You’ve been depressed for a long time. Your depression doesn’t let up. Now, you’re wondering if maybe this is the time to get some help. But, you don’t know what kind of help to look for. Or what kind of treatment really helps persistent depression? Maybe you’ve been in therapy before or maybe even many times. What do you do now?

Sometimes you wonder if it’s hopeless.

No, your persistent depression isn’t hopeless. But, hopelessness is a symptom of your depression. You can get help. And, you certainly don’t have to continue to live this way. Understandably you feel trapped and are looking for answers. It’s important to get the kind of help that leads you out of this vicious cycle.

Here are 6 things to look for when you’re seeking treatment:

A Specialist In Persistent Depression

Persistent depression isn’t just any depression.

Some depressions are due to a current situation, grief about the loss of a loved one, or difficulty you can pinpoint as the cause. But even if something specific has stirred up your current episode, if you have persistent depression, the cause isn’t that specific or current at all. 

With persistent depression, you often find yourself in depressive loops that recur over and over and you can’t get out. Either various things set your depression off: disappointments, feelings of rejection, ways your self-esteem seems to take one hit after another. Or, you have no real idea about why except that you so often feel down.

There are reasons.

Those reasons aren’t conscious and they usually date back to childhood experiences, traumas, or losses. Finding the right therapist will help you discover what is unconsciously causing your persistent depression. Working out what is at the root of these constant depressive feelings will help set you free.

Getting To The Root Causes 

You don’t want to choose just any therapist with a degree.

Look into a therapist’s training and background. If you’ve been depressed for many years, or if you’ve been in therapy before, you need someone with in-depth training and experience to help you. You might be wondering: what does this mean?

You need someone that can go beyond the surface.

The persistence of persistent depression can only be resolved with a therapist who has the years of experience, training, and knowledge to do that. This is usually someone with psychoanalytic training.

Look for a therapist who can get to the root causes of your depression.

Linking Your Persistent Depression To Childhood

Most persistent depressions originate in childhood.

If your childhood brought trauma, disappointments, losses, abandonment, harsh criticisms, or rejections, you live with the repercussions inside. Most often this brings low self-esteem and a harshly critical voice inside your head, a voice that induces guilt and constantly finds fault with you.

You need a therapist that connects the ways you feel about yourself to your childhood.

A therapist that can help you sort out specific links to your past. Your past lives inside you in its own way, creating symptoms and problems. You need a therapist that has no “formula,” but sees the effects of your past in its individual ways.

It’s important to find a therapist that helps you build your self-esteem.

Help For Your Low Self-Esteem

You have low self-esteem for complicated reasons.

Maybe you were criticized as a child. Or you had siblings you compared yourself to.  You felt you weren’t as good. Perhaps something happened to you that makes you feel shame. Or, if you had problems in school or a learning disability that wasn’t your fault, it made you feel different or “less than” others. Maybe you were neglected or abused.

There are many different scenarios for developing low self-esteem. You might have grown up imposing perfectionistic standards on yourself. Believing that living up to those ideals would make you feel loved and valued.

Or, maybe you aren’t even sure why your self worth is so low.

You just know that you constantly feel not good enough and terrible about yourself. And feeling depressed all the time and unable to muster up the energy to do a lot of things, makes you feel even worse. You criticize yourself for that too. You’re hard on yourself about almost everything. It’s a terrible way to live.

Your therapist must help you find what is causing your negative feelings.

There are answers. And a therapist that listens closely will take seriously the low self-esteem that is at the heart of your depression. And also how it is increased by the fact you can’t get yourself motivated or out of the depressed way you feel. 

You’re tormented by a constant barrage of all the things you think you do wrong.

Understanding The Critical Voice In Your Head

One common symptom of persistent depression is a critical voice in your head.

This voice is like an intruder. It barges in and tells you all the ways you don’t measure up. All the things you never do right. And, all the ways you “fail.” As soon as you text someone, it might tell you what a “stupid” thing you said. You should have said something more interesting. Or funny.

When you’re invited to a party, that voice criticizes everything you put on to wear. Tells you that no one will want to talk to you. Suggests you might as well stay home. In fact, that voice constantly makes you feel that no one will ever like you. Or love you. You always feel you’re being judged. It’s because you have a judgmental voice inside you.

It’s a vicious cycle. That voice makes it impossible to feel you’re worth anything.

Any therapist you choose should be well aware, right away, that your depression means you live with a harsh inner voice. You might try to hide the voice. Because you don’t want to “look” as bad as you feel. But, even in the first session or two, the right therapist will know that voice is there.

Your therapist must kindly help you to get free from these constant internal criticisms.

Kind & Deep Understanding, Not Tough Love

Your critical voice is already hard on you. Your therapist should be kind and sensitive.

It’s important to find a therapist that helps you feel a sense of safety and trust. A therapist who knows how to think with you about your depression. It has persisted for much too long. You especially need a therapist that knows how to see and say things you can’t possibly come up with yourself.

What you don’t need is “tough love,” confrontation, or judgment.

The harsh voice in your head might think this as exactly what you need. It does it to you every day. But, you really need a therapist that knows how terrible it is to be in the trap of this constantly critical voice.

To work out your persistent depression, you need a kind and helpful guide.

So, that’s what to look for, if you’re looking for persistent depression treatment.

There is help and there is hope.

Many therapists haven’t had the experience or training to understand what is at the root of persistent depression. So, if you’ve had disappointing experiences, it’s worth another try. It’s important to know that there is no formula. The reasons for your persistent depression are unique to you.

Those unique reasons need special attention and understanding.

And. they always have links back to childhood. Most often they go back to one form of childhood trauma or neglect, or another. If a therapist doesn’t begin to see those links from the very beginning, even in the first consultation, they aren’t on the right track. It’s best to move on.

You can find help.

There are therapists with the training to understand deeply embedded and persistent states of depression. Your depression isn’t hopeless. It’s either the voice in your head, unhelpful therapeutic experiences, or years of living this way that convinces you so.

Finding the right therapist makes a world of difference.

I’m Dr. Sandra Cohen, a Los Angeles based psychologist and psychoanalyst. I specialize in treating persistent depressive states and childhood trauma. You don’t have to live this way.  Feel free to contact me if you have any questions about finding the right therapist for you.