{"id":29999,"date":"2015-12-08T08:00:07","date_gmt":"2015-12-08T16:00:07","guid":{"rendered":"http:\/\/www.goodtherapy.org\/blog\/?p=29999"},"modified":"2016-02-24T15:56:04","modified_gmt":"2016-02-24T23:56:04","slug":"dealing-with-depression-why-get-over-it-doesnt-work","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/dealing-with-depression-why-get-over-it-doesnt-work-1208155","title":{"rendered":"Dealing with Depression: Why \u2018Get Over It\u2019 Doesn\u2019t Work"},"content":{"rendered":"

\"StormIn the face of our depressed moods<\/a>, friends, loved ones, and even our therapists may say things like, \u201cStop doing that to yourself!\u201d or \u201cGet over it!\u201d We may even say to ourselves, \u201cWhy can\u2019t I just get over it?\u201d These forms of \u201cpsychotherapy\u201d usually come from a loving place but often turn out to be ineffective. But why? Why is it that we can stop ourselves from doing certain things (touching a hot stove, for instance), but when it comes to the low energy, hopelessness<\/a>, helplessness<\/a>, and self-attacking thoughts of depression, we can\u2019t \u201cjust get over it\u201d?<\/p>\n

When \u2018Get Over It\u2019 Does<\/em> Work<\/h2>\n

Believe it or not, as a therapist I spend a fair chunk of my day using a form of \u201cStop It!\u201d therapy<\/a>, often with success. When a person is (1) in conscious control of a behavior, (2) no longer wants to do it, and (3) wants my help to stop, challenge (Abbass, 2015) or response-prevention interventions can be quite effective.<\/p>\n

\u201cGet over it!\u201d is a form of challenge or response prevention\u2014it says, \u201cStop doing the thing that hurts you!\u201d When you look at it that way, you can see the loving core of the comment. When someone asks me for help with a pattern they know is self-defeating, such as stubbornness or detachment, but they intentionally<\/em> continue to do it, challenging them with a \u201cdon\u2019t\u201d intervention is one of the most compassionate<\/a>, helpful things I can do.<\/p>\n

When \u2018Get Over It\u2019 Doesn\u2019t<\/em> Work<\/h2>\n

When someone has conscious control over a behavior, \u201cget over it\u201d-type interventions can help, but my clinical work looks much different when the self-defeating pattern is unintended or unconscious, habitual, or automatic. Decades of clinical research in intensive short-term dynamic psychotherapy<\/a> (e.g., Abbass, 2015) have shown that a portion of those experiencing depression\u00a0have\u00a0symptoms driven by an unconscious emotional process\u2014a process that, at least at the start of therapy, occurs\u00a0automatically and is entirely beyond their control.<\/p>\n

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In ISTDP, we call this process \u201crepression\u201d or \u201cinstant repression\u201d\u2014the process by which mixed emotions<\/a> toward another person are instantaneously and unintentionally shunted back against the self, either in the form of depression or somatic symptoms (this is a slightly different definition of repression<\/a> than in psychoanalysis<\/a>).<\/p>\n

Often, people who experience repression-driven problems never recognize they were mad at someone else; instead, they are instantly overcome by a process of self-blame and self-torture that leaves them feeling fatigued and hopeless. At no point did they decide to do this. Before therapy, this is just how their brains<\/a>\u00a0are wired; they\u00a0automatically say, \u201cWhen I feel anger toward someone I love, I protect them by pointing it back at myself.\u201d Considering the people we love most are the most likely to irritate us, this is a potentially dangerous state of affairs.<\/p>\n

Saying \u2018Get Over It\u2019 to Someone with Repression<\/h2>\n

So what happens when we say \u201cget over it\u201d to someone with depression that is driven by unconscious repression? Here, the \u201cget over it\u201d confronts the depressed mind with an impossible task: (1) gain conscious control of an unconscious process that is currently operating out of your awareness, or (2) do a thing you simply can\u2019t do (yet<\/em>).<\/p>\n

When people, especially people we love, challenge us to do something that is impossible, it triggers anger<\/a>, and in the depressed mind where instant repression is still active, that anger will deflect right back onto the self. Instead of lovingly reducing the person\u2019s symptom burden, then, the \u201cget over it\u201d would actually make symptoms worse by activating anger that will be sucked back in via repression.<\/p>\n

When people, especially people we love, challenge us to do something that is impossible, it triggers anger, and in the depressed mind where instant repression is still active, that anger will deflect right back onto the self. <\/span><\/p>\n

\u2018Get Over It\u2019 and Psychotherapies for Depression<\/h2>\n

Some therapies encourage us to challenge, question, or detach from our depressive thoughts and moods. Other therapies encourage us to get up and do something even when we have no energy. Sometimes, for some people, these approaches produce positive benefits.<\/p>\n

My concern, however, is that for folks who have depression caused by unconscious repression processes, questioning their thoughts implies, \u201cDon\u2019t think that,\u201d and encouraging different behaviors implies, \u201cDon\u2019t be like that.\u201d These both sound a lot like saying \u201cget over it\u201d to someone who is not in conscious, intentional control of the symptom; asking them to do something different when they literally cannot. This could trigger anger toward the therapist that will get shunted into repression and lead to worsened therapy outcomes. No one wants that.<\/p>\n

How ISTDP Can Be Useful<\/h2>\n

ISTDP is an ideal therapy for building the capacity to become consciously aware and tolerant of the mixed emotions that usually get deflected back on the self in repression-driven depression and somatization<\/a>. When working with people with depression in ISTDP, the therapist is in a largely supportive mode, helping people self-reflect on and feel the feelings that were previously getting automatically and unintentionally converted into depression or somatic symptoms. This builds affect tolerance<\/em>\u2014the ability to feel feelings while still being able to think clearly and channel them in a satisfying way.<\/p>\n

This process helps people with repression because, rather than telling them what not to do or what they should do, it gives them another option\u2014it helps them become more comfortable with their emotional reactions so\u00a0they <\/em>can then decide how to channel their emotions. In ISTDP, what people wind up \u201cgetting over\u201d is the destructive way their mind would unconsciously bury mixed emotions. Once they can think clearly while being in touch with their emotions, rather than being unconsciously overwhelmed by those emotions, they can then make wise, authentic decisions about what to do.<\/p>\n

Reference:<\/strong><\/p>\n

Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques<\/em>. Kansas City, MO: Seven Leaves Press.<\/p>\n","protected":false},"excerpt":{"rendered":"

Challenge (or response-prevention) interventions may help resolve certain issues over which we have conscious control, but depression isn’t one of them.<\/p>\n","protected":false},"author":2977,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[542],"tags":[31,161,314,25,27],"class_list":["post-29999","post","type-post","status-publish","format-standard","hentry","category-featured-articles","tag-psychotherapy-practice","tag-depression","tag-intensive-dynamic-psychotherapy","tag-psychotherapy-issues","tag-psychotherapy-models"],"_links":{"self":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/29999","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/users\/2977"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/comments?post=29999"}],"version-history":[{"count":0,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/29999\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media?parent=29999"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/categories?post=29999"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/tags?post=29999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}