Helping Him withTreatment: Psychological

Now that you know more about male depression and about the different ways that you can be both understanding and limit-setting, it is also important to know about all the different treatment strategies for depression – and how you can encourage your partner to utilize them.

Although this book isn’t a treatment manual for depressed men, it is a guide for the people who are in relationships with them. It is in your best interest to be as knowledgeable as possible about the variety of available antidepressant strategies: psychological, biological, and behavioral. You can be a valuable resource for your partner if you can recommend different therapies, one or more of which might hit the mark for him. Between this chapter and the next one, you will develop at least a basic knowledge of the most important interventions.

Throughout this chapter, you will learn about what we currently know about alleviating depression, and especially male-type depression, without medication or strategies that involve the physical (nutrition, alternative medicine, etc.). The biological and medical interventions are in the next chapter, and what we know about psychological, behavioral, and interpersonal interventions are in this chapter.

HELPING HIM REMEMBER WHATHE ALREADY KNOWS

A great teacher of mine, famed psychiatrist Milton Erickson, used to say, “There are so many things you know how to do, it’s just that you haven’t always known that you know them.” While we all know that people suffering from depression can benefit from new interventions that they have never tried before, one of the guiding principles in helping people cope involves helping them remember how they have been successful in the past. Success here may simply mean that they recall times in the past when they survived a depressive episode or maintained a reasonably positive attitude in the face of difficult circumstances. It may mean times when they felt sluggish or lethargic and started exercising more. Or it could be times when they told someone else how they were feeling and ended up feeling unburdened and less lonely.

When planning any kind of treatment or intervention, the first question I always ask a depressed man is “How have you been successful with managing your depression in the past?” The answer to that question, often quite idiosyncratic, leads to the conclusion that many of the skills necessary to pull out of his low moods already exist as part of his behavioral repertoire. It’s just that he has forgotten them, or that the weight of some emotional burden, stress, or biochemical breakdown has temporarily blocked his access to the warehouse of information that predates this current state.

Remember that there are many things you know how to do, it’s just that you haven’t always known that you know them. Remind him of this whenever you can. Remind him of what you have always loved about him and how he has been successful on so many levels at so many different times in his life.

BASIC STRATEGIES

In the exercise below is a list of basic guidelines that a depressed man should keep in mind as he tries to find a way out of the depressed mood and depressive behaviors. All of these will be explained in more detail throughout this chapter.

EXERCISE: Strategies for Managing Depression

In your journal, make note of the strategies below that you think you could suggest to the depressed man in your life, ones that he might be reasonably receptive to. Try bringing these up to him in language that is comfortable to you and that you guess will be comfortable to him.

For example, you may just decide to show him this list and go over it together. Or you may want to encourage him to exercise by saying, “It would be really fun if we worked out (went swimming, played volleyball, went for a walk, etc.) together. Want to join me?” If he is feeling overwhelmed by the prospect of accomplishing a task like cleaning out the garage, you could suggest this: “Let’s just carve it up into small chunks. Saturday, let’s just go through and clear out the old stuff we don’t need. We can do that in an hour. Then next weekend, we’ll take an hour to go through the small tools and boxes of crews and get them organized. If we put in an hour every weekend, it’ll be done in six weeks without a whole lot of pain.”

STRATEGIES

He needs to get some exercise! For a thousand reasons, this is one of the most potent interventions for depression. He can benefit from discovering, or rediscovering, any activities or relationships that offer him a sense of meaning and fulfillment. He may have to think about this more carefully than he usually does and push himself to engage in them even when he doesn’t feel like it.

He needs to keep his goals realistic and expect his mood to improve gradually, not immediately. Any improvement should be celebrated. One day at a time! It can really help him to find someone – his kids, somebody else’s kids, employees, homeless people at soup kitchens, friends – to whom he can offer something of himself. This is not only nice, it’s also very selfish in the best sense of the word.

