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Why is Your Client Depressed?

10 careful questions to identify root causes

People will often become depressed when circumstances change in such a way that their basic emotional needs stop being adequately met.

“I don’t know why I’m depressed!” Margaret almost wailed.

“I mean, I have a job, people who care about me…!”

It’s a sad fact that people can feel guilty about feeling depressed. The ruminating about being a ‘terrible person’ for suffering from depression can add ruminative fuel to the bitter, cold fire of depression itself.

It's a sad fact that people can feel guilty about feeling depressed. The ruminating about being a 'terrible person' for suffering from depression can add ruminative fuel to the bitter, cold fire of depression itself. Click to Tweet

Budding practitioners will sometimes ask why we even need to know why someone became depressed. Can’t we just focus on solutions and the future?

Then there are those who take the opposite tack.

What is therapy for?

The purpose of therapy isn’t just to discover why a person suffers emotionally. Some therapists have been rather hung up on causation with the assumption that once a client knows why they have the problem, then the problem will miraculously vanish!

This assumption has filtered down into our culture. People might seek therapy to ‘discover’ why they are as they are. One early client of mine came to see me in the hope of finding out why he’d never liked sports as a child! As though we might discover one neat and definitive cause.

So many clients have told me about former therapy in which they discovered (or, along with the therapist, concocted a semi-plausible theory on) why they developed panic attacks or became depressed… but were disappointed to find they still had the condition!

The fact is that understanding the origins of a problem is just a starting point in the treatment of depression. But it can certainly be a necessary starting point.

That’s because once we know what the client is or has been missing in their life, we can help them fill the gap of that missing need.

So what might we do well to discover about the origins of our clients’ depression?

Question one: Under what circumstances did your depression begin?

People will often become depressed when circumstances change in such a way that their basic emotional needs stop being adequately met.

If they then go on to excessively ruminate about those missing needs, they may begin to fuel the cycle of depression.

Margaret’s depression had begun when she and her husband ‘downsized’ to a new location in another part of the country. She became depressed soon after the move.

Suddenly the friendship group she’d valued, her community, had been ripped from her. Part of our therapy, then, was to help her connect with her local community. Finding this clue as to why she might have suddenly become depressed gave us direction in the therapy.

So what was going on for your client? What, if anything, changed in their life around the time they became depressed? This connects to the next line of inquiry.

Question two: Are you going through a tough transition?

This second question is really a variation on the first. Again we are seeking to understand what changed in our client’s life in order for the depression to arise.

There are classic times in our life cycle at which we are at greater risk for the onset of depression – which doesn’t, of course, mean that all or even most people going through these transitions will become depressed. But different life stages and the transition into them may leave us more vulnerable.

Is your client going through such a tough transition? For Margaret it was moving away from friends and a sense of security and connection, to a place she felt lost in. She’d also recently retired and was finding it hard having lost the sense of meaning and purpose her former work had afforded her.

Common life-cycle transition times to look out for include:

  • Going away to University or leaving home
  • Moving house
  • Illness – of your client or someone close to them
  • Loss of someone close, including the death of a pet
  • A new baby
  • Divorce and even marriage
  • A new job
  • Loss of a job
  • Retirement.

Difficult transitions may cause a client to overly ruminate in hopeless ways on those transitions and deprive them of the completion of an important need.

As we know, negative rumination fuels depression.1 It’s not the challenges life throws at us that cause depression so much as what we do in our own heads. Depression isn’t solely or even primarily an events-driven phenomenon.

It’s not just about what happens or has happened to a client, but what they inwardly do with what happens to them – how they respond and whether they are prone to negative rumination.

Which leads us to what else we need to discover.

Question three: What’s going on in your head?

Depressed people tend to misuse their imaginations and also spend a lot of time ‘in their own heads’, which can lead to the extremist, completely this/completely that, all-or-nothing thinking of depression. When you listen to the language of your depressed clients it may well be replete with extremist language: total disaster, complete loser, utter failure.

