There is a great paradox for the psychotherapist in helping a client navigate through depression. On the one hand, life can be extremely painful and debilitating for a person suffering with symptoms of depression, especially for moderate to severe depression. Some types of depression can be very serious and even life-threatening. Because of this, a common goal for the psychotherapist is to help the client move away from the depressive symptoms as quickly as possible.
On the other hand, depression can be a great teacher about a person’s life, and often serves as a catalyst for profound change and transformation. And herein lays the paradox and the challenge for both the mental health professional and his or her clients. For the psychotherapist, the alleviation of profound suffering must be one of the goals. But we can do a disservice to our clients if we do not take into consideration a careful and detailed examination of the depression and the possible life-lessons waiting to be discovered there. In other words, depressive symptoms can be purposive, taking a person to his or her depths.
There are many tools that the psychotherapist will need to utilize to assist the client with the navigation through his or her depression. This should be based on the uniqueness of each individual and the guidance of the unconscious. Of course, it goes without saying that for some types of depression, a referral for a medication evaluation may be warranted. But the intersection of symptom relief, along with the careful observation and exploration of the depression itself, contains the delicate balance that defines the art of psychotherapy and the movement toward healing and wholeness.
While keeping the above in mind, approaching depression can be a lot like approaching a tide pool. If you move too quickly toward a tide pool, much of the life there, like the fishes and crabs, disappear quickly under rocks and into crevices. And to the passing observer, it looks like a tide pool mostly devoid of life, color and things of interest. But if you approach slowly, and then patiently watch and wait by the side of the pool, the life in the tide pool comes slowly back out from hiding and can be viewed and examined in detail.
A depressed, twenty-something year-old woman had a dream:
There was a pimple on my forehead. I go to pop the pimple and out came a beautiful daisy flower.
This dream for this depressed young woman seemed to be suggesting that even though she had a noxious growth under her skin (the pimple) and it needed to be “popped,” it contained the seed for developing into a beautiful flower. It is common for the psyche to symbolize something, like depression, perceived and felt as “bad” as having the potential to grow into something beautiful.
Perhaps most importantly, psychotherapists should be able to hold the tension of the opposite goals of working toward the alleviation of depressive symptoms and suffering for the client, while simultaneously observing and waiting patiently for direction from the depression and the unconscious itself. Paradoxically, depression, often described as a place of profound emptiness and darkness, has also proven to be a place with a “hidden” life—containing transformative images and dreams as if they were hiding under the rocks and crevices of the unconscious, just like the inhabitants of great ocean tide pools.