Posted by Amy: Here’s a brief vignette from my office that illustrates how an interpersonal framework for depression can yield quick results for everyone involved. This is not an attempt to “sell” a method of therapy, but rather, to help us begin to see individual problems as dynamic–and changeable–by nature. It’s also gives us a glimpse into how, in our relationships, all of us well-meaning souls can inadvertently contribute to our partner’s distress.
The Case: Meg, a vivacious 32-year old graphic designer came to see me alone for symptoms of depression-–uncontrollable crying, lethargy, hopelessness. She wondered if her mood was “genetic”, since her brother also had periods of depression. In the course of our discussion, where I probed her current life situation, it became clear that her 4-year-old marriage was in trouble; Meg sounded depressed about her marriage, where she was feeling angry and alienated from her husband. I asked her to invite him for session #2.
The Second Session: Meg’s husband Brian worked as a writer for a well-known progressive think tank. He wore his political passions on his sleeve. His work commitments occupied a large 
share of his time and energy, and his wife appeared to feel somewhat sidelined by his almost frenetic schedule. More important, before the birth of their 2-year-old son, both Meg and Brian described a relationship with free-wheeling quality, where they enjoyed a high degree of individual autonomy. The transition from couple to family put some new demands on their “we-ness”, and challenged them to expand their way of operating as a couple. They had managed to avoid addressing some areas of conflict as long as they were only two. That’s easy to do. But the complexities of becoming a three-person family made these unresolved issues more pressing. I shared my thinking with them, as I conveyed the idea that Meg’s “depression” was in their duet, not within Meg alone.
It was clear at the first meeting that this was a well-meaning couple, with a reservoir of caring and commitment toward each other. At the second meeting, Meg described her “depression”; she clearly felt that her husband’s rigid adherence to his political principles didn’t allow enough room for her voice, or her perspective. She talked about how she looked forward to preparing a lovely omelet for their son, but Brian rejected her idea, based on his own vegan diet. Megan tried to reassure him, painting a picture of happy, cage-free chickens eating organic feed, but Brian was adamant in his opposition. For Megan, Brian’s passions felt exclusive, rather than inclusive.
Meg described how feeding her family a variety of delicious foods was an important way for her to show love. She understood and respected her husband’s beliefs, but she didn’t share them to the same degree. She wanted more flexibility with their son. Joy in the preparation of meals was something she learned from her own mother. And now their son was caught in the confusion between the couple. I said, “I think your son will enjoy seeing that his Dad loves his Mom more than he loves chickens.” To which Meg responded, “I don’t know if he loves me more than he loves chickens.”
We met for six sessions, and last session showed that this couple made the most of our meetings. Meg’s depression had receded, and she and her husband seemed more open and understanding toward each other. The wall had come down. Instead of talking about Meg’s depression, they began to talk about the changes that had happened to them since their son’s birth, and how this changed their shape as a couple. In response to my pushing him a bit past his comfort zone, Brian responded to his wife’s despair by examining some of his own rigidities. It wasn’t easy for him, and he showed some courage in being willing to question himself. Meg seemed relieved by this. She also realized some of the ways in which she contributed to their dance, especially her tendency to run away from conflict. The session ended, and we agreed they’d call as needed.
I didn’t see this couple for nearly two years, when they called me for a “tune up”. Meg had been feeling increasingly marginalized and “unheard”, and worried that her depression was beginning to return. The issues between them were much the same, but with less intensity. We met for several sessions, tweaking some of the familiar underlying patterns, and they left with their relationship in better balance.
This bare-bones narrative gives the flavor of what can happen when “depression” is understood within the context of a relationship. I have no doubt that if Meg had consulted a therapist who regarded depression as an individual problem, she would have received anti-depressants; she met all the criteria on the checklist for “depression”. More than that, her husband would not have gotten anything out of her depression: Exploring the relationship dimension of her mood allowed both Brian and Meg to learn new things about themselves, and how they are with each other. That’s an investment in the relationship that pays dividends.
True, this couple showed a healthy response to our therapy. Of course this does not always happen. But what DOES usually happen is that, once the the conversation shifts from an individual problem to one belonging to the family, possibilities emerge. In this case, the therapy wasn’t totally painless. Both partners, especially Brian, were invited to question some of their cherished assumptions about themselves and the relationship. Brian in particular needed to create a more expanded version of himself–not always easy to do.
It’s possible that this couple will return for additional sessions down the road. But the initial therapy, and follow-up, worked quickly, without side-effects, and was, I think, growth-producing. Treating Meg’s depression as also belonging to her husband made this possible.