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I spent years in therapy, depressed the whole time, perhaps getting a temporary lift, but quickly losing whatever short-term benefit it may have provided. Apparently, this is a common experience for men, and usually the problem is traced back to the difficulty many men have in expressing feeling. They’re not comfortable with emotions, resist therapy and won’t let it work, even if they give it a try.

For the most part, I’ve accepted that explanation. Even though I had many doubts about the different types of therapy I had tried, I well knew that I had never really let the therapists see everything going on in my emotional life. I had rarely found therapists (luckily there were a couple of wonderful exceptions) who were willing to discuss, let alone rethink, their own approaches in any depth. The guiding assumption: We know this form of therapy works. It’s all up to you.

It was startling, then, to read an entire issue of a professional magazine devoted to the question: Why aren’t therapists more effective with men? The editors start with a couple of facts. Only a third of all psychotherapy clients are men, and that can’t mean they have fewer emotional problems than women do. They also regress after treatment much more often than women. So what’s wrong with what we in the psychotherapy community are doing?

I’d never heard therapists evaluating their own methods and suggesting that the reactions of men, though obviously not good for them, weren’t all that surprising. Yet that’s what these articles are all about. They find that many in the profession don’t really know how to respond and adapt to the needs and styles of men.

Writing in the latest issue of Psychotherapy Networker, four therapists describe the psychological dynamics that guide many men and offer examples of the techniques they’ve used to create more responsive and effective therapeutic experiences. The articles don’t talk specifically about depression, but many of the ideas are particularly relevant to depressed men. While all these articles are full of interesting insights, I found one especially helpful.

David Wexler, in Shame-O-Phobia: Why Men Fear Therapy, focuses on two critical dimensions in the lives of many men.

First is the effect of shaming experiences men often have in childhood at the hands of parents and others whose support and respect they most need:

A shamed boy becomes a hypersensitive man, his radar always finely tuned to the possibility of humiliation. His reaction to slights—perceived or real—and his ever-vigilant attempts to ward them off can become a kind of phobia. Tragically, the very men who are most desperate for affection and approval are the ones who usually can’t ask for it: instead, they project blame and rejection and perceive the worst in others.

The second dimension is what he calls the “broken mirror.” By that he means the need of people with inner shame to gain approval from others in order to feel good about themselves. Those reactions – imagined or real – assume tremendous psychological importance. Getting approval is a desperate need, losing it a devastating experience.

Shame-driven fear and the impact of mirroring make therapy difficult because it asks such men to do something they already know they don’t do well. Since it’s geared toward disclosing emotion, therapy can seem designed to meet the needs of women who are often more comfortable expressing and talking through feelings. The environment doesn’t feel safe to a great many men.

Wexler believes that emphasizing the need for emotional openness from the start of therapy only plays into the fear of failure. To make therapy more welcoming to men who are skeptical and nervous about it, he recommends to other therapists several methods that have worked in his practice.

Here are of some drastically edited summaries of these techniques.

Destigmatize Self-Disclosure: Therapeutic self-disclosure can be an effective way to reduce avoidance and defensiveness by nipping shame in the bud. … I often tell men stories about times I’ve yelled at my kids, said nasty things, and stupidly overreacted to them. I tell men about the many times I’ve stubbornly insisted that my wife and I do something my way without really thinking through how this would affect her. … I reassure them that self-revealing will not lose them my esteem or confirm their worst fears of what will happen if they let down their guard. This is destigmatizing.

Permission to Disclose Gradually: In the beginning of therapy, it’s … important to give men permission to disclose gradually. It’s easy for therapists to get impatient when men take a while to warm up to the counseling experience. Often I’ll treat a man who initially minimizes the mistakes he’s made, blaming everyone else—his wife, his kids, his girlfriend. I don’t mess with this at first, because I know he needs to do this until he feels safer and more confident that he’ll get a fair shake in my office.

Provide Specific Plans: Since many men feel anxious about what they perceive as the vagueness of the whole therapy process, give them as much concrete information as possible. Tell them exactly how long the sessions are, what the length of therapy might be, the role you can and can’t play, and what’s expected of them to get therapy right. Offer homework, action plans, and the rationale for using them, since men’s needs and learning styles favor direct, clearcut explanations and instructions. I’ve found this valuable with almost all the men I see.

Clear, Brief Assignments with Time Limits: Recently, one of my male clients told me that his son had complained that he was making that “angry face” again—and my client had no awareness of it. The instant homework assignment: “Ask everyone in your family to let you know every time they notice your angry face or angry voice, and tell them that this is a direct assignment from your therapist.” He understood the rationale: you need feedback to improve performance. And he liked the clarity of the task.

