in Absence Is the Bridge Between Us: Gestalt Therapy Perspective on Depressive Experiences (Gestalt Therapy Book Series Vol. 4) (Italian Edition) Gianni Francesetti and Lynne Jacobs
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to define a depressive experience, we are faced with the need to define the experience of happiness, loc: 895
Defining happiness and the lack of it implies a definition of the ontology of the human being, loc: 896
Freud suggested the need to give up one’s own happiness in order to achieve safety loc: 898
systematizing a split between individual needs and social needs loc: 899
existential and phenomenological schools provided the bridge to connect the two polar elements of this split: loc: 900
Lacan spoke instead of “the desire of the desire of the other”, thus establishing a relational kind of ethics loc: 902
existence is not tolerable without desire; to use Heidegger’s words (1962), desire is implicit in the planning nature of man. loc: 904
desire to be desired by the other, from a background of belonging and reciprocity, loc: 907
depressive experience is related to the renunciation of the desire to be desired. loc: 908
a paradigm shift from a causal understanding loc: 909
to an experiential, phenomenological understanding: loc: 910
does not want to be desired and loved by others anymore, loc: 911
allows us to appreciate the experience of depression for what it is, without trying to explain it with the purpose of accepting it. loc: 912
treatment consists in being close to those who do not want to be desired, and doing so while looking for a thread that can unite the two lives of the patient and of the therapist. loc: 913
Galimberti (2009) links depression to the act of not recognizing what we are, therefore being unable to limit our desires. loc: 915
supports the Aristotelian ethical duty of a happiness that depends on a knowledge of ourselves, loc: 917
our ability to limit desires to what is possible, loc: 918
of “become what you are.” happiness is loc: 919
the virtue of governing oneself. depressive experience in this sense derives from the lack of self-government, the inability to feel what we are. I loc: 920
this ethic of happiness is absolutely necessary in a society like ours, dominated by globalized communications and by the lack of protective, caring relationships at the same time. loc: 921
Natoli (1994) defines happiness as a natural state of grace that does not require reflection, loc: 926
its opposite, pain, disconnected from the naturalness of the human being – that in Gestalt therapy is called the spontaneity of the self loc: 927
depressive experiences lack such an openness and full breath, and they lack a perspective of what is going to happen and of the now-for-next loc: 931
We are ontologically projected towards the future, and depressive experiences imply a collapse of this ontological dimension of the human being. loc: 933
The Projection Towards the Future as an Ontological Condition of the Human Being: Now-for-Next and Depression loc: 937
we could say that the opposite of a depressive experience is not happiness but hope. loc: 940
Our brain is made so as to develop empathy for the intentional movements of the other, loc: 943
consciousness is made by Gestalts of movement, loc: 944
Hope is an experience of empathy for the movement perceived in the other, loc: 945
Hope blooms under the light generated by the love of a caregiver who recognizes the intentional movement of the beloved loc: 948
generating in turn an experience of trust and openness towards the future in those illuminated by his or her light. loc: 949
depression could be seen as a lack of hope, as well as a lack of love from the significant other. depressed person does not feel other people’s love, he is not sensitive to the movement of the other and does not move towards the other. loc: 950
Hope is born in the space of the between loc: 960
Depression is the relational void that makes us walk among people as if we were surrounded by a bubble, insensitive to the other with our body and our soul. loc: 962
The treatment of depression should begin with a renewed sensitivity to the contact boundary with the other, loc: 964
letting the other look right through us and acknowledge our existence, and by grasping the intentional gesture of the other. loc: 964
treatment involves the relational engagement of being there beyond all expectations, a pure being-with, which is the basis of the vital sense of self. loc: 966
This book represents an original attempt to reformulate depression in terms of experience of contact with the environment, loc: 980
presents depression as the lack of a sense of connection with the environment loc: 981
there is a disturbance of the betweenness, of the experience of being-with the other, which, as regards depression, turns into unreachability, loc: 983
evolutionary phase of the person placed under stress or bereavement, loc: 986
an “embodied” configuration of the contact experience with the other. psychotic experiential contexts that emerge from the basic perceptual condition typical of psychosis. loc: 987
three forms of depressive experience of contact (evolutionary, “embodied” and psychotic) may all be linked to different styles of contact (introjective, projective, retroflective, egotistic, loc: 998
styles of contact made up of the contact skills acquired by the patient, loc: 1,000
the depressive experience emerges loc: 1,003
a renunciation to the other’s desire – seen as fear of failure and as an attempt to regain hope loc: 1,004
the depressive experience is precisely that profound renunciation to living fully the contact with the other – an ontological experience that each of us characterizes differently, based on the way we learned to make contact with the environment and on the way in which another person, without realizing it, might help him/her be consistent with this choice. loc: 1,005
the depressive experience becomes a co-created matter, which originates a depressive experiential field. Any clinical intervention must necessarily consider that both the contact and the experiential field are co-created: the change starts from the two (Robine, 2011), from a new co-creation by therapist and patient, in which it will be possible to experience the contact with greater participation of self-with-the-other, and consequently give life to a lighter and more spontaneous experiential field. loc: 1,011
the Polsters (Polster and Polster, 1973, pp. 67-75), who essentially link depressive experiences to the introjective style. In fact, when the system of beliefs and values on which people with an introjective style of contact tend to base their relationships with the world is put into question, an unbridgeable gap takes over in which it is really hard to react with the motivation of reaching the other. Everything they had identified with collapses. loc: 1,015
depressive experiences are, so to say, typically related to an introjective style, the act of giving up the desire to be desired by the other is, in my view, a self-determination in the contact and it is not affected by the preferred contact style of a person. loc: 1,018
Reactive Depression loc: 1,028
It is a traumatic imbalance of the organism-environment contact: loc: 1,033
event which is external to their experiential structure alters their sense of self within contact, the environment does not help, loc: 1,034
does not support adequately or strongly enough the energy of contact which the organism provides. loc: 1,035
“Embodied” Depression loc: 1,045
ad-gredere: the person creatively adjusts to the organism-environment field renouncing full participation in his/her own actions. loc: 1,048
has to do with a permanent renunciation of the movement-towards, with a structured experience of non-involvement in the situation while maintaining the perception of the border between oneself and the other loc: 1,049
“persistent depressive disorder” of the DSM-5 (the old “dysthymia” of the DSM-4), loc: 1,052
duration of the depressive experience (at least 2 years) loc: 1,053
The diagnosis of persistent depressive disorder of the DSM-5, however, is related to the behavior, while the kind of depression that I define as “embodied” is linked to the experience-in-contact, loc: 1,054
“Embodied” depression has to do with an existential attitude, and also with the spontaneity with which each of us lets intentionality develop into contact. loc: 1,060
People who have “embodied” a depressive experience tend to define and structure themselves in their bodies as non-combative: they do not engage in fights, they feel awkward when it comes to moving forcefully towards the other. loc: 1,064
at the bottom of that body always lies the fear of succumbing. loc: 1,067
