it’s so important when it comes to depression, that people are trying out little experiments. For example, if someone is struggling with depression and is having a hard time navigating it, I might give them an experiment to just walk around their block in the morning to get some exercise, followed by a coffee meeting with a friend. One of the ways to work through depression is to continue to practice overcoming the barriers and gaining confidence in the process.
Fourth, what is transformation?
Transformation is simply the culmination of one’s reframing depression, gaining insight about their depression, and putting their insight into practice. When a person does these three things, one arrives at transformation.
There are lots of tools to help someone reduce, manage, and ultimately work through their depression. If you utilize these tools and practice them deliberately, you will one day experience the transformation that you were hoping for when you gained your first insight on your depression.
Rhett Smith is a Licensed Marriage and Family Therapist in private practice in Plano, TX. He specializes in helping people struggling with anxiety find new opportunities for growth, as well as spending a majority of his week with couples as they navigate relational issues. He is the author of The Anxious Christian: Can God Use Your Anxiety for Good? and What It Means to Be a Man: God’s Design for Us in a World Full of Extremes. Rhett lives in McKinney, TX with his wife Heather and their two children. You can discover more about Rhett’s work through his writing and podcast at rhettsmith.com
