Depression Through the Ages:  A Counselor’s Perspective

By Sheila Howe, MA LMFT

A benefit to being in the mental health field as long as I have (34 years), is the acquired wisdom of the ages. Over time depression has been viewed as part of the human condition, an existential crisis, a “search for meaning”, a phenomena of faulty attachments, a chemical imbalance, a pathology, or perhaps a dys-integrated state of dys-regulation and dys-ease of the mind and body. As our perspective of depression has evolved so too has its treatment and the role of the counselor.

My earliest academic understanding of depression was that it was a neurosis, a developmental phenomenon, stemming from faulty attachments, as well as the result of maladaptive coping mechanisms from trauma, stress and grief/loss.  Therapy was long term, managed by psychiatrists and focused on client’s early attachments, maladaptive thinking and behaviors. Medication was limited in scope and efficacy. “Insight”, changing your thoughts and modifying your behavior were the objectives of therapy. I was once told that the prognosis for neurosis was neurosis. So in other words once depressed always depressed-therapy and heavy sedation was the answer.  Therapy was long term, often, and very expensive and not so readily available. The everyday depressed individual did not seek counseling as a means of coping.  Counseling was for the wealthy and the very ill and was usually provided by MD’s or by group counseling.

In 1987 I worked for a psychiatrist.  I remember so clearly his prediction that Prozac was going to change psychiatry as we knew it.  Prozac was going to stabilize depression, help clients lose weight, provide more energy and motivation and give new life to individuals suffering from depression. With the emergence of psycho pharmacology came the development of managed care.  Insurances began to manage depression treatment.  Medication in combination of short term, brief cognitive behavioral therapy became the treatment of choice and surprisingly continues to be today. However, since the advent of Prozac (1987-FDA approved), the World Health Organization (2016), claims that today, 35 million people in the world are depressed-1 out of 5 people.  There is also a 400 percent increase in treating depression with psycho pharmacology- only 40 percent experience full remission. These statistics are startling and point to a faulty and limited understanding of depression and a need for enhanced clinical understanding, efficacious treatment interventions and better practices of care.

Twenty first century understanding of neuro science and integrative medicine has led to an overall transformation of psychology and subsequent counseling care. An integrated, whole person perspective-mind, body and spirit, as well as the understanding of brain health and mood science have enhanced counseling practices for the treatment and prevention of depression, fostering renewed hope and vigor in psychotherapy and counseling.

Mood science gives us an evolutionary understanding of low mood.  Low mood is an important survival mechanism and all mammals experience low mood, especially when it is not successful in meeting its goals. A certain low, fatigued, burn out emerges.  Mood science tells us that low mood is necessary to get us to STOP and THINK. Depression can be an emotional and visceral invitation for us to take time out to breathe, unplug, tune out and tune in, to ponder, contemplate and assess and evaluate our lives and our overall well-being. Existentially, low mood becomes a template, a springboard and an invitation to a more meaningful and healthy life and lifestyle? The support of a counselor can assist clients in discerning depression disorders from lifestyle, existential or circumstantial depression. The counselor can teach mindful awareness, breathing techniques, self-compassion and self-care as well as hold space as clients discern their life and lifestyles and self-care.

Neuroscientific understanding of depression has brought incredible insight into the role of; neurotransmitters as establishing mood states-euthymic v. dysthymia; neuro pathways in reinforcing behaviors and beliefs; neuro plasticity for “rewiring” mood and outlook; and integrated brain health for well-being and resiliency and relationship health.  Additionally, understanding the role of inflammation has been very important in current integrative mental health studies.  Stress, environmental toxins, poor sleep, inflammatory foods all contribute to pro inflammatory cytokines which produce oxidative stress in the brain leading to neurotransmitter dysregulation and hemispheric disintegration.  Healing from the effects of trauma, stress, grief and embracing a healthier lifestyle by reducing inflammation and embracing loving attachments become important focuses of attention for the integrative mental health counselor while treating clients for depression.

After 34 years of moving and evolving as a psychotherapist, this much I know to be true for the treatment of depression.

Freud was right! Healthy, secure attachments are key for brain health, relationship health, emotional regulation and overall well-being.  Be open to the possibility of a healthy attachment and allow for a safe secure, therapeutic attachment to assist in healing past faulty insecure attachments.
 Beliefs and behaviors get embedded in the brain and take on a life of its own.  Pay attention to your beliefs, your self-talk and your cognitions. Become your own good friend and let go of the old programming. Make sure your cognitions are worthy of being embedded with you.
Medication can work and at times should be considered.  However it requires a commitment to lifestyle change and supplementation.
 Lifestyle is huge. It can create depressive states and it can prevent and treat depression. So engage in restorative sleep, turn off the blue light, unplug, breathe, meditate, reduce inflammatory foods, move, go outside and receive and pray.
 Grief, trauma and stress must be shared in a loving holding environment of compassion and care.  Left untreated and cared for it will creatively and emotionally oppress, highjack your brain, and control your life, relationships, mood states and personal successes. Allow for the safety and comfort of the counseling office and relationship to assist you in healing, recovery, resiliency and hope.
 The therapeutic relationship rules the day.  The importance of rapport, attunement, empathy, expressions of hope and compassion are the best medicine for depressed individuals.

Counseling is becoming more and more of a science.  We have embraced the science of the mind but we still must approach the client as an artist with gracious, creative curiosity and endless possibility.

Be Kind For Everyone Is Fighting a Great Battle


Sheila M. Howe, MA LMFT

Daily Practice:  Time Out and Tune In: 4-7-8 Breathing Technique 

Allowing the depressed mood state to become an invitation to take time out and tune in.

Begin by focusing your attention on your breathing. Notice your breathing. Notice the tension in your body and place your hands over your heart.
Inhale through your nose for 4 counts.
Hold your breath for 7 counts.
Exhale through your mouth 8 counts.
Do this three times in a row or until you begin to feel more calm and at peace. 

This technique is valuable in assisting depressed clients in their process of rewiring their brains for happiness.  Activating the vagal nerve by engaging in the above breathing practice tells your brain that all is safe and non-threatening. The body and the mind begin to relax and decompress and the brain opens up to greater possibilities and awareness’s.  Conditioning negative thinking and behaviors with positive breathing techniques assists the brain in developing new pathways of positivity and gives you an opportunity to care for your depression whenever and wherever you are. As you become aware of the negative thoughts and behaviors and sensations in your body-stop, redirect your focus to tune in, breathe and provide yourself loving/kindness.Type your paragraph here.Type your paragraph here.