I remember a 40-year-old female patient, who came to therapy because of the anxiety caused by a competitive examination that she was supposed to take part in a few months later. Second child after another female one, she had always lived in the shadow of her sister, more self-confident, more beautiful than her. She had structured her life so as to avoid fighting; if someone made her wrong she would avoid facing him/her, she would just smile and go elsewhere. She was very gifted, excellent in her studies, she received great recognitions at school and, later, at work. This was enough to compensate her for the lack of a complete presence in relationships. She was anything but introjective! This competitive examination made her anxious, because she knew she would have to fight, to assert herself, and this did not fit at all in the structure she had given herself for life. She was having nightmares, she dreamed of seducing colleagues that she knew could be more aggressive towards her (a clear example of Stendhal syndrome) and, even worse, she was not lucid enough to prepare for the competitive examination properly, and she did not collect information on the concrete elements that would help her understand what to study. Our work was focused almost exclusively on bodily processes (breathing deeply in front of me, for example) as well as on the possibility of turning her anxiety of standing out into excitement towards contact. loc: 1,069
The Psychotic Depressive Experience loc: 1,085
When we are sitting on a chair we can relax to the extent that we know the chair is not going to collapse; similarly, in relationships we are able to relax if we are certain of a consolidated, mutual recognition. loc: 1,090
deep uncertainty caused by the lack of this mutual recognition that characterizes the psychotic experience, loc: 1,092
Today, children spend little time with their parents, schooling is becoming earlier and earlier and the state of mind of parents is more and more anxious and distracted from contact with their children (see. Spagnuolo Lobb, 2013, pp. 24-29). loc: 1,265
lack of the other has become the constitutive experience of our times. loc: 1,266
The parents who have grown up with the idea that machines are here to solve all the problems of human uncertainty, and who have avoided emotions and human drama like the plague, have fathered children with no sense of self, who are desensitized and “liquid”, unable to contain within their bodies the excitement that comes from contact. loc: 1,279
The children of the generation that lived through the enthusiasm for technology now live through the lack of protective, caring relationships, in a world where technology has now become a new kind of anthropological code. loc: 1,285
Every sort of suffering – including depression – emerges as one of the Gestalten through which relational suffering expresses itself in the individual in a specific and unique form. Hence we speak of depressions, loc: 1,639
we pass from depressions to depressive experiences and then to depressive fields (Francesetti, 2015). loc: 1,644
specific and unique depressive experience, which reveals a suffering in a much vaster field that pre-exists the single individual and that is actualized in the here and now of the therapeutic session. loc: 1,645
common ground of the experiences that we call depression, taking us into the realm not of the individual, but of the relationship. loc: 1,648
viewing the individual’s suffering from a radically relational, developmental and positive perspective (Salonia, 2001a; Spagnuolo Lobb, 2001a; Francesetti and Gecele, 2009; Francesetti, Gecele and Roubal, 2013). loc: 1,654
common denominator underlying all depressive experiences will be identified in the hopeless sense of defeat experienced in the vain attempt to reach the other. loc: 1,655
first is extrinsic diagnosis, which involves comparing the experience we encounter to a map. loc: 1,987
this form of diagnosis that allows us to give suffering a (more or less appropriate) name loc: 1,989
inevitably, reify it by abstracting it from the ephemeral flux of what happens at the contact boundary between the patient and the therapist. loc: 1,990
it is a distortion. loc: 1,991
the diagnosis must first of all be referred to the relationship in two ways, loc: 1,992
What suffering of the relational field travelled is the person calling me for help expressing? loc: 1,993
How am I contributing to the creation of a depressive field between us? loc: 1,994
a hermeneutic loc: 1,995
horizon needs to be used. A hermeneutic approach instead considers diagnostic knowledge as one of the many types of foreknowledge which come into play in the therapeutic relationship loc: 1,996
the Gestalt therapy understanding of depression loc: 2,001
is a process of looking at this suffering through the conceptual tools of Gestalt therapy. loc: 2,001a
What happens to the figure/ground dynamic when we encounter a depressive experience? loc: 2,002
to intentionality? the functions of the self? loc: 2,003
second type of diagnosis used in Gestalt therapy is intrinsic or aesthetic diagnosis. loc: 2,007
Intrinsic diagnosis belongs to the realm of feeling and not of reflexive thought; it is made by perceiving the quality of contact as it happens, moment by moment, at the contact boundary – the phenomenological point where we border and converge. loc: 2,008
allows us to grasp the form (the Gestalt) of the figure that together we co-create loc: 2,013
and to support the emerging intentionality of the present moment loc: 2,014
Being conscious of what is happening in the experience emerging between us and supporting the emerging intentionality means therapeutically being-in the relationship. loc: 2,016
It is not an alternative or in contrast with extrinsic diagnosis, loc: 2,019
Depressive Experiences: A Gestalt Therapy Approach loc: 2,026
We can approach a person experiencing depression by considering loc: 2,040
symptoms to be a manifestation of what is happening in the relational dimension. loc: 2,041
posits the depressive experience in a frame of meaning that emerges from the relational field loc: 2,044
brought by the patient loc: 2,045
By relational field we mean the scope of present and presently possible experience in the subject’s relationships. loc: 2,046
The perspective that we will attempt to follow is instead hermeneutic and circular. loc: 2,052
if we view such phenomena as emerging at the contact boundary, then strictly speaking it is not the subject that suffers. What suffers is the relationship between the subject and the world: loc: 2,055
Psychopathology is the pathology of the relationship, of the contact boundary, of the in-between. loc: 2,057
Suffering may be perceived and creatively expressed by the subject, but it emerges from the contact boundary. loc: 2,058
agent of this feeling (of all feeling) is the self, which is a function of contact. loc: 2,059
As such, psychopathology must necessarily refer to the suffering of that boundary loc: 2,061
The epistemology underlying this perspective is radically phenomenological. loc: 2,071
the theoretical tools of Gestalt therapy loc: 2,084
building on the phenomenological literature loc: 2,085
Gestalt therapy literature loc: 2,086
The method we will be using is that of descriptive phenomenology, involving the faithful rendering of the therapist’s and patient’s experiences, loc: 2,091
structural (or genetic) phenomenology, involving an investigation of the constitution of the experience, of its transcendental conditions of possibility loc: 2,093
consider this constitution of experience as an emergent phenomenon of the present relational field, loc: 2,096
consider this field as the actualization of other relational fields travelled. loc: 2,097
A suppression of the future through the swallowing of the past. loc: 2,109
we initially encounter the experience of depression as a condition of sluggishness in the figure/background dynamic, loc: 2,129
figure strains to emerge from a ground devoid of energy. neither interests, nor stimuli, nor impulses of intentionality. loc: 2,130
“I know I should get up, but I just can’t”, “I know I should be doing things, but I don’t feel the urge. Nothing interests me, nothing gives me enjoyment…”. loc: 2,131
the patient often remains silent and immobile on the chair throughout the session. loc: 2,137
intentionality emerges and reveals itself through contact loc: 2,140
the force that drives all our encounters at the contact boundary loc: 2,141
enter into a depressive relational field, our senses encounter a nothingness loc: 2,143
For the therapist, a key experience with patients suffering a major depressive experience is the perception of a lack of direction within a dilatation of time and space, loc: 2,167
no figure can emerge. loc: 2,171
Rather, time and space emerge at the very moment at which the figure is co-created in the present loc: 2,172
«Therefore, the movement of the organism does not unfold in space and time, rather it is the organism that moves space and time. loc: 2,176
The present is the point source, the explosion point for time, loc: 2,178
(Maldiney, 1991, p. 84 it. trans. 2007). In melancholic experience, the present moment fails to emerge. loc: 2,180
