I have written extensively on various ways to work with people who are struggling with anxiety, but I find that working with people who are struggling with depression, to be quite different, and more difficult. The main factor that I have experienced is in the level of energy that one emanates, and, therefore, what the counselor or helper perceives. For example, I often find that those struggling with anxiety tend to have higher levels of energy, because anxiety tends to speed up certain emotions and feelings, which people often describe as manifesting itself in their heart racing, their palms sweating. And when in conversation, it often feels like their mind is moving at a high speed. But compare that with someone who is struggling with depression, and the energy level feels very low in terms of its affect. In fact, I often find those struggling with depression to have a very flat emotional affect, whereas, those with anxiety to have a high level, or at least moderate levels of energy.
Often I will be in my office working with someone struggling with depression, and I have to pay careful attention that I don’t allow my mind to wander, or my body to become tired, almost as if it’s about to fall asleep. Someone who is depressed, often creates this contagious mood in the room that can slowly lull the counselor or helper to sleep, or what I would describe as a helpless position. Sometimes people are so depressed that it seems like they don’t want to change, and that can have an affect on the ability of the one in the helper position.
This change in energy levels that I am describing can, therefore, often make it very difficult for the counselor or helper to know how to intervene, and the person trying to help can often get sucked into the low levels of energy, making it difficult to help the person struggling with depression make progress. This scenario in my experience is one of the reasons why I think that working with depression is much more difficult than anxiety.
But this is a topic that I have thought a lot about, and it’s one that I have a lot of experience in working with people. That being said, I would like to make some suggestions about how one can best help a person struggling with depression, especially when it comes to the factor of energy levels, and low emotional affect.
When it comes to a process, I recommend experimenting with, and using one that works best for you, and that at the same time you allow for a fair amount of flexibility, as I find that many processes I try to implement myself, often move back and forth, rather than moving step by step in a simple process.
When someone steps into my office and they are struggling with depression I often have a game plan in mind to best help them navigate through it, but I know that I have to be open to being flexible based on who is in my office, and what they feel energy to change in their lives, and what they don’t feel energetic about.
First, and foremost, the beginning of my therapeutic process when it comes to work with depressed people is creating a safe environment where they can be themselves, feeling free of judgement, or pressure to change. I find that these two aspects are extremely critical if someone is going to make progress through their depression.
Regarding safety…if a person does not feel like they can open up with with someone about their depression, then they are going to keep it to themselves, and more than likely, make little to no progress. It is amazing how many people struggling with depression suffer alone. So my first job is to make is safe for them.
Free of judgement…this is similar to safety, but it takes on a different nuance. It is one thing for a person to feel like they can open up in counseling about their depression, and for it to feel safe. It is a whole other thing for them to feel like they aren’t being judged. I verbally tell my clients who are depressed that not only are they safe in my office, but they are not being judged. I remind them that depression is part of the human experience, and I will often share some stories about my own depression to help them see that their therapist is human because depression has been part of their experience.
If I can begin my work by creating an environment of safety, as well as one of no judgement, then I have taken some huge steps towards helping a person with depression. I find this so crucial, especially those who are often coming from faith backgrounds, where issues of mental health are often used as reasons to question one’s faith (or lack of faith), issues around sin, and relationship to God. Because this is such a huge factor I think it’s important not only for mental health progressions, but clergy as well to speak truth into mental health, especially this issue of depression.
Second, after I have helped communicate and establish safety, I communicate to my client struggling with depression that there are three big movements that I want to help them navigate.
One, we are going to work towards identifying the underlying roots of their depression. I communicate to them sometime in the first session my belief (based on my work in Restoration Therapy), that depression (like anxiety) is not a feeling, but is rather a behavior, a coping mechanism in response to some other underlying issue. This is a very critical distinction, otherwise, one ends up helping a person simply chase after and try to bring healing and restoration to the coping behavior (i.e. depression), rather than identifying the core underlying issue that needs healing.
I have talked about how identifying one’s Pain Cycle in the Restoration Therapy model is so crucial to help a person create change and get healing with their depression. Without this crucial step, one simply ends up treating the coping behavior, rather than dealing with root issues that could lead to transformation.
Two, I let them know that I am going to help them identify and utilize a variety of tools that can help then navigate and manage their depression. I remind them that one does not need tons of tools to try and utilize, but rather, one needs just one to two tools that they can practice over and over and over again, eventually beginning to become proficient at it at such a high level, that it becomes second nature.
I believe that for depression to be reduced and managed, and ultimately worked through, clients need some tools and resources to engage them in the process of practicing and working on their depression. The good news is that today there are more than ever more tools to help with depression, and with all the great technology available to us, there are lots of accessible tools for people to use.