So what does your client worry/ruminate about the most? Ask them! Do they ruminate on disappointments, fears, unmet needs, or the welfare of loved ones? We need to know in order to help them address painful and exhausting inner dialogues.

Another important question is: “What do you imagine about the future?” Depressed people may not see a future, or imagine scary and hopeless scenarios.

So we need to not only help our clients ruminate less, but introduce hope into their ruminations. But how do we do this?

By helping our clients understand depressive thinking patterns, we can help them ruminate differently, with more flexibility and even self-compassion. And by helping them solve problems and act in ways that help them, we can reduce the opportunities for negative rumination as they begin to spend more time living ‘out there’ rather than in their own heads.

So, what has been and is going on in your client’s head?

It might have something to do with the following…

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Question four: Are you having an existential crisis?

Sometimes clients have reached a kind of crisis point.

Maybe they’ve started ruminating about the ‘bigger questions’. What’s it all about? What happens when we die? What’s the point in anything?

Of course, such questions need not depress us at all, and indeed have inspired some of the greatest thinkers in history. But for some they can take on a dark, scary, hopeless tinge.

Such ruminations may begin or intensify after some loss or bereavement. The client may worry they’re having some kind of a breakdown.

We might remind them that a ‘breakdown’ might really be a breakthrough, that coming to terms with such existential questions may help us live more fully, and that most people think about such things sometimes.

One client who told me miserably he’d started having all kinds of thoughts about life and the “point of it all” felt relieved to be able to openly discuss such philosophical issues with me.

I gently suggested that the mind can know reality in different ways, and that the bottom-line, bullet-point way of seeing was great for much of life, such as accountancy and bureaucracy, but that there is another way of knowing. One that doesn’t reduce or explain in one sentence but is imbued with knowing and experience. He really liked that idea, and stopped trying to reduce everything to one point.

But perhaps the depression is sustained through more prosaic means.

Question five: Is your diet, sleep pattern, or activity level depressing you?

Margaret had stopped going for her daily walk and had gotten into the habit of staying up late watching the news and “other depressing stuff”.

And when it came to diet, she told me she ate mostly ready meals, or sometimes just potato chips and loads of sweet stuff.

We all, of course, have physical needs as well as emotional ones (and of course the two influence each other). Too little sleep or exercise will increase stress in your client’s body and therefore their mind, leading to exhaustion and a greater likelihood of depressive thinking. Too many carbohydrates and refined sugars will send their moods on a roller coaster of dips, brief highs, and shattering lows.

So when treating depression we need to know to what extent our client’s physical lifestyle may be depressing them, and take steps to help them make healthier choices to lower their stress levels, improve their energy, and clarify their minds from the pernicious effects of brain fog.

Talking of which…

Question six: Are your meds depressing you?

If your client has felt more depressed since being on medication, you can encourage them to talk to their healthcare provider about any side effects of the drugs. Sometimes symptoms of depression can lift dramatically with a revised dosage or a move to another medication. So it’s important to be fully informed about potential side effects of medications.

Drugs that may cause or contribute to depression include:2

  • statins
  • beta-blockers
  • anticonvulsants
  • Parkinson’s disease medications
  • corticosteroids, and
  • hormonal medications.

Unless you’re trained in pharmacology, you’re not expected to be an expert or give medical advice, but it’s worth checking what kinds of drugs, if any, your client is on and if anything can be done to ameliorate any deleterious effects they might have.

As James Le Fanu writes in his book Too Many Pills, “There is no drug intended to do good that does not cause harm in some.”3

Mind you, your client’s depression may have less to do with physiology or pharmacology and more to do with ruminating on past events.

Question seven: Is your past depressing you?

Some clients seem to be meeting all their needs in their current life, but are depressed because of constant ruminating on past events.

