Therapists have to ask clients suffering from depression to talk about it in detail. That’s necessary to understand the level and history of depression and to develop strategies for treatment. Psychotherapist Bill O’Hanlon warns that “…an inadvertent side effect can be a deepening of the depressive experience as we bring it to the foreground,” in “Out of the Tunnel: Escaping the Trance of Depression,” in the November/December 2014 issue of Psychotherapy Networker. The constant focus on depression can “groove” the brain from all the depressed feelings and discussion.
To counter that effect, O’Hanlon uses a method called “marbling,” which he took from what he saw at his father’s meat-packing plants. Marbling refers to the streaks of fat embedded in the leaner meat in a cut of steak, which gives the steak more flavor. In therapy, he applies “marbling” to mean weaving discussions of non-depressed times into discussions about experiences of depression.
“We avoid losing contact with the depressed person by listening and being careful not to invalidate or minimize suffering,” said O’Hanlon. “By going back and forth between investigations of depressed and non-depressed experiences and times, the person who is depressed is reminded of resources and different experiences and often begins to feel better during the conversation.”
Putting the depressed experiences in the past tense can also allow room for positive possibilities in the present and future.
“If a client tells me, ‘I can’t get out of bed, I say, ‘You couldn’t get out of bed,’ O’Hanlon said in a video interview with Psychotherapy Networker. It may not be good to be flippant and say, “You got of bed and came to see me,” but just to acknowledge the positive and say something like, ‘”…but you’re feeling better now.”
Describing it as “acknowledgement and possibility,” O’Hanlon emphasizes the importance of “…reminding people that there are moments they weren’t depressed and won’t be depressed in the future.”
A pathway that helps push through of the darkness of depression is shifting away from the globalization perspective, which can be making things either black or white, for instance, when a person says, “I’ve always been a loser.” That can be balanced with a perspective such as, “So you say a lot of times you’ve been disappointed” or “Sometimes you’ve been disappointed,” said O’Hanlon.
Another critical element O’Hanlon focuses on is encouraging connection with a person or people in any way that helps the client step away from depression. If social situations are sometimes too stressful, O’Hanlon suggests connection through pets, perhaps short-term foster care of a dog or cat.
Finding out about times when the person feels better and may go to a movie or spend time with friends or listen to music can provide positive elements for the “marbling,” leavening the depressed thoughts with the lighter view of hope and possibility for the present and future.
O’Hanlon, Bill, “Out of the Tunnel: Escaping the Trance of Depression,” Psychotherapy Networker, November/December 2014.