Amanda Williamson Coaching and Counselling Service in Exeter, Devon

This post is written from a purely anecdotal and personal point of view. I am aware that depression can be a medical illness and any action taken should be in conjunction with the expert advice of a GP.

I am writing about my perspective on the concept of depression. Many people are diagnosed each year with clinical depression. Between 8 and 12% of the population experience depression in any one year (1). So I see a lot of it in the counselling room - those that have been diagnosed and those that haven't been diagnosed but that seem to be exhibiting similar responses.

I attended a workshop a year or so ago about Hidden Losses - there was discussion about the stepping stone emotions as a reaction to loss. One of the emotional stages was depression and this seemed to spark some debate in the room of person-centred counsellors. Some seemed positively horrified at what they see as an unhealthy "label" and I was surprised at the strong reactions of some to the very notion that when we suffer loss, that a certain amount of depression is likely, or at least possible. The thing is, depression is as natural and likely as sadness, anger, shock and all the other emotional states associated with loss and as such, I do not see recognising this as unhelpful. In fact, I think that denying the existence of depression further stigmatises those that are depressed.

DEPRESSION IS A NATURAL RESPONSE TO CERTAIN ASPECTS OF LIVING

Life sometimes throws some pretty hefty challenges our way and we are not always in the best place to deal with them then and there. We will suffer loss at some stage of our lives. Fact. We will have misfortune of differing size and shapes (such as relationship conflict, job loss, illness, financial concerns). Fact. We may also be exposed to the grittier fundamental realities of life (our lives are finite, the realisation that we are responsible for our own lives, fears that life has no intrinsic meaning). These things can shake us to our very core and sometimes, depression may be an inevitable response to dealing with these issues, until we are in a position to take action to work on them, or to work through the process of coming to terms with them (acceptance - the final stepping stone of the loss process).

This can be fairly straightforward to deal with, and the client can use the counselling relationship to work through the emotional impact of the loss/change in their life. NB change always involves loss - even if the loss is of something deemed a negative influence on our life. We can be attached to negative emotional states and even with the desire to make that change it can come with some discomfort. Somehow, getting in touch with and honouring the very real emotional reaction can create a shift which helps alleviate or lift the depression.

DEPRESSION CAN BE A PROTECTIVE, SELF-DEFENCE MECHANISM

Strong feelings such as shock, sadness and anger are physically taxing on the body. Our bodies are flooded with peptides associated with each emotional state. Imagine how you feel when you feel overjoyed, or angry, or afraid. We feel these emotions in different parts of our bodies. See this picture, a result of research done by Orlagh O'Brien asking people to sketch where they feel emotions:

DEPRESSION CAN ALERT US TO THE FACT THAT WE ARE DOING SOMETHING WRONG 

By this I mean that depression can be a natural response to the fact that we are living a life which is not in accordance with our real needs. From personal and professional experience I have witnessed that people can shift out of depression when they make change to their lives which mean they are doing things they want to do, rather than doing what they think they should do, or doing what others want them to do. The changes involved can be change of career, of relationship, or behavioural changes such as being able to prioritise one's needs as opposed to not even knowing what one's needs are.

Often, at the root of depression, is a lack of awareness of what one's own needs are. Helping people to get in touch with those needs is a privilege which I find so rewarding. I have had clients come back to me some time after therapy, delighted that they are now working in a field they really want to be working in, or that they have made relationship changes that means they are living a much more fulfilled life. This could be as simple as being able to share vulnerabilities and personal issues with friends, instead of continuing to be "the strong one". Sometimes counselling is a useful education in how to share vulnerabilities with others which leads to more meaningful relationships with others and the benefit of being heard.

One of the blockages to accessing and prioritising one's own needs can be a fundamental lack of acceptance, or unconditional positive regard towards the self. Many of my clients are absolutely selfless and so generous of heart and spirit to everybody but themselves. This may be a learned response from childhood, that their own needs don't matter, or that being in touch with their own needs has negative consequences. Sometimes, learning to access and honour those needs can create the shift required to help that person honour themselves and their requirements. This can be met with a fear that they will become too selfish. I point out that there is a spectrum of selfishness, with incredibly selfish and inconsiderate behaviour being at the far end, and that all they are looking at doing, is shifting along from the other end - of being completely selfless, towards the middle. A small change does not usually end up with the person leaping straight to the other end!

A WORD ON MEDICATION 

I have worked with many people while they are taking anti-depressants. I was told by my supervisor when in training that it is a waste of time working with people on anti-depressants but with experience have come to disagree with this viewpoint. I believe that when depression gets so bad that someone is unable to function, then taking anti-depressants can help lift them enough to take action against what lead to the depression in the first place. However, anti-depressants do seem to affect people's ability to access their emotions freely, which may make the counselling process take longer. Ideally, going on anti-depressants should be a short-term solution with a plan in place, for the client to look at the underlying reasons for the depression, and to subsequently wean off the medication carefully.

(1) http://www.mentalhealth.org.uk/help-information/mental-health-statistics/common-mental-health-problems/?view=Standard

Amanda Williamson is a professional, private counsellor working in Exeter, Devon.