Intended for healthcare professionals

Personal Views Personal views

An insider's guide to depression

BMJ 2001; 323 doi: (Published 27 October 2001) Cite this as: BMJ 2001;323:1011

Re: Depression can be lifted quickly

Dr McKall's article was indeed moving. But I found the technical and
prescriptively dogmatic views of Mr Tyrell on the nature of all
depressions for all patients decidedly off-putting. They should certainly
not deter those who seek treatments other than those focussed on simple
cognitions. If the 'power of positive thinking' were strongly effective,
depression would be eradicated in a fortnight.

I know of no work, for example, which shows that Mr Tyrell's views on
the nature and purpose of dreaming are anything other than
enthusiastically held theories. And I also feel that his omniscient style
would hardly do much to establish the necessary therapeutic rapport needed
by the majority of people suffering from depression. Psychotherapy is not
an aggressive discipline.

People come in all styles, shapes and sizes. Those who are not
especially introspective do well with Cognitive Behavioural Psychotherapy,
a tried and effective treatment. Those with more 'imagination' often
don't, and require a more integrated or 'Person-Centred approach'.

Although Professor Michael King's detailed depression study (reported
in the BMJ last December) showed that talking treatments were the most
effective for most depressions (lasting less than a year) - being superior
to GP care with anti-depressants - his outcomes did not show that CBT was
superior to other psychotherapies, including the psychodynmaic styles.

Does 'rehearsing' trauma always reinforce it? I believe it is likely
to depend on the context of the rehearsal. When you talk through a
disturbing experience with a warm and trusted ally, for instance, you
deflate negative emotional arousal in particular but also in general. I
have seen many depressed patients. Often they were unable to express
their 'past' anger. They were similarly unable to express their 'present'
anger - about anything at all. As a result of sympathetic talking
therapy, they not only removed their presenting symptoms, they repaired
their overall ability to react.

Sure we need to challenge the negative frameworks of such patients
but we must ACCEPT their underlying depressed feelings. I think the
dogmatic insistence on avoidance of such sadness is anti-therapeutic. It
amounts to a new rejection. If a therapist is not client-centred he must
be self-centred.

Phillip Hodson
Fellow, the British Association for Counselling & Psychotherapy

Competing interests: No competing interests

10 November 2001
Phillip Hodson
Fellow, British Association for Counselling & Psychotherapy
Psychotherapist and sexual therapist in private practice