lacks the support of the previous moment which (retention) and of the subsequent moment which is coming into being (protention). loc: 2,181
The energy required to traverse the space separating the therapist and the patient can even appear impossible. loc: 2,186
Husserl’s basic structures of time-consciousness (retention, primal impression and protention), loc: 2,199
the melancholia sufferer has no future loc: 2,203
because he has lost the transcendental possibility of constituting the future. loc: 2,204
the future mode itself that no longer exists. loc: 2,205
«What stands out in the melancholic is the loss of existential closeness to things and hence of their usability. loc: 2,217
no co-created figure of contact emerges and intentionality does not spread its transcendental wings. loc: 2,233
The fixed figure is a creative adjustment which serves what is probably a protective function; loc: 2,237
they come to the rescue to give meaning to the unbearable sense of anguish felt when faced with nothingness. delusion constructs a framework of meaning that placates the anguish of nonsense and of metaphysical loneliness. loc: 2,247
The only co-created figures possible are those that use/accept/confirm the delusion itself, loc: 2,254
in therapy it is these figures that need to be created so as to permit the experience of co-creation (however minimal) to emerge, loc: 2,255
makes more sense to attempt to contact the patient in the unoccupied areas that do not generate incompatible figures with the delusion loc: 2,256
in melancholia it is not an object that is lost but the very possibility of experience within traversable time and space. This leaves us, however, with a sense of hopelessness concerning the possibility and necessity in therapy to reach the patient, who, on our understanding of depression, appears to us comprehensible in a certain sense, but locked up and out of reach in the disturbance of his transcendental functions. loc: 2,264
we need to open up a relational dimension which we believe is foundational to the transcendental dimension. loc: 2,276
the transcendental functions can only develop if they are supported by a sufficiently good relational experience. loc: 2,277
those functions are continuously originated at the point where present experience emerges, i.e., at the contact boundary, loc: 2,278
intentionality is not absent in an absolute sense, but remains radically in the background as an impetus that does not come to life and does not participate in the co-creation of figures at the contact boundary. loc: 2,310
In what relational field does this mode of contact, this mode of being-in-the-world, take shape? loc: 2,314
depression is the way in which the subject experiences the surrendering of hope in the face of the hopelessness of his vain attempts to reach the other. We might also say that it is the way in which he perceives the defeat of his relational intentionality. loc: 2,317
How can this relational experience be connected phenomenologically with the disturbance of the transcendental functions of space-time loc: 2,321
done in the following way. The experience of being-with-the-other is the necessary element for constituting the temporal and spatial coordinates of individual experience. loc: 2,322
originate at the contact boundary, emerging at the point in which the abyss that separates us is bridged through affective attunement loc: 2,324
and resonance. the now is not supported by the fleeting moment that comes to an end and the emerging moment that comes into being, loc: 2,325
here is not united with a there by the arrow of intentionality. Time loc: 2,326
When this movement fails, what we experience is the abyss that separates us, loc: 2,328
Within the possibilities of human experience, the unreachable is always there (as opposed to here) and then (as opposed to now or after). loc: 2,339
one of the characteristics of depression is regret, loc: 2,340
be in this situation” (Maldiney, 1991). The past is the place in time of the unreachable and the unchangeable. Distance in space and time is an obsession in depression because only there and then is the unreachable constituted. loc: 2,342
In contrast, mania is all about the here and now, where everything is reachable in the euphoria of having everything-at-hand. loc: 2,345
the experience of moving across space-time in the direction of the other is absent loc: 2,347
In melancholia it is not travelled because the (untravelled) path no longer exists, loc: 2,348
In mania it is not travelled because everything has already been travelled; loc: 2,349
the other is not reached because neither sets off on the journey towards the other. loc: 2,350
case of melancholia, the journey does not begin – the pathways are surrendered along with hope; loc: 2,356
taking clinical experience as our starting point, loc: 2,371
the Still Face paradigm (Tronick, 2008). In these experiments, «mothers are instructed to face their infants and remain unresponsive. The effect on the infant is dramatic. Infants attempt to solicit the mother’s attention, but in failing to elicit a response, they turn away only to look back at her again. When these attempts fail, the infants tend to lose postural control and withdraw into a profound state of sadness» loc: 2,388
the children of non-responsive mothers, loc: 2,393
«become sad and withdrawn and use self-regulation to control their negative states. The effect is that they become disengaged from the world. loc: 2,395
these children develop a mood that is largely characterized by sadness, an image of the mother as undeserving of trust, and an image of themselves as helpless and powerless. loc: 2,397
(withdrawal of intentionality and disengagement from the world, loss of muscle tone, sadness and the pressure of self-regulation) accurately represent the phenomenological traits of depressive experience. loc: 2,402
a failure in the experience of the we stage, loc: 2,403
This failure can undermine the confidence/hope that one’s energy can leave a mark on the environment, creating a state of withdrawal and inhibition. loc: 2,405
melancholic depression is precisely this lack of underlying confidence/hope. loc: 2,407
hope itself is lost, not only hopes: loc: 2,408
“My hope for us lies in you”. loc: 2,409
with this statement that Gabriel Marcel immerses hope in the intersubjectivity of relatedness, thematizing it as a foundation of the human condition. loc: 2,411
this process that leads to the realization that the other is unreachable the pathway of depression loc: 2,436
1. Solicitation in a relational situation in which the significant and coveted other is present and necessary loc: 2,439
2. Anger and anxiousness in a situation in which the other person does not respond to solicitations and is not attuned loc: 2,442
3. Failure and the surrender of all hope when one’s helplessness is realized; 4. Withdrawal and forced self-regulation in a situation in which the other person does not participate loc: 2,444
person realizes the hopelessness of his attempts to reach the other person. The moment that he realizes that the other person is unreachable is what we might call the moment of surrender, loc: 2,456
He is helpless, in a situation with no way out, and with no other emerging intentionality. loc: 2,459
fundamental and typical themes of the phenomenology of depression: loc: 2,460
• suspension of time; loc: 2,460a
• loss of meaning and energy; loc: 2,460b
• exhaustion; loc: 2,461
• sadness and emptiness; loc: 2,461a
• lack of all stimulus; loc: 2,461b
• bodily inhibition; loc: 2,461c
• drop in intentionality. loc: 2,461d
• the experience of the impossibility of reaching the other. loc: 2,462
melancholic experience seems to correspond to being stuck in an intolerably interminable stage of surrender, loc: 2,466
The pain is generally alleviated by whining, by tears that become an underlying lament, by fiddling with something, and by a withdrawal of the senses from the environment (through sleep, for instance). There is a sense of exhaustion and disengagement. loc: 2,469
retroflexion is an effective way of withdrawing from pain in this situation. To protect from the suffering felt in each of the stages of this experience, various systems step in, each of which constitute a creative adjustment. loc: 2,472
to cope with the loneliness that constitutes this experience, but they cannot substitute the experience of contact. loc: 2,474
they diminish one’s presence at the contact boundary, rescuing the person in part from being plunged into a relationship that suffers – a relationship in which it is impossible to reach the other. loc: 2,475
anger, fear, lament, psychomotor retardation, emptiness and withdrawal. The various depressive Gestalten can be seen as original solutions found by the patient to express and cope with the basic experience of not being able to reach the other. loc: 2,482
For instance, a person who frequently or almost constantly experiences anger in her life may actually be immersed in a depressive field that has never been abandoned. loc: 2,485
