Melissa is depressed. She has begun hurting herself and has made a suicide attempt, for which she was hospitalized. Furthermore, she talks constantly about how unhappy she is. When asked about her day, she says it was horrible. She has difficulty participating in events. She looks sad all the time. Melissa says that her depression is biological and there is nothing that can be done about it. JoAnne, Melissa’s mother, is very concerned about her. When she visits her she asks Melissa constantly abbot her depression and her symptoms, trying to push Melissa to do something about her mood and start functioning again.
Melissa is in a treatment center to which she was admitted following her hospitalization for her suicide attempt. The team is very caring and compassionate, and they feel Melissa’s sadness. They are frustrated because nothing that they are doing seems to be helping. She is not getting better. Another troubling thing is that they do not understand why Melissa is so depressed anyway. Most of the kids they serve have been abused, abandoned, and uncared for. As far as they can tell, Melissa has had a fine life, and no one has reported any trauma. She lives with her two biological parents in the relative affluence of a suburb.
Melissa has described that suburb, Canondale. She says that all the girls in her high school are Canondale clones, with the same hairstyles, the same expensive accessories, and the same ideas. Melissa describes herself as having tried to be like them but failed. Then she realized the because she was depressed she shouldn’t even be trying to keep up. Depression means, she said to her therapist, that you don’t even have the energy to comb your hair.
The team has been doing their best to help Melissa come out of her depression, When she describes her day in negative terms, they ask her to make one positive statement about the day. They have taught her coping skills and encourage her to use them when she is feeling down (but she won’t). They have helped her to start a journal, but they feel impatient with all the sad things she writes, so they have instructed her to write what is good about her life.
A Different Approach
Perhaps they could take a different approach. Instead of fighting against Melissa’s depression, I suggest they help her explore it. Instead of teaching her coping skills I encourage the team to gently lure her back into life by inviting her to do things with them. Instead of family therapy being about reviewing her symptom, it can be about having fun together.
Staff Feelings about Melissa
The first step is for the team to talk together about their feelings in this case. It is hard to be treating this girl who is not getting better. It is painful to experience with her the sadness that is getting in the way of her life. It is frustrating not to know a “reason” for the depression and to sometimes feel like she should just snap out of it and realize how good she has it. If the team acknowledges and shares these feelings they will be in a better place to move forward in a different direction.
What Will Help?
If you are feeling sad, do you appreciate it if someone says “well tell me the good things about the situation”? No. Well neither does Melissa. As a first step, the team including the therapist should respond to Melissa’s statements of pain with active listening.
“So lunch was particularly hard for you today.”
“During free time you were having sad thoughts.”
“You feel hopeless and wonder if you will ever get better.”
“I feel sad when I hear you describe how hard that was for you.”
Validation. No push for change.
Melissa’s therapist, Tyquanda, can explore her experience with her. “So, what happened exactly? And what was that like for you? What did you do? What happened next?” No symptom or behavior changes by our pushing directly against it. That just solidifies the person in their position.
If Melissa brings up anything that is not specifically about being depressed, such as the statement about the girls being clones, Tyquanda could explore that. She shouldn’t jump all over anything outside herself that Melissa says, because that would frighten Melissa back into her depressive hole. Instead, be gentle. “What is the clone look in Canondale? What are the in brands? Oh really, I never liked Ughs… they don’t like ballet shoes? What are the ways to behave? Are there any other groups a person can belong to if they are not a clone?”
Let’s shift the idea of Melissa’s journal. The therapist or staff could write back and forth with her. If she writes about her pain, respond with validation and exploring. If there is something else you know about her, ask her about that: “Can you tell me more about your dog? What kind is he? How long have you had him?”
It is not important at this time to worry about why Melissa is depressed. It may be that she was feeling lost, unsuccessful and scapegoated in school and found this way out. There may be more to it. There may be biological components. We do know that there is a good reason; in other words, that the depression is solving a problem (or several) for her. And we also observe that the depression has now become her most successful way of connecting with people, including her mother. So, we try to limit pour interaction around either the depression OR ways to change it to brief validation statements. We try to engage with Melissa about anything else. In family therapy we talk about past family memories, present events, the weather. We don’t talk about activities (such as, say, knitting) as coping skills to be used to combat depression. Instead, we invite Melissa to join us in activities- “I’m going for a walk, Melissa, want to come with me?” We start a craft project next to her and invite her in. We invite her to join us in helping others. We especially try to engage with her (but not TOO enthusiastically) if there are any moments she does not seem focused on herself and her depression.
What is Our Real Job?
Melissa’s depression while painful for her, is also a friend, a refuge, a protection. She cannot give it up- or even allow it to lessen- until she is sure there is some other way for her to live in the world. Our job is not to teach her coping skills, or insist she make positive statements, or rehash her symptoms. Our job is to gently and compassionately lure Melissa back into the world. We hope to help her experience safety, connection and success.
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