The 4 Demons of Depression and How You Can Help Clients Overcome Them

In my 20-plus years of treating depression, I’ve identified 4 areas that are consistently problematic in the lives of depressed people. Here they are and how you can help.

  • thinking-thumbSocial Isolation. This tendency trumps all others when it comes to the perpetuation of depression and is most common in the chronically depressed. It’s generally not a planned thing; instead it morphs out of some of the accompanying physiological symptoms of depression, such as low energy, a decrease in motivation, an absence of pleasurable activities in one’s life and insomnia.

    Help these people by stressing the importance of adopting a routine, and be clear that they have to push themselves. It begins with a decision to get out of bed, get groomed, eat, and then decide on some structure for the balance of the day. Less is more here to minimize discouragement while in a fragile state. Help them get started, then modify and adjust along the way. Emphasize that they need living and breathing support to sustain them and that this can come from the obvious sources – family and friends, but also from conversations at the local coffee shop.

  • Attitude. Attitude serves as the “mind’s eye” – the way we view the world. Attitude never just stands still; it is an ongoing perceptual process requiring us to remain on guard. Negativity commonly accompanies depression, and this in turn, saps energy, dampens the spirit and lessens enthusiasm.

    Cognitive reframing is essential when working with depressed clients. Mindfulness techniques can also be very helpful. Depressed people often experience an immobilizing inertia because of cynicism, pessimism and unrelenting negativity. So they have to understand that to change the way they feel, they will have to adopt thinking and behavioral changes. Focus on helping them set realistic expectations (example: they won’t lose 20 pounds in one week), take on something new in their lives (example: learning to play a musical instrument) and stop making comparisons by understanding that their own individual uniqueness counts for something potentially big time. Another tip: ask them to read or listen to something funny every day. Newspaper comic strips and I Love Lucy reruns are great places to start.

  • Fear. Poor logic lies at the root of practically all fear, and the majority of what we experience as fear is a product of self-programming designed to make us feel helpless and run away. And when we identify with fear through our negative personal experiences, we are prone to examine the fear in an unempowered way. Fear then becomes the worrier in our heads that interprets a situation to mean the worst will happen. This is all too common in depression, because depressed people tend to focus on the worst of possible outcomes for any given situation and will scan their environment to support these limiting beliefs.

    Help clients to overcome this by encouraging them to first just notice the fear. Guide them to an understanding that when they feel afraid, they should take a step back and acknowledge it – without attempting to analyze, understand, assess or figure out the fear just yet. By doing so, they’ll give themselves some emotional space. Next, help them determine the difference between fear which is legitimately in the present from fear that is imagined. There’s a big difference between actually losing one’s job – and the financial concerns accompanying this – and believing one will lose the job. One is real; the other imagined. Then, do some probing, by challenging the client with these questions: What is the fear really about? If the fear came true what would that mean? What is the fear preventing the client from doing?

  • Lack of confidence, poor decision making, weak ego strength. The core element that drives these traits is a lack of assertiveness, and the default behavioral position is generally passivity. Assertiveness is the ability to articulate wants and needs without violating the rights of others. It is a direct, open, honest form of communication, and when done right, it enhances confidence, strengthens decision making and boosts esteem.

    Work with clients on being specific about what they think, feel and want. Teach them how to explain precisely what they mean – and don’t mean. Emphasize that they compare themselves only to themselves and that their individual uniqueness counts for something potentially big time. Role-play with them on maintaining direct eye contact, standing or sitting with good posture and speaking in a way that is audible and firm. Stress the importance of keeping their standards high and never compromising these simply to be “liked” more, that personal value is a function of improving self-mastery, and never should be gauged on being accepted by others.

    Helplessness, hopelessness, worthlessness, lack of motivation, pessimism and a life without pleasure – all core symptoms of depression – are fueled by these four demons discussed above. It’s not the other way around. Depressed people have to be challenged to improve in these four areas and must understand that they will have to push themselves to get there. The motivation to do so or not is their decision because motivation is intrinsic – you can’t do it for them.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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