a depressive experience to a depressive field, loc: 2,487
Depression can thus be understood as a co-created phenomenon built on three elements: loc: 2,504
deep bond with a significant other who is loved and necessary; failure of efforts to reach the other; loc: 2,505
emotional absence of the other from the relationship. the person experiencing depression is loyal to the relationship and the underlying bond, and expresses its suffering. In this sense, the person bears the suffering loc: 2,506
nursing his pain, he nurses the relational suffering of the field itself loc: 2,507
we hypothesize that depressive experiences are essentially a manifestation in the individual of a phenomenon in the present or a traversed relational field, namely the impossibility of reaching the other. loc: 2,546
we intend to trace depression back to the human experience of the impossibility of reaching the other, to the loss of hope and loneliness, and to the social field in which such suffering emerges. loc: 2,550
allows us to move from the pathology to experiences, and from the individual to the social and relational field. loc: 2,551
The Self and Its Functions in Depression loc: 2,557
it is clear what has been lost in mourning, Freud asks what it is that has been lost in melancholia; the frame of mind is the same, but in the latter case it cannot clearly be seen what has been lost. loc: 2,580
melancholic depression loc: 2,606
the relational frame in which we have posited melancholia allow us to say is that in this situation, as in mourning, the experience is that of the realization of the impossibility of reaching the other and the consequent loss of hope. loc: 2,607
experience shaped by changes in space-time, by the figure/background dynamic coming to a stop, by the drop in intentionality and hence the loss of interest, energy and vitality. loc: 2,609
exactly what is lost in melancholia? And what distinguishes it from mourning? loc: 2,611
the self is neither a structure and nor does it belong to the individual; it is a function that operates at the contact boundary, the point that belongs both to the environment and the organism, and, in phenomenological terms, to that no man’s land where experience emerges prior to the separation of subject and object loc: 2,613
The difference between reactive depression and melancholia is therefore more correctly located in the quality of the experience, because in both cases we can identify an event that triggers the sense of loss. loc: 2,638
a period of mourning is a time of coping, a period of melancholia is not. loc: 2,640
the impossibility of reaching the other, as we have seen, does not mean that the path is too long, too hard or too impracticable, but that there is no space-time for any path to be constituted. loc: 2,652
melancholia emerges in a psychotic context because the common ground of experience is lost. loc: 2,656
Any form of depression, even mild depression, can have melancholic features or transform into melancholia loc: 2,658
We hypothesize that whereas in the case of mourning (and of reactive depression) it is a person that has become impossible to reach, and it is that person who has been lost, in the case of melancholia what is lost is that which anchors the subject to the fabric connecting him to the world. loc: 2,667
detached from the in-between, from the we and from the possibility of a we. loc: 2,669
The in-between is the common ground that is constantly co-created between us at the contact boundary. It is the fabric that connects us to the world and to life, moment by moment. loc: 2,672
the case of melancholia, this common ground has ceased to exist and can therefore no longer be traversed; loc: 2,673
where the in-between is no longer a meeting place but an insurmountable abyss. we do not believe that melancholia involves an unconscious object-loss that is shifted onto the ego and which differentiates it from mourning. Rather, as we have described, we suggest it is a different sort of loss, a disturbance in the generation of experience itself loc: 2,675
Melancholia is a profound disturbance of the self and of its continual generation of experience at the contact boundary, loc: 2,678
The self function primarily involved here is the id function loc: 2,680
a disturbance of the id of the situation loc: 2,682
The profound dysfunction of the id function entails the impossibility of co-creating a figure of contact, loc: 2,696
What the patient experiences is a paradox. It is the experience of non-experience. loc: 2,706
the self loc: 2,725
keeps the connection between the organism and the environment alive, loc: 2,730
enabling experience to be linked to the flow of life and situated in the present moment. loc: 2,731
if it is disturbed, and the organism is not connected to the environment, then experience will be melancholic. loc: 2,734
a defined contact boundary cannot be created. loc: 2,735
neurotic disorders arise after the separation of the organism and environment loc: 2,737
the disturbance of the id function in melancholia. Why does it happen? loc: 2,761
if this experience occurs in the early stages of life, when the other is necessary for the development of the self the we is necessary for being anchored loc: 2,765
for acquiring the confidence that our energies can make a difference loc: 2,766
These phenomena will remain impressed in memory and be present as a vulnerability when the experience of unreachableness reoccurs. loc: 2,767
self is constituted and grows within rhythm of moving towards and moving away from the other, in a process of constant readjustment of affect attunement loc: 2,768
This dysfunction of the self occurs because a foundational element loc: 2,776
is missing, namely the presence of someone who is reachable at the contact boundary. loc: 2,777
needs is an adult to co-create a meaningful figure, and not be left alone at the threshold of experience. loc: 2,778
absence of affect attunement, loc: 2,779
The healthy development of the self entails the separation of the I from the world, and at the same time their union. loc: 2,781
establishment of this union is what is lacking in psychotic depression, psychotic experiences along the schizophrenic spectrum, what is lacking is separation and the establishment of boundaries loc: 2,782
development of the self therefore entails the acquisition of a basic ground, without which experience becomes psychotic. loc: 2,785
means learning to distinguish one’s bounds and at the same time perceiving oneself to be part of the flow of life – that is, being separate and connected at the same time. loc: 2,786
Melancholic depression allows us to focus on a fundamental element of this common sense ground, namely our anchorage in the in-between, in the intersubjective matrix, via our presence at the contact boundary through the id function of the self. loc: 2,788
Blankenburg’s words (1971, p. 103 it. trans. 1998) loc: 2,791
«These sufferers are constantly busy building a background that the healthy subject takes for granted, without thinking, so as to be able to confront the demands of everyday life loc: 2,793
this lack of anchorage that makes it so difficult in therapy to recover the archaic experience of the absence of the other in these histories in which absence has been so critical. loc: 2,795
it is difficult to recall experiences outside critical moments, also difficult to pick up the narrative threads of a history of lived absences. Words in the psychotic realm are not the same as in the neurotic realm (Francesetti and Spagnuolo Lobb, 2013). loc: 2,797
they are much closer to those of children and poets, who, like madmen, live alongside the original fount of experience, where the reduction to the individual is not yet seen illusorily as the sole reality. loc: 2,799
we can identify three theoretical possibilities for melancholic experience to emerge: loc: 2,802
One tied to archaic experiences: loc: 2,803
One tied to a present traumatic situation: loc: 2,807
One tied to a biological predisposition: loc: 2,811
Depressive Experience as Creative Adjustment loc: 2,930
psychotic experiences are not creative adjustments per se, but rather one of the different human ways of being-in-the-world, loc: 2,949
This does not mean that psychotic depressive experiences are not creative adjustments – to the contrary, what we encounter is the outcome of a long, hard and creative adjustment to given conditions of life. loc: 2,950
the more intense the suffering, the more similar depression all becomes, loc: 2,953
what function might it serve for the person or for the context in which the person lives? loc: 2,957
Outside the realm of psychological suffering, perhaps the closest experience to depression is probably hibernation (Roubal, 2007). involves motor retardation, lack of appetite, inhibition of libido, metabolic slowdown, and the drastic reduction of the organism’s interaction with its environment via the animal’s withdrawal into its lair. loc: 2,959
functional purpose loc: 2,962
