ABSTRACT
This chapter suggests that depression often includes a great deal of shame, and a central aspect is ambivalence toward the self. Even when the person did feel ambivalent about someone they lost, it is their shame, guilt, or regret about having ambivalence that most powerfully predisposes them to depression. The experience of depression has been beautifully captured by Lesley Dorman: Depression is a place that teems with nightmarish activity. The chapter suggests that, while the grieving person and the depressed person have both suffered some form of loss, the lowered self-esteem often present in depression complicates self care. O'Leary emphasizes helping the patient exert active effort to overcome a depressive lifestyle: “The core of the approach I recommend helps a depressed person to get moving again by encouraging and supporting personal agency, or proactivity. This requires collaboratively setting goals in several areas that appear to be related to personal well-being”. Neutrality means that the clinician should not be invested in any particular outcome of the patient's conflicts.
