London W1 Psychotherapy Counselling for Depression
Depression Counselling with a Psychotherapist
Please read as much or as little of the below as you wish, but please be reassured that our job as therapists is to help you to begin to bear what you might think unbearable. That’s why we’re here.
Depression is a very common condition (affecting one in ten of us according to some and one in five for older people according to others) but it affects people differently and it has varied symptoms. This page is by no means about what you, if you are depressed, may be feeling because it will be different for everyone. However you may recognise some of the following points. We would always stress that each individual needs individual therapy. That’s why talking therapy (one to one) can help.
Major depressive disorder (MDD), commonly referred to as depression, can severely disrupt your life. Depression can affect your relationships, your working life, your sleeping patterns, your appetite, or lead to abuse of substances in an attempt to avoid difficult feelings. Some symptoms of depression are constant feelings of sadness, irritability or tension, decreased interest or pleasure in usual activities or hobbies, loss of energy, lack of concentration, restlessness, a change in sleeping patterns, feelings of worthlessness, hopelessness or guilt or thoughts of suicide.
The reasons that depression can occur are many and various and may be circumstantial; maybe from a loss or grief: They may be biological (some say genetic too): they may be triggered by life’s stresses or by one’s conscious or unconscious expectations, by trauma or loss : They may stem from a more psychological background.
Depression can be set off by relationships, social situations, one’s own feelings of self-esteem or well-being, alcohol or substance abuse, lack of self-control or life getting away from one. It may be spiritual, religious or global or political concern. . It’s generally agreed that there is no single cause and that it’s a combination of genes, chemistry and life!
Common triggers in life events that can bring on depression are divorce, separation, bereavement, redundancy, money worries or illness. In some cases there are no obvious triggers and this is known as endogenous depression – which appears more from internal changes (sometimes hormonal) including pregnancy, childbirth & menopause. In other cases it may be more psychological (see below) – family, family background, self-esteem and self-critical issues can bring on the condition.
Types of Depression – knowing you have Depression
Depression is different to feeling down or feeling sad. It doesn’t tend to go away and it has physical and emotional side effects. It tends to be isolating and can imprison the sufferer. It is a difficult condition for those suffering and often for those around the sufferer. It is often prolonged by inaction towards solving the issues and a reluctance to deal with the depression. As the NHS says, Depression is a real illness with real symptoms, and it’s not a sign of weakness or something you can “snap out of” by “pulling yourself together”
Sometimes it may not be obvious that one is depressed, it may seem more physical or like a mystery illness (often with weight loss). But the relentless symptoms (see below) and the more of them one has, the more likely it is to be depression that one is suffering.
The below points divide the degree of depression by intensity but there are no clear edges to these categories. Talking therapy can be useful for all types of depression. More and more studies show the benefits of the correct psychotherapy either with, or over medication for depression sufferers. In some cases alternative therapies which aid relaxation and help anxiety may also help.
- Mild Depression – this is when symptoms of depression have a limited impact on your daily life even though sufferers will experience a persistently low mood. You may find it difficult to motivate yourself and to enjoy life. It may be that your depression improves by itself (“Wait & See”), by exercise, by self-help or by cognitive behavioural therapy (CBT)
- Mild to moderate Depression – this is when your depression doesn’t go away for weeks rather than days and when your GP will most likely recommend talking therapy – psychotherapy & counselling
- Moderate to severe Depression – this is when your doctor will suggest either or both medication and psychotherapy and in more extreme cases further mental health professionals may become involved
- Clinical Depression – commonly called major depression or clinical depression or major depressive disorder (MDD) – this is even more severe and can lead to hospital admission due to the effect of the extreme symptoms which will severely affect daily life. Suicidal thoughts can accompany suffering other symptoms when life seems no longer worth living
- Bipolar disorder – a form of manic depression characterised by extreme highs and lows.
- Pre/Postnatal Depression – this is a condition that can develop around childbirth –see our separate page on perinatal/pre-postnatal depression
- Seasonal affective disorder (SAD) – this is a type of depression that has a seasonal nature often related to the shortening daylight
Who suffers from Depression?
There are some differences between depression in men (please see the link below) and in women and between age groups. Middle age is a factor.
Women suffer from depression more than men and sometimes this is the influence of hormones. Symptoms are also more noticeable in women and can be expressed in weight gain, sleeping patterns and expressions of guilt. Women also seem to suffer seasonal depression (“SAD”) more than men.
Because men tend to hide or shy away from “being depressed” it may be harder to see and it may express itself through anger, violence, risk taking and occasionally suicide. (Please see our page for Depression in Men.)
For young adults & teenagers depression may be seen through irritability & hostility and maybe through sadness. Sometimes unexplained pains can be symptomatic. Needless to say, depression in young people should be treated to avoid problems in maturity.
Some Symptoms of Depression
There are psychological, physical and social symptoms of depression, such as…
- Blaming oneself & excessive guilt
- Anxiety, fear and tearfulness
- Excessively thinking about oneself self, criticising oneself and focussing only on & pre-occupation with oneself
- Feeling lost, confused or pointlessness
- Pessimism, a bleak out-view, dread, feeling crushed, dwelling on the negative and the hopelessness
- Difficulties with decision making or sometimes over keen-ness
- Loss of enjoyment, enthusiasm
- Turning to sex, drugs or alcohol
- Suicidal ideation
- Changes in sleeping patterns – restless or sleepless nights or oversleeping
- Sleeplessness, listlessness – or over tiredness
- Changes in eating patterns – loss of appetite or overeating
- Tiredness and loss of energy & sloth
- Headaches or stomach upsets & aches, pains
- Moving or speaking more slowly or more confused than usual
- Loss of libido, sexual appetite – or over keen-ness
- Changes to the menstrual cycle
- Disinterest in others, friends & family or colleagues
- Isolation from family & friends
- Less social interaction and less interest in socialising
- Lower performance at work or in social situations
- Neglect of interests, hobbies, commitments
The Problems & Stigmas of Depression
- One of the problems with this disorder is the viscous circle of unhelpful thoughts that come with depression and the consequent pessimism. And this may make it harder to get better and harder to seek help. Inaction can lead to a further sense of uselessness and it can add anxiety to the equation. Similarly guilt and self-blame can compound depression and make seeking help more difficult.