to save energy at a time when any effort would be hopeless for finding food, protecting the animal from a hostile environment, loc: 2,963
it makes functional sense to acknowledge this limit and impossibility and refrain from seeking to reach an impossible other. loc: 2,968
melancholic depression, where there is no (unless specific support is provided) spontaneous work towards coping? loc: 3,017
reveals an existential dimension of humanity, that of being generated and constituted by being-with-the-other, as well as our powerful drive towards the other, loc: 3,019
suicide of a melancholic sufferer tells us that death is more desirable than such absolute loneliness loc: 3,021
The person suffering from depression brings the pain felt over the absence of the other into figure, and in doing so drags into the open the suffering of the relational field, loc: 3,029
The depressed person bears a burden loc: 3,032
passed onto his shoulders in the relationships he has encountered. transform this suffering into awareness, into a resource, into a new creative adjustment or into love, no matter in how small a way, loc: 3,034
heals the suffering of the entire world. He interrupts the chain transferring that suffering across relationships loc: 3,035
parental depressive field can deeply affect the child, loc: 3,061
stops the mutual affective regulation and the impossibility of reaching the other becomes a memorized and embodied experience. loc: 3,063
A son of a depressed mother can carry on the depressive field as an impossibility of being sad or tired: it could happen that he can be only active and with high mood. The depressive field would be carried in the background, perceived maybe in very intimate situations, and when touched and actualized could be unbearable loc: 3,068
Patients bring to light the relational wounds of the world, the relational fabric of humanity, launching an appeal for them to be healed. loc: 3,222
Every wound identified and healed gives new presence and vitality to life, and new energy and creativity to the world. loc: 3,224
depressive experiences all share a common root in the experience of the unreachableness of the other, they may each refer back to very different histories, experiences and relationships and hence each need different kinds of support. loc: 3,583
characteristics loc: 3,584
and guidelines for providing specific support. loc: 3,585
The Presence of Absence: Mourning and Reactive Depressive Fields loc: 3,594
The Work of Mourning loc: 3,607
Due to the similarity of the experiences to which they each give rise, mourning is considered a state akin to depression. loc: 3,614
the unreachableness of the other is evident. loc: 3,615
Freud worked within an intrapsychic epistemological horizon. For him, mourning is a battle between a reality principle and a clinging to a libidinal position loc: 3,642
In a relational horizon, mourning can be understood as a process of assimilation not only of the loss event, but also of the relational experience with the person who is no longer with us. loc: 3,647
One of the gifts that death gives us is its revelation of the beauty of our late loved ones. Their absence reveals the depth and worth of their presence. loc: 3,650
Ultimately, and paradoxically, death reveals the presence of the departed and the absences of those who remain. loc: 3,653
the unreachableness of the other that remains in the foreground, that is the presence of absence; loc: 3,661
with time older memories resurface, memories of being-with the other, memories of shared experiences. Through these processes the experience of the relationship is assimilated and the subject gradually attains a state of presence in absence. loc: 3,662
The Topic of Aggressiveness loc: 4,482
From the Gestalt therapy perspective that we propose, depressive experience comes from a withdrawal of the intentionality to reach an unreachable other. It is an abandonment of the ag-gression (in an etymological sense, meaning “to move towards”) that comes before depression – a giving up of approach, but also of the effort needed to feel and express the frustration and anger that the impossibility of reaching the other provokes. loc: 4,494
Here we are in an other world, where aggressiveness towards the other cannot be experienced because there is no other, just as there is no connection to a common world. loc: 4,504
once the id function is revitalized and the connection re-established to a common world, issues will emerge concerning lack of aggression or misplaced aggression, or retroflexive aggression, and so on, and the patient will obviously need to get back in touch with her aggressiveness. But that is another phase of therapy loc: 4,509
The therapist must be mindful not only of the type of experience the patient is going through, but also of the fact that aggressiveness – how we understand it and therefore how we should work on it – is context dependent. Today, in the fluid society of post-modernity, aggressiveness takes on a very specific meaning and requires very specific support (see on this Spagnuolo Lobb, 2013a). loc: 4,513
In psychotherapy, we need to be very sensitive to the emergence of aggressiveness, to that moment in which the energy and intentionality for contact burst into life, loc: 4,518
as it is the awareness of aggressiveness that needs to be supported, not aggressiveness tout court. loc: 4,519
other. If aggressiveness is supported too early or without awareness, the risk is that of encouraging its acting out, generally in the form of self-aggression. loc: 4,521
the patient will find it especially difficult to assess the situation and place the intense swells of emotion that emerge without any background. That emotion is channelled into self-aggression since the patient’s energy is withdrawn into the self (a strong sense of inadequacy or guilt is often present); it cannot be channelled into aggression towards others because that outlet is still b locked (otherwise the patient would not be depressed!). loc: 4,523
Some Elements of Specific Support loc: 4,560
essential that the therapist does not amplify the depressive experience, help define it through appropriate reformulations and verbalizations. loc: 4,591
the therapist should avoid amplifying inner experiences that isolate the patient even more, loc: 4,603
instead seek to bring the experience back to the contact boundary, as it is here that reanimation takes place. loc: 4,604
extreme weariness which often plagues the depressed patient loc: 4,610
comes from their being detached from every situation. loc: 4,611
first approach to body work loc: 4,617
focused on functional mobilization. Any motor activity or exercise falls within this horizon, where the focus will be to get the patient moving. loc: 4,618
second body work is aimed at promoting awareness in the patient, which will raise the sensory and motor potential of the body. At this point, the patient’s body will not only be more mobile and efficient, it will also be more alive, sensitive, free and creative. Every exercise designed to raise awareness falls within this horizon, where the focus will be on what the patient feels while moving. loc: 4,620
the therapist is the guardian of hope and the future, but also, more radically, of space and time. loc: 4,654
Depressive experience in the presence of a borderline relational style loc: 4,959
In phenomenological terms, moments of borderline depressive experience can be more severe, more sudden and less predictable, and at times difficult to attribute with any ease or immediacy to life events. They are chaotic, distressing and full of anger, often involving the acting out of emotions. Sudden swings in affective states are a fundamental feature of the borderline dimension of experience loc: 4,961
in the borderline dimension, although time is fragmented, it never subsides, becoming a rapid succession of nows that are very different from each other. It is a sequence of discontinuous presents that are not anchored to, and hence not contained by, retention and protention. loc: 4,970
constantly exposed to depressive experiences, characterised by anger loc: 4,974
by emptiness loc: 4,976
by a feeling of losing out on life loc: 4,977
by a constant loss of vital energy loc: 4,979
Borderline experience arises in relational fields characterised by trauma and unpredictability loc: 4,985
razor’s edge between falling into the confusion or lost in isolation. loc: 4,992
Depressive experiences can thus emerge suddenly and surprisingly for the therapist, abruptly turning the patient’s emotional situation upside down, for which it can often take some time to understand what is going on. loc: 5,006
symptoms are not those of melancholic experience. loc: 5,007
most importance among these episodes are suicide attempts, which occur unpredictably loc: 5,009
the case of narcissistic experience, where one remains astonished at the fact that “a person like that” could commit suicide; loc: 5,010
question is, rather, “why now?”. loc: 5,012
narcissistic suffering, suicide is usually pondered, prepared and planned. Here it is impulsive. loc: 5,014
