From the author: From the personal website 1. The word “depression” is loved by the people, it is often and easily used, it is decent and understandable to be depressed. Most often it is used to denote a bad mood, depression, sadness, and powerlessness. “I was very depressed yesterday morning,” “When a child is naughty, I immediately become depressed.” During the initial diagnosis, it often turns out that we are talking about a situational reaction to life difficulties or traumatic situations, or about exogenous depression - the same reaction, only already prolonged. At the beginning of my therapeutic practice, inspired by the ideas and prospects of Gestalt therapy, I was sure that depression could and should be treated only with psychotherapy, awareness of what was happening, my contribution to the disease, and a change in attitude towards life. Like many beginners, I was lucky, and so were my clients; at first there were no difficult cases; the clients’ depressions were reactive, caused by life’s difficulties, crisis events, and indeed, they could be dealt with without medications. But life does not stand still, throwing up We are faced with more and more complex tasks as we develop (or rather, we begin to notice these tasks and take on their solution). I began to have other clients, different from the previous ones. Sometimes there was a tragic event in their life, sometimes they could not remember anything obvious, but everyone had a feeling of depression and hopelessness. Life is hard. No forces. It's difficult to deal with problems. Nothing works. Live joylessly, hopelessly. Many people had an objectively good life, well-organized, interesting, full - but all the joy that these people could experience constantly disappeared somewhere, flowed away like sand through their fingers. Talking sessions brought only short-term relief to clients and took a lot of energy from me. Joy was not absorbed in their souls, just as some people cannot absorb lactose or iron in their bodies. Endogenous depression sat in the chair opposite and, sighing heavily, slowly complained of feelings of worthlessness, guilt and hopelessness. My knowledge of clinical psychology and psychiatry was clearly not enough. When I studied to become a psychologist and then to become a Gestalt therapist, listened to lectures on psychiatry and did internships in dispensaries, I was firmly convinced that I would not work with psychiatric cases, that my future clients were people with a healthy psyche, of a neurotic type. who are experiencing difficulties in life. That’s it. My clients were socially adapted, adequate and sane, had families, friends, and jobs. But the joy of some of them was not absorbed in the body. At the same time, a decrease in mood, a pessimistic, decadent outlook on life, lethargy, low self-esteem and loss of interest in life were noted. Often this was the reason for seeking help, or was the cause of other difficulties (in the family, at work). I began to learn about drug treatment for depression. I read many authors offering their models of its treatment. I started reading medical reviews. I talked a lot with doctors, went to training, read protocols and case reports. I searched and found books written by psychiatrists for patients suffering from depression and their loved ones. (R. Evsegneev. Psychiatry for everyone., A. Dobrovich. Get out of depression.). I am grateful to these authors for their work and only regret that their books are not replicated enough. I am a psychologist, not a doctor, and do not have the right to prescribe or discontinue medications. This is not my job, not my territory. And clients who come to me for help usually understand this. Moreover, many are afraid of pills, afraid of psychiatrists. People still have a fear of shrinks, people are afraid of “numbing” pills, they are afraid of “turning into a vegetable,” “being registered,” etc. I was lucky to meet Russian-speaking psychiatrists working in the public and private sectors. Now I could recommend my clients to contact specific specialists and gethelp in your native language. This is important, especially when a person is confused and weakened by depression. This joint work has proven to be very useful. For me, as a Gestalt therapist, it was because I could share responsibility with the doctor. For doctors - the fact that their patients, in addition to chemical changes (regulation of the level of serotonin, dopamine and norepinephrine), receive mental changes, forming new neural connections in the brain with the help of psychotherapy. Well, and above all, for my clients - all of the above, (none During my entire practice, the client, by the way, did not turn into any kind of vegetable and did not become dependent on medications). This work is long and difficult. It's rewarding work. I admire my clients - their courage, their will, their courage. I feel like a guide accompanying brave travelers in their long and difficult way out of depression. I have walked along these paths many times, and each time it is a new road. But it is always the road from cold and darkness to light, to warmth. From insulation to contact. Contact with yourself, with loved ones, with the world2. The client, describing his experiences of depression, made a slip of the tongue. He wanted to say that for him depression is “a wall that keeps out,” but he said “a wall that keeps out.” I corrected myself, but I started thinking - which description is more accurate? Perhaps both definitions are correct, but for different cases. With reactive depression, a person is protected from problems, troubles, worries and gets the opportunity to survive the crisis, take a breath, and gather strength. With endogenous depression, this wall becomes a prison wall, it fences off contact with what is happening, from participation in life, and leads to isolation, alienation, increasing the feeling of loneliness, uselessness, worthlessness. A person suffers, his relationship with the world deteriorates. To deal with problems in relationships, you need to understand what feelings arise in them. These feelings may be uncomfortable, frightening, incomprehensible, but they are there. Avoidance leads to isolation, to depression. It is important to be in contact with feelings, in contact with the person to whom these feelings are directed. Then it becomes possible to change something in the relationship. If feelings are suppressed, not recognized, ignored, and the problem itself is carried with it to the other side of the “fence” - into depression, then nothing can be done about it. All that remains are obsessive, repetitive thoughts that lead nowhere. Feelings are an indicator of needs. What do I want, what am I afraid of, how do I stop myself. I stop and take it to my hole. The need remains unsatisfied. Moreover, it is unrecognized. In depression, a person stops himself before he has time to want something. He does not allow himself to want. 3. Alone, one cannot cope with a problem that has arisen in contact - only in contact. In fact, this is why therapy is needed. You can read a lot of books, advice, take a lot of tests, but this will not replace a relationship. The relationships in which we find ourselves all our lives - from birth, receiving (or, alas, not receiving) feedback from our parents “you exist”, “you are good”, “we need you”. Reflected in their eyes, focusing on their emotional reactions, we form an idea of ​​ourselves. I am, I am good, I am needed. This is the base, this is the foundation. Then an idea of ​​the world is superimposed on it - what is good and what is bad? What makes mom happy? What upsets her? Why is daddy angry? How does he cope with his anger? While the child is small, it is difficult for him to deal with his feelings; emotions take over him entirely, like a wave. To avoid drowning, you need to hold on to something. Normally, this is the parent. He also experiences emotions, but he is strong and resilient. They don't drown it or wash it away. Mom is upset by my behavior, but it doesn’t destroy her, she loves me. Dad is angry with me, but he still stays in contact with me. My world can survive. If the world is unstable, unpredictable, dangerous, if there is no support in the form of stable parents, there is only one way out - to hide away into yourself, to go deeper into depression. 4. The child learns from his parents, internalizes.