Treating Complex Depression Symptoms with Bill O’Hanlon’s “Exceptions” Technique

Rarely is someone always depressed, or always empty, or always without energy, or always suicidal. If you (or the person you’re helping) explores exceptions to the usual problem, feeling, or thought, you can usually find moments when it’s not occurring. A lot can be learned from these exceptions that may be helpful in finding relief from the depression. In other words, we’re just trying to acknowledge that there are exceptions to the rule of whatever the person’s complaining about. For example, he has no energy (except when he does). Or he can’t get out of bed (except when he does). He feels bleak (except when he doesn’t). He never laughs anymore (except when he does).

What I’m pointing out is that life and people are more complex than we sometimes think or acknowledge. Remembering and recognizing that complexity helps us keep our perspective. Rarely is a situation all one way or all the other. Rarely is a person only one way. Of course, we have to be careful with this technique in therapy, as it can be invalidating or sound flippant or glib. For example, if the depressed person says, “I can’t get out of bed,” and you respond with, “Yet you got out of bed to get to my office,” it probably won’t have the validating and expansive effect that this technique intends. Rather, this technique mostly involves listening carefully and choosing the right moments and words to highlight the exceptions in a respectful way. I listen for reports of things that have been better or different from the usual problem in the recent past.

For example, if the person says, “I did better the first few days after I came in last week, and then everything just fell apart again,” I ask him what he felt or experienced during those first few days before I ask about what happened when he fell apart.

One specific way to discover and highlight exceptions is to listen for and acknowledge moments of non-depression. Perhaps the person got absorbed in a movie and “forgot himself” for a few hours. Perhaps he spent time with a friend or family member and felt better for a time. Perhaps there was a time in the recent past when, inexplicably, his depression was better for a day, a week, or longer.

Another way to find exceptions is to find out about what happens when the depression starts to lift that’s different from what happens during the depressive episode. Maybe the person starts to become more social, or listens to music more, or goes out of the house or eats different foods. Of course, one way to find this out is to listen for reports of those times, but you can also elicit such reports by asking about them directly. Here’s an example of such a direct elicitation: “I’m curious. You’ve been through these times of depression before and have come out of them. What happens when you start to emerge from that darkness and begin feeling better?”

One last way to discover exceptions is to investigate why the depression isn’t worse or the person isn’t less functional. This is sort of a backward way of discovering exceptions. For example, you might ask your client, “How have you been able to go to work or visit with friends when some people with depression haven’t been able to do those things?” or “Why haven’t you given up on seeking help?”

Obviously, one has to ask these questions and investigate this area with a great deal of sensitivity. You don’t want to imply that the person needs to be doing worse before he can convince you that he’s really suffering or that he has to reach the depths of suffering that others do. Instead, you’re trying to awaken in him an appreciation for the times and parts of his life that aren’t so dysfunctional.

Here’s an example of the kind of inquiry you might make: “I was a little surprised to hear that you finished that big project at work even though I know you’ve been feeling like hell. If I were talking to someone else who was depressed and had a similar kind of project in front of them, what would I tell them about how you were able to pull that off even though you felt so impaired?”