How to work through depression

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SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

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The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

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Strategies for working with depression in Gestalt therapy

A strategy for the therapeutic transformation of relationships with depression, or why hamsters prefer to live in cages.

- You live like a pig, master!
- I was depressed.
- So it's depression, not paralysis...

M. Weller

No matter how much people now talk about the fact that depression has become a common occurrence in our day, this does not at all alleviate its painful symptoms. No matter how well it is diagnosed and no matter how much work is published on the nature of depression, it is almost impossible for a person in this grave condition to get out of it on their own.

Almost. And this is good news! We can only do what is possible for us, and the impossible will catch up. I want to clarify my point - in a large number of cases, depression can be dealt with on your own, and - which makes the task easier - with the help of a psychologist, for example, a Gestalt therapist.

So what is possible for a depressed person? What is impossible? The simplest answer that can come to mind for a person who is depressed for most of the day, has lost interest and the ability to enjoy, feels tired and loses energy almost daily is: “Lie down and die.” Paradoxically, this is the answer to both questions. A person in this state can neither cope with sadness and depression, regaining his joy and interest in life, nor finally come to terms with his worthlessness, weakness, guilt, helplessness ... It turns out that “lying and dying” is at the same time possible and impossible.

I hope to return to the topic of the benefits of facilitation and process transformation in another article. In the meantime, I remember the old logical puzzle about an indestructible pillar and an all-destroying core. What will happen if they meet?
In search of an answer to this question, your mind will become more and more entangled, you will be more and more firmly established in the vicious circle of your own stereotypes of thinking, if ... Let's leave the question open for now and return to this a little later.

But it seems that life itself does not skimp on such puzzles... But what does life have to do with it? In this case, we are dealing with a certain way of thinking: thoughts are triggered automatically. These thoughts are listed more than once in various reference books and textbooks, and they are called “automatic”. Sometimes they turn into "depressogenic beliefs", but the essence of the subject does not change from this. So, I will briefly review a far from complete list of them:

I feel that the whole world is against me.
There is nothing good in me.
I can't do anything?
Nobody understands me.
I upset people
I can't seem to do it anymore.
I would like to be a different person.
I am so weak.
My life is not going the way I want.
I am completely disappointed in myself.
Nothing pleases anymore.
I can't take it anymore.
etc.
(according to M. Williams, J. Tisdale and others)

If you look closely, each of these attitudes contains a hidden, very well-disguised need. In it lies the key to unraveling all the mysteries of the depressive state. Only a person who has fallen into a vicious circle of his way of thinking and perception is not able to take a closer look. Attention is scattered, there is not enough concentration and concentration, unfortunately. (For self-help, I highly recommend the practice of meditation here, but more on that another time.)

I have a favorite English proverb, it says: "When there is a storm on the sea, there are many smart ones on the shore. " And it's good that there is a shore. Let's try to take a close look at any of these beliefs "from the shore". For example, "no one understands me." What is the hidden need here? Take your time. Probably not the one that catches the eye. That's why she's hidden. When a person wants to be understood, what is he doing? Probably, first he determines the subject of understanding: “What do I want to convey?”, And then, probably, he cares about the language in which this something needs to be conveyed, because people live in different languages ... From practice, I can say that many people suffering from depression , far from such vigorous activity and "concern about". They passionately want to be active in sympathy and care from near and far. And after all, such active care and “rescue” heal. At first. Until the depression turned into a chronic form and began to serve the "secondary benefit." Remember that joke about the frog? “The latest research shows that licking frog sweat can cure depression. Only when you stop licking it, the frog gets depressed again”...

Without noticing it, a person receives a tool for "extracting love from others." With the second or more times, the tool becomes dull, it becomes impossible to work with it, uncomfortable, painful ... But there is no other.

Returning to the attitude “No one understands me” or, in an understandable translation, “I want love”, I dare, again from practice, to declare that those who do not love themselves do not receive love. Fresh thought, isn't it? But from this it does not lose its relevance. The recipe for happiness is simple, but it is difficult to implement: Happiness = Love + Unconditionality.

Everyone who is depressed craves one or more of the ingredients in this recipe. The only problem is that he is waiting for this - from the environment. The famous Gestalt therapist Paul Goodman wrote: “There is no such function in any organism that would not be involved in the environment in the most essential way. And vice versa, the real environment, the place, is what is chosen, organized and adapted by the organism.

This is what happens: if you want love - love, if you want unconditionality - do not set any conditions for anyone, in a word, if you want to be happy - be it. After all, happiness is not what a person has, but what he experiences at the same time.

