Psychotherapy – or simply, therapy – is usually the first form in treating depression. (Smith 2008). However, it has also been proved effective in the diagnosis and treatment of personality disorders. (Leichsenring & Leibing 2005) Psychotherapy usually involves different types of techniques of treatment. During the therapy, the person suffering from depression identifies and works through the different causes of his/her depression with the aid of a licensed and trained mental health specialist. There are actually different causes of depression.
It may be due to chemical imbalances in the brain. It could also be hereditary or a combination of heredity and chemical imbalance. In any case, it is important that the psychological as well as the psychosocial aspects of depression are addressed. (Smith 2008) One form that this may be done is through psychodynamic therapy. In psychodynamic therapy, it is assumed that the causes of depression may be unresolved and generally unconscious conflict, usually rooted in the individual’s childhood days.
Therefore, the goal of psychodynamic therapy is for the individual to talk about his/her own experiences, thereby helping him to understand these and to cope better. Administration of this type of therapy can last just a few days or it could expand up to months. (Smith 2008) For this paper, the case of Hannah (not her real name) will be tackled in order to appreciate psychodynamic therapy better and see its real life application. Although names of actual people involved are not revealed in order to protect their identities, the situation described here is based on real life.
Hannah is the only daughter of Fred (not her real name) and Sussy (not her real name). Fred and Sussy were sweethearts ever since early college years and they have been through a lot together. Intially, both their parents were against their relationship. Sussy’s parents are very conservative Christians. Therefore, they insist that Sussy should only be involved in a romantic relationship only after college. Fred, on the other hand, is the only son of a very rich business tycoon. After graduation, he is expected to take over their business, especially since his dad is already in well advanced in years.
As such, the commitments that Fred and Sussy wanted to have is no where in the picture until after about half a decade, when Fred has already mastered the business and is ready to get on with life. The decision of these two love birds to be in a committed relationship disappointed their parents deeply. Because of this, Sussy’s parents drove her out of the house until “she comes to her senses. ” Concerned for Sussy’s situation, Fred housed Sussy which caused his mother to burn in anger to his son. In fact, Fred’s mom was so angry when she heard the news that she had a heartattack.
Fred’s Dad blamed Fred for what happened to his mother and cut his support from home. With no one to go to, Fred and Sussy worked while studying. They went through the eye of the needle together but their love was greater than their hardships. Finally, after graduation, the two decided to get married and have a honeymoon. Even though they were leaving in the same house and have a deep love for each other, they restrained themselves from having physical relations. Since they waited for so long for it, their honeymoon gave them unspeakable joy. A few months later, Hannah conceived and was born.
How they love their little daughter – especially Fred. To him, Hannah is a bundle of joy. That is why he didn’t mind working another job, just so as to bring in extra-money for Hannah’s needs. One fateful December night, just a few hours before Christmas, Fred met a car accident. On the way home, his car was hit by a twelve-wheeler truck at a traffic intersection when the driver of the truck tried to beat the red light. As a result of the impact, the car was crushed and Fred died instantly. At four years old, Hannah was too young to understand the gravity of what just happened.
But her mother, Sussy carried the whole weight of the situation. At first, she couldn’t believe it. But as the days passed by, she refused to believe it. How can the love of her life die in a very senseless way, she asked herself. Months passed by and Sussy’s situation got worse. She is often found staring in the window, as if waiting for someone to come. Concerned relatives noticed that she almost neglect Hannah so they decided that someone should stay with them until Sussy recovers. But weeks passed and Hannah seemed not to be improving.
So, they decided to enlist the help of a psychodynamic therapists named Ken (not her real name). Ken was the best in his class and highly esteemed in his profession. He is very diligent and seemed to be very much eager to help. The only problem is the Sussy doesn’t seem to respond well to the treatment. Moreover, Hannah went through a roller coaster of emotion herself, seeing her mom depressed from the accident. According to Smith (2008), there are actually two approaches to therapy that might be used to Sussy. The first approach is individual therapy.
Here, only the therapist and the patient is involved. The second approach is family therapy wherein the family members are also involved so that they may understand what their loved one is going through, how to cope, and what are some measures they may undertake in order to help. The third approach is done with the help of the spouse and is called marital therapy. Because one of the partners, Fred, has already passed away (and is actually the cause of Sussy’s depression), then this approach is irrelevant. Let us now look at these two approaches in detail.
First approach is the individual therapy. According to Fenton (2008), this can be classified under “talking therapies” which has been used solely for the treatment of mental illnesses in the 70s and 80s. A particular field of individual therapy is the interpersonal psychotherapy (IPT), a short-term but proven effective treatment that is usually lasting up to 20 sessions of weekly meetings that last about an hour per session. Here focused to one or two key issues related to depression are focused. (University of Michigan Depression Center 2006)
For instance, the psychotherapist may focus on Sussy’s relationship with her parents and with her parents-in-law. Due to the things that happened in the past, Sussy might have issues of alienation from them which has affected her deeply but did not surface only until now due to her great marriage with Fred which helped her overlook such things. Now that Fred is gone, there this problem started to surface. Although Sussy’s depression is not directly caused by interpersonal event, the University of Michigan Depression Center claims that usually, it would have an interpersonal dimension.