He needs to break large tasks into small ones. There is nothing more discouraging than looking at a whole house that is a mess. He can think of it as one room at a time, or even one corner at a time. It is really helpful for him to try to be with other people and toconfide in someone, and to let his family and friends help him. Anhedonia is his enemy; finding any activities or people that offer him some spark of pleasure will help. He should try not to make any major decision when he is in the thick of the depression – especially the ultimate permanent decision of taking his own life. Depressive moods play tricks with the brain and judgment cannot always be trusted under these circumstances.There is nothing more important than for him to keep track of – and challenge – his self-talk and the stories he tells about himself, his relationships, and the future.

He needs to adopt the philosophy of “Fake it until you make it.” Even if he doesn’t feel like exercising, playing with his kids, or cleaning out his car, he should do it anyway. The more he acts like a nondepressed person, the more likely it is that he will become one.

THE POWER OF NEW STORIES

The stories that a man tells himself about his life and his relationships can either destroy or enhance his mood, symptoms, and behaviors. The narrative can easily intensify the avoidance, withdrawal, and acting out – or liberate the man to handle the challenge of depression in new and more successful ways.

The negative narratives are known as depressiogenic thinking: self-talk patterns that generate depression just like carcinogenic substances generate cancer (Seligman 1998). What this really boils down to is helping men develop what Seligman describes as flexible optimism (1998). This is based on his studies clearly indicating that optimism is usually a more psychologically healthy perspective, but only in situations where it is based in reality. For the man who sees a job setback as resulting from some personal law (“I’m stupid”), thus feeling more depressed, treatment involves helping him develop a story based on something he can change (“If I developed better skills in that area, I’d be more valuable for my company.”)

You can’t change his stories. Only he can do that. But you can recognize how powerfully these stories govern his moods, attitudes, and behaviors. If you understand how these work, you can offer him some gentle feedback or influence at crucial moments to help him keep his stories in perspective (explained in the “What you can do” sections in the pages to follow).

The most widely researched and used clinical intervention for depression is known as cognitive behavioral therapy. This is a treatment approach based on the theory that how one thinks about issues in one’s life will have a direct impact on mood, emotions, and ultimately behaviors. The treatment approach involves the dual strategy of targeting and challenging dysfunctional beliefs (also known as self-talk, self-cognitions, stories, or personal narratives) and encouraging new behaviors that are likely to lead to symptom relief and personal development.

What you can do.

Encourage his therapy. Encourage him to read self-help books that emphasize cognitive behavioral approaches, like Burns’s The Feeling Good Handbook (1999), Seligman’s Learned Optimism: How to Change Your Mind and Your Life (1998), Yapko’s Breaking the Patterns of Depression (1998), and McKay and Fanning’s Self-Esteem (2000).

EvidenceSeligman identifies the four basic strategies by which someone can dispute the labels or stories that are plaguing him. The first strategy is evidence. The absolute most powerful intervention for a man to change negative, pessimistic, depressiogenic beliefs is to prove to himself that they are not accurate. Or at least not as comprehensively and morbidly accurate as he has come to believe.

What you can do.

When you hear your partner saying that he feels left out in social situations, gently point out to him the situations in which this has not been true, when he has actually fit in just fine. Or if he is feeling discouraged about blowing up at the kids, remind him that last week your son said to you,” Daddy’s not getting mad as much as he did before, is he?”

Alternatives

There are almost always multiple alternative narratives to describe a life situation. The more optimistic man has the capacity to focus on the changeable, the specific, and the nonpersonal: “I don’t have to keep doing this. It has only happened in certain situations and not in others, and many of these times it has not been my fault (or at least there was plenty of responsibility to go around).” This leads to a conclusion that is not ridiculously rosy, but simply realistic: “It’s not great, but not as bad as I thought.”

What you can do.

When your partner blames himself for not being successful enough in is job, acknowledge that he has made some mistakes in judgment – but gently point out to him that one job does not a career make. Or, when he looks in a mirror and says, “I’m really losing it, aren’t I?” you can joke with him about how normal it is to get a little bulge at his age. It does not have to be a sign of personal weakness.

