The patterns beneath the symptoms

“Many depressed patients experience only minimal relief from symptom-focused treatments, or experience relief but then relapse….In many cases, [depression] may appear chronic because the personality processes that give rise to it have never been addressed in psychotherapy.” -Jonathan Shedler

Many clients who find their way to my office have tried therapy before. These treatments often focused on teaching coping skills and managing symptoms. While sometimes effective in the short-term, they often miss the underlying personality patterns giving rise to a client’s specific symptoms, resulting in mental health concerns reappearing later in life.

Psychodynamic psychologist Jonathan Shedler compares psychological symptoms to the emotional equivalent of a fever. A fever can present in patients with a mild cold or be a symptom of cancer. It tells us little about the actual diagnosis, just that something is wrong. Brief, symptom-focused treatments can sometimes feel like giving someone Tylenol for a fever, but never fully investigating why someone has a fever in the first place.

Depression for one client might be a sign of repressed anger toward others that has been turned on themselves. For another, it might point to disconnection from their own needs and desires. Symptoms have meanings and causes. They are responding to something, and trying to communicate something very important. If we try to just get rid of them or treat all depression with a single approach, we miss these individual nuances that hold the key to lasting symptom relief. 

Psychodynamic psychotherapy focuses on slowing down to notice the patterns in how we relate to ourselves and others. These patterns often appear in the relationship between therapist and client, allowing us to notice them in real time and practice different ways of being. Reworking these personality processes tends to get to the root cause of our depression or anxiety, and to alleviate it in the long term.