Posted by niborr on February 21, 2001, at 12:40:40
This comes to you all by special request of dj. It's from Chapter 13 of Active Treatment of Depression.
"There Is a Part of Me That Doesn't Want to Get Well"
I think we might as well just state it at the beginning of treatment: Most people with depression want to feel better but are going to be afraid of doing some of the things necessary to feel better. The same skills of depression which ironically contribute to the existence of the problem will be activated even more strongly when we try to change the problem. Many patients will resent the idea that they have to change anything to get relief; after all, they certainly didn't wish this condition on themselves. Most patients will acknowledge that they sometimes have moments of sanctimonious self-satisfaction, as if they've earned the right to be depressed. Many feel comfortable with depression as a familiar and safe place of retreat and self-indulgence. Acceptance of a depressed state means that the patient has been able to give up trying for success and focus instead on preparing for future disappointments. These "resistances" should be presented as an expectable part of the syndrome of depression, which contribute significantly to the patient's guilt and self-blame.
Naming this resistance in a matter-of-fact, objective way at the beginning of treatment has enormous advantages over waiting until it gets manifested and then pointing it out to the patient. For one thing, the patient is alerted to the problem (and also warned that we are alerted to the problem) and will be more likely to notice and acknowledge it himself. We can positively reinforce such noticing on the patient's part, contributing to the overall tone of respect and collegiality we want to maintain. The patient's view of himself as an active and capable agent is reinforced. On the other hand, if we wait until the patient manifests resistance to change, and then pounce on it like a cat on a mouse, we only reinforce the patient's sense of guilt and inadequacy, and we make him defensive. He will want to argue with us, instead of considering that we may have a point.We have to help the patient develop awareness of the advantages and disadvantages of the sick role. It can be comforting; it can elicit sympathy and pity, which can be effective ways of getting some of our needs met and provide a sense of emotional closeness and support. But it also reduces one's self-esteem and ability to function, and in the end it drives others away—pity is not love. The patient must develop an awareness of the paradoxes of the disease model of depression: It is a disease, but one in which we have to take responsibility for our own recovery.
poster:niborr
thread:4784
URL: http://www.dr-bob.org/babble/social/20010209/msgs/4784.html