Therapy in a Nutshell: For Depression

Presenting Issues

Bhavna* sought therapy in an attempt to alleviate her presenting severely depressive symptoms (such as suicidal thoughts, acts of self-harm, crying outbursts, a general pulling away from what interested her earlier, low self-esteem, low self-confidence, etc.).

Background Information

Upon coming in, Bhavna mentioned a few factors that could be contributing to her state at the time of intake: her marital relationship wherein she felt her needs were not understood and accordingly not met, the loss of her father a few years prior, being away from her established circle of support and friends due to her recent relocation to another country with her partner. Away from home, it had suddenly felt like too much change, and not enough support.

Assessment

Bhavna* came in with severe signs of overwhelm and depressive symptoms. She further mentioned she wanted to understand what’s happening with her and work towards feeling safer in her body.

Treatment Plan

Goals

1. First and foremost, working with the thoughts of self-harm, suicidality and overwhelm by slowly allowing and building on a sense of safety and trust with the Therapist.
2. Building on their accessibility to various resources around them that could help them experience more ‘glimmers’ of hope and possibility, while identifying potential triggers and possible responses to them.
3. Going back to understanding how various patterns and learnings from past experiences could be enabling the concerning symptoms.
4. Working with releasing the self from such learnings over time, thus allowing for more of the client’s natural confidence and presence to come in to the Therapy space.
5. Keeping the goals flexible to allow for shifts to be made as and when the overwhelm lessens and the confidence in making their own treatment related choices is enhanced.
6. Exploring cognitive-behavioural strategies to build on work with the ‘freeze’ response that often exhibited within depressive symptoms.
7. Over time, helping with the uncoupling of anxiety/fear from specific actions and situations by building a practice of tuning into the body’s creative responses (and not just the mind’s) in place of suppressing them (which, from a trauma-informed perspective, can lead to depressive symptoms).

Intervention Strategies

1. Somatic Experiencing to identify a pace that’s comfortable (and is least likely to result in retraumatization), and to facilitate a sense of ‘discharge’ about the ‘stuckness’ seen in the ‘freeze’ trauma response, commonly seen within depression.
2. Nature-based imagery was employed to help to ground and orient in natural, instinctive directions.
3. Rational Emotive Behavioural Therapy to help identify concerns, add directiveness to the approach and to reframe as needed.

Frequency and Duration

Weekly therapy sessions for 18 months, and continuing.

Results

1. In the first few sessions, Bhavna* was able to feel more of a sense of safety through her rapport with her Therapist, around which at least within the span of a session, was able to create some distance between her Self and her suicidal ideations, thus decreasing the possibility of any acts of self-harm. She also began feeling slightly more present and conscious in her life experiences, and reached out to her Therapist for emergency sessions, if the need came up.
2. In one year of being in therapy, she has experienced various changes and stressors, which affected her sense of progress within therapy. Through it all, therapeutic work focused on allowing for flexibility in goals and structure, while making room for preparation and coping related to the planned or unplanned changes in life.
3. Bhavna has since been able to recognize, orient and stay with her own sense of Self (which for many years had remained overwhelmed to some degree), to recognize her own needs and wants, and to creatively go about fulfilling them. Through this process, she has also learnt to recognize what kind of relationships and supportive structures are healthier for her.
4. A big shift in her functionality has been related to being able to ‘feel’ more of her choices (with the objective of making more self-aware choices) in place of just having them and feeling too paralysed to act on them. She also has a healthier relationship with the emotion of anger now, which for her, translates to lesser likelihood for emotional suppression in the present and future, and thus a lesser likelihood for depressive symptoms to present again in a severe manner (indicative of enhanced psychological resilience to life stressors).