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Depression
How Depressed Do You Want to Be?
Helping folks get clear on what their feelings mean.
Posted February 8, 2014
I believe many people in our culture are extremely confused about what negative feelings are, and how to deal with them. This is probably a function of many things, including the medicalization of feelings (i.e., a culture that says: Feel bad? Take a pill), a lack of an ability to tolerate negative feelings, shallow pursuits of trying to be happy all the time, a fragmented society with many cracks that people can fall through, and an unsophisticated understanding of core human needs, to name just a few of the things contributing to the dynamics. I can also point to my profession of health service psychology, which tends to send the meta-message that emotional health is something for the professionals to deal with, rather than something basic for every person, couple, and family.
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With that caveat, below I describe one useful way I address some of these issues in the clinic room. After hearing someone describe heightened levels of emotional distress and depressed mood, I not infrequently ask, something like "How depressed do you want to be?“ or words similar to that effect. I have done this several times, and what follows is a generic rendition of how the conversation might unfold.
The set up is I am starting to work with Jan, a 20-year-old college student, who presents with problems with depression, anxiety, loneliness, confusion about her identity and core life purpose. Thirty minutes in to our session, she is talking about being bummed that she feels depressed.
"Are you as depressed as you want to be?" I ask.
Jan looks at me quizzically, as if she has not heard the question correctly. “What do you mean? Obviously, I am here because I wish I was less depressed.”
I reply, “I certainly hear that you are in emotional pain. And it makes perfect sense that you wish that you were not. But what I am not sure of is whether you feel your depressed mood is the problem or if it is better to think of it a symptom of a deeper problem.”
“So what are you saying?” she asks.
“Our emotions and moods communicate key pieces of information to us. We feel happy when something good happens and the happiness is the signal that this event was good for us, at least at some level. In the same way, negative feelings are sending the signal that something is wrong. You have mentioned that many areas in your life are not going well…”
“So,” Jan replies, “you mean, because I am lonely and not doing well in school, and have serious questions about where my life is headed, then maybe I should be depressed? That is a weird way of thinking. Everyone just tells me to not worry and be happy. And I feel bad that I can’t just make myself feel better.”
“And so you are frustrated with yourself for being depressed, which makes you feel even worse. And that is also why my question at first seemed so weird to you. You are depressed and bummed about being depressed, so it seems obvious to you that you are more depressed than you want to be. I hear you. But I also hear that you are beginning to get my meaning. Let me put it to you in the form of a question: If you are lonely and not getting your needs for competency or relatedness or whatever met, then would it make sense to you that your emotional system would signal to you that there is a problem?”
Jan responds, “You mean, like, if I get hurt, I feel pain and that pain is good because it is doing what it should because it tells me I am hurt? Based on that, you are saying that I feel depressed because I am not getting my needs met for doing well and connecting with other people...Is that kind of what you are saying?”
“That is exactly what I am saying, Jan. And so, what I am asking is, given your core needs, who you are deep down, and considering what is going on and what needs are not being met, does your depressed mood make sense? Is it telling you something valuable about the direction things are going? Does it make sense to you that you want to be known and valued by other people, that you want to be successful in what you do, and that if a part of you sees that not happening you will feel bad.”
“Yes, that makes sense. And things aren’t going super well." Jan pauses for a moment. "And, at the same time, things aren’t going super horrible. I mean, I could imagine it going worse. So, I am a little confused.”
“You make an excellent point, and I think I can help clarify where you might be confused,” I replied. “The idea here is that there should be some calibration between what you feel and what the reality of the situation is. If the situation is horrible, then it makes sense that someone would feel horrible. Indeed, it would be a bit odd to feel fine in a horrible situation, right? At the same time, feeling horrible in a difficult but not horrible situation would be problematic, right?”
“So, I need to figure out what I really think about my situation and decide what level of depressed mood makes sense?”
“Well, that puts it a bit more like an engineering problem than I might put it, but basically that is a key point about what I am saying. I guess the first point I want to make is that we need to figure out how to listen to what your feelings are telling you. It sounds to me that when you start to feel down or bad, your first reaction is to feel bad about feeling bad.”
“Yes, I think to myself, this situation isn’t so bad. What’s the big deal if I am a bit lonely or if I got a C. Here I am over-reacting again. Why can’t I just be happy like everyone else?”
“Given what we have been talking about,” I ask, “do you see how that reaction to your feelings might be problematic?”
“You mean, by thinking that way I would not even think about why I feel bad, or what the feeling is telling me? Instead, I would just feel bad for feeling bad?”
“Exactly.”
“And then I would feel worse and worse, which does happen.”
“And, so,” I ask, “what does that mean in terms of my original question, are you as depressed as you want to be?”
“I guess I am more depressed than I want to be because I get depressed about being depressed. But, things aren’t going great, so it makes sense that I am feeling somewhat down.”
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This exchange attempts to capture a key point, which is helping folks understand what their negative feelings are and how to stay attuned to them. This is a key insight from emotion focused work. And, at the same time, we do need to realize the symptom sequence of anxiety and depression are such that the symptoms themselves do lead to problems, which is a key insight from CBT approaches. The issue is that we need to help clients understand what aspects of their feelings reflect how they really feel and what their deep sense of the situation is, and what are problematic reactions to reactions that create maladaptive neurotic cycles.
