More from forthcoming book chapter—depressive personality

"Despite its omission from the DSM, depressive personality is the most common personality syndrome seen in clinical practice... People with depressive personalities are chronically vulnerable to painful affect, especially

2/ feelings of inadequacy, sadness, guilt, and shame. They have difficulty recognizing their needs and when they do recognize them, they have difficulty expressing them. They are often conflicted about allowing themselves pleasure. They may seem driven by an unconscious desire

3/ to punish themselves, either by getting into situations destined to cause pain or depriving themselves of opportunities for pleasure. A psychologically insightful observer might describe the person as their own worst enemy.
Where there is an enemy, there is often anger and

4/ aggression. One underlying psychological theme in depressive personality style is internal attacks against the self. The person is angry, defends against experiencing anger, and directs it against the self in the form of self-criticism, self-deprivation, and self-punitiveness.

5/ The relevant SWAP item is, 'Has trouble acknowledging or expressing anger toward others, and instead becomes depressed, self-critical, self-punitive, etc.' In short, the person treats themselves like someone they despise.
Clinicians can easily miss the patient’s anger

6/ and aggression because people with depressive personalities tend to be overtly agreeable and put others’ needs first, including the clinician’s needs. If psychotherapy is to bring about meaningful psychological change, anger must be recognized, experienced, and explored in the

7/ therapy relationship.

A second underlying theme concerns separation, rejection, and loss. The person may be preoccupied with, & painfully vulnerable to, rejection, abandonment, & loss. Undue 'people-pleasing' and helpfulness serve to ward off feared disapproval or rejection.

8/ In psychotherapy, such patients suppress legitimate criticisms and dissatisfactions for fear of hurting the clinician’s feelings or damaging the therapy relationship. Rather than communicating their needs and wants, they accept what they get and 'make do.' This can lead to

9/ a relationship dynamic in which the clinician thinks things are going swimmingly and the patient does without—thereby recreating the patient’s dysfunctional relationship pattern in the therapy relationship...

10/ Depressive personality is most common personality style in people drawn to mental health professions. Clinicians have endless opportunity to care for others instead of themselves, be unduly helpful, & fault themselves for falling short of unrealistic, self-imposed standards"