Best Way to Get Help with Psychotherapy in Dealing with Your Depression

What is psychotherapy

It is possible that your doctor will recommend you see a psychotherapist for help in dealing with your depression. Psychotherapy involves talking about problems with a therapist and developing strategies to deal with them. Psy­chologists, psychiatrists, and licensed clinical social work­ers can provide this type of care.

Psychotherapy can help you get more pleasure and sat­isfaction out of life. It can make you more aware of your feel­ings and thoughts and the ways your actions affect others. It can teach you new things about yourself. It permits you to try out new ways of thinking, behaving, and interacting with others in an atmosphere of support and encouragement.

Therapy can also help you change the way you deal with problems in your life. Therapy won’t make those prob­lems disappear, of course. It won’t make a lousy job better or entirely take away the pain of losing a loved one. But therapy can help you learn better ways of handling the issues of everyday living.

Types of therapists and therapy

Several different types of mental health professionals can provide psychotherapy. Psychiatrists are medical doctors (MDs) who can prescribe medications as well as provide psychotherapy. Most other psychotherapists do not write prescriptions. These include psychologists (who may have either a PhD or a master’s degree), social workers (who have a master’s degree in social work), counselors with a master’s degree, and mental health nurses, who are regis­tered nurses (RNs). Practitioners who are not MDs often work with physicians when they think prescription medica­tions might complement psychotherapy.

Across all these professional groups, you’re likely to find a wide variety in the kinds of psychotherapy that indi­vidual therapists practice. The five most common kinds of therapy are

•  Interpersonal therapy
•  Cognitive-behavioral therapy
•  Behavioral therapy
• Problem-solving therapy (PST)
• Psychodynamic (or family-of-origin) therapy

You might find that a particular psychotherapist offers only behavioral therapy, whereas another may prefer a psy­chodynamic approach. But all therapists are trained to pro­vide support, encouragement, and education and should be able to help you create worthwhile changes in your life.

Four of the five main types of psychotherapy for depression have been evaluated extensively: interpersonal therapy, cognitive-behavioral therapy, behavioral therapy, and problem-solving therapy. For people with mild to moderate depression, all four have been found to be as effective as antidepressants in reducing the symptoms of depression. For severe depression, antidepressant med­ications are more effective than psychotherapy.

Psychotherapy takes a little longer than medication to begin showing results, but after 3 or 4 months psychother­apy and antidepressants appear to work equally well. Some Patients benefit from a combination of antidepressant and psychotherapy. Antidepressants can help relieve many of the physical and emotional symptoms of depression, restoring the energy and emotional reserves that can help you benefit from psychotherapy.

Therapy may be done on a one-on-one basis, through couples counseling, or in a group setting. Choose one that bests suits your personality and your needs.

In addition to being good listeners, therapists act as educators and coaches for their patients. For most people, therapy begins to alleviate depression in a month or two.

Interpersonal Therapy

Personal crises such as a death in the family, a divorce, or marital or family difficulties are often the trigger for an episode of depression. Because problems in close rela­tionships are among the most common risks for depres­sion, interpersonal therapy was developed to treat people whose depression is triggered by these problems.

Many people who seek interpersonal therapy have trouble grieving for the loss of a loved one or taking on new roles, or they find themselves in conflicts with loved ones. They may also lack the social skills that make it pos­sible to have warm and satisfying relationships with oth­ers. Interpersonal therapy is based on principles of more traditional (or psychodynamic) psychotherapy. One impor­tant principle is that our difficulties in current relation­ships are often related to beliefs or assumptions about ourselves and others. Relationships in early life may be important influences on those beliefs and assumptions.

A typical interpersonal therapy session will concen­trate on your current problems and relationships. The therapist may help you understand your thoughts and emotions after divorce or the arrival of a new baby, for example. Or the therapist may encourage you to talk about the pain of losing a loved one.

Cognitive-Behavioral Therapy

One of the assumptions underlying cognitive-behavioral therapy is that stress can lead to a repetitive cycle of neg­ative thought patterns and that these thought patterns then cause depressive moods.

