Category: depression

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Forgiving Your Partner for a Past Injury

A recent New York Times article on forgiveness reminded me of how important forgiveness can be in relationships and how costly it can be to not resolve disputes. Throughout my personal and professional experience, I have witnessed firsthand how devastating unprocessed injuries can be to relationships. When left unaddressed, resentment can fester and create a toxic atmosphere that seeps into all aspects of one’s life. It’s not just the initial injury that causes the issue, but rather the complexity and longevity of the hurt. The offender may struggle to apologize due to feelings of shame or anger, while the injured party may struggle to forgive, despite the long-term negative consequences of holding onto bitterness and resentment. The result can be a breakdown in communication and a disconnection from loved ones, with family members cutting themselves off from each other and avoiding contact altogether.

Everett Worthington’s REACH model is one way of looking at the process of forgiveness. In this model, there are five steps to forgiveness: Recall the hurt, Empathize with the offender, Altruistic gift of forgiveness, Commit to forgive, and Hold onto forgiveness. This process can be followed as an individual who has been injured, but perhaps it has the most power when it involves both parties involved, typically a couple. Of course, it can apply to any relationship, such as between friends, coworkers or family members.

Recall the hurt

This involves acknowledging and accepting that one has been hurt, and allowing oneself to feel the pain associated with the hurt. This is not easy because we humans generally prefer to avoid pain at all costs, distracting ourselves and being ‘too busy’ to deal with it. The truth is, it is both uncomfortable and a necessary step in the process of forgiveness.

Sometimes there can be an entanglement of hurts in which the injured party reacted to being hurt by injuring their partner back. Talking about an entangled hurt can lead to recriminations and comparisons about who was injured the most. It is important to maintain focus on one complaint at a time with the understanding that both injuries ultimately need to be addressed. Allowing space to take turns in speaking and listening is crucial to be able to disentangle the injuries and for each partner to understand the other’s point of view. Therapy can help with this, and if you struggle with hashing things out at home, a communication method such as Nonviolent Communication can be very helpful.

Empathize with the offender

This means trying to see things from the other person’s perspective and understand why they acted the way they did. This step can be challenging, especially if the hurt was intentional, part of a pattern of offensive behavior, if the offender is not willing to take responsibility for their actions, or if there is too much hurt to be able to feel empathy for the other.

Being injured by someone close to you can carry with it old feelings of times in the past where you have been injured or not considered. A fresh injury can stir up anger, which can be activating and marshal your resolve to refuse to be treated this way. This can be a healthy reaction to being mistreated. A less healthy adaptation might be to feel that you are dependent on this person and so must endure ongoing mistreatment in order to survive.

Red Flags

It must be said in terms of forgiveness that there is a red flag when there is a situation of domestic violence or ongoing abusive behavior. Forgiveness can be a part of a the response, but partner violence and repetitive emotional abuse are unacceptable. Some people might try to forgive their partner for abusive behavior, but fail to hold them to account. When the injured party minimizes the injury or explains it away, perhaps feeling it was their own fault, it can perpetuate an ongoing cycle of abuse. If you are in this situation, it is a good idea to seek help from a domestic violence center or by talking with a therapist who can provide support and help you to think more deeply about the abusive dynamics in your relationship.

Altruistic gift of forgiveness

This involves making a conscious decision to forgive the offender, even if they have not apologized or asked for forgiveness. Recall how it has felt when you have been forgiven in the past. It’s important to note that forgiveness is not the same as condoning or excusing the offender’s behavior.

Commit to Forgive

This means making a commitment to work on forgiving the offender, even if it takes time and effort. This step involves letting go of any desire for revenge or punishment, and focusing on healing and moving forward.

Hold onto Forgiveness

This means making forgiveness a part of one’s identity, and actively choosing to let go of any resentment or bitterness towards the offender. This is important for maintaining healthy relationships, and in practice it does require effort to truly put resentment aside.

The Cost of not Forgiving

The emotional tension of not forgiving someone for a wrong can be overwhelming and exhausting. It can create a persistent feeling of anger, resentment, and bitterness towards the offender, which can lead to a breakdown in the relationship. Holding onto grudges and past hurts can also take a toll on one’s mental health, causing feelings of anxiety and depression. When you choose to work towards forgiveness, you can release the emotional tension and move towards a healthier, happier life.

As a therapist, I understand that forgiveness can be complicated, and not usually something that is achieved overnight. However, I also know that forgiveness is possible, that it is good for your health, and that it can lead to healing and growth in relationships. With the REACH model in mind, it is possible for individuals and couples to work towards forgiveness and create stronger, healthier relationships.

If you and your partner are struggling to forgive each other after a hurtful experience, even one that happened long ago, I encourage you to seek support from a therapist. Couples therapy focused around forgiveness can heal old wounds and create a brighter future for your relationship. If your partner is not willing to participate in a therapeutic process, you can still do a lot of work with the help of individual therapy.

Bruce Hearn is a psychotherapist in private practice in San Francisco. He works with couples and individuals.

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Considering Meds for Depression?

medication for depression?