Therefore, if we help ourselves or others out of depression, we make sure to devote time and effort, a lot of time and effort, to working out the defense mechanisms that keep a person from "doing" what corresponds to his request to be loved and happy. Here it happens in different ways: either the request is not clear (confluence of the first kind), or I wait for them to guess (confluence of the second kind), or “if I was good for something, I could do it” (introjection) , either “I don’t need anyone” (a projection of pure water), or I’m simply afraid to talk about my need for affection - I’ll manage somehow (retroflection). There are many variations here - the strategy is one: you need to be aware of the leading need, as well as what prevents it from being satisfied, or rather, to say: “how I prevent myself from satisfying it.”

A scene from Andrei Tarkovsky's famous film comes to mind here. The stalker, risking his life, at the cost of the most severe overcoming, reaches with his "clients" the room for the fulfillment of cherished desires. He doesn't go there. Never. Why? The answer is as simple as it is cryptic: No wish is to be made in this room. Fulfilled themselves: cherished. Master went there one day and woke up a millionaire. And he couldn't bear it. Not what he expected from himself ...

Our task is to help a person realize his real need, since it is precisely this need that can be called the core around which balance is created in the body-environment field. Needs are nothing but the very life force that drives a person in his development and supports his will to live.

Gestalt therapy, in contrast to the psychoanalytic approach, believes that a person is free in his will. He can choose how to behave without being severely limited by his instincts. And at the heart of such a free choice are precisely the needs that can be realized. Choice is aimed at satisfying needs, not at fighting them.

The need, which is currently the most relevant and distinguished from other, background needs, must be satisfied immediately (in Gestalt therapy this is called a figure), otherwise it runs the risk of “hanging” in the background, becoming neurotic or leading to depression. Realizing his real desires, a person organizes his behavior in accordance with them, becomes adequate to himself and interacts with the environment in a way that satisfies him. It is always very important for a therapist to understand how the interaction of a depressed person with a need is organized.

Typically, the depressive patient experiences the lack of love or attachment as an unconscious sadness. He does not grieve over the loss, does not part with what is especially valuable to him (attachment to a loved one, to values, etc. ). This unbearable (or devalued by significant relatives) sadness is the trigger of a depressive reaction. Meanwhile, if a person consciously experiences sadness, he believes in the support of others and accepts it. Then there is no depression.

Some famous person said: "Depression is a state of absence of sadness where sadness would be appropriate."

So, back to the children's problem. What do we need to solve it? Everything is as simple as possible: consistency. Well, these two concepts cannot exist in one given: indestructible and all-destroying. The problem is not solved under such an incorrect condition. A vicious circle is obtained. Eliminate the inconsistency of thinking - solve the problem. Either there is no such pillar, or there is a core. Choose. How does it say? To solve a problem means to understand it. It’s the same with depression – I want something, I don’t know what, and I do everything (or do nothing) for this. Come on, solve this puzzle! Here you can not do without awareness of the need - once, and without coordinating behavior with the need - two.

Let's sum up by outlining the focus of therapeutic work with a depressed client:

1. We establish contact, develop motivation for psychotherapeutic work.

Soon the fairy tale is told, but the deed is not soon done - it takes time and special support for a person to want to change something in his life. It is like a foundation for building a house.

I can't help but remember our pet hamster, who was frantically chewing on the bars and desperately trying to lift the cage door with his nose, striving for freedom. When they let him out, he just as persistently began to look for his feeder and did not calm down until they put it outside. Then he climbed into it with all his paws, and he frankly didn’t give a damn where he would be carried in this feeder. Though back to the cage - it does not matter. If only not to lose his usual feeder.

2. Recognize the basic need, formulate a real request.

This is painstaking work, but it is precisely this that determines the direction of all our psychological activity. It is like the quality of cement for building a house. It is here that it is decided whether we will go along the right or wrong path with our client. (I don't really like this commercial name of the person I work with, but in the context of the definition of the request, it is more or less appropriate).

3. We strengthen "compliance", that is, we bring the action in accordance with the request.

At this stage, as I already mentioned, we will work with defense mechanisms that prevent a person who is in a state of depression from building behavior that is adequate to satisfy the “bursting” need. These are our bricks, logs, blocks - in a word, the main building material. Having collected information about the ways of a depressed person, how he prevents himself from being happy (mechanisms of resistance), we get access to the building material, that is, the organization of the transformation process as such (contact).

