“The sun’s gone dim,
And the moon turned black;
For I loved him,
And he didn’t love me back.”
Dorothy Parker’s above poem, titled “Two-Volume Novel,” manages to encapsulate the sweeping effects a pivotal relationship can have on one’s well-being—even when it exists purely in their own mind. Intersubjectivity, and specifically intersubjective therapy, similarly offers up the notion that an individual’s central relationships shape the way they view the world, themselves, and their very existence. This advancement of more traditional forms of psychotherapy has been found to be particularly beneficial when treating depression. Read on for more on how intersubjective therapy can offer patients the support they need.
Intersubjective therapy aims to implement the philosophical idea of intersubjectivity, which describes the discourse created by having two or more perspectives on a given topic. While intersubjectivity can refer to broadly accepted terms such as axioms and common sense, intersubjective therapy deals more with how the patient’s relationships with others in their life contextualize how they interpret themselves and the world around them.
Intersubjective therapy stands in contrast to classic psychoanalysis in their differing approaches to the patient-therapist bond (also referred to as analysand and analyst). Classic psychoanalysis is a “one-person” therapeutic approach, which focuses solely on the patient and aims to interpret the content raised in therapy through understanding the patient’s childhood, personality and formative experiences. Even the psychoanalytic idea of countertransference, which deals with the emotions, thoughts, and imagery raised in the mind of the analyst, presses the analyst to consider what within the patient caused their own, internal experience.
Intersubjective therapy, on the other hand, turns the spotlight on the relationship between the patient and their therapist. A two-person approach that views therapy as more of a partnership, intersubjective therapy recognizes the therapist’s own contribution to the content the patient raises during their sessions, as well as to the ways this content is discussed and understood.
The very name of intersubjective therapy underscores its view that there are two complex, well-rounded subjects in the room, whose minds, perspectives and emotions create an interplay with one another. As a result, the experiences of both patient and therapist should be considered when deciphering the topics raised during a therapeutic session.
Intersubjective therapy puts such a large emphasis on the patient-therapist relationship, because it considers it to be emblematic of other, key relationships in the patient’s past and present. This particularly applies to the patient’s link to their parents, as the therapeutic bond can often reflect the central issues and conflicts that characterize this early, significant relationship.
With this in mind, intersubjective therapy makes room for patient and therapist to explore their own therapeutic bond together. This makes it possible for the therapist to share certain thoughts and feelings of theirs, at an appropriate moment, in an effort to explore the ways the patient may be interacting with others.
Depression is among the most common mental health disorders, and is considered by the World Health Organization (WHO) to be a leading cause of disability across the globe. A mood disorder, the symptomatology of depression is centered on its emotional aspects, with key symptoms including a deep and unrelenting sadness, a sense of hopelessness that things will improve, and a feeling of emptiness coupled with the sense that something precious has been lost. Unable to release what is no longer in their life, the patient leaves a part of themselves with them, and as a result, cannot turn their attention back toward the world, a possibility that often raises an additional emotion—guilt.
Depression can also cause other types of symptoms. It can affect the patient through cognitive symptoms such as a difficulty concentrating; behavioral symptoms such as neglecting personal hygiene; physical symptoms such as sleep disturbance; and interpersonal symptoms such as self-isolation.
Roughly 17.3 million US adults (or 7.1% of this population) face depression. It is believed to affect 6.7% of the global population (one in 15 adults), with the WHO stating that 264 million individuals battle this condition worldwide.
Despite focusing on the patient’s individual experience, psychoanalysis stresses that understanding the relationship at the center of a patient’s depression is the key to understanding their disorder. In his seminal work “Mourning and Melancholia” from 1917, the Father of Psychoanalysis, Sigmund Freud, stated that melancholy—an earlier iteration of the currently held view of depression—stems from a great sense of loss. This lost object can be a relationship with a loved one, a physical ability, a desirable social status, or even the belief in a certain idea.
According to Freud, when such a loss is considered too painful to consciously acknowledge, it is repressed by the individual. As a result, the normative process of mourning cannot take place, with the individual continuing to direct their mental energy to what they have lost, unable to make their peace with what it meant to them while they had it.
While Freud saw depression as the result of an unbearable loss that needs to be raised back to consciousness to be processed, intersubjective therapy makes use of the therapeutic bond to work through formative relationships that may be linked to a patient’s depression.
Tapping into the emptiness the patient may describe when facing depression, the intersubjective therapist will aim to gradually work through the patient’s depression. This can be achieved by moving from a relationship centered on idealizing the therapist, to a more complex bond that can also contain arguments and the recognition of the therapist’s shortcomings.
Initially, the patient dealing with depression will likely blame themselves for any disappointment in therapy or the continuation of their depression. As the therapy continues, however, repressed complaints and feelings of resentment toward the therapist will begin to be outwardly expressed. This will allow the patient and therapist to examine the feelings raised in each of them, bringing the relationship itself to light, thus providing a safe environment in which they can explore the ways in which the patient tends to experience other relationships.
Surviving such a shift in perspectives and being able to share the internal dynamics that arise as a result, helps create a more realistic relationship between patient and therapist. This is primarily made possible through the act of separation, as the patient is able to view the therapist as an individual whose different characteristics are more than a continuation of their own self.
Recognizing the therapist’s subjectivity within the context of the patient-therapist bond allows the patient to begin to make amends, to forgive themselves for mistakes they have made, and to choose to forgive the therapist for their flaws. When this is made possible, the patient will have a greater chance of acknowledging whatever has been lost to them, mourning its loss, separating themselves from it, and turning their attention to the rest of their life.