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Bonime, W. (1965). A Psychotherapeutic Approach to Depression. Contemp. Psychoanal., 2(1):48-53.

(1965). Contemporary Psychoanalysis, 2(1):48-53

A Psychotherapeutic Approach to Depression

Walter Bonime, M.D.

THE ESSENCE OF MY APPROACH to the psychotherapy of depression is to examine with the patient his depression as something which is his practice, a sick way of relating to other human beings. The object is to discover, with him, the nature of this way of relating and to inquire: "How does this produce for him a painful existence?" He comes with what he considers an affliction; we examine how he lives.

One of the most significant demonstrations of his functioning would be found through scrutinizing his approaches and responses to the therapist. Making inordinate demands on others is a characteristic of the depressive's way of living and this is also how he functions in the psychotherapeutic relationship. Outstanding psychoanalysts, such as Edith Jacobson 6 and Frieda Fromm-Reichmann, 5 have recognized, in dealing psychotherapeutically with depressives, the necessity for engaging more actively, more affectively, than was their custom with other patients. Both emphasized the necessity for being responsive in a personal way to demands, and both included in their personal responsiveness, first, giving a clear indication of limits, and second, showing open resentment toward the efforts of the patient to go beyond these limits. Jacobson explicitly states the wisdom of giving early warning to the patient of his probable later resentment of unfulfilled fantasied promises. Sullivan 8 was baffled by the depressive, sensing the tendency to encompass the therapist in undefinable ways. He found the depressive a most unusually elusive personality to define. I think Sullivan was responding to the vague but effective practices by which the depressive seeks to attach and involve, but at the same time to remain outside the natural reciprocity that would evolve from the close involvement he seeks for himself.

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