Dealing With the Therapist's Vulnerablility to Depression

The working life of every therapist can be negatively affected in varying degrees by a patient's reactive or endogenous depression or by symptoms such as futility, shame or guilt. In this book, Sheldon Heath describes how depressed patients can put their depression into others through projective identification. Therapists can introject these depressed feelings or psychic parts and, in turn, become depressed. Heath explores the ways in which therapists can strengthen their internal psychological boundaries in order to minimize their vulnerability to depression. They can then remain open to patients' projections without being overwhelmed by them. The recognition that these depressive bits are alien to the therapist brings relief for the therapist from the hopefully transitory depressions that are created by patients. Sometimes the personal life experiences of therapists make them especially vulnerable to the depressive symptoms created by patients. This can be worked on by self-analysis in the ongoing therapeutic process with the patient or client. When patients are depressed, they affect those who care for them. This depression threatens therapists' narcissism and self-esteem, and therapists can react with denial, disavowal and contempt. This gives an illusion of mastery and control and a false sense of triumph, since it implies that only the patients have problems. Therapists' own manic defenses have to be scrutinized and worked with, just as patients' have to be interpreted. Therapists' awareness of their vulnerability and of how patients influence them is valuable in diagnosing what is disturbing the patient and can be of major use in the formulation of effective interpretations. Heath shows that therapists' vulnerability to various forms of depression and depressive-like conditions is not only a natural occurrence in therapy, but one that can be utilized, controlled and reversed.