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In an interview with The Wall Street Journal, Dr. Nancy Burgoyne discusses how you can help someone who is depressed

Nancy Burgoyne, Ph.D., ABPP
• November 26, 2018

Dr. Nancy Burgoyne describes how to help a loved one who is suffering with depression in an interview with Elizabeth Bernstein, Bonds columnist from The Wall Street Journal.

Read article in The Wall Street Journal

How Can You Help Someone Who Is Depressed?

An expert describes how well-meaning offers of support can go awry — and how to really make a difference

By Elizabeth Bernstein
November 26, 2018

A person who is depressed needs as much support as someone suffering from any other serious illness, such as cancer. Yet depression often makes people isolate themselves. It can change their personality and sap their energy. And it can make them resistant to assistance.

Nancy Burgoyne, a licensed clinical psychologist, discussed why even the most well-meaning offers of support sometimes go awry and gave advice on how to help a loved one who is depressed. Dr. Burgoyne has been a therapist for more than 25 years and is the chief clinical officer at The Family Institute at Northwestern University, where she oversees 170 therapists and teaches marriage and family therapy at the Center for Applied Psychological and Family Studies, the institute's research partnership with the university. Here are excerpts from the interview.

How can you tell if someone is depressed?

Dr. Burgoyne: The usual symptoms include a change in sleeping pattern and appetite, feeling sad or less expressive, an inability to concentrate, irritability, easily angered or tearful, no longer taking pleasure in things that were formerly pleasant, social isolation, negative or irrational thoughts.

My advice if you observe these things for longer than a week or two, Ask, “I don’t want to be intrusive here, but are you okay? You do not seem like yourself and I wanted to check in.”

It can sometimes feel impossible to help. Why?

Dr. Burgoyne: Depression isolates. The depressed person tends to be more internally focused. And what they are hearing from themselves is a highly negative tune that does not motivate them to relate to others. They may hear thoughts like: “People don't care,” “No one will put up with me or really wants to help” or “If I tell you what I'm thinking, you'll reject me or think I am crazy.”

And because depression is also a total mind-body experience that makes it hard to concentrate or access energy or motivation to do simple tasks, like bathe or be present during a conversation, the depressed person struggles to participate socially. A client of mine asked: “Should I show up in sweat pants and dirty hair and hope I can focus, or should I not show up? Because I can't shower, dress and get myself there.”

There is a way to be there for someone without putting pressure on them. Provide your presence, your acceptance and distraction.

Friends and family members can play an important role, but do not help when they make it their mission to “fix” the depressed person. The person does not want their family members to suffer or to need to perform for them. Family members cannot help but be impacted. But finding a balance between care for self and care for others is especially important in the relationship with a person who is depressed.

Are there things people do that are not helpful?

Dr. Burgoyne: People sometimes say things casually that are meant to be reassuring but ring hollow: “It’s going to be OK,” “You'll be fine” or “I’ll call you tomorrow,” but then they don’t.

Most people mean for these reassurances to be genuine. But there’s a difference between a glib “it’s going to be OK” as a way to wave the depressed person off and genuinely communicating that it will be OK because you will be there for them while they are going through it.

Other things that are not helpful include telling the person to just “snap out of it”; not understanding that depression is an illness and treating it casually; having the same expectations for your loved one that you would have if they weren’t depressed; not educating yourself about depression.

Also not helpful is letting the person ruminate. Research shows that social interactions that are overly focused on discussing the depressed person’s problems or negative thoughts may be counterproductive. This can be a tricky balance to strike. Compassionate listening is helpful. But co-rumination is not. The difference is when you are really listening, the conversation moves forward. When there is no forward momentum, when it's the same thing over and over, it’s time to change the channel. And you can do that respectfully. You can say: “I know that this is driving you crazy and I’m here for you. But this isn’t very helpful to go over and over.”

What is helpful?

Dr. Burgoyne: Ask your loved one. Not everyone needs the same kind of support. Some people value encouragement. Others experience it as pressure. Some value instrumental support, a favor such as picking up milk. Others find that patronizing.

There is a way to be there for someone without putting pressure on them and without joining them in their focus on the negative thoughts. Provide your presence, your acceptance and distraction. Set a low-pressure agenda: Go to a movie. Hang out and watch an amusing TV show. Cook together, talk about your own life a bit, ask about a topic that interests them. Respect when they have had enough.

Depressed people often resist getting professional help. How can you encourage them to go?

Dr. Burgoyne: You can offer to help them find a therapist or encourage them to see their primary doctor. But harping on them is not helpful. They may feel ashamed with needing help, particularly men. They may need some time to come to terms with the fact that they can't fix it on their own. If you have had an experience that you think might relate, you can offer it up.

Depression can be hard on relationships, especially couples, right?

Dr. Burgoyne: Yes, because the depressed person is unavailable. They may be withdrawing from contact, not contributing to the household, not participating in things to enjoy together. As a result, one of a number of things can happen. The person who is not depressed can become angry or hurt. Or they may try to take over and become a superhero in an effort to be helpful. So many dynamics get set in motion that then the relationship needs help, not just the depressed person.

The best way to address this is with a couples therapist. A professional can help the couple work within the limits that the depression presents while helping them stay connected and well-functioning.

Should you leave your loved one alone if he or she pushes you away?

Dr. Burgoyne: Not for long. Respect that the person with depression has limited capacity for engagement, so they may have less to give. Talk about this and establish an understanding: “I respect that you want to be alone, but I don’t want us to make the mistake of having you be alone for too long.” Then go back to introducing the low-pressure agenda.

If you suspect that someone is suicidal, ask them. You will not give them the idea. I have never heard from anyone who suffers with depression that they mind that question when it is asked directly and with care. When you suffer with depression, hearing that your life matters enough to someone for them to ask “are you safe?” is meaningful.

Nancy Burgoyne, Ph.D., ABPP

Chief Clinical Officer
Nancy Burgoyne, Ph.D., (she/her) is the chief clinical officer at The Family Institute at Northwestern University. She is a licensed clinical psychologist and a family therapist who abides by the scientist-practitioner model. She has more than 30 years of experience providing direct service to clients, and for more than 20 years, has supervised and served as a leader to her fellow clinicians. In Dr. Burgoyne's current leadership role, she created and oversees The Family Institute's continuous clinical quality improvement team. She led the integration of teletherapy into the practice, established the Clinical Practice Advisory Council, and leads the organization's effort to provide continuous learning opportunities for clinical staff in order to ensure high quality care. Dr. Burgoyne is a faculty member in the Master of Science in Marriage and Family Therapy program and has extensive experience developing graduate school level systemically oriented curricula. Dr. Burgoyne is committed to approaching her work with cultural humility and believes that every human being is worthy of compassionate witnessing.