That more than a third of patients with mood disorders will go on to have a chronic course if treated exclusively with biological therapies is an established fact. For most of these patients depressed mood is often accompanied by a complexity of other factors, including trauma in the developing years, which affect personality development and therefore coping styles in later life. Early chronic devaluation may often be found at the core of their trauma, causing considerable shame that is largely unconscious, but expressed as ‘hopelessness and helplessness’ in the clinical situation. Co-morbidity is often related to treatment un-responsiveness. The focus of treatment has therefore to shift to aspects of self and relationships, as in psychotherapy, often with the addition of pharmacotherapy.
This seminar will focus on several important dimensions of TRD with the help of clinical examples:
1. Recognition and management of avoidant patterns of relating, which make the therapeutic relationship rather difficult to establish
2. Recognition of patient’s developmental vulnerabilities
3. Actively but empathically mobilizing and naming Shame
4. Processing and resolving internalized shame.
5. Improving the capacity to affirm self from within.
8. Development of a core-self.