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Since psychotherapy is based on dynamic concepts, the psychotherapy of the depressed patient must hinge on a particular conceptualization of depression. The patient with a depressive personality is seen here as a person whose illness involves distorted interrelating with other people and manifests six cardinal elements. Despair, or the sense of being trapped, is one such element. It arises out of the deprivation of "affectual nurturance" in childhood and leads to the next element, manipulativeness. Aversion to influence and unwillingness to enhance others are elements that are also closely related to deprivation. The depressed person is likely to feel so empty and coerced that giving to others is perceived as a demand which must be rejected. Anxiety follows from these circumstances because the depressive wonders who will help him or her. Finally, anger, manifested by low mood and low energy, is an invariable concomitant of this syndrome. The psychotherapist must be aware of these elements. A depressed person's anger and suffering must constantly be explored. Depression in the therapist must be quickly discerned because he or she must not participate in the patient's need to be punished and cannot back away from the patient's severe anxieties. The progress in therapy is characteristically slow. The patient often fights against "coercion," and it is a problem for the patient to accept the clinical collaboration with the therapist. Exploring the depressive's affect is another part of the therapy which not only is informative but also helps the person to see himself or herself as playing a role in his or her own "misery" rather than being a helpless, entrapped victim.