4. At the same time, do not forget from time to time to “use a level and a plumb line”, check the “quality of the supplied material”, namely:

reduce the level of anxiety (recognize fears and learn to deal with them)
we increase the level of field independence (we transfer the locus of control to ourselves, we stop seeing the causes of our troubles in circumstances and other people)
realizing the hidden meaning of the symptoms of depression (the so-called "secondary benefit" from suffering is our hamster's feeder; here it is important to replace the feeder in the cage with honestly discovered treasures - with the conscious use of the experience gained)
the distinction between responsibility and guilt (this is an interesting topic in itself, deserving special attention). However, I will note here the retroflexive nature of self-accusation and the effective, active nature of responsibility. This is important because healing (in gestalt therapy, psychodrama, somatic therapy of trauma and other psychotherapeutic approaches occurs through active action, through the body and the development of new forms of response)

5. Cognitive elaboration of the predicted future.

To implement any - grandiose and not very - projects, it is necessary to complete the unfinished in the past and live what is happening in the present. Otherwise, the roof, waiting under tons of construction waste, will not be able to be found and erected in its proper place.

6. The last thing that is important to pay our attention to is working with awareness, new meanings, a fresh vision of the meaning and value of life. OTC, so to speak. The house was built and put into operation.

When needs and mechanisms that hinder their realization are realized, all conditions are created in order not to reduce the tension and value of the previously frustrated need by devaluing one's existence and losing the meaning of life. You can look for ways to satisfy it by expanding your role repertoire and enriching the tools for transforming reality.

So instead of a cage, we built a new house for our hamster. Only one assumption - it must be on his own design. In other, human, words, we made a cursory revision of our capabilities in helping people who are depressed. I really hope that it was useful for you to read my thoughts and generalizations on this topic, both for psychologists and for those who are familiar with depression not by hearsay, but from their own experience. The topic is interesting, necessary, I hope to return to it in future articles. But in other perspectives - psychodramatic, somato-traumatic-therapeutic and Bodynamic. I wish you health and happiness.

Author: Sviridkina Tatyana Leonidovna

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Beware of depression! Should I tell my boss about my illness?

The difference between a depressed person and a healthy person is very simple: in the case of depression, it is almost impossible to enjoy life, be active and experience positive emotions. This mental disorder brings bad mood, fatigue, mental retardation and lack of desire to do anything. It is extremely difficult to work in such a state. Recognizing depression and explaining your condition to others is even more difficult. We share with you the stories of people who have gone through this.

A year ago, I was diagnosed with an anxiety disorder by a neurologist. By autumn, it seemed that the anxiety had gone into remission - I was calm. But on New Year's Eve there was a short and very stressful project. The working chat in Telegram was bursting with messages. They came constantly - both at 3 am and at 8 am. I dreamed that this chat would just stay in 2020 and never appear again. Then I took sedatives because it was impossible to sleep, but I did not think that I was depressed.

The January holidays passed calmly and routinely. After returning to work, everything started spinning again - and the stress returned.

In the spring, I found out that I had health problems that required an operation. The blues and melancholy continued, but now I thought that the reason was in the diagnosis. In addition, the first priority was urgent medical matters - preparation for the operation. It seemed that as soon as everything ended well, I would become a happy person.

Before the hospitalization, I decided to ask for a week's vacation in order to take all the tests and have some rest. Colleagues picked up communication with clients. But as the guys kept writing and asking questions, I kept doing a lot of work. Now I understand that I overdid it. Colleagues could manage on their own.

After the sick leave, when I went to work, it turned out that I had a new client in addition to the existing ones - a colleague quit for family reasons, and her project was transferred to me. In the office, this girl was condemned for dropping her business and leaving. She was not understood. It also made me angry at the time. As a human being, I sympathized with her, but I got her projects in poor condition, and this made me angry.

The first week, when I was waiting for the results of the operation and was in touch with the doctors, I was constantly shaking. I thought about taking a break and telling my superiors about my condition. I consulted with one of my colleagues. He replied: “You can only say that it’s hard for you if you are ready to say goodbye to this job.” At the same time, he himself had problems, because of which he was depressed, but also did not say anything to his superiors and did not take a break.

Depression interferes with work. Any work task causes panic. The body gives out a constant physical reaction - trembling or heat, tension presses on the temples. Super inefficient. Realistically do only something very simple or work with familiar projects. It is difficult to take on large clients, conduct large deals and launches.

