A Review of Hilary Jacobs Hendel’s It’s Not Always Depression

It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self. By Hilary Jacobs Hendel (2018). New York: Spiegel & Grau. 298 pp.

By Stephen McDonnell, LCSW

Hilary Jacobs Hendel, LCSW, has written a friendly and simple “User’s Guide” to AEDP therapy, core emotions and defenses, attachment and trauma, and “the gold” of Core State, or as Hilary has nicknamed Core State for a general audience, the Openhearted State. It’s a great book that could be offered to clients who would like an informed supplement to our experiential therapy with them, a book to recommend to others in our lives for whom we might want to plant seeds about trying therapy, or to those who might need some self-help for their emotional regulation (a friend of mine just sent it to her son in college). Also, other clinicians—those new to AEDP as well as well-seasoned AEDP therapists—will find the book useful in learning how another therapist practices AEDP.

The book is user-friendly and simply written, yet it shows the depth of Hilary’s deep inquiry into these subjects—AEDP, Eye Movement Desensitization Reprocessing (EMDR), Internal Family Systems (IFS), Somatic Experiencing (SE) and neuroscience.  Simply put, the book contains everything one needs to understand emotions, why they are important for us humans, and what blocks us from being in touch with them. 

There are many lists in the book. For example, in the Appendix there is a list of most of the sensations and all the emotion words we use when describing a core emotion.  Every chapter has shaded boxes that describe complex concepts simply, such as “Things to Know about Panic Attacks,” and “Shame Is Not Guilt,” and “How to Stay in an Openhearted State in the Face of Life’s Challenges.” Every chapter ends with “Experiments,” as Hilary calls them, akin to AEDP’s interventions to try something new—quizzes and practices to apply the theory, e.g., how to do “Belly Breathing” to slow down, and “Nine Ways to Begin Working with Your Shame.”

The book is structured to cover all the “essential skills” for doing this on one’s own:  (a) explaining the importance of core emotions and their release, (b) understanding how our defenses inhibit emotions, (c) identifying both big T and small t trauma, (d) using the “Change Triangle,” as Hilary has nicknamed the Triangle of Experience to name defenses and release core emotions, and finally (e) appreciating the “Openhearted State.” 

One of the most delightful aspects of the book is that all this information is woven into stories of Hilary’s work with clients. The reader is introduced to Fran, Sara, Bonnie, Spencer and Mario, and can learn firsthand what it’s like to be in AEDP therapy. For example, Bonnie is a 25-year-old graduate student who had been depressed on and off most of her life, but came into treatment because of her parents’ divorce. The reader gets a sense of how therapy starts, with the first phone call, the first session and building rapport, with all that goes on in a therapist’s mind. When Bonnie starts exhibiting her defense of vagueness, Hilary gets her to slow down, feel into her body, feel the working alliance between them, and begins to do parts work, where they discover an eight-year-old part who’s angry at her father. That recognition of anger was a milestone for Bonnie. Hilary worked to make this core emotion experiential and expressive. Hilary demonstrates how she coaches her clients, by making a portrayal understandable to them, describing it as similar to fantasy, and not acting out, but a way of releasing the energy, and experiencing relief and transformation. Clinicians will especially benefit from the book to get a sense of how another therapist works with portrayals.

Hilary is generous with the reader in her self-disclosures as well. Early in the book she describes growing up with parents who encouraged her to control her feelings with intellectual insight. After meeting her husband in dental school and having two children, things fell apart, and left her with depression. She took Prozac and began psychoanalytic psychotherapy, when eventually she met Diana Fosha and was introduced to AEDP. Her love of emotion theory and the healing and transformational changes that Diana taught became possible for Hilary too. Later in the book, Hilary shares what came up for her in an experiential exercise in AEDP training, i.e., slowing down and paying attention can lower anxiety. Finally, Hilary shares an experience meeting an acquaintance for lunch, and the friend saying something—“That is such a therapist question!”—which stunned Hilary and had her imploding, so much so that she had to excuse herself to go to the bathroom to work the Change Triangle on herself, to discover, recognize and soothe her core emotion of shame. The reader can trust a therapist who shares her own experiences with growing up, marital difficulties, depression, anxiety and shame, and how she uses the tools she describes in her own life. 

A major gift of the book is how Hilary suggests that people use the Change Triangle as a tool and a map. Throughout the book, the stories of her clients, as well as her own stories, are accompanied by illustrations around the Triangle. The case example specifics are on the triangles, and the movement around the triangles is illustrated with arrows. As each case progresses, the illustrations document the changes that occur in the triangles:  (a) what they look like at the beginning of treatment, (b) when one processes core emotion, and finally (c) once the client drops down into the Openhearted State of the Authentic Self.  Hilary suggests that one can use the Change Triangle on one’s own, or with a trusted friend or a partner. 

All the features in the book make for a comprehensive book for the general public: the stories of clients in the therapeutic process, Hilary’s sharing of her own process, her understanding of the science of emotions and defenses, attachment and trauma, the illustrations of the Change Triangle, and the “experiments” in the self-help inventories. It’s Not Always Depression is a welcome addition to books we suggest to clients and other lay people who express interest.   

A bonus of the book is the foreword by Diana Fosha, who writes an accessible overview of all the components of AEDP—privileging positive emotions, transformational affects, transformational experiences and transformational spirals, metaprocessing and core state. I imagine that the foreword itself would be an excellent place for clients to start in understanding AEDP therapy. 

In summary, perhaps most important in creating and sustaining the reader’s interest is that Hilary in her book embodies AEDP. Readers can trust her to take their own risks to free up core emotion, to do the work of using the tools such as the Change Triangle and the other worksheets, toward one’s authentic self and openhearted state. Hilary describes emotional expression in a way that seems like it should be so simple for us humans. She puts all this in clear language, and yet under this simplicity and clarity is Hilary’s own life inquiry, study and practice.