Implications

Seligman’s third strategy focuses on implications. Even if this belief is correct, how bad is it really? What does it really suggest for the future? This his challenge in self-talk requires the capacity to “decatastrophize” the story.

What you can do.

Encourage him to think like this: “Okay, even if I did fail at this job, I still have a lot of other opportunities and skills. This doesn’t mean I am stupid or a failure.” Whenever you can, remind him of all the positives in his life – including you. And always remind him that this tough period is temporary. You have both been through these before, and you will weather them again.

Usefulness

Usefulness is Seligman’s fourth strategy. Even if a negative belief is true, get practical with it. Is it doing him any good to keep focusing on the belief? “Yes, it is probably true that I keep withdrawing in social situations whenever I feel like people are judging me. And it probably gets in my way in terms of people feeling comfortable with me or liking me. But what is the point of focusing on this? It just makes it worse – which is the last thing I need!”

What you can do.

Point out to him that the regret he feels about being a distant or even abusive father when the kids were younger only has value if it motivates him to change. After that, it is simply paralyzing. And remind him that his most important values as a father will not be honored if he shuts himself down. If he is having trouble performing sexually, suggest that the two of you just spend time touching each other nonsexually in bed – because his worrying about performance is only making the situation worse.

From Blaming to Twinship

As we discussed earlier, one of the nastiest features of male depression is the pattern of blaming. This blaming pattern is in direct proportion to the man’s lack of tolerance for experiencing negative emotions and identifying himself as weak or powerless. He blames others (and especially you) when things don’t feel right instead of either blaming himself or simply recognizing that shit happens.

The twinship perspective is much more adaptive at this point. Twinship refers to the need we all have to be members of the same club or clan: the experience that “we are all in this together” or at least “neither of us is perfect.” Here’s an insight about twinship from one of my male-type depression clients:

My wife and I took off with our kids to the beach, and she forgot to bring the baby wipes. In the past, when I was depressed and everything irritated me, all I did was get mad at her and tell her how stupid she was. Now it looks different. Don’t get me wrong – it’s still irritating when she does something like that. But I forget things too. We’re in this together. When I remember that, I can blow it off rather than blowing up.

Here, the two of you are profoundly alike. You are no longer the enemy, but rather a comrade along the difficult road of life who is also suffering, feeling deprived, worried, or not totally and completely fulfilled. When he thinks of his relationship with you as a twinship experience, he is less likely to feel resentful and victimized. And he is less likely to approach you in ways that will make you defensive!

What you can do.

When he is blaming you or feeling sorry for himself, remind him that the two of you are in this together. It helps if you can deliver this message without sounding angry and defensive. If you can get through, you will be offering him a profoundly valuable antidepressant by helping him rewrite his depressiogenic narratives. Or, when he feels defeated by trying to get the kids to listen to him, remind him of how often you feel the exact same way.

Religion and Faith

Perhaps one of the most profound examples of how personal narrative can determine mood and coping skills is evident in the relationship between religious belief and depression. Studies have found that churchgoers, in general, experience less depression than nonchurchgoers (Brown and Harris 1978). Depressive and pessimistic men tend to see failure as something that is a lasting source of hopelessness. Churchgoers or not, people of faith often have the capacity to maintain a larger perspective. A belief in God and an afterlife often means that life setbacks are only temporary defeats. A person with faith can reframe them in that context: “Bad things that happen to me all have meaning. They provide lessons. They are all part of God’s plan. In the afterlife, I will suffer no more. That which does not kill me makes me stronger.” And Hindus or Buddhists may perceive suffering as an opportunity to deal with karma – with another chance to get it right in the next lifetime.

What you can do.

Don’t try to ram religion down his throat. But if the depressed man in your life is religious or is even open to thinking in spiritual or religious terms, it can be enormously comforting and inspiring to remind him that his setbacks and his faults are tremendous opportunities for growth and a renewal of faith. They may even be viewed as part of a divine plan for him, which strips them of the toxicity and allows them to be actually welcomed as gifts. You may find it helpful to remind him that God has a plan for him, and some of the rough times he is going through are all part of the plan.