There are flashes. Suddenly you become very efficient, like performing well or doing a lot of tasks on your way up. In this state, it is dangerous, for example, to subscribe to KPIs with clients - the view of things is not entirely realistic, and then the depressive mood returns anyway.

It becomes hard not only to work, but also to hang out. There is stiffness, and alcohol does not help to relax. Probably 70% of jokes are impossible to understand and you just have to smile when everyone laughs. The feeling that all the good that is in me, in my head, is hidden under a layer of darkness and it is impossible to break through it.

I often compare myself with other people who are also in a difficult situation and cope with it. It seems that it is not possible to export only from me alone. It seems that I am afraid to face not only external stigma, I blame myself internally for what is happening.

Now I have changed my psychotherapist, I am taking antidepressants and waiting for the result. At work, I never said that I had a depressive-anxiety disorder.

* The heroine's name has been changed

In total, my depression has lasted 16 years. Exacerbations happen quite often and take several months. I worked in the office for about 6 years. I did not tell the employer, I was shy. The official hospital with a diagnosis of "depression" did not ask the doctors and just drank the medicine. Therefore, when exacerbations occurred, she often lied that she was poisoned or something else happened. Or came home from work, overeat, drank wine and slept until the morning. Then it was necessary to suffer for 8 hours at work and you can sleep again. But, in general, this is a so-so strategy. Because of this, she left the office for project work and freelance work.

Freelancing is easier: in remission, I try to earn a financial cushion and do not take long-term projects. If all of a sudden I am running a long-term project and an aggravation begins, I finish everything on moral and strong-willed efforts and do not start anything new. It was difficult to accept that my resource is limited and sometimes I can’t work at all, but only stare at the wall. There are signs by which I already understand when the battery is running out and it is necessary to complete current obligations and look for something that will give a resource. Or, if there is no strength for this, the doctor corrects the therapy - and I'm waiting for improvement lying down.

The employer, with whom I constantly do projects, knows about my depression - I told him everything honestly when it came to transferring me to a permanent salary instead of project work. He does not always understand, but he accepts and for some reason still works with me. Although he himself adheres to the position "in the army it becomes easier for everyone." I keep stubbornly refusing the constant so as not to let him down and drive myself into a corner with guilt.

In terms of money, of course, it comes out less and not so stable. But my life is dearer to me, and in general, for 5 years now I have been able to balance and twist.

When the depression started, I was 18 and in college. Then there were more episodes. One happened when I was working in a publishing house. Due to the fact that we had a friendly team, I was able to transfer most of the processes, push everything away from me to just lie down. But even then I had to work, just less. It was terrible anyway. Each action - such as opening the mail - already required enormous efforts, it seemed unbearable, and even writing a letter ... I told the authorities about depression in general terms, it didn’t really bother anyone and didn’t affect the attitude towards me.

Depression was difficult, I had to overcome myself. Managed with the support of family and friends. I tried to relax, put off work, contact people.

To minimize the risk of depression, I try to listen to the slightest bells, and it is even better not to bring them to my attention. I try to make my life varied and fulfilling. Quite simple things help: food, sleep, walks, people, books, sports.

If you don't have the strength for it, you have to lie down. It's so hard to work, I can't do much in this state and therefore I try not to take projects. As soon as strength appears, I try to invest it in something useful - try to cook something balanced (vegetables, cereals) or walk, go out, maybe even swim in the pool - in general, do something that will fill me up later and let it last for a while. I try to do something simple - wash my face or wipe the table - and be sure to praise myself for it. It is important not to devalue your condition.

I took antidepressants for a long time, but I have already stopped them. I'm lucky that I can somehow manage without them, but for many without the support of pills, it's completely impossible, and this is also normal.

I have been diagnosed with a depressive disorder. At that time I was already in psychotherapy, and my therapist referred me to a doctor who prescribed antidepressants.

At work I didn't say anything, didn't consider it necessary. Actually, the work saved me: I had to go to it, and then one question appeared, another - you look, and already got involved. It was rather scary to go home, where I was alone and everything could worsen. Here, probably, the key point is that I like what I do, and my company is very humane. Elsewhere, the situation could only get worse.

In a state of depression, sometimes it took a lot of strength to get together to do something. Especially new and incomprehensible. The illness lasted for about a year. I took medication and continued to go to therapy. I hope that this material will help other people, I think this is an important topic.

In world practice, more and more people openly talk about depression and adjust their professional plans because of this disease. For example, Japanese tennis player Naomi Osaka recently refused to participate in Roland Garros, and the youngest British MP, Nadia Wittom, went on vacation due to post-traumatic stress disorder and tweeted about it.