Another problem comes up when men are urged to begin discussing their feelings and relationship issues with their partners. Many men delay this because they’re afraid it will turn into unbearable marathon sessions. So Wexler suggests setting a limit. “When you talk about this issue at home, set an alarm for 10 minutes. Discussion ends then, no matter what.”

Recognize Heroism: I tell men that, every day, they have an opportunity to give to their loved ones, including their kids, a man who’s generous, empathic, and honorable. A man can choose to inform his partner about what he’s feeling, rather than just withdrawing or acting out. I call this, or any of a thousand other “unnatural” pro-relationship behaviors, an act of genuine heroism. To choose a path that’s hard, unfamiliar, awkward, and even frightening—but which is more in keeping with what really matters to them—takes the kind of courage and resolve that characterizes, well, real men. … Men perk up when I implore them to act like heroes or reward them for doing so—rather than simply telling them to be more sensitive or more accommodating.

The goals of therapy remain the same, but these adaptations can make the experience much more approachable for many men. I’m not so sure, though, that they would have worked for me when I was trying hard, often quite unconsciously, to defend against revealing my deepest feelings. It was so unthinkable to let myself go that often I wasn’t even aware of what I was doing. Looking back, I realize I intuitively resorted to strategies designed both to seal off spontaneous emotion and to win the approval of the therapist. In my case, Wexler gets it right. Shame-driven fear and broken mirrors guided me all the way.

Adapting therapy, as Wexler suggests, to help resistant men open up is certainly a good idea. But a therapist can only do so much. A lot of depressed men like me can outmaneuver any number of sound methods. Getting lasting benefit from therapy is still up to me.

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Lately, I’ve come across a number of questions online by plainly anguished people, asking: Why do I have no friends, no life? The first time I saw one this blunt, I reacted almost defensively, laughing as I recalled an old film in which a man hires a private detective to find out why he has no friends. Isn’t it obvious? But I knew so well how much the question implied. Lonely and depressed, I had often asked that same question, or at least felt the need to ask it.

I wrote an earlier post about the difference  I experience between loneliness and depression. Loneliness is a sadness at the loss of close relationships. It drives me to reach out to people. Depression pushes me away from them. When I feel these two at the same time – as I can if the depression is not too severe – the tension of these opposing forces makes it all the harder to find the help I need.

Thinking back over many years of living with depression, I can quickly find many reasons why I had such trouble finding a friend to talk to when I most needed one. (I’ll set aside the much worse problem of not talking to my wife. I’ve said a lot about the reasons behind that, especially in this post.) Here are some of the problems from my experience. I can’t say how true they might be for others.

1. Sometimes it wasn’t I who had an issue with reaching out but friends who had trouble opening themselves to listen. Many people refuse to talk about depression or other serious illnesses. I first found that out when I had cancer. It was stunning to me that a few people I had known quite well simply disappeared from my life. Though I never heard any explanation from them, my wife and I believed they couldn’t face the risk of emotional involvement and possible loss.

   Depression adds another dimension. Many may feel helpless in the face of a friend’s pain and despairing mood. When I reached out for support, some friends were sympathetic but at a loss as to what they could do to help. And, of course, some friends are not in the habit of probing their own emotional lives and run from the idea of listening to someone else trying to go deeply into feelings. That’s a language they haven’t learned and never want to know.

2. One habit of my own depressed thinking was to assume that everyone I met had the same negative and contemptuous view of me that I did of myself. I projected my own shame into their minds and then retreated before the dislike I was sure they felt. It’s so strange to imagine that this could have been such a common occurrence, but it was. I stopped myself from reaching out because I “knew” these friends wanted to have nothing to do with me.

3. Then there was the isolating drive of depression, the belief that I was in too much pain to face anyone – too lost in despair to move. I believed I could survive only by cutting myself off from everyone, yet that only intensified the feeling of having nowhere to turn. I ruled out the possibility that anyone could break through the wall I’d put up around me. The result was that I went more deeply into despair. Eventually, the crisis passed, but it wasn’t the isolation that had helped me survive. That only increased the likelihood that I might push myself over the edge.

4. When feeling more numb than despairing, I could often get out and talk to people, even at social gatherings. But I became very nervous at what I might say. It wasn’t uncommon for me to make an attempt at getting to know someone or to get into a personal issue with a friend. But the words I found myself speaking were not at all what I intended. They had an edge to them, putting a jab into each pleasantry, souring a compliment with a sarcastic tone, or pouring out so much so fast that I sounded impossibly egocentric and uninterested in anyone but myself. I acted like someone I would never want to know. Of course, people could tell at once that I had “issues” and walked the other way.

5. So often, I had to mix with people when I wanted only to hide. I made it hard for anyone to find me, no matter how many people might be in the room or how prominent my role was supposed to be. Emotionally, I lost connection with what was happening and just watched it go by. I felt so small and tried to be invisible. If anyone asked me a question, I’d become tongue-tied, or, if I tried to say much, the words and thoughts came with painful slowness. It was impossible for anyone to talk to me.

