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Case Study: a Psychosynthesis Approach to the Treatment of Depression by Michael H. Brown, Ed.S. Michael H. Brown, Ed.S. Contents: On the 22nd of February 1991, a 46 year old white female, Mrs. Margaret Stevens, was referred for counseling by her Family Practice Physician (all names have been changed). She had been suffering from persistent anxiety and depression and had been on and off the medications Xanax, Inderal and Desyrel for eight years. A recent major depressive episode mobilized her will to seek counseling. In our initial interview, Mrs. Stevens acknowledged multiple complaints. She suffered from nervousness, stress, an inability to relax, low energy, tiredness, depression, insomnia, memory and concentration problems, procrastination, trouble making decisions, stomach and bowel trouble, unhappiness, marital problems, conflict with her children (Mary, 13 and Joan, 17), multiple fears, low self-control, anger and bad temper, over eating and weight problems, inferiority feelings, and disturbing thoughts. The diagnosis which seemed appropriate was DSM III-R 296.33: major depression, recurrent, severe without psychotic features. Mrs. Stevens said that her first husband, with whom she was married for eight and one half years, ran around with other women throughout their marriage and she finally had to divorce him. She married her 2nd husband, Dennis, in 1973. Unfortunately, he was an alcoholic. A home maker, Mrs. Stevens spent her time by day worrying about Dennis's lack of caring and concern. By night she fretted about his whereabouts and drove around the countryside searching for him at the various bars and clubs where he hung out to make sure he wasn't running around on her and, secondarily, to see that he got safely home. Mrs. Stevens had seen a psychiatrist for three visits while hospitalized for depression in 1989 but, although she had also spoken to her preacher several times about her troubles and concerns, she had never undertaken any formal or comprehensive counseling program prior to her interview with me. She cried openly toward the end of our initial interview, grateful to have found someone who really listened to and heard her. Mrs. Stevens was referred to counseling for relief from anxiety and depression. According to the model of Psychosynthesis, she would have to take a number of very specific steps to find this relief, to reduce her suffering and achieve more satisfaction in life. First she would have to align with the principle of growth within and begin to connect to the wisdom and guidance of her Higher Self. Then Mrs. Stevens would have to become aware of, experience and explore three distinct levels of consciousness: the Middle Unconscious – issues in her life about which she felt burdened, hopeless, and overwhelmed and which resulted in physical, mental, and emotional pain; the Lower Unconscious – underlying negative patterns and internal dynamics of which her difficulties, issues and depression were an overt expression; and the Higher Unconscious – psychological and spiritual resources necessary to illuminate and transform these dynamics, their patterns and effects. Achieving this, Mrs. Stevens would become more integrated, Self-reliant, and fulfilled.  Below are described some of the techniques employed in Psychosynthesis counseling. An explicit process for using these and others methods is outlined at the end of this article.
Unfortunately, a thorough discussion of the application of Psychosynthesis with this client is not possible in this brief case study. A summary, however, follows. I met with Mrs. Stevens from the 22nd of February to the 29th of May, for a total of 15 sessions. A period of 10 minutes was used for relaxation training at the beginning of each session. This helped her put aside her chronic worries and concerns at the beginning of each encounter, release her stress and tension, calm down, relax, and become focused on the topic on which she then chose to work. Deep relaxation, which Mrs. Stevens began to practice at home, was immediately helpful to her both in getting the most from counseling and in increasing her satisfaction at home where she immediately began to assert more control. March 6th. In the third session, we began to more thoroughly explore elements within Mrs. Stevens' Middle Unconscious. She explained that in early February, while on a vacation to Florida with her family, she had an overwhelming period of anxiety and depression for 11 days straight triggered by her husband's alcoholic behavior during the trip. This had been so traumatic for her that she lost 30 pounds and resulted in her desire to get counseling to effect some change in her life. Mrs. Stevens said she had felt for a very long time that she should divorce Dennis. Her daughter, Joan, told her she should have left him years ago. But she had been unable to leave him, felt trapped and desperate at home, and could not improve the situation in any way. Hence her chronic depression. Having identified and discussed some of the troubling dynamics in her present life, it then seemed important to help Mrs. Stevens get in touch with her Higher Unconscious, to connect with her strengths and positive qualities and begin to mobilize her energies for change. In a reflective thinking exercise, Mrs. Stevens identified 16 aspects of herself about which she felt proud. The top three were that she felt she was a very loving person, a good house keeper, and smart. Her depression lifted and her mood was much improved at the completion of this process. To crystallize and make explicit this positive energy, I asked her to allow an image or mental picture to come to mind that would depict the way she felt at the end of the exercise. Into her field of awareness came an image of herself as being thin, happy, in a beautiful black strapless dress holding 2 dozen pink roses. "From where had the roses come," I asked? She gave them to herself, in imagery, as an expression of appreciation and self-love. Her homework assignments were to write up a summary of the session in her journal, as usual; to reflect on the list of positive qualities, and add to it if possible; to practice deep relaxation for 10 minutes at least twice a day; and to try to make a sketch or drawing of the mental image. March 13th. In the fourth session, Mrs. Stevens reported feeling much better as a result of the previous session and mentioned how helpful the relaxation process continued to be. She had done a lot of reflective writing during the week. In her journal she