Relationship Issues

Many people with depression, particularly if they have been depressed often or for a long time, develop a pattern of interacting with others that is designed to protect them from disappointment. Avoiding disappointment is obviously a good thing, but in some people it leads to relationships that are not satisfying. We believe strongly that addressing the issue of unsatisfying relationships is important, and we also think that almost every body who is unsatisfied with their relationships can benefit from a systematic examination of what is happening in those relationships.

First it is useful to realize how very, very common these problems are. Often someone with depression, and their significant others, will tend to view the difficulty in having good relationships as something personal. This is not true. To some extent relationship issues are universal in those with ongoing mood disorders.

James P. McCullough, in his book Treatment for Chronic Depression, has helped us to understand what happens for many people with depression. By its very nature, depression is associated with disappointment. Moreover, in the midst of a severe depression, one's capacity to respond to stress is severely reduced. People with depression tend to experience disappointment and a sense of helplessness about addressing that disappointment.

Over time, there is a shift in thinking and even of perception that is subtle but profound. The person with chronic depression loses sight of the connection between their own behavior and the responses that they get from others. This makes sense as a way of avoiding being disappointed over and over again. Don't expect that you can do anything positive and you won't be disappointed when things don't work out. But it becomes a self-fulfilling prophecy.

The chronically depressed person comes to see the social world as some combination of:

A world in which emotional reactions (sadness, hopelessness) that they experience when they encounter disappointment are inevitable and often overwhelming.

A world in which there are few differences in how others interact with them, in which other people are more alike than they are different.

A world that tends to be experienced "in the moment." So that disappointment in the moment makes past experiences that were satisfying "disappear."

These changes are natural, but they are not inevitable, and a systematic approach to addressing them is at the heart of one of the most effective psychotherapies for chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). The impressive results achieved by combining this form of psychotherapy with medications for depression are outlined in a New England Journal of Medicine article in May of 2000.