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Types of Psychotherapy for Depression

Which Treatment is Right for You?
  -- By Dean Anderson, Behavioral Psychology Expert
So you've realized you’ve got a problem with depression. Now what? What kind of professional help do you need, and where do you find it?

If you’re like most people, the first thought that comes to mind when you think about treating depression probably involves medication. It certainly would be wonderful if the illness that afflicts 17 million American adults every year could be cured by a simple visit to the doctor and a prescription. However, the evidence is clear that this dream has not yet become reality.

The consensus among health professionals is that major depression is a complex, “biopsychosocial” illness, and that treating all three of these dimensions (biological, psychological and social) is necessary for most people. For a small minority, medication alone may be enough to quickly end a current depressive episode. But for many, medication isn't enough. Studies show that your chances for avoiding or minimizing the effects of future depressive episodes will be greater if you get the help you need to recognize and manage the patterns of thought, feeling, and behavior that make major depression so debilitating.

Research also shows that the most effective treatment plan for most people includes eight to 12 weeks of weekly psychotherapy, either with or without medication. This article will explain the most common types of psychotherapy, which all have proven track records for helping people deal with the psychological and social dimensions of depression. Use this as a guide when deciding which type might be best for you.

Psychotherapy: What It Is & How It Helps
About 100 years ago, Sigmund Freud described psychotherapy as the “talking cure.” Although current forms of therapy bear very little resemblance to his approach, the emphasis on talking as a cure does help illustrate how psychotherapy differs from other types of medical treatment. When you go to your doctor’s office, your “job” is mainly to describe the symptoms you’re having. Once you’ve done that, it’s pretty much up to the doctor to come up with a diagnosis, present a treatment plan, and carry it out if you accept it. Your words are simply used by the doctor in order to find the right cure.

The situation is very different in psychotherapy. Your words play a much more central role. In fact, it’s fair to say that you are both the doctor and the patient, and that you cure yourself by changing the way you talk and think about the problems you are having. The therapist’s job is to support and guide you through the process of looking at your own thoughts, feelings and actions, determining how well they are working for you, and changing the ones you decide you want to change. A good therapist will provide encouragement, emotional support, and a variety of techniques and tools to help you keep this process moving along as productively as possible. But basically, you’re doing the work, making the decisions, and producing the results yourself. Nothing is being done “to” you.

What may be most important, however, is that you find a therapist you feel you can trust enough to be open and honest when you’re talking about what’s going on. It may take a few sessions to build up that trust, and you may even have to shop around a little before settling on someone to work with. But you probably won’t get much out of the experience if you feel like you have to hide what’s really going on to please your therapist. In fact, keeping your thoughts and feelings to yourself can worsen your depression, especially if you do so because you feel ashamed of having them, or like you ought to be able to handle things yourself. It’s important to realize that your depression is an illness, not a weakness, and that you can’t just “snap out of it.” You need to talk your way through it in order to see exactly how it is affecting you, and discover the best ways to reduce its effects on you.

Types of Therapy
The different types of therapy primarily reflect differences in the techniques and tools your therapist will be most likely to utilize. Although some therapists strictly stick to the toolbox their particular school of therapy is most familiar with, many therapists these days are able and willing to use the tools provided by several therapeutic approaches, so you shouldn’t necessarily assume that you have to pick one approach or another. The more you know about all the proven techniques and approaches, the better you and your therapist will be able to work together to find the approaches that will help you address the particular issues you need to work on. Three of the most common and effective psychotherapies for depression include cognitive/behavioral therapy, interpersonal therapy, and psychodynamic therapy.

Cognitive/Behavioral Therapy (CBT)
Technically, “cognitive” and “behavioral” therapies are two distinct kinds of therapy. But in practice, the two are most often joined together, because research has shown that this combination is more effective for treating depression than either approach by itself. The basic idea behind CBT is that thoughts, feelings, and behaviors are all connected together by two-way streets. Therefore, if you make a change in one area (how you think, for example), it will lead to changes in both of the others (how you feel and behave). It is a "here and now" approach—it doesn’t really matter which problem came first, or where it came from originally.

If your depression is making you feel helpless and hopeless, you'd change that by identifying the specific thoughts and beliefs that you have about yourself, the world, and the future that make your hopeless feelings so powerful. You'd also examine the behavior patterns that confirm and justify your beliefs. Then you'd experiment with and practice more helpful thoughts and beliefs, and choose alternative behaviors, until the “depressive system” you’re stuck in begins to break down and your symptoms fade away. This will also help you better manage life events and situations that might otherwise trigger another depressive episode in the future.

Interpersonal Therapy (IPT)
Interpersonal therapy assumes that the most troublesome aspect of the depression is how it affects your relationships with others, which can often lead to increased social isolation and lowered self-esteem. This type of therapy can be especially appropriate for people whose depression may be related to unresolved grief over the loss of a loved one, to conflicts and problems in relationships with significant others, or to difficulties handling transitions or changes in social roles (such as job loss, retirement, empty nest syndrome, or loss of functional capacity due to illness or injury). By focusing on relationships, IPT can help people identify personal needs that are going unmet, find ways to resolve interpersonal problems or end negative relationships, and build the social skills and opportunities needed to develop and maintain supportive relationships. In some cases, IPT make take the form of group, family or marriage counseling, rather than individual therapy.

Brief Psychodynamic Therapy
Psychodynamic therapy for depression rests on the idea that the common symptoms of depression often happen when some event in your life triggers “core conflicts” that may have originated earlier in life, and no longer play an active role in conscious memory or thought processes. For example, an individual may experience an unusually persistent and debilitating sadness over the loss of a current relationship, far beyond what could be attributed to “normal” grieving, because that loss has triggered feelings associated with an earlier loss which was not fully “processed.” Or an individual may be overwhelmed by feelings of helplessness or powerlessness that are not appropriate to their adult situation, but may have been appropriate during a similar situation that existed when they were much younger. The aim of psychodynamic therapy would therefore be to help the person make the connection between past and present, and work through the feelings associated with the past so she can face the present without the added burden of this extra “baggage.”

Clearly, these major types of therapy are quite different in their assumptions and approaches, and none of them is appropriate for every individual. To a certain extent, the decision of which to use may be indicated by the nature of your problems. People who have a long history of recurring major depression, very severe depression, or a combination of major depression and other chronic mental or physical health issues to contend with, may not be able to benefit as much from a short course of Cognitive Behavioral Therapy, and may need longer term treatment. Your therapist can help you figure out this aspect of the decision.

But it’s also important for you to feel like the treatment you receive is relevant and helpful to you, and to have a voice in deciding what kind of approach you want to try. You’re the one who will have to do the work, after all. Hopefully, this information will help you make the best decision.