6. At other times, anxiety and fear could hold me back from talking freely. Taking part in conversation was hard because I had to double-think everything I wanted to say. There was a danger in the simple spontaneity of conversation among friends – a danger for me of any uncontrolled talking. I had to reflect to get the words just so, and then would miss the right moment as talk flowed on to something different. It’s hard to imagine now, but talking freely felt risky, as if an inner violence might escape my control.

7. Apart from all this, there was the natural reaction anyone might have at suddenly hearing from me when I was in need of someone to talk to. Wrapped up in myself and in depression, as I was, my reaching out was an attempt to meet my own need in a one-sided way. Not only that, but my friends would not find me at all even if they wanted to listen and offer support. I wasn’t the same person because I was driven by the strange, isolating rules of depression. Even if I didn’t want to be hidden, I was nowhere to be found.

All this added up to a comprehensive strategy for remaining friendless. And that’s what it was – a series of my own actions to keep me isolated from the help that friends might offer and pull me out of the life I’d had with them. This hit me one day when I was the one who was asked to listen to a friend in the midst of a terrible depression.

I met him at a restaurant for lunch one day, and I could tell at once that he had changed in a way that made him hard to recognize. Of course, he looked and sounded the same, but there was nothing in his words or reactions that was like my friend. He was lost, partly in rage, partly in despair.

When I tried to tell him the deep sympathy I felt for what he was going through, that only made him angry. More than that, I felt a deep rage boiling inside him as his eyes stared through me with steel intensity.

It was especially hard to see him this way since I knew I was looking at myself.

What has your experience been in trying to reach out to friends when deeply troubled?

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I’ve written an overview post in this series on Depression Central, and I hope you’ll have a look at that. Thanks.

Talking to a depressed partner can be more than frustrating. It can feel hopeless when you’re faced with a slammed door shutting you out completely or a furious attack full of blame and rejection. If your partner says anything, the words are likely either accusing you as the cause for the onset of severe depression, or angrily denying there’s any problem at all. Or you may not get any response and have to deal with someone who is emotionally absent, empty of feeling, gone from the relationship. This is likely the worst crisis you’ve ever faced with your partner.

The First Step

I discussed in a previous post some approaches recommended by prominent authors to the partners of depressed people and mentioned Julie Fast’s “big picture” plan as the one that made the most sense to me.

The first step toward healing for your partner, as well as yourself and the relationship, is to recognize that it’s depression driving you apart. Both partners need to be able to sense the early signs of its onset. But only your partner can make a commitment to action and take charge of their own treatment. There are some ways you can help with this process, but you can’t do it for them or take on the leading role in recovery. That’s not your job. You didn’t cause the problem. You can’t cure it.

I’d like to describe here how difficult that first step of recognition was in my case and then look at a method for getting a clearer picture of what’s happening, one that proved effective for my wife and for me. With the understanding and insight gained from that work, it slowly became possible to communicate without getting caught up in confrontations driven by depression.

Recognizing the Shadow in the House

As I’ve mentioned in an earlier post, for years I had a very limited understanding of what depression could do. Apart from the feelings of bleakness and despair, I never grasped that so many other things I was experiencing were linked to this condition. That’s important to know because a partner may be in treatment for depression but not be dealing with all its effects and distortions of thought and feeling.

I assumed that other symptoms, now so familiar to those who have tried to educate themselves about this condition, were either a part of my nature or were caused by some external circumstance. The anxiety, the obsessive way of thinking, the inability to focus and mental blank-outs seemed to be limitations that I could not change, even though they were by no means permanent.

My constant negative thinking and the shame I felt seemed justified by my inner failings. Projecting negative judgments about myself into the minds and attitudes of others also felt like reality. That’s the way they must be judging me. Everyone should think badly of me because I was empty inside.

On the other hand, I blamed my wife for the problems I imagined were plaguing our relationship. I could certainly see that I was contributing to them, but that didn’t stop me from raging at her and our kids for everthing – and for nothing.

All of this made any real communication about what was happening completely impossible. I cast around me a net of control to capture and hold everything still. Most of my crazy behavior was based on fear of ripping that net. Everything I saw felt like part of me, an extension of my nervous system. On the surface, I was enraged at each unexpected tremor, sudden shift, raised voice, spontaneous action.

But anger can be a mask for fear, and inwardly I often burned in fear, even panic. Any effort by my wife to tell me what she was seeing in me and the effect it was having on her and our children only prompted more anger as I denied I had any problem and shut her out even more.

