The first thing to do is search for a hidden agenda. The man who hates his job, the woman who can't stand sex, the youngster who cannot compete with his peers in some way - they, and others like them, are all likely to harbour a reason not to get better, not to have to face the world and view their inadequacies yet again. Easier to stay out of it and blame the lot on their depression. We're not going deeply into ways of doing that here - suffice to say that gentle questioning about their lifestyle and what would be the first thing they would change, other than their symptom, is a good place to start. We also need to make sure we understand what they perceive to be a 'normal' state of mind and then help them work towards that state throughout their therapy - although if their idea of normal is very far from reality, we may have to work in a different direction or even consider the possibility of psychosis.

It is always a good idea to seek to in some way address the reasons that the client believes are the cause of it, if they have any, whether or not we believe they are right or not. We have to get their belief system in congruence with us and if we don't first address what THEY believe is the cause (or if we first start to address something which they believe is definitely not the cause) then that won't happen. Resistance will get in the way and speed is important here if we are not to risk the therapy becoming PART OF the problem - i.e. the client begins simply to accept that going to therapy is one more thing they do as part of their depressed life-style, instead of looking for improvement.

When we have explored what they brought in with them, or when the client has no idea what is at the root of it all (and especially if it has been long-lasting) then an analytical approach is probably best, using regression or free association. In truth, I could not clearly define what I do with any one client. I KNOW they have to feel I am their friend as well as their therapist and I KNOW they have to feel that I will treat them honestly. I have never had a problem with telling them that the therapy will take 'as long as it takes'. It definitely helps when I say that I usually see people for between 5 and 10 sessions, but that I am like a terrier with a bone, once I know we're on to something - I don't give up! The important thing is that their spirits MUST be lifted, at least a bit, every time they come to see you.

Talking of number of sessions, we should be unconcerned how long therapy takes (within reason), as long as we are working conscientiously and as long as we continue to believe we are going to get a reasonable result. Maybe somebody COULD do it faster. So what? The client is with you, not them. They could just as easily be with someone who was slower or maybe even totally ineffective. And that would only be with that particular client, anyway. Just give your best, all the time. Sometimes you'll get it right, sometimes you won't get it quite so right. ALL the time you'll be treating your client the best way you know how, whether you've been in the business for 10 months or 10 years or more, and ALL the time you will be learning new ways to help future clients. If you come to realisation that you've gone as far as you can go, then, if they're not where they want to be, find a competent colleague who is prepared to take them on, and refer them. The same is true, of course, if you realise you're simply out of your depth for some reason. Forget what other therapists might think of your efforts - it's the customer that counts!

Interventions

Since no two clients are the same, no two clients' illnesses are the same and depression seems to bear this out dramatically. They may be morose and determinedly non-communicative, hyperactive, weepy, apparently cheerful (beware the continual smile!), aggressive, resistant, submissive, compliant, apologetic... We need to be prepared to be flexible.

Therapeutic interventions that can work well are: silent periods; laughter; blowing 'stuff' away; shouting at the world or whatever; externalisation; inner child work; anything that is going to get your client realising something that is of immense importance - they are human and their mind and body work just like those of other humans. For what it's worth, I also teach them that they are not depressives. They are, in fact, perfectly normal people who have learnt how to feel depressed. They somehow learnt how to do that instead of something else that they would rather have done but for one reason or another were not able to. Their depression is a displacement activity and the sooner we find out what is was they REALLY wanted to do, the sooner they will start to feel well. In this way, we achieve something of immense importance - we begin to separate the client from their symptom.

The thing they are often replacing is anger, frequently anger at two people. One of them is sitting in front of you, but the other one has yet to be identified; find THAT person and the anger will surface from the depths of the subconscious. Usually, then, the depression fades very quickly indeed.

But what if their life outside our consulting room is so darned appalling that we can see straight away that NOBODY could be happy under such circumstances? Well, how would somebody who is not depressed, who is what your client may regard as 'normal' feel in that situation? They would feel unhappy! So we offer the client the chance to feel plain common or garden unhappy instead of depressed and explain that in this way they will gain the strength to address the stuff that is making them unhappy. They go for that, every time.

It is not unusual for the depressed client to state that they want to kill themselves. Now, I have discovered an enormously effective method to deal easily, quickly and safely with this situation. I usually say very gently: "Now why are you telling me that?". Think about it. If they truly wanted to do it, they would not tell anybody, because they know that somebody would try to stop them. Asking them why they are telling me - and helping them discover why, if they do not grasp straight away where we are going - encourages them to the realisation that whilst they may be having suicidal thoughts, they DO NOT WANT to commit suicide. They want to be saved. That old belief system thing again, plus, resistance to therapy has been lowered. In the nicest possible way, the client must never feel that they have any sort of hold over the therapist; the relationship between you and the client should be as level and equal as possible. That is part of what is going to get them better.

One more thing - we should seek to avoid painting a picture, during our initial consultation, that is too distant for our client to easily believe it. When they don't achieve the goal that they believe you have set them, their sense of inadequacy will be deepened. Not only that, they will believe that our sort of therapy does not work for them, even if it does for others (because you will have told them it does) and this will add to their depressive state - it will actually make them worse. I usually say that we will get them out of the depths that they are now in and then reassess the situation to see where to go next. I usually SAY that, but it does not usually happen - they just go and get better! Just the fact that they are not being expected to get better in one go is enough to allow them to work towards a more reachable goal and the next thing you know, they are feeling somewhat as they believe they should feel - which, of course, you have elicited at the beginning of therapy.