The psychotherapy of depression and anxiety

The psychotherapy of depression and anxiety

Depression and anxiety are among the most common reasons people seek counselling or psychotherapy. They are also broad terms that can describe a wide range of emotional and physical experiences, many of which can be difficult to recognise, access or articulate.

Understandably, most people want relief from the distress associated with anxiety and depression. However, depth psychotherapy takes a somewhat different approach. Rather than focusing solely on eliminating symptoms, it asks what those symptoms might be communicating.

Techniques for managing anxiety or low mood can be useful, particularly in the short term. However, lasting change often involves going beyond symptom management and developing a deeper understanding of the emotions, experiences and patterns that lie beneath them.

Symptoms often have a purpose

Depression is commonly associated with low mood, passivity, sadness and hopelessness. In my clinical experience, however, it can also reflect difficulty accessing more primary emotions such as anger, rage, fear and grief. There may also be difficulty acknowledging less acceptable aspects of ourselves, such as envy, aggression or shame.

When these parts of our emotional lives are pushed away, something else can be lost too: our capacity for aliveness, desire, pleasure and joy.

Depression can therefore function as a psychological defence against feelings that once seemed unbearable. While this defence may have served an important purpose at an earlier point in our lives, it can eventually leave us feeling emotionally disconnected or numb.

Something similar can happen with anxiety, obsessive thinking and other distressing symptoms. Although everyone’s experience is different, symptoms can be understood as signals from the mind and body that something is not quite right, perhaps pointing towards feelings that have become too difficult to contact or express.

How we learn to hide our feelings

A defence mechanism is an unconscious way of protecting ourselves from emotional pain. These patterns usually develop early in life and can be highly adaptive at the time. They allow children to manage experiences that might otherwise feel overwhelming.

The difficulty is that what protected us as children can become restrictive in adulthood. We may continue to suppress certain feelings, avoid particular situations or relate to ourselves and others in familiar ways, even when those strategies are no longer helpful.

Many people have never consciously decided to suppress their emotions. Instead, they have learned which feelings are acceptable and which are not.

Sometimes these messages are explicit. Phrases such as “big boys don’t cry” or “pretty girls don’t get angry” communicate that certain emotions should be hidden.

More often, these rules are absorbed through observation. In some families, anger is easier to express than sadness. In others, achievement and productivity take precedence over emotional life. Children adapt to these emotional environments, often learning to express only those parts of themselves that feel safe.

The role of Drivers

In Transactional Analysis, some of these early adaptations are described through the concept of Drivers. Drivers are unconscious survival strategies that develop in response to restrictive messages received during childhood.

The five recognised Drivers are:

• Be Perfect
• Please Others
• Be Strong
• Hurry Up
• Try Hard

For example, someone with a strong Be Strong Driver may find vulnerability uncomfortable and struggle to ask for help. Someone with a strong Please Others Driver may find it difficult to express anger or set boundaries because of a fear of rejection or disapproval.

Most people have one or two dominant Drivers. These patterns may once have helped us gain acceptance, avoid conflict or maintain important relationships. However, they can become restrictive when carried into adult life.

Moving beyond old patterns

A central part of psychotherapy is gently uncovering what lies beneath the presenting symptom, while also understanding the protective function that symptom has served.

As therapy progresses, we may begin to recognise deeply held beliefs about ourselves, other people and the world. These beliefs are often rooted in early experiences and may no longer reflect our present reality.

With greater awareness comes greater choice. We can begin to recognise which patterns continue to serve us and which keep us stuck. Old defences can gradually be replaced by healthier and more flexible ways of responding.

Towards a more authentic life

Depression and anxiety are not signs of weakness or failure. They can be meaningful responses to experiences and emotions that have never been fully understood, processed or expressed.

Psychotherapy provides an opportunity to approach these experiences with curiosity rather than judgement. By becoming more able to recognise and tolerate the feelings we have previously defended against, we can begin to reconnect with ourselves.

The aim is therefore not simply to feel less anxious or less depressed. It is to develop a fuller relationship with ourselves, one that allows greater authenticity, emotional freedom, connection, pleasure and spontaneity.

Ultimately, psychotherapy is not only about getting rid of symptoms. It is about understanding what they have been trying to tell us, and discovering what becomes possible when we are able to listen.