Psychotherapy is the treatment of mental and emotional disorders by psychologic techniques and counseling. Psychotherapists can include:
- Licensed psychologists
- Psychiatric nurses or nurse practitioners
- Psychiatric social workers
- Individuals trained in counseling
Various methods of psychotherapy can help depression, including:
The word "cognitive " pertains to the mental processes of comprehension, judgment, memory, and reasoning. Cognitive therapy (also known as cognitive behavioral therapy) is based on the premise that people become or remain depressed because they are drawing distorted, negative conclusions about situations and people with whom they interact.
Cognitive therapy helps a person become aware of how distorted thinking is self-defeating and can lead to depression. The person learns to recognize thought patterns and change attitudes and behavior accordingly.
Common types of distorted thinking among depressed people include:
- Over generalizing ("all men are ignorant")
- All-or-nothing thinking (perceiving something as happening "always" or "never")
- Seeing only the negatives (the glass half-empty instead of half-full)
- Jumping to conclusions (without knowing all the facts or giving the other person a chance to explain)
- Overanalyzing (brooding, thinking too much about something)
- Blaming oneself for things beyond one's control ("If I'd been a better child, my parents wouldn't have gotten divorced.")
The first step in cognitive therapy is to identify how and when one leaps to the wrong conclusions and to catch oneself in the act. The person is often encouraged to keep a diary of how he or she is thinking and feeling throughout the day, and of what is going on in his/her life. A chart divided into columns can be helpful. Under each column, the person typically lists:
- The situation
- Negative thoughts (about the situation)
- Feelings (resulting from the negative thoughts)
- Rational thoughts (upon considering all sides of the situation)
- Feelings now (that one has realized it isn't that bad, that there are alternatives)
The second step is to discuss with the therapist alternative ways of drawing conclusions. An example is the situation of the man who feels shunned when his greeting is not returned:
I called hello to Marla across the street but she ignored me.
She doesn't want to associate with me anymore; I'm not likeable.
Hurt, lonely, depressed.
There was so much noisy traffic between us, she might not even have seen me, much less heard me.
Neutral. No cause to be hurt or depressed. I can get on with my day.
The person must take a very proactive role in cognitive therapy and be willing to work at it. A person who does so may feel empowered with the knowledge that in many everyday situations, we can choose how we react and how we feel. This empowerment can help dispel feelings of depression.
Interpersonal therapy examines one's relationships and interactions with others. This form of therapy helps a person recognize how the quality of his or her relationships can play a part in depression.
Among the goals are to:
- Honestly identify one's needs in a relationship
- Examine healthy and unhealthy behaviors that one practices to get those needs met
- Improve communication and behavior in relationships
- Learn new ways to cope with stress and other problems
Situational counseling involves seeing a professional who specializes in the area that is linked to the depression. For example:
- If the depression is associated with a death, it can be helpful to seek a counselor who specializes in bereavement.
- If the depression is associated with alcohol or drug abuse, it can be helpful to seek a counselor who specializes in addiction.
- If the person is suffering from a chronic illness or has a loved one with a chronic illness, there are counselors and support groups for many such situations (cancer and AIDS support groups, for instance). A local hospital or clinic may be able to provide a referral.
A psychologist or trained counselor guides a small group of people in discussions of problems and how they are handled. Group counseling can be effective because:
- It shows the person that he or she is not alone
- It helps the person realize that many people share similar problems
- Learning from one's peers can be a powerful step on the road to recovery
Need To Know:
How long to continue psychotherapy is a highly personal decision. At the beginning, a person may see the therapist once a week or more often if necessary. Most people taper off to once a week or biweekly thereafter. If therapy does not relieve the depression after 10 or 12 weeks, another option (such as medication) should be added.
Nice To Know:
Q: Is entering psychoanalysis a good way to quickly get over depression?
A: Not necessarily. When we think of Sigmund Freud (the "grandfather" of psychoanalysis), we think of traditional psychoanalysis, or analytic psychotherapy. We picture the patient lying on a couch while talking, sometimes not even facing the therapist. The therapist often says little. This style of therapy rests on the principle that what develops reflects the pattern of earlier relationships, and that because the therapist is relatively passive, various emotions may freely emerge and may then be identified as the source of current problems. This type of therapy is not aimed primarily at relieving symptoms of depression, but rather at helping people learn more about themselves and how their past has contributed to the present. Any benefits from this type of analysis can take years. If one is depressed and in need of help now, it is advisable to seek treatment with a therapist who specializes in one of the newer approaches.