Usually, the causes of this issues are (1) interpersonal disputes/conflicts, (2) interpersonal transition in role and complicated (3) grief going beyond the normal time for mourning. In this case, it can be said that it is a combination of all these three. It involves interpersonal conflict since it involves issues with parents in the past which have not been resolved. It involves transition in role since the death of the husband would force Sussy to act both as father and mother. Finally, it involves grief going beyond the normal time for mourning since Sussy still retained her depression problem even after initial psychodynamic sessions.
The goal of the therapist, then, would be to find out and address which of these issues is the most important and greatest contributor to maintaining depression. (University of Michigan Depression Center 2006) IPT sessions usually begins by identifying the specific issues that needs to be addressed for the remainder of the therapy. Usually, one to three sessions are devoted for this. While the University of Michigan Depression Center (2006) claims that this type of treatment is not effective in all cases, research suggest that it is effective in aiding short-term depression issues as anti-depresant medication.
Aside from attending sessions, Fenton (2008) also recommends treatment. Decision to use IPT and medication should be based on the answer to the following questions: (1) How severe is the depression? (2) Is there a past treatment history? (3) What are the preferences of the patient. Moreover, a qualified interpersonal psychotherapist such as a psychologist, psychiatrist or social welfare should provide the different options to Sussy’s family in treating her during the assessment phase. Furthermore, the rationale for this must also be communicated well to them.
University of Michigan Depression Center (2006, however, recommends combining successful short-term treatment with an ongoing maintenance therapy once a month after. In this way, there would be less likelihood of depression recurring at in a short span of time. (Frank et. al. 1990) The second approach is family therapy. According to Herkov (2006), this can be used when a person’s symptoms are taking place in the larger context. In this case, the problem was not at all confined to Sussy but very much involved Hannah as well due to the not so healthy responses of Sussy to the situation.
There are actually three techniques that may be employed here. First is the use of a genogram where a therapist constructs a family tree for Sussy. One by one, the therapist would then examine the different relationships that the patient is linked to and examine its impact on the patients’ current emotional technique. For our case, the therapist may see the sour relationship of Sussy with her parents and with her parents-in-law due to Fred and Sussy’s decision when they were in college and focus the effort on dealing with this.
The second technique is systematic interpretation where the depression is viewed as a symptom a larger problem in the family. It is also possible that Sussy’s depression is due to the feeling of aloneness. Even though she has relatives who care for her, she thought of Fred as her only companion due to the fact that they went through so much together when everyone was against them. So, when Fred passed away, Sussy may have focused too much on the loss of Fred and forgot about Hannah and the rest of the people who loves her.
Because of this wrong focus, all she could see is that she is all alone because the world is against her and the only one who is for her is no longer there. The third technique is communications training where communication patterns that are dysfunctional are identified and corrected. Due to Sussy’s neglect of Hannah, Hannah could have had a hard time in communicating her needs. Therefore, when these needs are not satisfied since others are not aware of them because Hannah fails to make them aware, she gets frustrated.
In the same way, when things seem to be going her way at times to the point that it almost seems that everyone could read her mind and satisfy her, then she gets happy. However, because no one really understands her because of her failure to communicate, she goes through an emotional rollercoaster ride frequently and it’s through communication training that problems such as this is addressed. Based on the discussion so far, it is recommended that the third technique of the second approach be employed in the case of Sussy. After all, she is not the only one affected by Fred’s death by Hannah as well as can be seen in the previous paragraph.
According to Winkler (2006), mothers with depressive disorder put their children to double the risk of developing affective disorders themselves later in life. In fact, recent studies involving 15-year old teenagers suggest that children of depressive mothers have a high risk of having depressive problems as well in addition to various psychological problems such anxiety disorder. According to Winkler, there are several causes of this. First, depression is biologically linked which means that if parents have depression disorders, the offspring is likely to develop it, too.
Second, the relationship of the mother with the child could also be affected and based on the severity and duration of this would be the child’s propensity to affective disorders. Furthermore, it is also possible that if the mother is depressive, the child would have bonding problems with the mother. Third, the behavior of the mother could also lead the child to conclude that the behavior of his/her mother is his/her fault, attaching it to some perceived negative behavior which and resulting to poor self-esteem.
Moreover, depressive mothers are negatively disposed to their children with negative behavior (Hammen 1991), making the children’s situation worse. Finally, depressive mothers do not relate well to friends of the child, causing them not to come to their home and thereby resulting to additional social withdrawal of the child. That is why Winkler also recommends that children also be considered in the equation and supporting earlier recommendation of using communications training in the context of family therapy.