In Russia, the disease is still surrounded by stigma and guilt. Usually it is not customary to talk about it at work, where the employee is expected to effectively fulfill contractual obligations. The problem is that an employee with depression needs the help and support that the company can provide, and ignoring the problem affects not only the person's personal life, but often also business performance.

“It is impossible to give a definitive answer as to whether or not to tell management that you have clinical depression. It all depends on the culture of the company and how it relates to human health, says Marina Lvova, Director of Organizational Development HeadHunter .

Marina Lvova, Director of Organizational Development HeadHunter

If the company culture allows you to explain what is happening to you, and you trust your manager, you definitely need to talk about it and get support. Perhaps the company has access to psychologists or the HR department knows where to turn.

If you work in an organization with a fairly rigid structure and understand that you will be pressured after such a recognition or that you may lose your job, I would recommend not to speak, but to think about why you are in such an environment at all.

In any case, first of all, you need to take care of your health, because depression requires treatment. Only a doctor can diagnose it. If you are at the stage where you can combine treatment and work, keep working. If it’s hard for you and you can’t get out of bed, take sick leave or write an application for leave without pay - in this case, your condition is primary. ”

If you decide to take a breather, it is important to know that an official sick leave with a diagnosis of depression can only be issued by a neuropsychiatric dispensary or a psychiatric hospital. In other cases, sick leave may be issued for another reason.

In the fall of 2020, the State Duma proposed giving paid days off with a doctor's report on depression. The initiative is based on data from the Organization for Economic Co-operation and Development, according to which the productivity of an employee who is in a state of depression is reduced by four times. Whether this proposal will be accepted is not yet known, but it is a good step to help employees of companies experiencing this problem.

Being depressed and having to keep working is, of course, difficult. This is confirmed by the stories of our heroes. If you find yourself in this situation, the most important thing is to take care of yourself as much as you can now.

Talks about how you can support yourself Maria Shumikhina, psychologist, executive coach, member of the board of the International Association for the Psychoanalysis of Business and Organizations :

Maria Shumikhina, psychologist

“If you find symptoms of depression in yourself, try to seek professional help as soon as possible. Of course, you will be told stories about how depression was cured by meditation and douches, but it’s not a fact that you have enough time to try all the random recommendations. Unfortunately, very often depression, which is not treated, ends with a loss of working capacity.

Once diagnosed, it is important to understand that depression is a long marathon and how you take care of yourself and your ability to keep running will determine your destiny. You are the author of the most important part in the recovery process. A psychiatrist selects medicines, and your part of the job is not only to drink them, but also to be aware of the process of change, learn to listen to yourself.

Psychotherapy will help process traumatic experiences and teach sensitivity to one's condition. Often people, especially those most prone to burnout, lack self-compassion, and without self-support, we can rarely handle high overload.

In the process of psychotherapy, among other things, we learn not to succumb to the cognitive distortions that we find ourselves in during depression. They are quite easy to identify if you understand this mechanism: depression makes a person think in a certain way, gives him a specific view of reality.

This "voice of depression" says:

"You're the problem" (guilt and shame come to the fore during depression).
"Everything makes no sense, there is no solution, everything is already useless."

In a healthy person, such experiences are balanced by a more complete picture of the world and oneself. If the drugs are chosen effectively, these cognitive distortions disappear, “tunnel thinking” goes away, and the ability to look for new solutions appears.

If you need to look for new solutions in your work, healing will allow you to keep this skill. But, if depression is not treated, you can lose the ability to make any decisions.

The state of depression is a period when the body's resources are depleted, and this determines life strategies. Time to invest wisely everything you have: energy and physical strength, money and social connections. The restoration of the body is no less important than the restoration of the psyche. In some countries, recovery through regular physical activity is a prerequisite for receiving insurance-based psychotherapy. A good doctor will also give advice on improving sleep and nutrition. There is, for example, a high correlation between depression, neuroinflammation processes and an increased amount of carbohydrates in the diet. The microbiome (yes, the one that lives in the gut and prefers greens) is on your side in the fight against depression.

Process optimization is required to be able to stay operational. It's hard to do it alone when you're depressed. Is it possible to discuss at work how tasks will be temporarily redistributed? If yes, this will help you a lot. And a supportive atmosphere at work provides much more loyalty to all employees than forced sick leave or dismissal because it was not possible to redistribute tasks.

If you suspect depression and are unsure whether to see a doctor, the first step may be to complete a questionnaire.

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