the patient may find relief in putting an end to his participation in life. «In contrast with the schizophrenic who, faced with the threat of his own transcendence, seeks to look forward to a future, illusory possibility of finding himself, the borderline patient tends to escape from it, dissolving his ontic individuality loc: 5,015
aspiration for death is radically different from the suicide of the schizophrenic, who very often sees suicide as a last chance to fulfil his existence» (Kimura, 2005, p. 64). loc: 5,019
Dependent Experiences loc: 5,122
the depressive personality. People with this style only allow experiential figures to emerge if they are compatible with their introjects loc: 5,155
and are unaware of neglecting their own feelings. This is their way of ignoring or denying the creative potential of the present situation. loc: 5,156
real interest in life is lost and the subject over-adjusts to adapt to roles or to the people to whom he is tied, loc: 5,157
birth of his son created a relational bond that was the source of intense anxiety for him – he could not control his son’s life, he could not protect him at every moment. Previous control systems were no longer enough and had been intensified. At times desperation loc: 5,466
urge to escape, even through suicide, would emerge. loc: 5,468
Depressing Together. Therapist’s Experience in a Therapy Situation with a Depressed Client loc: 5,744
Phase 1: Sharing depressive experience. loc: 5,938
the beginning of the experiential trajectory therapists’ experience becomes similar to the experience of their depressed clients. Therapists experience self-doubt, feelings of failure, helplessness, hopelessness, and also overall dullness and tiredness. They are experiencing symptoms of depression themselves as if they were falling into depression together with their clients. They are losing distance from their client’s experience, they are missing a broader perspective, and they feel that they are being pulled down into the depressive experience themselves: loc: 5,938a
Phase 2: Turning to oneself. loc: 5,955
therapists start to perceive co-experiencing the client’s depression as personally dangerous for them: “The client is pulling me down. It is killing me” (FG1). Therapists feel threatened by the situation: “Not to sink into it too much” (FG2). The intensity of the therapists’ depressive experience is increasing until it reaches a turning point, where therapists stop resonating with their clients’ experience. Instead, they change their focus to themselves and instinctively start to protect themselves loc: 5,956
Phase 3: Striving for symptom change. loc: 5,984
therapists stop co-experiencing depression with the client and take a safer, experientially-more-detached expert position. From this position they then focus on the symptoms of their client’s depression, thus they are able to externalize and depersonalize the overall depressive experience. This prevents them from falling further into co-experiencing depression and provides them with a feeling of distance. They take a more directive therapeutic approach, give practical advice to their clients, and try to help them solve their problems: loc: 5,985
Phase 4: Distancing from depressive experience. loc: 6,010
therapy session proceeds, therapists experience themselves distancing more and more from the depressive experience of their clients. Therapists’ efforts to change the symptoms of their client’s depression appeared fruitless within the session. Encouragement, activity, and an optimistic approach do not lead to any change; therapists are not satisfied with the results of their efforts. The clients are not changing according to the therapists’ expectations. They stay depressive, immersed in their feelings of emptiness, resignation, and hopelessness. Therapists get the impression that they are “pushing somewhere where the path is closed” (Fanny) the therapy situation gets stuck loc: 6,010a
Phase 5: Turning to a client. loc: 6,040
becoming experientially so far from their clients now that they are losing empathy for them. They protect themselves so much from co-experiencing depression with the client that they temporarily lose their helping position: loc: 6,040a
In this phase therapists experience most intensively the inner tension between a natural tendency to protect themselves on one side and their professional responsibility on the other. loc: 6,055
Phase 6: Focusing on the relationship. loc: 6,060
therapists’ experience starts to come closer to the depressive experience of the client again. Instead of focusing on symptoms, therapists are turning to the relationship now: “I am joining her. Nothing gets better really, we will not come to any solution, will not come to anything [new], but a kind of contact can happen. I am with her, [...] [there is] some kind of a relationship” loc: 6,061
Therapists are re-defining their role in the current situation and it helps them to start moving towards the client again: “I stop prompting him to move, and I join him instead” (Fanny). Resignation to not changing the symptoms but focusing on the relationship instead makes their work personally meaningful again. loc: 6,073
Even the very experienced therapists report repeatedly becoming trapped in the fixed relational pattern with depressed clients. loc: 6,094
depression is “contagious” not only emotionally, but rather as a complex of all its symptoms such as helplessness, tiredness, and hedony, loc: 6,100
these “automatic” and “universal” emotional responses also manifest at the bodily level and states that, to a large extent, the therapist does not have a choice whether to contain or express them. loc: 6,102
a therapist’s brain pairs itself immediately with the brain of the depressed client before the therapist can even notice or consciously influence it. The therapist’s “internal simulation” of the client’s mental state leads the therapist to co-experiencing the depression with the client. It seems that due to the automatic nature of such loc: 6,118
Acknowledging the fact that therapists are unable to avoid this reaction, it is important to assert that skipping this initial attunement to their clients might actually prove detrimental to the therapeutic process, as this reaction embodies the crucial «gateway of empathy» (Siegel, 2012, p. 165) and opens the «intersubjectivity of consciousness» (Thompson, 2001, p. 15). In her phenomenological analysis of empathy, Thompson (2001, p. 15) claims that «[in order] to perceive the Other, loc: 6,125
When a therapist is attuned and conveys the understanding of a client’s inner affective state, it provides the client with the experience that one’s affective state can be seen and shared by another (Greenberg, 2006). loc: 6,137
reaching the other through attunement and bridging the interpersonal “abyss” loc: 6,139
This bridging is already healing, because it facilitates the development of a parallel, prefrontally mediated process in the depressed person, as the «intimate, reciprocal human communication may directly activate the neural circuitry responsible loc: 6,141
We can notice that a therapist’s experience with a mourning client differs from that with a depressed client. With the mourning client the therapist experiences Sharing depressive experience, but she does not perceive it as overwhelming or dangerous (as she does with depressed clients). loc: 6,149
different dynamics of mourning and depression loc: 6,153
«In the mourning one loses the other to whom one is attached, in the depression one loses the conditions which make it possible to form such a tie» (Francesetti and Roubal, 2013, p. 442). loc: 6,154
therapist’s attunement to depressed clients can be seen not only as risky for burn out, but also reversely as natural and inevitable for the effective treatment of depression. «Mirror properties in our brains enable us to imagine empathically what is going on inside another person. Internal simulation – the process of absorbing and resonating with others’ internal states – is thought to be the first stage of compassion, or “feeling with” other persons» (Siegel, 2012, p. 165). loc: 6,165
attunement to a depressed client can be reduced when therapists become more aware of the actual in-session processes. Emotional contagion, which is mainly an unconscious, spontaneous, and involuntary reaction, could then be transformed into empathy, loc: 6,173
When a therapist strives too much to pull the client up from the whirlpool of depression, both of them just slip more and more down into the black hole. loc: 6,194
she only holds the client and focuses on standing firmly herself, the client can stop desperate and useless attempts to clamber up faster and exhaust herself even more in doing so. loc: 6,195
Conclusion: Compassion to Oneself loc: 6,272
A client brings a fixed pattern of depressive functioning into a therapeutic relationship and it influences radically the way in which the field of a therapeutic situation is organised.
