This introduction is the first in a series of articles summarising the various, most common therapies used for treating depression.
My experiences with depression eventually led me to undertake a formal course of study in counselling and psychotherapy, which is still on-going at the time of writing.
So I’m fortunate to have some theoretical and practical knowledge of the various therapeutic approaches.
But, and I think this helps my understanding in a big way, I have also been subject to some of these treatments and I recognise how confusing all of this can be for those suffering from depression, or those looking to help a depression sufferer.
I don’t suggest that these articles will be is an absolutely comprehensive outline of all possible treatments for depression, but I do hope that they at least present the main options with some clarity.
What is therapy and who can do it?
It might help if first we clarify some of the terminology that you will hear in association with depression treatment and therapy.
There is a considerable amount of overlap between some of the terms used (and thus, room for confusion), as you’ll see below.
Let’s start with therapy. The word therapy can be used to describe a wide range of treatments or techniques used to cure or alleviate abnormal conditions.
Hence we have such practices as physiotherapy, occupational therapy, art-therapy, and psychotherapy.
Psychotherapy is essentially therapy for the mind.
It involves the treatment of disorders of the mind, or of conditions with some psychological element, by non-invasive and non-pharmaceutical means.
Psychotherapy works through a course of treatment, involving the establishment of a therapeutic relationship through discussion and interaction between therapist and client over a period of time.
Psychotherapy seeks to help the client improve self-awareness and bring about positive change in the client’s ways of thinking and behaving.
Such changes and increased self-awareness can enable clients to overcome or lessen the impact of their presenting condition and equip them to manage their life and relationships in more effective ways.
Psychotherapeutic techniques can be employed by psychologists, psychiatrists, psychotherapists, counsellors and clinical social workers.
There are a range of different psychotherapy techniques, such as cognitive behavioural therapy (CBT), person centered therapy, psychoanalysis, psychodynamic therapy, gestalt therapy, solutions focused therapy and narrative therapy. Some therapists employ a single technique, some use a range of different techniques.
Counselling is a broader concept than psychotherapy. In essence it is the process by which a skilled person provides advice and guidance to another.
Counselling can cover many fields. Thus we have careers counsellors, debt counsellors, disability counsellors and so on.
Counselling can often employed where the client needs help with some particular problem or difficulty, but where there is no pathological effect – i.e. no specific condition such as depression or anxiety associated with it.
When dealing with mental health issues, such as depression, counselling involves the same kinds of techniques as those employed in psychotherapy.
Counselling may be carried out by a counsellor, psychotherapist, psychologist, psychiatrist or clinical social worker.
In the context of depression treatment, the terms counselling and psychotherapy are often used interchangeably, which is how you’ll see them used on this website.
Which Depression Therapy is best for You
Working out which is the best overall treatment program for depression in any given situation is something you need to do in conjunction with your medical advisers.
But you do need to take some responsibility for this yourself, because no approach is going to work unless you are actively committed to it.
Very often you will be advised, especially when you are first diagnosed, to combine medication with a course of counselling or psychotherapy. You may need the medication to lift you into a frame of mind where you can actually benefit from therapy.
In most cases, a combination of approaches may be tried, either together or sequentially.
CBT is the therapy most usually used to help with depression and is aimed at changing some of the automatic thoughts patterns that can lead to depression. In many cases it delivers results in a reasonably short time.
For some people, however, there may be a need for a longer term, more analytical approach, such as psychodynamic or gestalt therapy, where the emphasis is on understanding and uncovering aspects of the patient’s past that may be impacting on their current states of mind.
The particular approach that best suits you will depend upon a number of factors, including the type of depression you have and how receptive you are to different approaches.
Interestingly, and perhaps not so well know outside of the therapeutic community, there is a substantial amount of evidence that suggests that in psychotherapy generally, the quality of the relationship between therapist and client is more important in bringing about positive change than the technical ingredients of the mode of therapy being practiced.
It is therefore important that you have a belief in both the therapist and the type of therapy that you are undergoing, otherwise you may find that you gain little benefit.
This means that if you do not feel that you have developed a productive relationship with your particular therapist, you must be willing to make a change if you can.
Mode of delivery
For some people, the mode or delivery may be an important factor.
Historically, it had always been thought that therapy needed to be carried out on a face to face basis. But there is clear evidence that some approaches, such as CBT, can be delivered successfully online.
Further, services such as Skype and Facetime can deliver an experience nearly comparable to the traditional face to face one.
Therefore, for people with disabilities or who live in isolated areas, appropriate therapy can still be available.
It seems to me that some of the most important drivers for successful therapy for depression are as follows:
- Finding a therapist of counsellor who you can establish a good and trusting relationship with;
- Having some belief in the approach to therapy that is followed;
- Following up and completing tasks that you are asked to do between sessions;
- Remaining patient and committed to working with your therapist over a sustained period (there are no quick fixes); and
- Committing to the process.
I’ll look at some of the different modes of therapy in the next few posts.
I’ll also try to explain them in language that we can all understand since, in my experience, the impenetrable descriptions that many therapists seem to use to describe their practices are of very little use to anyone who might want to use their services.
Ruwaard, J., Lange, A., Schrieken, B., & Emmelkamp, P. (2011). Efficacy and effectiveness of online cognitive behavioral treatment: a decade of interapy research. Annual Review of Cybertherapy and Telemedicine 2011: Advanced Technologies in Behavioral, Social and Neurosciences, 167, 9.
Norcross, J. C. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. Oxford University Press, USA.
Norcross, J. C., Ph.D., & Lambert, M.J, Ph.D. Evidence-Based Therapy Relationships, http://www.nrepp.samhsa.gov/Index.aspx
Main image: “It was a promise they were not to keep” by Martin Grover
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