- Sometimes depression can be debilitating. With no energy to escape sufferers may hide in their depression where they may ironically feel safe. Sometimes feeling bad can be the right thing but at some point we need to turn around and move forward.
- The stigma and/or the embarrassment of depression can stymie asking for help
- Other people saying cheer up or thinking that you’re “over it” – or should be – when neither is the case. Sometimes depression becomes more intense later when friends and family think you’re “better”
- The pressure to be positive in our modern Western world. This isn’t part of the depressed disorder and until you seek help, being positive may seem impossible
- The loneliness of depression – being depressed can be very lonely. It may be from not knowing what to say or not wanting to talk about it and seeking isolation. Being lonely in company is very common for the depressed
- It’s harder to relate to other people and this can escalate or exacerbate the depression
- The ongoing nature of depression can be unrelenting and the inability to find solace is hard to deal with. Sufferers find it impossible to think of the situation/their depression ever ending
- And losing the ability to see a way out can mean getting locked into depression. Sufferers are unable to imagine a future life without the depression and therefore procrastination and avoid getting help
- Depressants can lock out happiness as though they shouldn’t have it – or deserve it – and find more comfort in depression
Therapy & Help for Depression
Treatment for Depression
If symptoms persist for more than a fortnight, it is probably time to seek professional help – your GP for starters, who should take tests to rule out any other reasons for your condition. You might then want psychotherapy – and your doctor can advise you on this – either as an alternative or as a complement to medication. The good news is that depression is very treatable.
The professional therapists at Cavendish Psychotherapy Practice will help with treatment for depression by working with you to pin-point its source or sources, which will be very individual. The exploration is a very delicate and personal time and the relationship with our non-judgemental, listening counsellor is critical to the process. Depression counselling techniques from focused therapies such as CAT or CBT can be helpful in developing an awareness of the cycle of belief that can maintain depression. The important thing about therapy with a psychotherapist is that it aims to help those with depression to understand their illness and to understand its triggers.
Understanding the triggers and hooks that make us depressed is a start and understanding which stress points do not help our depression. Understanding how we got here can help us to move forward with more certainty. The therapist will help those with depression see a bigger picture which they will paint together.
The counselling process moves forward from the beginning to allow some of the issues discussed below to be examined. The process itself includes becoming comfortable talking; understanding how counselling works and/or may work for you; exploring the background; working together to move forward; agreeing what is important; moving towards the end of counselling.
To move on from depression, something has to change and we need a gentle and helping kick start to begin the virtuous spiral out of the depression’s vicious circle. This in itself may be daunting but without some understanding and some thoughts about change for the future, it may be difficult to move on.
Part of the therapy may be dealing with a refusal to accept where we are. Possibly being stubborn in one’s depression can become a badge to show dissatisfaction.
Therapy will look at what makes you happy – which may well be very different to what makes other people happy. So the solution in therapy and in dealing with depression has to come from you and your life and circumstances. Other people may not understand – whereas a trained therapist will take a very neutral stance and will work to understand (and help you to understand) you!
In the process the therapist may explore challenging your perceptions and beliefs which may hold you back from understanding how happiness can be achieved. Maybe, some perceptions – and expectations – have led to the depression and a re-configuration of what’s-what may help. The therapist will also ask you to explore what you think you deserve. Therapy may include the exploration of what expectations one has of happiness and what is realistic as an adult – and why. Goals in this context may not be helpful as they may focus on misleading assumptions of what happiness is for you. Discussing being contented without the pressure of “happiness” can be more helpful.
Being altruistic, helping others, thinking about others and being less self-centred may be a route to a more stable level of contentedness or happiness, without the hard struggle for “happiness” per-se.
Likewise concentrating on external relationships rather than self-examination may be explored as a way to move on from depression.
An all-round full life (which includes good physical health, eating, exercising and socialising and being content with the good things in life) will usually help.
The sometimes comforting sense of depression will need to be turned around to be able to escape the negative and the inactive. Understanding what makes you happy or sad may ironically include the depression one is considering. Therapy looks at this too if this is an issue.
Some people see depression as a positive sign that something in one’s life or in one’s way of thinking needs to change and therefore can be embraced as a signal for change and a new outlook or a new behaviour.
During Therapy for Depression
Counselling for depression will quite likely look at some or all of these issues which may have a bearing on your depression
- Self-identity, self-worth & personality traits
- Sensitivities, relationships
- How one deals with changes (or loss)
- Feelings & emotions
- Behavioural patterns
- Self-sabotage, destruction, self-harm
- Unhealed wounds, background
Counselling will discuss help you to understand some or all of the following
- Your symptoms
- Your triggers
- How to deal with depression
- Causes of depression
- (Discussing how dealing with depression is possible)
- Treatments for depression
At the Cavendish Psychotherapy Practice, sessions for depression take place over many weeks in one hour weekly sessions (ideally at the same time weekly). All of these are one-to-one sessions with one highly qualified psychotherapist counsellor who will counsel you all the way through. the number of weeks is not defined to ensure that a time scale adds no anxiety.