DISTRACTION: THE ANTIDOTE TO RUMINATION

Ruminations are mantras. They circle around in our brains and loop again and again and again. They won’t cut us any slack. Ruminations, actually, can be either positive or negative. But ruminators who are also pessimists are otherwise known as depressives. That particular combination, in fact, is especially potent. Even people who are pessimistic in their personal narratives can usually avoid the more oppressive levels of depression if they refrain from ruminating.

Wenzlaff reports that there is an automatic quality to the negative thinking of depressed people (1993). The negative thoughts are right out in front of them and easy to grab on to, interfering with the ability to focus elsewhere. In contrast, positive or more realistic self-talk fades into the background. Anyone who is depressed suffers from a particular deficit in the suppression of negative material.

Ruminators often convince themselves that they are doing some important work by thinking things through very carefully. This may be true for the first ten minutes, but not for the next few hours, days, or years. One example of ruminative thinking is that of the man who goes back and forth and back and forth about an important issue – and then makes an impulsive decision anyway. Changing either rumination or pessimism helps relieve depression. Changing both helps the most.

Distraction

Research (Tice and Baumeister 1993) and common sense are unified in recognizing the value of distraction as a way to allow the brain and nervous system to shift gears when a person is upset or depressed. In fact, in all mood management (including depression,anxiety, and anger), distraction emerges as a most potent mind-altering technique (Zillman 1993).

Simply put, rumination prolongs depressed mood, and successful distraction shortens it. Both depressed and nondepressed people report that one of the most common ways they attempt to cope with unwanted thoughts is to try to eliminate them by thinking of something else (Wenzlaff 1993).

However, just “thinking it over” is not always the ticket if a guy is depressed. Many men who ho just try to “take a break and think things over” are more than likely to use the time to ruminate about things that depress them rather than focus on something that is positive or at least neutral and distracting. Studies show that nondepressed people are able to let go of focusing on disturbing events over time (Wenzlaff 1993). Depressed people, however, actually become more and more obsessed with the bad events, even as they get further away in time from when they happened.

If distraction helps your partner pull out of the depths of a depressed mood or helps him manage his critical, blaming, and destructive interactions with you or the ids, then it’s a brilliant and creative use of his personal resources, and you should encourage it. Obviously, if he consistently employs distraction and never comes around to face the meaningful issues that are bothering him, he will eventually suffer. But, used in moderation, the capacity to employ creative distraction is a gift and a sign of emotional intelligence.

When employing distraction (which some people do naturally, others need to do less of, and still others need to learn how to do better), the basic advice is to engage in pleasant, absorbing, and comparatively unexciting activities that do not stimulate more anger, depression, or anxiety.

EXERCISE: Creative Distractions

The list below identifies some tried-and-true distractions that might be useful for your depressed partner. Read through these and check off any that seem worthwhile (or even remotely likely to be received well) to recommend to him. You are not his therapist, but many any of these are based on common sense, backed up by research, and (if you catch him in the right mood) may allow you to help him out.

Whenever I recommend various strategies that may be of help to your depressed partner, you have two basic options for how to utilize them: either tell him you read about the techniques in a book and that you’d like him to go over them with you because it might help him; or find some subtle way to encourage him to think or act on these things himself. For instance, “I know you’re feeling down, so let’s rent some really light comedy together and just try to break the mood.” Or “It would be great if you would go out and play soccer with Katie. She’d love it and it would probably do you some good, too.”