wrote: Other people seem to see more potential in me than I do. But I have begun to realize that I am worth more than I thought and it feels good to realize that I am special and just as good a person as everyone else. Psychosynthesis asserts that the process of growth is a spiraling journey of unfoldment. In the previous session Mrs. Stevens connected to insights and energies of her Higher Unconscious. Now it was necessary to help her bring her good feelings and positive energies back into explicit rapport with Middle Unconscious realities and dynamics. We discussed her chronic self doubt, fear of judgment, lack of confidence, and perfectionism. She said her interactive pattern was to get overwhelmed, then angry, then explosive, then walk out of a situation, calm down and, after a long while, return to face the issue at hand. We outlined a four step process for her to practice whenever she felt herself becoming overwhelmed: 1) Awareness: notice when she begins to be upset, 2) Choice: disengage from the situation before the anger starts to build up or explode, 3) Self-management: practice relaxation even for just a few minutes, then 4) Action: return to face the situation more centered and clear about what really needs to happen. The session closed by Mrs. Stevens stating that, although she hadn't worked in 20 years, she was ready to consider getting out of the house and look for work again. March 20. In the fifth session, Mrs. Stevens said that upon returning home her husband had mocked and insulted her about the slim possibility of her finding work. Undeterred, she went out and began to look. With much enthusiasm and excitement, Mrs. Stevens reported that she had stopped in on her former employer, had asked for and had gotten back the job she had done for him as a medical transcriptionist 20 years ago! Much stimulated by this turn of events, for the next three sessions Mrs. Stevens dealt with the sources of stress at home and work. She said she was getting along far better on all fronts than she ever might have imagined she could. For instance, she use to take Inderal every morning to slow down her rapid heart beat, and Xanax four times a day, but was now down to Xanax once a day, a sign of some improvement, and was off Inderol altogether. We also discussed her need for regular exercise, to which she made and kept a daily commitment, and how she used food as a tranquilizer and source of comfort. April 24. In the tenth session, uplifted to a significant degree, Mrs. Stevens was empowered and ready to move into an exploration of the Lower Unconscious – to identify and confront some of the primal conflicts and inner dynamics of which her present troubles were an expression. She discussed in some detail the negative and self-abusing thoughts that constantly ran through her head. Employing a technique of visualization, I had her get an image for what in Psychosynthesis is called a Subpersonality, the automatic and unconscious part of her that caused her feelings of guilt, concern, and self disgust. Below is a pen and ink rendering of her colored pencil drawing of this Subpersonality and what she wrote about the creative interaction she had with it.  May 1st. Imagery carries much complex information to the conscious mind for exploration an integration. In the 11th session, I felt the need to help Mrs. Stevens explore more deeply the meaning of the Subpersonality she discovered in her Lower Unconscious. I asked her about her childhood, in general, and about her relationship to her father, in particular. I suspected his patterns of interacting with her might have been, as an introject, the source of her self-abusing Subpersonality. With a great emotional release, Mrs. Stevens said her father had been a Commander in the Navy, then the Principal of a High School and an alcoholic. Her mother divorced him when Mrs. Stevens was in the 2nd grade and she was forced to live with her paternal grandparents for a year and a half. She constantly craved attention and did poorly in school. Mrs. Stevens tried to run away from home at age 9 but her father caught and severely punished her. Later, after her father remarried, her stepmother totally ignored her. Mrs. Stevens cried all the time and "ate because food was my best friend." Her father repeatedly beat her until she was 18 years old at which time she escaped by marrying the first man who paid her any attention. "He treated me like everyone else and ran around on me until I couldn't stand it any more and divorced him." May 8th. In the 12th session, Mrs. Stevens continued to talk about the physical and emotional abuse she experienced in childhood. She said she herself began an abusive parenting style with her first born child, a son, but went the opposite way with her daughters, providing too little discipline and accountability, too few boundaries for them. As a result they were now "hard to manage." In another visualization exercise, Mrs. Stevens again connected to her inner child Subpersonality. Below is a pen and ink rendering of her colored pencil drawing of the image which emerged. A comparison of her drawings and journal notes provides a clear reflection of the process of growth and transformation taking place within her.  After the Subpersonality work, with its resulting catharsis, her feelings of depression completely disappeared and her use of medication ended. Mrs. Stevens came in for three more sessions and then discontinued counseling. In these integration sessions she became a little more aware of how she used food as a replacement for the love she lacked in her life. She said her energies were totally focused on improving her living situation. She was now too busy reconstructing a life based on career development and better self care to be overly obsessed by or concerned about her husband's dysfunctional behavior. I followed up with a phone call to Mrs. Stevens in July, September, and then in mid-October, when I received permission to use her story for this case study. Her career continued to develop in positive ways. She remained free of depression, off medication, more centered and self-confident. She had regained the 30 pounds she lost in February, and her relationship with Dennis had improved, but only, she said, because her attitude about it had changed. While she acknowledged the fact that she still had many problems to confront, and wished to continue making improvements in her life, when last we spoke Mrs. Stevens was pleased to be enjoying the fruits of this counseling experience. 
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