The place of defensive exclusion in depressive disorders
Twice weekly each patient received analytically oriented psychotherapy in which, in E. J. Sachar’s words, “the emphasis on confronting and resolving the precipitating depressive issue, that is, the loss and its meaning to the patient”. The phase was judged to have ended when the patient’s depressive symptoms had abated and she was able to plan her future fairly realistically. Support for the formulation comes from the consequences of the therapist’s efforts to help the patient consider in honest detail the nature of the event that had provoked her depression, what had led up to it, and what its implications for her might be. In illustration the therapist describes how a little before Christmas the patient, who had begun some part-time teaching, complained during M. B. Cohen session of not feeling well. After admission a detailed history was obtained from each patient by a resident or a social worker, and psychological tests were given.