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Depression and low mood problems are the result of a partial or full shut down of our internal psychological system in response to an emotionally intense experience. The individual’s internal psychological system is in crisis and is flooded with feelings of helplessness, powerlessness and a sense of never-ending doom.

When we are faced with loss, such as job loss, divorce or the death of a loved one, we may experience low mood or become depressed due to the partial or full shut down of our internal psychological system

During depression an individual may feel mentally and emotionally depleted or exhausted and carry a sense of ‘never ending doom’, feeling helpless or powerless, and finding everything around them as useless, irrelevant, painful, irritating or annoying

Depression may resemble sadness, however, depression is characterised by the difficulty to tolerate emotions of anger and the guilt that usually follows. And contrary to popular opinion, depression can be triggered by both negative and positive emotionally intense experiences – not just negative experiences. 

When depression is acute, it affects an individual’s capacity to access their internal resources and their will to live. The individual’s internal psychological system becomes partially or completely shut down. The severity of the depression depends on how extensive internal shutdown and repression is.

In times of such extensive suffering, a personal and supportive therapeutic approach is warranted in the immediate term, to help the person to survive through this difficult period. The depressive symptoms may be accompanied by elevated levels of anxiety. Interestingly, sometimes anxiety may have a protective effect for individuals experiencing acute depression, whereby the anxiety pushes away ‘dangerous internal experiences’ outside of conscious experience, minimising what the person needs to deal with at that point in time. 

When the individual starts to feel better and they regain the internal capacity to claim more control over their life, therapy focused on working through the depressive system can take place. 

Intensive Short Term Dynamic Psychotherapy (ISTDP) has been shown to be effective in not only treating depression, but also for treatment-resistant depression where other therapies have not succeeded.

Therapy should have a focused approach and consists of the following steps;

  • Step One: Assessment of the client’s capacity to observe and understand their internal system in action
  • Step Two: Evaluation of their ability to tolerate distress and the complexity of their feelings, and building up their capacity to increase that tolerance
  • Step Three: Learning about existing mechanisms of disconnection and repression and upgrading them with the mechanisms which are more flexible
  • Step Four: Integration of the learned material and new capacities into their psychological system
  • Step Five: Working through initially repressed emotional material which caused depression in the first instance.

Therapy focused on working through the depressive system can be an extremely helpful and liberating experience. 

Let us know if you have any further questions and we will do our best to answer them. 


Valeria Zoteyeva, Health Psychologist
This post is an intellectual property of the Melbourne Health Psychology Centre (c) 2020

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