How did we begin to cut through the defenses and barriers to real communication? At calmer moments, we applied some tools we had learned from a therapist and gradually retrained our reactions to each other. That process made a breakthrough possible, but it was a long time coming.

Ideas on Coping with a Depressed Partner

As Julie Fast suggests in Loving Someone with Bipolar Disorder, making lists of what works with your partner and yourself is a helpful starting point. That process begins by writing down changes in behavior and learning how those changes relate to the symptoms of depression.

Then, it’s important to list the specific actions, tones of voice, words and physical gestures – everything you perceive when the familiar partner is slipping away into depression. These steps make it clear that depressed partners are no longer the same people you’ve known but have been transformed by a condition they may not recognize at all or just can’t control. Next, think about your own responses to what the “new” and estranged partners are doing. By writing down those reactions – not just the feelings but also what you’ve said and done – it may be possible to separate the responses that seemed to get nowhere from those that helped move toward a truer dialogue.

Julie Fast gives many examples of how to focus on what works, but she also understands how hard it is. Faced with irrational and abusive attacks that threaten the core relationship and tear into one’s own self-esteem, no one can stand back and calmly set aside the raw emotions of the moment. For one thing, the “well” partners have plenty of issues of their own. They may have experience with depression, anxiety, fears of abandonment, damaged self-esteem, a history of abuse. Everyone has vulnerabilities, and it is often those dimensions that are the targets of of a depressed partner’s abuse.

To be most effective, though, learning from such methods has to be shared, if at all possible. The burden can’t fall on one person. In our case, I had enough periods when depression receded that I could work with my wife in therapy and begin practicing ways of catching myself early on. That didn’t stop repeated episodes of illness, but it did give my wife something to appeal to when I started going into a tailspin. She could tell me what she was observing before I got out of control – the initial irritability, obsessive thinking, secluding myself, constant frowning, never looking directly at her. Her ability to do this gave me pause because I could see where I was heading. If I could admit to her that she was right, I was getting depressed, we could both focus on the illness instead of getting into a blaming match.

Many depressed partners are beyond reach and refuse to talk at all. Even in those cases, though, working through this method alone at least helps partners of the depressed avoid self-blame or the trap of believing they can fix the problem on their own.

But no matter how severe the depression, the effects of abuse and irrationality are real and can’t be allowed to continue. It’s especially important for the unreachable partners to face the consequences of the pain and damage they inflict on their familes. If nothing else works, a boundary has to be sharply drawn. More than once, I faced an ultimatum from my wife, and that forced me to acknowledge the havoc I was causing and to get serious about treatment. As addicts often say, it wasn’t until they lost everything that they finally admitted they were out of control and could begin recovery. Unchecked depression can be that bad. The illness pushes everyone affected by it toward destruction, and it can take extreme measures to stop it.

These methods helped us avoid the extreme, but every relationship has different needs. Does this one sound feasible in your case? Have you found any method that works for you?

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People – sorry -tweeple have been finding all sorts of uses for Twitter – live tweets from conferences, on-the-spot reporting from cell phones, group collaboration and even a webinar in 10 tweets, not to mention serious micro-blogging. You can tweet tweeple with common interests by using this format – #recovery, or searching at Twemes, and pick from many groups to join or form a new one (Twibes). You can search for tweeple to follow based on their stated interests (Twellow) and have the equivalent of a chat room using the private message feature. The best way to use the platform is not through the website but through a desktop client like Twhirl, Tweetdeck or Seesmic. You can schedule posting tweets through Tweetlater and add pictures through Twitpic. That’s just a start – twitter applications keep multiplying, and there seems no end of perfectly silly names for them.

Here are a few thoughts about recovery from depression.

• In early recovery, I tried to forgive myself for the childhood harm I never caused.

• Why so hard to say honest & feeling words, why so many bad-tasting bitter ones, so many sugary & false?

• If I could watch my recovery from a distance, I’d see a reaching hungry shadow at my back slowly disappearing.

• Real depressed men want recovery by changing partners, cities, jobs but always stare at the same mirrored face.

• Recovery is the small seed in winter that compresses all life in a tiny space & waits for the spring unfolding.

• If depression is Hell and recovery Purgatory, I’m sure not stopping there. Something’s up ahead.

• It’s a mystery. Depressed, I hid rage, fear, despair & fought each one in turn. In recovery, they vanished! How?

• Recovery like conversion sends waves of new self-belief, meaning & purpose crashing through everything.

• Recovery from depression begins with determination & a quiet stirring of imagination. You will do it.

• Recovering by medication alone stops symptoms, recovery from within opens life and the future.

• Now I can hear what people say to me and respond to who they are. Amazement makes me verbal once again.

• Recovery is a forecast of great weather amid storms of mild air and still broken blue skies.

• Recovery shocks me with unexpected laughter at the oddest times – beats the opposite.