DISTRACTION TECHNIQUES

Absorbing mental activities: TV, movies, listening to music, reading, video games
Pros and cons: He feels better because he can’t remember exactly why he felt sad or upset, but he needs to be careful about retreating excessively to passive activities like TV or video games.
Mood-lifting distractions: Funny movies, inspiring books, watching sports (as long as his team is winning!)
Pros and cons: The best distractions actually lift his spirits, but he can’t always count on these to be available.
Exercise: Walking, running, working out, team sports
Pros and cons: One of the best sources of distraction because it is so physical and because it stimulates endorphins, but he needs to be careful of ruminating while working out or of engaging in anger-stimulating activities (punching bag, aggressive basketball game).
Relaxation techniques: meditation, self-hypnosis, visualization, yoga
Pros and cons: Excellent for cooling down physiologically from anger or anxiety, but not as helpful for depression because there is too much room for unstructured negative mantras.
Personal pleasures: Massage, Jacuzzi, favorite food, listening to music, sex, buying something
Pros and cons: Anything that activates pleasure can come in very handy – except if it leads to negative consequences (drinking, drugs, overeating, spending money). Also, he needs to be careful about sex as an antidepressant – you may not want to sign up for that.
Accomplishments: Cleaning the garage, balancing the checkbook, writing a thank-you note, taking care of some phone calls, finally getting the clock right on the VCR
Pros and cons: This activates a feeling of self-efficacy (or personal competence) and distracts him from the unhappiness or powerlessness that he was experiencing.
Helping others: Playing with his kids, volunteering his time, tutoring, coaching his kid kid’s soccer team
Pros and cons: Helping others reinforces his feeling of being needed and valuable, and also absorbs him in a task separate from ruminating.

Thought Stopping

The classic intervention aimed at negative-thought distraction is known as thought-stopping – simply ordering the brain to stop the negative thoughts and get on a different track. Let’s look at an example.

Your partner starts worrying about how ineffective he is in dealing with his kids. This self-critique, looping around in his brain hour after hour, has not helped him change his behavior or understand himself better. It is just paralyzing and often brings out even less-effective behavior.

Thought-stopping derails this negative cycle by stopping these thoughts. One thought-stopping technique is to snap a rubber band on the wrist and loudly say “Stop!” Try it. The thought chain will be broken. Or try carrying a card with the word “Stop” in bright red letters and looking at it when the ruminating starts. This works very well for some, not as well for others.

What you can do.

Make sure he knows about this technique. Sometimes the simplest interventions have an impact. Or, if he is willing, develop a playful secret signal so you can remind him when you notice him heading down the rumination track.

CompartmentalizationYour partner may also find it helpful to employ the technique of compartmentalization, or making an appointment with himself to focus on worries only at and for a specific time. He starts to worry. From painful past experience, he knows where the worrying will lead. So he makes a deal with his brain. This appeases the worries. They get the message that they will be attended to, so they don’t have to constantly demand attention.

What you can do.

Compartmentalization is especially valuable for the depressed man who is also a worrier. And you can help him use it by providing him with a time and place to exercise these worries. Suggest that you can be available to listen to what’s worrying him. “I promise to pay attention to what you’re worried about, but this isn’t a convenient time. Let’s schedule in fifteen minutes tonight at seven to talk. I promise to give you my complete and undivided attention for these fifteen minutes.” Offer yourself as an audience for the scheduled fifteen-minute worry period. During that period, your job is only to listen to his doubts, obsessions, and regrets. Only respond with questions to help draw him out. Offer no suggestions, no problem solving, no reassuring. Save those for another time. When you help him establish a specific box or compartment like this, you are helping him keep his worries in perspective. The message is “Yes, your worries are to be taken seriously – but they don’t have to consume you.”

Focusing on Positive Thoughts
A third approach for generating distractions involves specific focusing on positive thoughts. The strategy here is to prepare a specific sequence of positive thoughts that can replace the negative ones. He owns those positives, and nobody can take them away from him.

What you can do.

Your partner can do this for himself. Some people focus on the positive naturally, others need to discipline themselves to do it. You can also help him. If your depressed partner starts ruminating about something, you should empathize, then remind him of the flip side. For or example, if he is ruminating about all the things that are wrong with the kids, you can say something like, “Yeah, I know we can’t get Brian to read a book and he’s hard to manage at school. It worries me, too. But he’s still till a great kid in so many ways: a great heart, a quick mind, the best soccer goalie in the district. We have to keep reminding ourselves about these things when he worries us.”