When it comes to tools, I continue to use the 4 steps of the Pain and Peace Cycles in the Restoration Therapy model as my foundation tool, and from there I try and encourage others to experiment with some other tools that they can use to gain insight from, as well as to practice.
I don’t think it’s enough that we just do talk therapy with clients, or that we simply try and help them gain insight about their depression. It is important for therapists to encourage the use of tools that a client can engage in using. Because it’s that engagement of the tools that make up the practice component of therapy that I consider really vital to change.
Three, I explore with them the idea that depression in one’s life is another opportunity for growth for them. I am fond of using the metaphor of a car, and all the information that is on the dashboard of the car. This is a helpful and easily accessible metaphor to use with a client, because most of them drove to therapy session in a car. So the imagery is readily available. The dashboard has a number of lights and dials, all helpful in terms of informing the driver of how the car is working, and exactly what is going on underneath the hood. Some lights might come on when the gasoline is low, or when the oil needs changing, or it might even come on to indicate that something major is wrong the engine. Those drivers who pay attention to the warning lights and heed what the lights indicate, will be able to to keep the car in good shape, and on the road, and headed towards the original direction of the drive. But those who don’t heed the lights, drive at their own peril, and may find themselves broken down and stranded somewhere long the road. Like the lights on our dashboard, depression is a light that goes off internally within us. It says something to use like “pay attention, pay attention, pay attention to me.” Depression is information about our lives, and we do well when we pay attention to it. But if we ingore it, we do so at our own peril, and one might suffer even greater consequences down the road.
Depression is either an opportunity to help move us towards health and growth, or it’s moving us towards a position of unhealth and stagnation. When I share this news with clients, it’s almost too good of news for them to believe. They often say to me out loud in session, “How can my depression possibly be something good for me? How can I possibly learn from it?” And it is here that I remind them that depression is their body letting them know that something isn’t right. And they can either ignore what the depression is saying, or they can pay attention to it. One former path leads to only more chronic depression and a bevy of issues, while the latter path opens up a plethora of creative opportunities for one to move forward in their life.
Third, after one has begun work in identifying their root issues with their depression, gaining tools to help them navigate it, and learning to reframe it, then I think perhaps the hardest part of this journey is learning to help a someone identify their Truth. One’s Truth is the belief about themselves that does many things, one of which is helping a person regulate their emotions. And it is in that process of emotional regulation that a person is able to hit pause on the underlying feelings that lead to their depression, and instead, look for an opportunity to reframe the truth about themselves.
This is where the negative, low emotional affect really begins to take a toll on the counselor or helper, let alone the person struggling with depression. My mentor Terry Hargrave has said in one of our Restoration Therapy trainings, that trying to speak truth into someone who is struggling with depression, often feels like throwing dry kindling on to a raging inferno. It’s burnt up and gone in an instant. The person struggling with depression has to learn to speak truth into their life, which is often so very difficult.
Because depression is a response to an underlying feeling, it’s critical to find a truth that speaks into that underlying feeling, and allows the client to move in the direction of non-depressive behavior. Like the Pain Cycle, I often will use handouts with clients, as well as helping them locate their truth from God, self, or others. One of the things I mentioned in a previous post is that this can often be a difficult step with Christian clients. As a Christian myself, I know that it’s quite tempting to give the Sunday school answer to the questions, “What is the truth about you from God’s eyes?” or, “What does God want you to know and believe about yourself?” Clients don’t hesitate and often respond with things like, God wants me to know that “I am loved”, or “Have value”, or am “His son or daughter.” And it’s not that these truths, aren’t true. It’s just that they are often intellectual beliefs that are stuck in their head, but they haven’t made the journey to the heart where transformation takes place. So it’s important to push back in some gracious and healthy ways with Christian clients so that they can move from the automatic Sunday school answer to one that is more life changing for them because it’s something the know deep down and have experienced.
The Fourth and final piece of the process that I like to employ when working with depression is that of practice. In other posts I have written about my simple formula which is pretty simple: Insight + Deliberate Practice = Transformational Change. I believe that when it comes to depression, practice is the missing component. A therapist can spend endless hours helping a client gain insight into their depression, but that is often a very fruitless endeavor if the client can’t create change from the insight.
I have lots of stories from clients who were able to try and practice their way through their depression, and they succeeded. What deliberate practice looks like changes from person to person, but if one follows the steps above, then I believe they have a helpful and proven guild to help other navigate through the difficult seasons of depression.
Though I believe there are many ways to engage and help people working their way through depression. The key is to be flexible and patient, knowing that that the journey through depression is often a very difficult one. I hope you have found this information helpful, and if you do nothing but one thing, I encourage you to let them know that their depression is an opportunity for growth and it can be used for their good. That alone can transform 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