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Psychological Therapies

If you seek counseling for depression, you will most likely be treated with one or more of the three following forms of psychotherapy:

  • the psychodynamic approach
  • the cognitive-behavioral approach
  • the interpersonal approach

What follows is a very brief introduction to each therapy.

The psychodynamic approach was pioneered by early psychiatrists such as Freud, Jung and Adler. This system relates the development and maintenance of depressive symptoms to unresolved conflicts and losses rooted in childhood. The psychodynamic approach can involve long-term therapy (more than a year), with the emphasis placed on the individual's gaining insight into the nature of his or her problems, working through conflicts, and finding new ways to look at relations with others. The therapist-patient relationship is a key part of the treatment because of the client's tendency to transfer unresolved feelings about a parent or authority figure onto the therapist (a process called "transference"). Since Freud believed that many depressions were caused by unexpressed mourning, the patient may also be encouraged to grieve his or her early losses, including deaths and the emotional unavailability of primary caregivers.

More recently, the psychodynamic approach has been broadened to include women's issues, the social factors that contribute to mental health problems, and an interpersonal focus on the client's primary relationships.

In cognitive-behavioral therapy, patients are taught new ways of thinking and behaving to replace faulty beliefs about themselves, the world, and the future. Specific focus is placed on identifying erroneous assumptions, expectations and conclusions ("this will never end"), and letting go of self-destructive thoughts ("I'm worthless; no one can love me because I am depressed"). The behavioral aspect of therapy teaches constructive behaviors-such as learning to relax, to set goals, and to be assertive-that will help in overcoming feelings of helplessness and powerlessness. The cognitive approach may involve short-term therapy aimed at resolving current problems, or it may explore entrenched, unrecognized belief systems and emotional habits learned in childhood that contribute to current depressive symptoms.

Finally, cognitive behavioral therapy also seeks to reduce emotional distress by using a wide variety of strategies to induce physiological changes in the brain and nervous system. Such strategies include meditation, visualization, progressive muscle relaxation, biofeedback, and stress reduction techniques.

Interpersonal therapy looks at the role of interpersonal relationships (or lack of them) in contributing to depression. The depressed person is taught new skills for interacting with people and developing healthy, functional relationships. In many cases, the task is to rebuild impaired or absent social bonds or to heal family or work conflicts. Improving interpersonal communication skills is a central focus of the therapy. A fourth therapeutic approach, more popular in Europe than in the United States, consists of the existential psychotherapies, the most noted of which is logotherapy, created by psychiatrist Victor Frankl. While a prisoner of the Nazi concentration camps, Frankl observed that those people who found a meaning to their suffering and to their lives were more likely to survive their ordeals. Logotherapy focuses on helping the client to deal with the existential problems of human existence-discovering the meaning and purpose of life and finding worthwhile ideals to live for.

Each of these approaches has proven valuable in treating various levels of depression. The technique (or techniques) you choose should depend on your temperament, your level of functioning, the severity of the depression, and the therapist's training and background. Research has shown that any of these therapies can be beneficial if used by a competent professional. Moreover, in today's therapy office, it is not unusual for therapists to be familiar with several psychological theories and to combine eclectic technical approaches tailor-made for each individual's needs. The important thing is to try some type of therapy with a professional trained in the assessment and treatment of depression. Studies show that psychotherapy and medication are more effective in treating depression than medication alone, especially in the long-term maintenance of mental health.