There are many different approaches to treat depression with psychotherapy. I, of course, have my own thoughts about what works best. But first I need to outline three of the most common psychotherapy approaches:
- Cognitive-Behavioral Therapy – Focuses on identifying and changing unhealthy thoughts and patterns of behavior. Cognitive techniques focus on changing irrational thought patterns, which are assumed to contribute to depression. The idea is that if you work on changing these thought patterns, your emotional distress and depression are lessened. Behavioral activation techniques focus on changing behavior by adding more pleasure producing activities, reducing stress, and problem-solving situational factors that may be contributing to depressed mood.
- Interpersonal Therapy – Focuses on the depressed person’s relationships or relationship patterns, which are assumed to be a contributing factor in terms of their depression symptoms. The idea is that by learning how to improve relationships and working on these issues, the depressed person will feel better overall.
- Psychodynamic Therapy – This approach, more than the others, tends to focus on how the person’s unconscious conflicts, childhood and family issues, and attachment patterns may contribute to depression. Many different versions of this approach are employed, and it is probably the least well defined of all the options.
There are certainly other approaches, and I am not claiming to be an expert in any of them. It is important to understand that in the field of mental health treatment, researchers and clinicians often debate the issue of what it is about psychotherapy that actually helps people. Some will say it is the particular set of techniques that are used, and will argue strongly that their specific approach is best. In fact, there is a whole movement in the field toward what are called “Evidence-Based Practices,” where “manualized” approaches of a certain number of sessions, with certain techniques, are used. Proponents of these approaches will point to the fact that research shows that they help…at least for the period of time that the research studies are measuring.
I am not disparaging any technique or approach that helps people feel better. But, there is a whole group of researchers and professionals in the mental health field who strongly believe that it is actually the quality of the relationship between the therapist and the client that makes the biggest difference. I am very much in this camp. I believe that in order to benefit most from any therapeutic technique, the client must feel comfortable with the therapist. He or she must feel able to talk openly, and feel supported and understood. Obviously, the therapist has to be well trained and experienced enough to know when to use what techniques. But, in my opinion, without the foundation of a strong therapeutic alliance, therapy is much less likely to be of benefit.
My advice for people wanting to try psychotherapy is to talk to a potential therapist on the phone prior to scheduling an appointment. If they aren’t willing to do this, they aren’t the right person. Ask about their approach to treating depression. Trust your gut about whether you feel comfortable with their responses. If so, see them for a few sessions. If it isn’t the right match, try someone else. Don’t settle! A good therapeutic alliance is invaluable, and a bad match between therapist and client can actually make things worse!
Next Month: My Approach to Psychotherapy for Depression