Working in psychiatry can sometimes make you lose sight of how far the medical model influences what we think and do.

It is a model that makes us talk about depression as if it was a 'thing'. Someone might have depression, in the same way that they might 'have' a car.

But depression is not like this.

When we talk about depression we are in effect talking about the consequences of past relationships that the person with depression, sitting in front of us has experienced, and how these affect what's happening for them here and now.

We choose to call how the past affects the present - 'depression'. 

A relational perspective

Cognitive Behavioural Analysis System of Psychotherapy (CBASP) takes a “relational” perspective on depression.

We could all benefit from taking this perspective in mental health work. 

This is important because we want to make sure that the relationship we have with the person sitting in front of us is a “different” one from all of the relationships which have resulted in them experiencing depression.

One way of doing this is to recognise the traps we can fall into.

Breaking the cycle

Long-term depression can be the consequence of being disempowered through relationships with controlling people over many years.

As mental health workers it will be easy to fall into the trap of being yet another “controller” albeit one with a more “friendly” face.

If we don’t recognise this trap our “friendly dominant” controlling role will perpetuate the cycles of disempowerment and the person with depression continues to feel that they are unable to change their world.

Once we are aware that this could be played out in the relationship, how might we respond?

Against being a blank slate

Mental health work traditionally trains us to be “blank slates”, never saying how we feel because this can supposedly distract us from the problems of the person with depression.

People with depression have problems with expressing their emotions.

I believe that if I am a “blank slate” hiding how I feel will result in two people sitting in a room not communicating how they feel!

However, saying what you feel is not easy.

Talking about feelings opens us up, leaving us feeling vulnerable, making us fearful of damaging the person with depression.

Psychodynamic psychotherapy calls the feeling we have in such relationships ‘counter transference’ and identifies two types.

Subjective counter-transference comes from our personal histories. If we respond in an angry way to someone it may be because they remind us of someone from our background.

Objective counter transference on the other hand may involve responding in a similar way but is generated from the person sitting opposite us and their history and “not” from us. A CBASP approach in dealing with this might say,

 “I value the relationship with you but I will let you know when you say something which affects me. If it is something similar to what you have experienced in the past, I would like to talk about it.”

All of this requires is being more self-aware which is not such a bad thing.

At the end of the day, all we have are our relationships.

More authenticity in relationships is good for mental health for people with depression and for the people who work with them.

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