Psychodynamic/Psychoanalytic Approaches to Depression
At a time when quick-fix, oversimplifying approaches to addressing psychological struggles are rampant, I would like to summarize some psychodynamic perspectives on depression, to inform the reader about a depth-oriented alternative. Many stereotypes and myths have been attached to this form of treatment, and some consider it obsolete or unscientific. Nevertheless, it is my personal and professional experience that this way of working produces deep and rich results, and can penetrate barriers that may be insurmountable to other therapeutic approaches.
Given that different psychodynamic approaches emphasize different factors as most influential in the development of depression, the following explanations assign varying weight on trauma, constitutional factors, and psychophysiological phenomena.
One possible process that underlies depression is a self-destructive unconscious need to shut down our life-force, creativity, generativity, or sexuality. At times, the unconscious reason for such self suppression has to do with deeply rooted guilt as well as ambivalence stemming from our early lives. The goal of this drive-based approach would be to become more aware of repressed, unconscious conflicts within us, increase insight into aggression pointed at ourselves, and attenuate overly moralizing, self-critical internal structures.
Another possible reason for depression may be related to stuckness in splitting mode, wherein we can only hold a very partial, “all bad” view of ourselves and/or the world. In other words, depression is about an inability to conceptualize ourselves (and others) as whole, complex, simultaneously good and bad. In this “object relations” approach, the goal would be to be able to overcome constant splitting, as well as achieve the capacity for empathic caring, compassion, gratitude, and nuanced understanding of our own selves and of others. At the same time, the ability to “split” will be retained for situations in which black-and-white discernment is necessary.
Other related perspectives note excessive compliance, a tendency to disconnect from authentic aspects of ourselves that we had deemed to be too overwhelming or unbearable for our caregivers. In such situations, our childhood self had unconsciously judged certain parts to be unsafe and chose to protect loved ones at the cost of disavowing our “true self.” Living our life as a “false self” eventually leads to emptiness, boredom, imposter syndrome, and lacking fulfilment in one’s pursuits and relationships.
Another process that is often hidden behind depression is intense perfectionism. More specifically, the unbridgeable gap between one’s idealized self that was constructed in childhood (due to various psychologically unfavorable conditions), and one’s actual self, can often be intolerable, and manifest as depressive symptoms. Other interpersonal or relational explanations may include excessive conformity to societally established norms; or depression that is secondary to pronounced narcissism, which in itself could be a defense mechanism or a symptom of developmental emotional deficits.
Psychodynamic therapists vary significantly in how they conduct therapy, and psychoanalytically oriented approaches emphasize the therapist’s personality as an important variable in each therapeutic encounter. Across psychodynamic therapies, there is a close attention to the therapist-patient dynamic, and the here-and-now relationship between the two informs the therapist in the most immediate, unmediated way about the patient’s pains, strengths, motivations, and needs. Additional interventions unique to psychodynamic therapy include illuminating unconscious patterns, drawing meaningful connections between past and present; dream analysis and exploration of fantasy, symbols, and metaphors; processing stuckness as deep ambivalence; reflection on our bodies as a parallel to, or alternative expressions of, our minds; and detection of internalized others in the individual’s inner world.
Psychodynamic psychotherapies tend to respect the patients’ symptoms, and rather than attempting to eliminate depression, the focus is on shedding light on unknown, shadowy parts of the self, and strengthening capacities for creativity and love, in order to promote meaningful and responsible living. It is noteworthy, nonetheless, that psychodynamic work does not necessarily result in an easier life or “happiness.” In fact, in some cases a lifted depression can reveal significant underlying hurt that was masked by those symptoms. Despite this, getting in touch with our earliest pains is often a step toward a more authentic living, and gradually enhances our agency and freedom.
If this is a journey you may be interested in embarking on, consider contacting a psychodynamic or psychoanalytic therapist. May the Life-Force be with you!
Written by Lilia Berkovich