NEW HABITS: FAKE IT UNTIL YOU MAKE IT

A central factor in maintaining depression is the man’s pattern of depressive guy’s habits. Sleeping late. Staying up late. Avoiding social situations. Withdrawing emotionally. Keeping things to himself. Drinking. Compulsively flirting or philandering. Having a messy room, house, car, or workspace. Criticizing you and others. Complaining.

And, although many people find this concept foreign, it turns out that one of the most effective components of treatment for depression is the conscious choice to engage in nondepressed guy habits instead. Even if he doesn’t feel like it or if it feels unauthentic because it does not spring from an organic process within, jumping into more positive behaviors can help turn a depression around.

Since depression is composed of an interactive cycle of thoughts, feelings, biochemical processes, and behaviors, it turns out that interrupting or changing any of these usually has an impact on the rest. Obviously, if he can change the feelings associated with depression, the other depressive symptoms usually abate. And we see that if he can change his self-talk, the domino effect is likewise powerful. Changing biochemistry through medication, exercise, or herbal remedies will have an impact on the rest.

Changing Depressive Behaviors

The same is true with depression-related -behavior patterns. If he starts acting like a nondepressed guy, he is more likely to start feeling like a nondepressed guy. This is partly due to self-image and self- efficacy: “I’m exercising more now like I used to. Depressed guys don’t usually do this, so I must be less depressed!” And it is partly because the behaviors which nondepressed guys engage in help to fend end off depression. They keep men active, involved, connected, and successful. Or at least offer them just enough of these experiences to feel good enough about themselves and their lives.

What you can do.

This strategy for treating depression is simple. Tell him what you have been reading about this, and make this suggestion: “This book on depression that I’ve been reading says you should just try acting like a nondepressed guy. Just pretend. Let’s try remembering times when your behaviors didn’t look or feel like depression andrevive them – even if you don’t feel like it.” As with many of these recommendations, you may determine that your partner would feel offended and act defensive if he knew you got these ideas out of a book. You can always approach him just by presenting this like it’s a casual idea based on your personal wisdom: “Sometimes it helps just to act like you’re feeling up for doing something even if it’s not really true. We just have to help get you out of this rut, and maybe your feelings will follow.”

Specific and Concrete Instructions

Many men respond best to very specific and concrete instructions about how to pull out of depression rather than more general guidelines and insights. Many women don’t make their expectations clear enough; they expect their partner to get it in the ways that they or other women usually understand things.

Divorces initiated by women of depressed men often come at times that are very unexpected for the men, because they have never clearly heard their wives directly asking for the things she needs. Many depressed men are at their best when they are asked for specific, concrete things. Some of the emotional intelligence deficits that many men suffer from require you to spell your needs out for them. Your partner may feel more generous, protective, and effective when he knows precisely how and what to offer you. Even empathy, to a large extent, is a learnable skill. He can act like the nondepressed guy that you fell in love with if you show him what to do. I don’t mean to suggest that this is easy and automatic, but “faking it until you make it” has more potential impact than most people think.

For men who have been engaging in behaviors that both reflect and perpetuate the depressive cycle, the assignment is simple to explain (although, obviously, a little more complicated to consistently execute). Guide him into making an effort to try something different, considering it an experiment to see how he feels, what he fears, and how else he can use his time more constructively for himself and others.

What you can do.

In a supportive and noncritical way, ask for very specific behaviors from your depressed partner that would really make a difference for you. Always frame these requests positively (what you want instead of critically telling him what he shouldn’t do). And if he is reasonably successful at pulling them off, make sure to notice and let him know how much it means to you.

Here are some examples:

“I would appreciate it if you would not log on to the Internet until you have been home at least one hour. Let’s just try it and see.”

“It’s important to me that you check your temper at the door when you walk into the house.”

