Dear Therapist:

I’m writing about my father-in-law, who is in his mid-seventies. He has significant health issues, including serious kidney problems that may require dialysis, and it has been very hard on him. He is still sharp, but we believe he is depressed. He has always had somewhat of a low disposition, but now it feels like it is really affecting his day-to-day life. We are wondering how best to help. At this stage in life, is psychotherapy something that can really be effective, or is treatment usually more focused on medication? We want to support him in the right way, but we are not sure what is realistic or helpful in a situation like this.

Response:

It’s normal for someone in your father-in-law’s situation to feel depressed. The question is whether his feelings are a normal reaction to the medical issues that he’s facing, or whether they point to something more significant.

As our lives progress, we experience changes—in our health, our jobs and careers, our family structure, and other areas. Aside from the mental adjustment needed to navigate these changes, we also face changes in our roles.

For many of us, our roles help define who we are. In a perfect world, our sense of self would come solely from who we are intrinsically. Realistically, however, we all base our sense of self—at least to some degree—on the roles that we play (wording intended).

If my self-definition is largely based on my position in the family, changing family dynamics can place that sense of self in jeopardy. If I lose my job or retire, any “self-esteem” tied to that role may need to be recalibrated. For example, if my sense of self is largely based on being a therapist, losing that role can feel like losing a major part of who I am.

Ideally, we would all build our self-esteem based on who we are intrinsically. If I feel good about qualities like my intelligence, caring nature, sense of humor, and honesty, external changes have far less power to affect my self-esteem. As a result, they are less likely to lead to feelings of depression and anxiety.

Certainly, it can be helpful to focus on intrinsic qualities; it’s never too late to work on this. However, most of us do define ourselves, at least in part, based on external factors. From a more practical standpoint, this often involves both mourning losses and finding new sources of meaning and self-definition.

If your father-in-law is feeling somewhat useless or diminished, it may be helpful to gently reinforce the ways in which he still has value. For instance, recognizing his role and connection within the family can help him recalibrate his sense of self.

Psychotherapy could help him work through feelings of loss, fear, insecurity, and diminished self-worth. This can be difficult to do alone, and a trained therapist can help identify and address these areas.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro University

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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