2 types of depression

Recent psychodynamic ideas about depression see it occurring across two dimensions: 1) dependent and 2) self-critical. These two dimensions mirror the two primary lines of human development: self-definition and relatedness (see post for more).

Dependent

A dependent depression is pre-occupied with themes of being unloved, unwanted and abandoned. Often these people have had early experiences of being neglected. Their fundamental need to be comforted and protected may not have been met. They learn to view themselves as someone unlovable, and this lonely stance toward oneself becomes more and more intolerable. There are often very intense levels of anxiety which stem from chronic fears of abandonment.

Self-critical

On the other hand, is the self-critical depressive, in which there manifests extreme concerns about one’s own self-worth and a sense that one is fundamentally guilty, and a failure. There may be a chronic fear of criticism, and a strong sense of being unworthy. Often there have been early experiences of being dominated, having excessive demands placed on them, and having been told that their self-worth is not intrinsic, but dependent on their achievement and “success”.

Treatment

Again and again, studies find that all bona fide treatments of depression are equally effective. So what makes the difference? The major factor contributing to therapeutic change is the relationship between therapist and client. You have to “click” with your therapist. So if you are considering going into therapy and are wondering what the best type of therapy is, it is probably better to consider what type of person is doing the therapy. Do they listen to you? Do they try to understand your perspective? Do you feel safe with them? Are they reliable? These are the most important things when considering a therapist. Research shows that the dependent and self-critical depressions require subtle differences in the therapy that person needs. It is critical, therefore, that your therapist understand your needs. And if you don’t know what your needs are, they should be able to help you get in touch with them.

We don’t fall neatly into any of the categories that psychological research indicates. We move between them and even, at times, defy them altogether. But often we can recognise that we lean more heavily toward either the dependent or self-critical pole. It is useful to know because it gives us greater insight in how our minds are organised, and the ways in which we got to be the way we are. That kind of insight, processed in a therapeutic relationship, is one step further toward recovery.

References

Blatt, S. J. (2008). Polarities of experience: Relatedness and self-definition in personality development, psychopathology, and the therapeutic process. American Psychological Association.