“When the kids want your attention for something, I would really like for you to try to stop everything and offer it to them.”

“I’d really like you to let me know every day something you appreciate about me – even if you’re in a bad mood or mad at me for something else.”

“When I tell you something that upsets me, please try saying ‘Wow, that must have really worried you’ without getting defensive, trying to correct me or problem-solve, or watching a football game at the same time.”

“It would mean a lot to me if you would tell me at least once each day about some emotion you experienced that day – not just anger, but worry, uncertainty, excitement, or pride.”

ACTIVATING SOCIAL SUPPORT

One of the most important interventions for anyone who is depressed – and especially for men, who are so much more likely to be self-isolating – is generating and maintaining a healthy social support network.

Utilizing Social Intervention

The first way that this social support can be so valuable is simply to make sure that the depressed man confronts his denial and seeks help for what is going wrong. It will often be the case that you, as his loving partner, can’t pull this off by yourself. It is important to realize that most men seek help only when pressured to do so by significant people in their life, and the single most important thing anyone can do for a man who may have depression is to help him get to a doctor or therapist for a diagnostic evaluation and treatment. You and the other people he cares about can try to talk to him about depression, helping him understand that depression is a common illness among men and is nothing to be ashamed about.

Hearing this from another man, a man whom he respects and who has earned his stripes with your partner as a solid guy, is probably the most potent intervention of all.

Empathy, Normalization, and Connection

The second most important thing that his friends and family can offer is basic, old-fashioned emotional support. This involves understanding, patience, affection, and encouragement. They need to engage him in conversation and listen carefully. They need to stay away from disparaging the feelings he may express, instead pointing out realities and offering hope.

Unfortunately, depressed individuals often behave in ways that help assure that their social worlds are less than positive. Not only are they apt to be socially isolated, but research indicates that they often undermine the opportunities for positive social experiences (Wenzlaff 1993). For example, they tend to prefer others who are unhappy like themselves, and they may gravitate toward others who are disapproving of them (in an unconscious attempt to confirm their negative narratives and beliefs). And, most frustratingly to the mega-goals here, they tend to behave in ways that make others unhappy. This makes it harder to attract the social support that is so desperately needed.

What you can do.

Remember that what comes easily for you in terms of engaging with other people in your life may not come easily for him, either because of his basic personality, his depression, or both. Encourage him to take small steps to reach out to others in his life and to feel good about these steps (for example, feeling good about a brief phone call he initiates). If you are helping to engineer his increased involvement with other couples, don’t throw a huge party. Instead, start with less demanding interactions where social pressure doesn’t feel overwhelming, like watching a video or a football game with some friends who are easy to be with socially. You can also help find friends or family members who have been through some version of what he’s experiencing and respectfully play “matchmaker.”

You also can be of help to him by locating a support group for depression through his therapist, his doctor, local mental-health agencies, or your religious organization. Sometimes you are faced with a very difficult decision about how much to inform others or to involve them in what your partner is going through and what he needs. He may feel extremely protective about his privacy and extremely sensitive about the possibility of looking bad to others. This is completely understandable. However, it is often self-destructive. Although each situation is different, in general I recommend erring on the side of involving others rather than excluding them. And the more serious the depression, the more strongly I recommend this. Of course, you run the risk that your partner will be deeply offended and feel betrayed that you have exposed him, but it is just as likely that he will be relieved. If not immediately, then possibly later.

SUMMARY

One of the most important ways you can be of value to your depressed partner is to understand the range of different strategies and interventions out there (both professionally, like therapy, or more informally, like everyday activities or social support). You can be a gentle ally to him in helping change some of his depressiogenic narratives. You can offer him ideas about ways to distract himself from the most damaging ruminations and negative cognitive patterns. You can also introduce him to the “fake it until you make it” concept in ways that might actually make sense to him. You can help him develop his social support network. The more you know about what has been found to work, the more you can either help him do it or at least be supportive when his therapist or someone else suggests it.

 
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