If you feel down, discouraged, isolated, lack motivation, or no longer enjoy work or personal relationships as you used to, you might be clinically depressed.

Many people consider antidepressants when they get into this state. Anti-depressant drugs are often seen as the first-line treatment for clinical depression, but there are some very good reasons to think twice before signing up for the happy pills. Recent studies have shown anti-depressants are not effective except in cases of severe depression.

When you lose your job, it’s normal to feel sad, discouraged and anxious. When a loved one dies, you can feel a lot of very intense emotions.

A quarter of American adults live alone. Direct emotional contact with friends happens a lot less than it used to. One of the most painful forms of isolation is to live with a partner to whom you don’t feel connected. Many people are affected.

Social changes enabled by technology have increased our sense of isolation from one another. We’re each on our islands, feeling a sense of isolation and meaninglessness that only connection can solve.

Recognizing Depression

Depression can be recognized because of how much it impairs normal functioning. It becomes increasingly clear to friends, colleagues and family that something is wrong, though men and women may show it differently; men tend to isolate themselves, experience fits of anger and turn to substances or sex for comfort. Isolation doesn’t help matters. Energy levels plummet, you can’t bring yourself to eat and lose the sense of pleasure in the things you used to enjoy. Suicidal thoughts can turn towards planning.

If you, or someone you know fits this description, it can be cause for alarm, and it becomes important to visit a doctor or therapist to assess your condition.

In the rest of this article, I’ll be considering the implications around the use of anti-depressants on mild and moderate depression.

The Stats

The Center for Disease Control (CDC) reports that eleven percent of Americans over twelve years old take an anti-depressant. Primary care doctors are responsible for the majority of this prescribing. Most primary care doctors lack psychiatric training in depression, anxiety and ADHD yet are the main prescribers of medications to treat these conditions. Physician office visits tend to be quite brief.

Few people wish to identify themselves as having a mental illness and don’t feel at ease in starting to take a drug. This may partly explain why doctors often don’t record a diagnosis of clinical depression when prescribing anti-depressants.

Americans tend to have trouble staying the course with their medications, and some drop out as soon as they start to feel a little better or a little worse. Side-effects of anti-depressants can range from dizziness, drowsiness, upset stomachs and loss of sexual appetite. It’s no surprise that many don’t want to stay on their meds.

After hundreds of studies, we now know that anti-depressants are only marginally more effective than a placebo in clinical trials for mild to moderate depression. This is a shocking finding given that antidepressants continue to be used as the first line treatment for depression. And it’s the unspecialized primary care MDs who are handing out these pills.

Chemical Imbalance

From a medical perspective, the practice of treating depression with a pill came out of the chemical imbalance theory. This is the idea that chemical imbalances in the brain give rise to mental illness.

This assumption is outdated by modern research but a lot of pill prescribers don’t seem to have caught up. Most of the time, it is not faulty brain wiring, but the effects of one’s isolation, of common sadness and self-defeating thoughts arising from difficult life circumstances or transitions that can lead someone to depression.

Many people who suffer from depression experience constrained thoughts that seem to be stuck in a loop. When feelings of sadness and isolation lead to negative self-evaluations and unhelpful actions or inactions, a vicious cycle can be set into motion.

Taking a drug like an SSRI to alleviate depression does not directly address the cognitive or emotional processes that gave rise to the imbalance. At best, in cases of severe depression, chemical treatment can help the brain to break away from the vicious cycle of depression. At worst, prescribed for mild depression, it can cause severe side-effects. It can also lead to the emergence of psychotic symptoms in some patients, who are then given mood stabilizers and diagnosed with bipolar II disorder.

How about a little exercise?

Exercise is one of the best ways to help with depression in mild and moderate cases. It can be difficult for people who are depressed to get motivated to exercise.

Fast walking for an hour a day has been been shown to be more effective than anti-depressants and leads to lower recurrence rates for depression. Other forms of cardio exercise are also helpful.

Studies of Yoga practice have shown similar results, with two 90-minute sessions of Hatha Yoga classes each week leading to significantly reduced depression, anxiety and pain. Group activities like yoga also help by providing a sense of group membership, which can be very reassuring to people who would otherwise feel isolated.

Therapy for Depression

Even if you’re exercising a lot, you might still have a lot on your mind that could benefit from thinking and feeling more deeply into.

Group therapy, couples counseling and relational psychotherapy all tend to be more effective than anti-depressants and have lower relapse rates.

Couples counseling promotes supportive emotional bonds between couples that shield individuals against adverse conditions, so that you potentially lead a life reassured that your partner has your back.

Groups can offer a valuable sense of community and the sense that you’re not alone, that others face issues as bad or worse than your own. 

The interpersonal connection of individual psychotherapy can allow people to develop internally, reshape their relationships and develop new perspectives on the world.

When therapy provides the space to talk through difficult feelings and foster greater self-awareness, depression may gradually yield, allowing for a more honest accounting of one’s life and prospects.

Bruce Hearn is a Psychotherapist in private practice in the San Francisco Financial District. He works with couples, men and women. He welcomes people who struggle with depression in his practice.