Depression is one of the most common phenomenon encountered in psychotherapy and counselling. When we talk about depression it is crucial that we differentiate it from low mood, grief or sadness. In the case of depression, the individual will not only see the world as empty and hopeless, but will see themselves as the source of worthlessness, despair, pointlessness. Depression hence needs appropriate attention in therapy—one that differs from regular mourning or feeling low.

Symptoms of depression and their manifestation

Given depression is an emotional phenomenon, its symptoms most significantly occur on individual’s feeling level. They are usually associated with feelings of worthlessness, low self-esteem, feelings of pointlessness and hopelessness about the world, feelings of self-contempt and even self-hatred, feelings of inadequacy or not fitting in, overwhelming feelings of guilt, despair and utter sadness. There is often a general sense of life being pointless and no hope for it to ever get any better.

Depression does not only occur on the feeling level, but also affects the body and thinking. Thoughts of suicide often accompany depression, as does intense and quite fierce self-criticism.

Depression can also manifest itself on somatic level. This will often occur in the form of muscle ache, fatigue, sleep disruptions (either sleeplessness or feeling of not getting enough sleep), agitation, digestive problems.

Object of identification and the significant other

Depressed individuals will usually identify themselves with their achievements, social status or any other object of identification—which can also be another person in their lives (i.e. parent, spouse). Their sense of self, their mechanism of self-validation worth and their purpose will depend on this point of identification. As long as they get recognition this way, they will remain feeling OK.

People who suffer from depression usually have a strong sense of responsibility. They are hard on themselves and have high standards. If they perform, they identify with their performance. If they achieve, they identify with their achievements. If they reach a certain status, they identify with it. Once this point of identification is lost; once performance is diminished; they will be in a position to get depressed.

The same occurs when another person is someone they identify with. Once closeness and recognition of this significant other is present, a person will feel OK. However, once the significant other leaves their life, they will regard themselves as worthless, their life will turn pointless, their sense of self will be abolished. This “other” does not necessarily need to be only one person in their life. It could be the case when depression hits every time the person ends an intimate relationship or when they lose a loved one (e.g. mother, father, spouse, etc.). They cannot picture their life without them—life loses its meaning and purpose.

General personality characteristics—view of self, others and the world

A person that tends to get depressed will usually have poor self-esteem and sense of worth. The sense of worth will strongly depend on how others see them or how they manage to satisfy their own internalised expectations (i.e. do well at work or school, have a successful career, have important social status, etc.). They will put excessive amount of importance on how others see them and will tend to disregard their own views of themselves—their views will essentially become the views of others. Others will become more important to them then they are to themselves.

They will also tend to be highly critical of themselves, put themselves under immense pressure and demand of themselves more than they would demand of any other person. When they don’t achieve their “perfect goals”, they will consider themselves as worthless—the world is, therefore, either black or white for them.

A lot of introjected content and rationale that propels depression can usually be traced into very early childhood and is therefore not accessible intuitively to the depressed person. It can often times be surpassed into subconscious and needs to be addressed in the form of psychotherapy in order for it to be resolved.