Psychotherapy of the Depressed Patient1

THERE IS A TRADITION OF EXCEPTIONAL difficulty in the psychoanalysis or other psychotherapy of depressives. Edith Jacobson (1954) spoke of a more intensive affective involvement with them. She referred to intervening with a "spontaneous gesture of kindness or even a brief expression of anger, " but wisely added, "… since these patients are frequently very provocative and exasperating, such a deliberate show of emotional responses naturally presupposes the most careful self-scrutiny and self-control in the analyst." Sullivan (1954) commented on the depressive's functioning as particularly difficult to comprehend and deal with, the person "remaining, " as he expressed it, "most remarkably obscure and unknown." Freud (1959) found in the depressive "an attitude of revolt, " which is a formidable barrier to productive therapeutic collaboration. Frieda Fromm-Reichmann (1959) noted the depressive's "lack of interpersonal sensitivity, " which we can recognize as an emphatic hindrance in exploring interpersonal experience; she may also have been referring to a quality in the depressive which Freud (1959) characterized as "incapable of love." Despite the distinguished status of the analysts here referred to, and many more could be quoted to confirm the arduousness of working with depressed people, I feel safe in suggesting, as the most impactful single reference to cite, one's own personal professional experience.

This sketchily indicates a consensus regarding an inherent difficulty in psychotherapeutic approaches to the depression prone person. There is, however, an additional complication because of