Supportive-expressive therapy for chronic depression

We describe our clinical experience with a subset of chronically depressed patients characterized as introverted, with an early onset of feeling different from, and often feeling more sensitive than, others. We outline six central issues that concern a psychodynamic approach to chronically depressed people. This article describes and illustrates how a modified supportive-expressive psychotherapy influenced by the relational perspective can help in the treatment of these patients. In particular, we facilitate an interaction in which the patient speaks from rather than merely about his or her depressed self. A couple of clinical moments are presented to illustrate how a lack of recognition by the therapist of the self the depressed patient is at the moment leads to a kind of lifeless despair, and conversely, how the therapist's recognition facilitates the patient talking from his depressed state rather than merely about it. (C) 2003 Wiley Periodicals, Inc.