What types of psychotherapy are available to treat my depression?

The following is a list of different types of psychotherapy that you may encounter.

• Psychoeducation: Psychoeducation (PE) is the process of learning about unipolar major depression, what causes it, and what makes it go away. Your doctor and therapist should contribute actively to PE to help you understand your thoughts, emotions, and behaviors, and the ways to make things better. PE can help you learn how to live a healthy life, reduce stress, and minimize your vulnerability to having another depressive episode. Many studies show that PE works as well or better than other types of psychotherapy for relieving depression. And in fact, this book was written to help you understand your depression, and the act of reading it already makes you a participant in psychoeducation. You will find other ways to extend your depression education in Appendix A, Resources.

You should make sure that your doctor and therapist know that you want to share their knowledge about unipolar major depression and its treatment. They should discuss the benefits and risks of all your health choices with you until you feel comfortable making treatment decisions. This psychoeducation is an essential part of depression treatment, and in many cases, it is required by law.

• Behavioral Therapy: Behavioral therapy (BT) uses learning, training, and behavioral techniques that were specifically developed to reduce depression. BT teaches relaxation techniques that can protect you against stress and the depression it causes. It helps you plan activities that you enjoy, and it helps you become a participant in your life again. BT can change the negative workings of your mind by helping you remember prior, undepressed ways of thinking, feeling, and acting.

You can find relaxation exercises in Chapter 13, Stress-Reduction Techniques, and behavioral therapy programs on pages 246-250 for you to do at home. BT requires homework, but depressed people seem to be able to complete it relatively easily. Unfortunately, only a limited number of psychotherapists are trained in behavioral therapy, and they may be difficult to find.

• Cognitive Therapy: Cognitive therapy (CT) was developed specifically for the treatment of depression. CT is based on the notion that we develop basic patterns of thinking, like overgeneralization, negative filtering, catastrophic thinking, and attempts to predict the future, that need to be changed in order to recover from unipolar major depression patterns. CT also aims to correct erroneous core beliefs that stem from depression, such as feelings that you are bad, weak, helpless, unworthy, or unlovable. Studies have shown that CT is useful for the treatment of depression.

Unfortunately, some severely depressed individuals are not able to do the homework that is required in CT, especially if they do not have energy or free time. It can also be difficult to find qualified cognitive psychotherapists in many locations, but the CT crowd is growing.

• Psychodynamic Psychotherapy: Psychodynamic psychotherapy (PP) is an outgrowth of Freudian and Jungian psychoanalysis that helps you acquire insight into your inner self and use it as a tool to resolve your depression. Over time, you may have developed bad habits and maladaptive ways of dealing with your depression by pretending your problems do not exist (denial), running away from them (withdrawal), pretending someone else is responsible for them (projection), or expressing your frustration through annoying others (passive aggression). If any of these sound familiar, then PP may be the answer.

Modern psychodynamic psychotherapy uses the interaction between psychotherapist and client as a tool to reveal internal assumptions and fantasies. It is potentially very helpful for unipolar major depression. Although this approach is thought to be slow, many PP therapists are trained in brief psychodynamic therapies specifically targeted at unipolar major depression.

• Interpersonal Therapy: Interpersonal therapy (IPT) is a brief psychotherapy specifically developed for the treatment of unipolar major depression. IPT examines significant relationships in your life and helps control your depression by improving communication and gaining insight. Improving your understanding of important relationships, social interactions, and communications can improve your life dramatically.

• Group Therapy: Group therapy provides a safe environment to share thoughts and feelings with others who also suffer from unipolar major depression. It is an opportunity to acquire insight from other peoples’ experiences and to hear about new coping strategies that others have discovered. Group psychotherapists may be trained in interpersonal, psychodynamic, family, supportive, or other types of psychotherapy, and could use any or all of them in their groups. The quality of group therapy depends very much on the training and expertise of the professional psychotherapist who leads the group. Group therapy that is just a bunch of unsupervised chatting will not help your depression. Similarly, groups that have broken away from a professional psychotherapist and simply meet on their own, as well as groups led by untrained leaders or other patients, can also be more damaging than helpful. These waste your valuable time and money, and whether they make your depression better or worse is just a toss-up.

• Family Therapy: Family therapy (FT) brings your spouse, parents, and children into your therapy session. It places emphasis on communication and problem solving between individuals in the session. Problems identified in one member of the family are examined in the context of the family system and the contributions of its members. Family therapy is popular but may be more useful for problems that arise from dysfunction in the family than for problems that arise from lack of control over thoughts and emotions (depression).

• Supportive Therapy: Supportive therapy (ST) is positive social feedback developed into a form of psychotherapy. ST seeks to encourage, nurture, and reassure you that things are not as bad as you think, that you will be successful, and that tomorrow is another day. Unfortunately, from the depths of depression, this rosy view is often annoying, and it can be disconcerting to be feeling so bad at the same time your psychotherapist acts as if the world is her oyster.

Some supportive therapists believe that bringing back and reexperiencing past miseries and failures will cleanse them from your system. Unfortunately, this practice can make depression worse.

Overall, therapies for depression that focus on practical life changes seem to be the best way to treat unipolar major depression; ST can make you feel good for a while, but it might not help you make the changes that you need in your life.