Casebook: Low level chronic depression

Sometimes just a small change is required to set off in an altogether better direction and then the low level depression will fade away.

Nita and Rita needed a reframe that would seed the change they required

Nita and Rita both came to see me a number of years ago now. Neither was highly depressed but had what I would call is chronic depression. They were both worrying too much and for too long about an issue in their lives that they felt needed to be addressed.

This worrying was unproductive as the issue was not being resolved. The consequence for both was that they were dreaming too much and so feeling less and less themselves. And this was unexpected as they saw themselves as capable individuals who dealt with such problems easily and by themselves.

For Nita the issue revolved around her relationship with her husband and how her career would fit in with his as he was an investment banker on his way to a prestigious position in New York.

Rita’s issue was also work related. She had a middle ranking clinical position in the NHS.  Her problem was not that she felt what she did was not important (exactly the opposite), but that the combination of family pressures at home and nightmare bureaucratic restrictions at work meant that she felt permanently unfulfilled and so undecided about her future.

For both Nita and Rita, my approach was not my typical one. That is (if you remember) to focus on the causes of depression and so shift attention temporarily away from rumination until dreaming and sleep improve and mental exhaustion recedes.

Instead what I felt was needed was a reframe – a different interpretation for where Nita and Rita each found themselves, from which they themselves could begin to move.

And in both cases they subsequently told me, it was little more than a well chosen word by me that did the trick. For Nita it was a reminder of previous times where she had managed to think outside the box. And for Rita it related to the opportunities that she knew were there at work that would be under her control – where she could focus much more on her satisfaction from one on one interaction with patients.

In fact, I could barely remember what I had said. I imagined that my approach was much more scatter-gun than they were implying (which is often the way), from which they had taken what they needed.  In each case I was pretty certain that the breakthrough had come during a trance session and that I had used a metaphor that they could instinctively understand and use.

Looking back after these years, I wonder what the metaphor might have been? Mountain tops to see the bigger pictures, opening doors to many paths, a broad and deep river denoting all the many possibilities open to us all, a tide receding leaving behind what was really valuable…… I wonder what it was.