These patients are frequently refractory to conventional antidepressant drug therapy or psychotherapy. The aggression or frustration identified in the affect is mobilized and rechannelled into self-fulfilling ways of being. The question concerning what is most troubling about a patient's situation often evokes responses that trace the pain of these patients to their early memories of trauma. Expression of empathy is then possible, and these patients are encouraged to explore strategies to deal with their pain. The session serves to remind both patient and physician that the burden of responsibility for this work rests with the patient.
Dependency is discouraged.
Instead, the physician is a valued, concerned ally. Illustrative Case . Unipolar depression was diagnosed, and an antidepressant was prescribed. In follow-up visits, the patient described a current abusive relationship, as well as severe physical and sexual abuse in the past. This patient spoke frequently of feeling fear and anxiety.