Casebook: Depression pessimists are wrong
When you are stuck in the middle of a depression, it is hard to appreciate how quickly you can feel better – and that the depression pessimists must be right. My experience as a therapist is that improvement will typically be noticed within a week and most of my depressed clients will have fully recovered within a few weeks after that. And for those of my clients who take a little longer – we are only talking of a month or so at the most.
I realise that even to say such things will immediately have me labelled as a charlatan and a fraud. But if you are depressed now, then have faith. Don’t listen to the depression pessimists. They hide behind jargon and pseudo science and fear and ignorance and are wrong.
You can be optimistic and hopeful – as Isobel’s story makes clear.
Isobel was drowning and on the edge of extinction
Isobel (not her real name), single and in her late twenties came to see me in late 2013. What was noteworthy about Isobel was the depth of her depression (as measured by the CORE system I use) and that there was no obvious trigger cause or trauma to be dealt with. She was almost literally drowning.
The truth was she believed (with good reason) that she was a capable young woman but had been so shocked by her descent into a trapped hell of emotions out of control and failure to get out on her own, that she was experiencing a raw terror and fear that was completely beyond her expectations or experience. Indeed in Isobel’s case there remained a veneer of assurance about her – which belied her desperation. Her CORE score at that first session was 38 – the highest by far that I have ever come across and much higher than I was expecting. Let me explain.
I ask all my clients at every session of therapy to complete a CORE 10 form, which measures their emotional health over the previous week – that I have come to trust to be reliable. There are ten questions, and each is scored from zero to four, depending on the distress indicated by each question (not at all, occasional, sometimes, all the time). The maximum theoretical score is therefore 40 (10 times 4) which would be an indicator of permanent distress, covering experiences of panic, anxiety, isolation, bad sleep, suicidal thoughts and so on. A score approaching 30 is quite rare in my experience and indicates severe distress, while any score over 25 is a red alert. Before Isobel, the highest score I had come across was 34 and I had found that scores at that level or slightly less related to clients enduring addictions.
To score 38 was almost beyond my belief and when I saw Isabel’s score, it frightened me a little and the verge of extinction metaphor came to my mind. She talked of suicide in a matter of fact way – knowing exactly how she would do it and finding each day was a big effort not to. But she had got nowhere from her GP, was taking anti-depressants that were self evidently doing her no good and I believed that I was her last best hope.
As is normal at a first session with a depressed client I only spent a little time asking Isobel about herself. I ascertained though that her waking up time in the morning was agonising for her but that she had just moved into shared accommodation where for the first time for a long time she felt it might be good for her. She also revealed in passing that she was a dress designer and gave a hint that she might be talented and that she revelled in her creativity. The other thing I got then was her determination to stand on her own feet and her ambition – now horribly thwarted for three years.
And then I normalised like mad – with the objective that she should begin to understand her situation less catastrophically and personally and so begin to worry less and get some energy back by dreaming less. I also emphasised that we would leave her problems to one side until she was feeling better. I urged her to listen to my Depression Mp3.
Isobel came back a week later and her CORE score had fallen to 24 – still high but a big improvement over the week. Isobel had noticed the improvement and was much more engaged in what I was saying. At that second session, we focused on job application efforts she felt she could make in the rag trade. An opening had come up, in selling and she felt she could do it and wanted it. We undertook an extended trance session which focused on her ability to put the nightmare of the last few years or so behind her.
A week after that she returned, having applied for and had an interview, which she felt had gone well. Her CORE score had come down to 16 – indicating just moderate stress and an almost miraculous change in just two weeks. She emailed me a couple of days after that third session to say she had got the job and remarked that even a month before, there was no way she could even have contemplated applying.
At our final session, a fortnight later she was flying. She scored nine – an indicator of solid emotional health. And at that session I de-traumatised some remaining residual fears around the horror of her depression returning. She emailed me the next day to say that she felt that I had literally saved her life. And perhaps the truth is that I had.