Depressed people often exhibit ‘learned helplessness’. This means they have found themselves helpless or relatively powerless in a particular situation in the past, and are now making a faulty link to a new situation (or even spreading this sense of helplessness to all situations) and continuing to act as if they are helpless even though things have changed and they no longer actually are.

A good analogy is that of a bird locked in a cage for years whose cage door is left open one day, but because of its past conditioning doesn’t fly free, even though it could.

I discovered that Margaret still ruminated about her marriage that had ended 9 years before. She felt guilty and had struggled to ‘move on’. So one goal of therapy was to help her leave the past alone more.

Learned helplessness produces what we might call emotional overgeneralizing.

Perhaps past traumatic experiences taught the client that “all men are sadistic” or “all women are manipulative” or “everything always goes wrong in the end!” These overgeneralizations are damaging, so we can help our clients start to challenge and reframe them.

If they’ve been traumatized by past events and you suspect the intense effects from these events is sustaining depression, you could help them by using the Rewind technique, which will help lift the traumatic feelings from memories.

But maybe it’s what’s going on now that is depressing your client.

Question eight: Is a situation depressing you?

The word worry comes from an Old English word meaning ‘strangle’ – and certainly worrying can feel pretty suffocating. We often worry about situations that seem impossible to solve. We worry about other people when only they can help themselves. We worry about unjust situations, about being bullied or misrepresented, about money and relationships.

To decrease worry, we need to help our clients either deal with the situation or stop worrying about it so much.

So we can ask clients if anything ongoing in their life is upsetting them, and if so, we can explore how we can help them deal with or even resolve that issue.

Or is it your client’s overall approach to life that’s holding them back?

Question nine: Is your perfectionism depressing you?

All-or-nothing thinking, as we mentioned above, can manifest as maladaptive perfectionism. Does your client demand unrealistically high standards for themselves and other people, and therefore often feel inadequate or let down and disappointed?

Perfectionism is, it seems, a risk factor for suicidal thoughts.4 Research shows that people with strong perfectionistic traits are not only more likely to consider suicide, but also less likely to discuss those feelings, as ‘showing weakness’ is something a perfectionist doesn’t like to do.

For some clients, treating depression is primarily a case of treating perfectionism, so that they can approach life more flexibly and not beat themselves up so much.

Mind you, the people in our lives can sometimes depress us as well.

Question ten: Is somebody depressing you?

Moods, attitudes, and emotions spread from person to person.5 Low morale can spread like wildfire. There may be significant people in your client’s life who transmit negativity, pessimism, defeatism, and other classic depressive thinking styles.

Margaret told me she had one friend who insisted they meet up three times a week and “depressed the hell” out of her. She always felt worse after seeing this person. I suggested she limit her exposure to once a week, and I helped her not be so affected by this negativity spreader.

Sometimes it’s a husband, parent, co-worker, or child who is spreading depressive biases in your client’s direction. We may not be able to influence how much time our client spends around this person or people, but we can help them ‘recover’ faster after being with them and not be so affected. Or we may have to teach our client how to manage their relationships more adaptively, worry less about them, and set better boundaries.

Now we don’t have to – and indeed shouldn’t! – ask these questions bluntly as some kind of form-filling tick list. Rather, we can explore these areas with our clients naturalistically to get a real sense of what may have instigated and what may be maintaining the depression.

One and the same client may have all or none or other of the above contributing factors to their depression, but I think pursuing the ‘lines of inquiry’ I’ve drawn up here is a pretty good way to go.

Margaret found that starting to see why she had become depressed and understanding clearly what was still depressing her was a profound move towards discovering how she could become happier.

Discover a New Way to Approach Depression Treatment

Treating depression can feel like a thankless task, as you battle the incessant negativity of the depressive mindset. The approach to treating depression you will learn on Mark’s online course How to Lift Depression Fast will not only empower you against depression but also protect you against its negative bias. Developed over more than 20 years of working with top psychologists, training health professionals, and treating clients, How to Lift Depression Fast will make you look forward to your next depressed client. You can read more about it here.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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