When criticized by a supervisor, a person who is not vulnerable to depression might react by thinking, “I’ll have to improve this aspect of my work,” or “The boss must be having a bad day.” In a person with a tendency toward depression, however, the same criticism can trigger a host of negative thoughts that turn into beliefs about the per­son’s overall competence and self-worth. A supervisor’s comment about a missed deadline might lead to conclu­sions like, “See, I’m failing again,” or “This just shows how incompetent I am as a worker and provider for my family.”

We all have thoughts like this occasionally, but in peo­ple with depression such thought patterns are more per­sistent and are triggered more easily.

Cognitive-behavioral therapists can help by

•  Identifying these recurrent negative thought patterns
•  Encouraging you to challenge negative thought patterns
•  Gradually helping you to replace the negative patterns with positive thoughts

In a typical session, you and your therapist may review a weekly “homework” assignment. For example, you might be asked to keep track of your moods and activities every day. If depressed feelings begin, you will be able to back­track and identify the precipitating stress or event and describe the negative thoughts that event triggered. In this way you may discover that a certain event (such as criti­cism by the boss) did not cause depression, but certain negative thought patterns on your part led to a decline in mood after the event.

The therapist functions as a teacher and coach, often leading you through a logical line of questioning such as “What’s the worse thing that would happen if you did that?” This would be followed by “And then what would happen?”

Behavioral Therapy

When you are depressed, you stop doing things that reward you with a sense of pleasure or accomplishment. To counter this, behavioral therapy helps you plan and carry out activities that are enjoyable and rewarding.

Behavioral therapy also helps you improve your ability to solve problems and communicate with others, which enables you to become more active and effective at work and at home. The result: both your mood and your self-esteem improve.

Behavioral therapists encourage you especially to increase the amount of rewarding social activities in your life. The love and support of friends and family can be a big help in challenging negative thought patterns. Training in relaxation and in problem-solving may also be part of behavioral therapy.

Behavioral therapy is very action oriented. As in cogni­tive therapy, you should expect to have homework assign­ments—for example, you may be encouraged to structure at least one positive activity into each day, such as taking a walk with a friend or going out to dinner with your spouse. In a typical session, you and your therapist might review the previous week’s homework to evaluate its effect on your mood.

Problem-Solving Therapy (PST)

This type of therapy focuses on improving your problem-solving skills. Major life problems (like financial difficulties or conflicts at work) are also common triggers for depres­sion. Depression in turn interferes with your ability to manage life problems effectively—even minor stresses can leave you feeling overwhelmed. This self-reinforcing cycle ‘s another part of the downward spiral of depression.

Problem-solving therapy is designed to improve your skills for managing major and minor life problems. The idea is to follow a series of specific steps:

•  Breaking a big problem into a number of smaller (and more manageable) pieces
•  Identifying a wide range of possible solutions
•  Choosing one possible solution to try first—and trying it
•  Evaluating the results of your experiment and (if nec­essary) making any changes in your plan

In a typical session, you and your therapist would begin by identifying a problem to work on. It’s important to start with a problem that will allow some progress. During that session (or a series of sessions), you’d follow the steps list­ed above and evaluate your progress. The goal is to develop your skills and confidence in applying these steps to other problems (large and small) outside the therapy sessions.

Psychodynamic Therapy

A fifth type of therapy, known as psychodynamic (or fami-ly-of-origin) therapy, can help relieve depressive symp­toms in some people. This therapy focuses on helping you understand how past family experiences affect your cur­rent ways of thinking and acting. Psychodynamic therapy can be provided on an individual basis, through couples counseling, or in a group therapy setting.

Sessions are likely to deal with early experiences that may have affected self-image or self-esteem. Some thera­pists encourage you to talk about your dreams, which may be useful in revealing unconscious motivations or desires. The therapist may ask questions and point out patterns of behavior. Generally there’s little if any “homework” of the sort that’s commonly associated with cognitive-behavioral and behavioral therapies.

Many people find that psychodynamic therapy helps them develop insight into their problems, but the evi­dence for its effectiveness in depression is not as strong as it is for interpersonal, cognitive-behavioral, behavioral, or problem-solving therapy. Psychodynamic therapy tends to focus on long-term changes in ways of coping with stress and relationships and less on immediate relief of symptoms.