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Depression: Two Types, Two Treatments

by: Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice)

We’re used to thinking about depression in terms of its symptoms: for example, depressed mood, inability to feel pleasure, sleep disruption, and loss of appetite, weight, and/or sexual desire, among others.

But, have you ever thought about there being two types of depression? 

Some mental health professionals have begun to focus not just on symptoms, but also on the everyday life experiences associated with depression: feelings of loss and of being abandoned and unloved on the one hand, and feelings of worthlessness, failure, and guilt on the other.

Based on these two different experiences related to depression, Sidney J. Blatt, a professor emeritus of psychiatry and psychology at Yale University’s Department of psychiatry, along with his colleagues, distinguished two types of depression.

One type of depression is the “relational” type, sometimes called the “anaclitic” version, from the Greek word for “to lean on.” Typically, this depression is characterized by feelings of loneliness, helplessness, and weakness, as well as intense and chronic fears of being abandoned and left unprotected and uncared for.

The other type of depression is the “self-critical” type, sometimes called the “introjective” type. Typically, it’s characterized by feelings of unworthiness, inferiority, failure, and guilt. Introjectively depressed individuals engage in harsh in scrutinizing and evaluating themselves. They have a persistent fear of criticism and of losing the approval of others.

Not only do these two types of depression reflect two different internal experiences of depression – “I’m empty, I’m hungry, I’m lonely, I need a connection” (relational) versus “I’m not good enough, I’m flawed, I’m self-indulgent, I’m evil” (self-critical) – they also indicate different therapeutic needs.

Research shows that those who are relationally depressed are more responsive to the supportive interpersonal or relationship aspects of therapy. In contrast, those who are introjectively depressed are more responsive to the interpretive or explorative elements of the treatment process. A mental health therapist who understands different types of depressive experiences can help a range of depressed individuals understand themselves better and also overcome the difficulties that come along with depression.

Psychotherapists at CFIR can support you to deal with your negative beliefs of self and other, and the relentless characteristics that might be at the root of your depression. We integrate cognitive-behavioral, mindfulness and acceptance and commitment, and psychodynamic-based approaches to help you deal with the thinking that might be contributing to your depressed moods.

Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice) is a psychologist in supervised practice at the Centre for Interpersonal Relationships (CFIR) in Toronto. Dr. Vasilovksy works with adult and couple clients from an integrative therapeutic perspective, and helps them overcome difficulties related to depression and mood, anxiety and stress, trauma and PTSD, interpersonal conflict, major life transitions, and identify-related struggles.