Janet was an appealing young woman in her 20s experiencing depression for the second time in her life.  In a series of interviews, we identified a prior depression that she suffered in her teens.  The symptoms she described in adolescence sounded like classic symptoms of depression, such as decreased energy and indifference.  We explored what was going on in her life at that time, as well as her overall childhood and family history.  But nothing about Janet’s youth jumped out at us.  She had never experienced any kind of trauma.  Her parents were (are) good people, and they raised her well.  There seemed to be no history of depression or mental illness in the family.

Her mother had noticed issues with Janet’s drive and ambition, though, and repeatedly cautioned her to slow down.  Janet was the oldest of several siblings.  I wondered if she experienced the pressure that comes sometimes with being the firstborn child from whom parents expect a lot.  My patient’s younger siblings did seem to look up to her, literally and figuratively.  Janet had big ideas, and she was physically tall.  I told her she was one of the few people I needed to look up at (or to) when standing next to her, since I am tall too.

Later I thought about the meaning of my spontaneous remark.  Did Janet need to have that effect on her siblings and on other people somehow?  In other words, to have them admire her?  I thought this might be an important piece of information that I might be able to use to help her explore her personality and her depression.

She had been raised in a small rural town in the Northeast, attended college in Florida, and moved to our big city.  Small towns and big cities could serve as a metaphor for Janet’s depressions.  As if feeling too small was followed by feeling big, a continual cycle of self-esteem deflation and expansion, almost like a bicycle tire losing air and then being pumped up again with big ideas so as to not feel flat and empty.

Janet was in a period of contraction, her life shrinking down.  She had broken up with a partner and quit a company she founded with a friend.  There had been big plans for this company, but they didn’t pan out.  She was working in the service industry when I met her.  I thought she had found a way of taking time out from her ambition to succeed that often seemed to run aground in some way.

I saw issues with Janet’s self-esteem, which required the presence of big ideas in order not to fall back into depression.  I felt therapy could help her in the areas of self-esteem and depression, which I have studied for decades.  Unfortunately we had to stop meeting after only about 3 months due to practical considerations.  I often see people for long-term therapy for entrenched, enduring emotional issues, where we can take the time to sort out people’s complex thoughts and emotions without feeling pressured or rushed.  But Janet and I did not have the luxury of time, so we were unable to fit all the pieces into the puzzle.  She was forced to go find another therapist who took her insurance to continue her therapy.  But even this brief therapy experience was very helpful to her.  Here is a direct quote from a note she sent me a couple of weeks after we stopped meeting;

“Well, Dr. Lagomasino, if this isn’t one of the best investments I ever make in my life, I’ll be pleasantly surprised to know what is.  Seldom have I had such a rich relationship with such a consummate professional.  The sessions we spent together and the discussions we engaged in helped me in more ways than I could have possibly imagined going in.  There are too many layers of silver linings to put them down here; I’d simply like to say thanks for helping me to see them.  For everything it took to get me into your office, I will only remember how positive the experience was.  I wish more people in my position could meet more people like you.”

Mental health professionals do not often write about their work in publications such as this one.  One of the most important parts of our work is client confidentiality.  I have taken precautions to disguise Janet’s true identity so no one who reads this recognizes who she is.  But people in my field should get the message out that psychotherapy can often be extremely helpful, as it clearly was to Janet.

Andrew Lagomasino, PsyD, ABPP is a psychologist and psychoanalyst in private practice in Miami, FL.  He obtained his doctorate at Nova Southeastern University and spent about 10 years working as a Staff Psychologist on the Latino Team at Cambridge Health Alliance (CHA) in Cambridge, MA.  At CHA he studied and learned about therapy, including with the most difficult to treat low income, immigrant, and chronically mentally ill people.  He did additional training in Boston, then moved back to Miami in 2003 to be closer to his family.  He tested children for the public school system and was trained in child therapy. He maintains an interest in cross-cultural psychotherapy, and has a private practice in Coral Gables, FL, where he sees children, adolescents, and adults for psychotherapy and psychological testing.  He is active in his local institute, Florida Psychoanalytic Center in Miami.  To learn more about his practice, please visit www.coralgablestherapy.com, or call him for a consultation at (305) 441-6655. 

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