Carl Rogers’ advice: «You cannot help anyone without risking yourself» (as cited in Anderson, 1997) can be supplemented with a second part: “and you cannot help anyone without taking care of yourself”. In loc: 6,281
Wolf, Goldfried and Muran (2013, p. 5) put it: «Compassion is not just responsiveness to the suffering of the client; it is responsiveness to one’s own suffering, with the goal of understanding the interaction that constitutes the psychotherapy relationship». loc: 6,291
The sustainable self-development process has the rhythm of a contact and withdrawal (Perls, Hefferline and Goodman, 1990), separation and identification that become preconditions for building the boundaries. These two processes are interconnected as separation is impossible without experiencing identification. loc: 6,788
For practitioners of Gestalt therapy, suffering is a sign of tension between excitement and anxiety. loc: 7,167
Suffering is part of the movement towards an unknown solution. loc: 7,168
2. Depressive Experiences Over the Life Cycle loc: 7,933
depressive states for children and adolescents closer and longer observation is needed to grasp the connotations of their suffering. loc: 7,937
messages are conveyed through the body, expressed by somatic symptoms or behaviours loc: 7,938
quite distinct from, if not opposite to, the depressive tone. loc: 7,939
the time of adolescence, distress tends to be conveyed in ways more typical loc: 7,949
such as permanent boredom, disinterest, and chronic fatigue, loc: 7,950
depressive connotations can be given to many syndromes connected with hyperactivity, or many kinds of aggressive or risky behaviour loc: 7,951
it is unlikely that the adolescent will effectively be aware of his suffering loc: 7,956
hand, adults also tend to find it difficult – especially parents loc: 7,957
because the prospect of depression puts a great strain on the parents themselves, and on their sense of inadequacy and failure. loc: 7,959
Depressive phenomena in adolescents loc: 7,969
are often a sign of an existential condition loc: 7,969a
issues of solitude, responsibility and conscience come to the fore loc: 7,970
difficult at this age to draw a line between alternating moods, of sadness, shame, guilt, and lack of self-esteem, which are often present and are typical at this stage of development, loc: 7,971
with depressive connotations, which drive disheartened adolescents to take refuge in their intimate and silent selves. loc: 7,972
the field of adolescent depressive experience is a certain hypersensitivity, a reactive mood, and a degree of instability in interpersonal situations. loc: 7,988
«Depression in adolescence is conveyed through what does not happen in the development of the adolescent, loc: 7,989
the adolescent does not complain directly about being depressed» loc: 7,990
4. Intentionality for Contact and the Unreachableness of the Other in Adolescence loc: 8,008
Profiling the adolescent is an arduous task, loc: 8,011
kids it is a time of transformation, a time to break free of parental moulds as they seek out their own individuality. loc: 8,013
the contact process, the “developmental task” loc: 8,017
unfolds over the three foundational steps of contact sense of self, independence and responsibility, loc: 8,018
feeling oneself to be individuated as a clearly defined “I” opposite a “you”; the desire for the other, or intentionality for contact; loc: 8,019
the capacity to draw nourishment from contact, in terms of the possibility of taking from the environment what is needed to grow, while keeping a clear perception of one’s own individuality loc: 8,020
The “desire for the other” is of key importance at this age, loc: 8,021
a desire that itself permeates many facets of life, as in the desire to measure up to the external world in a unique and original way, to relate to one’s peers, to fall in love, to have sexual experiences, and so on. loc: 8,022
The other-in-itself is so important at this stage of life the developmental question of the adolescent: Who do I want to become?, becomes: Who do I want to become for you and for the world? loc: 8,024
McConville (1995), loc: 8,026
The time of adolescence is loc: 8,028
• of relationships loc: 8,028a
• a renewal of the relational ground loc: 8,029
• to assimilate the important novelties arising in the adolescent field loc: 8,031
also the resources available in the environment at the family and social levels loc: 8,032
If, the relational ground is fragile, situations of suffering may be created, which can take on different forms and degrees of seriousness. loc: 8,044
Specifically, wounds tied to the experience of unreachableness (to the hopeless sense of defeat at the vain attempt to reach the other) loc: 8,046
there may develop «experiences of relational incompetence which cause difficulties in the perception of the intentionality for contact loc: 8,047
The perception of unreachableness can lead to experiences of the painful loss of the other-in-relation-to-me loc: 8,050
giving voice to the vulnerability of the individual and, above all, to the suffering present in the field, loc: 8,051
The adolescent’s intentionality for contact loses steam; doing and acting loc: 8,052
become dull and lose their intensity, the healthy aggression (Perls, 1942) needed to deconstruct the world fades away loc: 8,053
figure/ground relationship is turned on its head. loc: 8,054
in the adolescent with depressive experiences, caution becomes figure in the form of immobilism and/or rejection (of study and/or school, of friends, of sport, etc.), while the desire to discover life fades into the background. loc: 8,055
The peculiarity of adolescent depressive experience lies in the emergence of a hopeless sense of defeat and in the difficulty of pushing ahead with the process of “taking on” the environment, loc: 8,058
It is only by reaching the other, and being reached by it, that it is possible to differentiate oneself and accept one’s own diversity, while defining “who” and “how” I am. loc: 8,060
“Depressive Forms” in Adolescence: Self Functions and Phenomenological Understanding loc: 8,064
this is a time of life marked by the vulnerability typical of an equilibrium that is deconstructed and a new equilibrium that has yet to be reached. loc: 8,067
physiological reorganization of the self (Perls, Hefferline and Goodman, 1951) involves key changes in the id function (transformations in the body, the perception and acknowledgement of new sensations, the emergence of new needs still in the making) loc: 8,068
in the personality function (the new definition of the self, the assimilation of past contacts, the assimilation of changes connected with becoming an adult). loc: 8,070
creative adjustments become necessary in relation to bodily experience loc: 8,071
ground constantly present in the contact process, the sure basis on which rests both the feeling of existing and having an identity (the fullness of feeling oneself to be an “I”) loc: 8,072
putting that identity into action through gestures, postures, and actions that lead to the other loc: 8,073
it is indispensable that creative adjustments are developed in relation to the need for new definitions of the self and of «the coordinates of one’s identity along the same as/different from axis, loc: 8,074
integrating both masculine and feminine qualities, behavioural codes, and the different emotional values associated with them» loc: 8,075
It seems today loc: 8,078
adolescents come to face these new challenges in a much more fragile state than before. loc: 8,079
the adolescent is still in need of a great degree of holding, though of a new quality loc: 8,081
by adult figures, loc: 8,082
as the go-between and lets us into the world» (Gecele, 2011, p. 223). When excitement lacks support, it transforms into anxiety and desensitizes the body so as not to be felt; loc: 8,083
no meaningful figure is created to support intentionality. loc: 8,084
There are neither interests, nor stimuli, nor impulses of intentionality» loc: 8,086
In adolescence, the personality function is vivid and fertile in assimilating creative experiences that are hungry for novelty. loc: 8,110
the impasse of depression, however, it becomes tinged with a sense of inadequacy and helplessness loc: 8,111
Adolescents that go through a depressive phase are torn by the conflict between what they want to be and what they are able to be, loc: 8,114
between what they want to do, their dreams and expectations, and what they effectively can do loc: 8,115
a conflict that is irresolvable in the rapid space of time in which they think it ought to be. loc: 8,116
become even worse if the expectations that others have had loc: 8,117
are called into question and need to be replaced with new expectations they feel are more their own – if they can find them. can give rise to feeling how hard it is to become one’s self, to a sense of inadequacy and inhibition, of helplessness, to the fear of not being “seen,” of not being any good. loc: 8,118
All this can also come with a loss of words, an inability to narrate and share the experience. loc: 8,121
“Who am I?” comes with a sense of frustration and failure. loc: 8,122
If we consider that adolescence is meant to be an age of movement, exploration, and expansion, a time of “I’ll do it” and “I can decide,” loc: 8,132
it is not hard to grasp how dramatically dystonic the depressive experience is for the adolescent, making it all the more distressing and unbearable. loc: 8,133
Borderline and Narcissistic Elements in the Adolescent’s Depressive Experience loc: 8,143
In describing our own society, the literature often speaks of it as an age of narcissistic and borderline tendencies. loc: 8,147
a cultural context can only exacerbate the experiences and frailties of adolescence, loc: 8,148
The struggle to deal with narcissistic elements and parental introjects can bring to the fore issues of negative self-criticism, low self-esteem, inferiority, and failure, loc: 8,152
