1/ Depressive personality style as a pathway to clinical depression (from forthcoming book chapter)

"Depressive personality refers to enduring personality dynamics, not mood state. People with depressive personality may or may not experience clinical depression, and people with

2/ recurring or chronic depression may or may not have depressive personality styles.
Difficulty recognizing needs and desires can lead to clinical depression. It is difficult to meet your needs when you do not know what they are. Failure to meet basic emotional needs leads to

3/ depletion and depression. Work in psychotherapy should focus not just on expressing unrecognized and unarticulated needs, but on understanding the psychological processes that interfere with recognizing them. The clinician should be alert to subtle ways the patient steers away

4/ from needs and desires and help them articulate the fears that lead them to steer away.
Anger directed at the self can lead to depression. Being berated, punished, and scorned causes pain, and this is equally true when the person doing the punishing is oneself.

5/ To stop the self-torment, the person must recognize and consciously experience the anger they habitually disavow. This process cannot be merely academic or intellectual; the anger must be experienced in the here and now of the therapy relationship. The therapist should be

6/ alert to indirect indications of irritation or disappointment or their absence where they might be expected, and actively invite them into the therapy relationship. 'I’m sorry I was late' is not an invitation to explore disappointment or anger. 'I notice you didn’t say how it

7/ felt when I was not here' is an invitation.
Patients who have not internalized a reliably available caretaker remain dependent on others for emotional care and are vulnerable to depression when left to rely on their own internal resources. They benefit from experiencing and

8/ internalizing a relationship with an attuned and reliably available therapist. Brief therapies with arbitrary session limits can be destructive. Instead of helping to repair early experiences of relational disruption or loss, they can force the patient to relive them."