Depression: A Disorder of Power
By Susan Heitler, Ph.D.

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Resolving Conflict; Lifting Depression
by Susan Heitler, Ph.D.
-- Treatment Today

My patient, Mary has a persistent depression treated with antidepressants, behavioral interventions, cognitive therapy and psychodynamic explorations. But in order to stay out of the depression, Mary and her husband, George, had to learn to interact on an equal-power basis.

George dominated his wife, overruling her preferences. Mary often gave up in order to keep the peace, but then sank into severe depression.

This case taught me the following lessons about the ingredients that sustain or destroy positive emotional functioning:

* Although feelings are experienced within a person, they usually are generated by interactions between people.

* Treating only the depressed person leaves an essential component of the depressogenic system still toxic.

* The toxic factor is not the spouse, but rather the system of interaction between the spouses.

* Virtually every interaction in which one person gives up or gives in produces a quick dose of depressive biochemistry.

If depression emerges as a result of frustrating marital interaction, must both spouses be included in treatment? The answer is a resounding yes. If depression is treated as an individual's pathology with only individual interventions, curing one spouse's depression can cause iatrogenic distress. That is, as one partner gets emotionally healthier, the spouse and/or the marriage will become more troubled. Treatment with medications and individual therapy alone, without a couple treatment component, is insufficient and even potentially harmful. In order to be fully effective in treating depression, to decrease the likelihood of subsequent depressive episodes, and to be certain that treatment does not incur harm to the spouse or the marriage, a couple component of treatment is essential.

From the audiotape
Depression: A Disorder of Power

Depression produces feelings of powerlessness and helplessness. Depressed feelings are triggered by a situation in which a person gives up on getting something of felt importance.

Treating Depression with a Conflict-Focused Visualization.

The following visualization, illustrated on the audiotape Depression: A Disorder of Power, can powerfully combat depressed moods. Designed for therapists to use with patients, the visualization may also be used as a self-help technique.

The depressed person closes his/her eyes, and the therapist asks the following questions, leading the depressed person through six re-empowering steps.

If you are doing the technique as self-help, you might ask a friend to read you the questions at each step. Alternatively, open your eyes to read each question, and then close them again to observe the images that come up on your visual screen.

• Identify the conflict. "If you were going to be mad at someone, or at something, not yourself, notice what image comes up of who you could be mad at."

• Fill in the details. "In that scene, what do you see him (her) doing? How do you respond? What do you want? What do you feel, and think?"

• Check relative sizes. "Who appears bigger, you or the other? By a little, or by a lot." Note: if there are no size discrepancies, you are not dealing with depression, or have not yet identified the depressogenic situation.

• Alter the sizes, increasing the patient's sense of power. "Picture yourself suddenly growing very tall, like Alice in Wonderland, shooting way up tall."

• Broaden the database."From this new height, from this perspective, what can you see now that you may not have noticed before when you were small?"

• Find new solutions. "Knowing what you now know, from this bigger size, what are some new ways you might handle the problem to be more effective in getting what you want?"

Note: This protocol can reestablish normal power, eliminate the negative thinking of depression, and reestablish a sense of positive humor and well-being. For well-being to be sustained, however, the pattern of depressogenic interactions needs to be changed. For this reason, when depressogenic conflicts occur with a spouse, both partners need to be included in the therapy process so that both make the changes necessary for cooperative, rather than dominant-submissive, interacting.

$14.95 One audiotape 45 minutes ISBN 1-884998-09-7
$19.95, One CD 65 minutes

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