Many teenagers express a fear of failure and a sense of autonomy and self-esteem that is very fragile. find it difficult to reconcile the discrepancy between how he “is”, how he “would like to be”, and how others want him to be. loc: 8,154
The adolescent instead feels like a “zombie”, walking around the house in search of a self he cannot find, while his peers are obviously “out there having fun”. loc: 8,165
A prevalence of borderline elements instead brings instability and chaotic anxiety to depressive experiences and, leads the sufferer to escape from the experience itself. Impulsive, impetuous and sometimes aggressive acts are frequent. loc: 8,168
the borderline personality style struggles to deal with limitation, loc: 8,169
in borderline depressive experiences, limitation is complicated by a distance that is never quite adequate and by the ambiguity in determining it. loc: 8,171
experience seems to be one of being caught in quicksand that is sucking her in. nothing to anchor her and pull her out; loc: 8,184
feels a sense of abandonment, by her friends for instance, and has no confidence in building a future for herself; loc: 8,186
Elements of Specific Support loc: 8,190
in clinical work with adolescents in crisis, it is often difficult to distinguish manifestations of physiological depression loc: 8,193
it is developmental and relational support that is important, loc: 8,194
What makes the difference is not the type of depressive episode or its “seriousness”, loc: 8,198
rather the possibility of contacting the organism’s spontaneous creativity within significant relationships that can support the specific impasse loc: 8,199
stumbled. “I don’t know what to do.” “I don’t know what to say.” “I’m bored.” “Nothing really interests me.” “I can’t cope.” “I know I should care, but I just don’t.” loc: 8,200
all expressions of a loss of outlook and a withdrawal into oneself, rarely do young people experiencing a depressive episode become silent like adults do, loc: 8,202
conveying, sometimes in quite a provocative way, the urgent need for contact. loc: 8,203
«The happiness glimpsed, and then lost, in adolescence, does not dry up or burn to ashes instances of desire loc: 8,205
This desire is sometimes what saves them from desperation, sometimes the impossibility of desire coming true can be wounding» (Borgna, 2011, p. 113). loc: 8,206
early experiences of abandonment have complicated the process of building a sense of “us” loc: 8,207
the impossibility of the desire for the other coming true can be wounding. loc: 8,209
the sense of unreachableness and desensitization will smother spontaneity; faculties of choice in contacting the environment are greatly inhibited loc: 8,210
Time loses its sense of flow and becomes static. loc: 8,211
figure of inhibited action invades all aspects of life. loc: 8,212
In other cases, teenagers may have a need for silence, a moment of standby that can help them push back the “too much” that overwhelms them, loc: 8,214
In this way, retreat becomes a creative adjustment that enables the ground to breathe, in a field that is too thick with stimulus. Note:(Figure) loc: 8,215
a retreat in which to find the solidity and the sense of self given by the body’s putting down roots and by the presence of an adult gaze. loc: 8,217
Sometimes, the perception of support in the field (such as a friend who promises to stay by your side if you go to the party) can help an adolescent find the courage in herself to run the risk of stepping out again into the world. loc: 8,220
where clinical support is advisable, the therapist needs to consider loc: 8,222
specific elements that the depressed adolescent brings to the therapeutic relationship. loc: 8,223
suggesting to an adolescent a relationship with an adult who is a “specialist” loc: 8,224
is in itself a dystonic element loc: 8,224
out of tune with the adolescent’s pressing need to “do it myself”. therapy needs to be modulated, around the adolescent’s need to cut the strings of adult help and, loc: 8,225
around the importance of not encouraging the adolescent’s narcissism. loc: 8,226
an additional difficulty is the risk of colluding with a “dependent”, introjective mode that leaves things up to the other, that is, to the therapist. loc: 8,227
prevent this first a context needs to be created which the teenager can be helped to experience once again, through contact with the therapist, loc: 8,228
feeling of hope and confidence in her own ability loc: 8,229
means responding to the need for support and offering the possibility of building a trust that does not become dependence, loc: 8,230
contact that can nourish the adolescent’s own growth and independence. loc: 8,231
adolescents with depressive experience, one of the first pillars to crumble and collapse is the sense of confidence that they can do something to make themselves feel better. loc: 8,240
A depressive state will trigger continuous calls for confluence and introjection that pervade the therapeutic field, loc: 8,242
leaving the therapist with a sense of dullness in which it is easy to feel bogged down. loc: 8,243
up to the therapist to “shake up” the ground to recover the developmental questions loc: 8,244
and bring them back to the centre of attention. loc: 8,245
The silence of a depressed teenager is tied to the difficulty of finding the words to express an experience he is unable to convey and share. loc: 8,252
long silences are inappropriate and pointlessly distressing. loc: 8,253
can be helpful to come to the teenager’s aid when invaded by the paralysing sensation of having nothing to say, loc: 8,254
generally useful to create a flexible setting that encourages communication through several different channels and codes, loc: 8,255
including performance, drawing, writing, music and songs, the use of different objects, and symbols and metaphors. loc: 8,256
much of the therapy process will turn on the capacity to create in sessions a flexibility that can overcome rigid depressive stiffness and un lock the wealth of possibilities loc: 8,257
that help keep at bay the sense of emptiness at feeling lost. loc: 8,258
the importance of working with the parents needs to be stressed. loc: 8,259
not only in order to provide the parents themselves with support, necessary so as to enhance their ability to reach their children and give them support. loc: 8,260
this means helping parents to bring to the fore their intentionality for contact loc: 8,261
often concealed behind attitudes of aggressiveness, intrusiveness, or helplessness or that are full of anxiety loc: 8,262
work with the parents should be assessed on a case-by-case basis loc: 8,263
depend on factors, the adolescent’s age, her own wishes, the emerging need to work on being independent or rooting one’s frailties in primary relationships, and on the family’s means. loc: 8,264
Viola’s Narrative loc: 8378
The most important steps in my therapy experience were: 1) Metaphor of nourishment: I learnt to say “I need it”, “It’s good for me”, “Without it I can’t ‘blossom’”, “I’m entitled to it, I can let myself”. 2) Refocusing: Learning to put myself before others, before the world, before what has to be done loc: 8,393
The fact that one day the therapist said to me, “think about it, at least some little thing worth saving, that you like, must exist”, like a branch you can hold onto on an escarpment… I couldn’t see it at first, unfortunately, I felt like there was nothing to hold onto… Then I found a little thing, then another… then more; with time the wonderful things worth keeping became many, loc: 8,399
My therapist’s approach and attitude helped me – never judging me and paying attention to even the smallest details during the session, loc: 8,406
Nurturing hope of taking small steps forward together, reassuring me that moments of “stagnation” or apparent regression were to be expected and that therapy works like a spiral, circling back over itself and facing a different aspect of the same problem, until it’s digested. loc: 8,407
Her not creating dependency and leaving me free with confidence. Her being responsive. Speaking plainly, without lies. Knowing how to play things down and laugh over them, to take things less seriously. Being patient; having confidence in me and valuing me. loc: 8,410
Psychotherapy has meant a lot to me, if not everything. I was very wary at first, loc: 8,413
realizing there are different ways to be happy, learning to indulge and spoil yourself, letting yourself have “what’s good for me”. It meant finding someone who could reassure me and tell me “a positive and happy life is possible and within reach; let’s start by together removing the obstacles (which I myself sometimes raised) by giving a name to the pain and crying if you feel like crying – there’s nothing wrong with that”. loc: 8,415
The nurses were complaining about her because she was never satisfied with anything they offered her. The life story of this woman was an accumulation of disappointments: as a child she took care of her mother who was often ill. To escape from this she married quite young, but soon after the wedding her husband became ill with Multiple Sclerosis. He was severely handicapped by his illness and again she took care of him until he died at the age of 56. During all these years time for herself was very limited. loc: 8,868
In our present way of thinking in the Western world, loc: 8,894
The general idea is that, increasingly, success or failure is regarded as a person’s individual task and achievement. In other words, being happy or being unhappy is a person’s individual responsibility. This way of thinking puts so much pressure on people nowadays to make something of their life and to be successful, that when they do not achieve the utmost goals (targets), do not have a successful life, people will feel like losers, which of course increases the chance of depression as a response to life. loc: 8,899