Case 2, Episode 5: Therapy That Goes Deeper – Remembering What Was Buried

“We talk about the depression. The thoughts. The behaviors.

But I don’t think I’ve ever told anyone what it actually feels like to be me.”

— Marcus, 48

Medications can help lift the fog.

But they rarely change the internal story—the hidden beliefs, the buried grief, the early conclusions we draw about what it means to be alive, to need, to feel, to hope.[1]

For Marcus, the most dangerous part of his depression isn’t the sadness.

It’s the belief that he is beyond help.

That belief wasn’t born in adulthood.

It was shaped—by abandonment, unmet needs, and years of silent survival.

This is where therapy must go.

Not just deeper into symptoms—but into meaning.

Why Standard Therapy Often Falls Short in Chronic Depression
Many patients like Marcus have already tried therapy.
CBT. Mindfulness. Journaling.
They’ve challenged thoughts. Monitored behaviors. Practiced skills.

And yet…

“I understood everything. But nothing changed.”

Because insight doesn’t equal transformation.
Especially when depression is not just a mood disorder—but a protective system.

The Protective Function of Depression[2]
What if Marcus’s depression isn’t just a disease?
What if it’s a defense? 

Against rejection.
Against the pain of needing what was never given.
Against the terror of feeling again. 

When we see depression this way, therapy becomes less about fixing a problem and more about honoring the wisdom of adaptation—then gently creating space for something new.

Three Core Therapy Shifts That Create Breakthroughs

1. From Behavior Change to Self-Contact[3]
“What’s it like to sit here and say that out loud?”
Move from interventions to interpersonal presence.
Validate the act of showing up—not just doing the work. 

2. From Cognitive Challenge to Narrative Reconstruction
“When did you first start to believe you weren’t worth helping?”
Instead of correcting distorted thoughts, explore where they came from.
Help the patient locate the origin story of their despair—and re-author it.

3. From Coping to Reclaiming Emotion
“What feelings were never safe to feel in your house growing up?”
Focus not just on surviving emotions—but on feeling what was long disowned.
Depression often lifts when grief, anger, or longing are finally given a voice.

Modalities That Help Go Deeper
Psychodynamic Therapy[4]

• Understand unconscious patterns from early relationships

• Surface core conflicts (e.g., “If I ask for help, I’ll be hurt or humiliated”)

• Reframe symptoms as meaning-laden messages, not malfunctions

Schema Therapy[5]

• Identify maladaptive schemas (e.g., defectiveness, emotional deprivation)

• Use experiential techniques to heal early wounds

• Reparent the self through consistent validation and guided visualization

Mentalization-Based[6] or Emotion-Focused Therapy[7]

• Build the ability to observe and make sense of inner experience

• Develop emotional language and self-attunement

• Repair the broken bridge between feeling and self-understanding

What You Say Matters
Sometimes the healing starts with a single sentence.
“It makes sense you feel hopeless—because so much of your hope was never seen.”
“Your depression doesn’t mean you’re broken. It means you survived by shutting down.”
“Let’s stop trying to fix you—and start listening to you.”
Therapy that goes deeper is less about tools and more about truth-telling in relationship.

Coming Up Next: Episode 6 – A New Narrative
In our final episode in Marcus’s story, we’ll explore:

• How to help patients define recovery for themselves

• What to do when progress is slow

• How to hold space for both grief and growth

• And how the therapeutic relationship itself becomes the model for healing 

Because the goal isn’t just to feel better.
It’s to feel real, again.

Reflective Prompt for You
Think of a patient whose symptoms made sense only after you heard their story.
What helped you go deeper?
What did you learn about yourself in the process?

Sometimes the deepest work is done beneath the surface.

References

[1] Petersen, Anders. "Antidepressant Medication as Identity Construction: And So What?." Education, Parenting, and Mental Health Care in Europe. Routledge, 2024. 191-204.

[2] Rosenfarb, Irwin S., and Jacky Aron. "The self-protective function of depressive affect and cognition." Journal of social and clinical psychology 11.4 (1992): 323-335.

[3] Ruggieri, Vezio, Carmela Guiliano, and Antonio Fusco. "Relationship between depression and self-contact." Perceptual and Motor Skills 51.1 (1980): 195-198.

[4] Summers, Richard F., Jacques P. Barber, and Sigal Zilcha-Mano. Psychodynamic therapy. Guilford Publications, 2024.

[5] Martin, Rachel, and Jeffrey Young. "Schema therapy." Handbook of cognitive-behavioral therapies 317 (2010).

[6] Daubney, Michael, and Anthony Bateman. "Mentalization-based therapy (MBT): an overview." Australasian Psychiatry 23.2 (2015): 132-135.

[7] Greenberg, Leslie S. "Emotion–focused therapy." Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice 11.1 (2004): 3-16.