Psychotherapy approaches depression differently from other mainstream practices.
Psychotherapy for Depression
What is psychotherapy? How does it differ from psychology and psychiatry?
What is depression? What are the signs and symptoms? How is it diagnosed? How is depression treated/managed? How can psychotherapy help in the management/treatment of depression?
What is psychotherapy?
Generally, the term psychotherapy can refer to any type of formal-professional counseling process where the focus is usually upon the patient’s issues, mental disorders or emotional suffering. It is a difficult term to define because there are over 400 different types of psychotherapy practices. The dominant practice is psychoanalytical or psychodynamic and that is what I am referring to here.
How does it differ from psychology and psychiatry?
To become a psychiatrist, you become a medical doctor first and then undertake specialist training in psychiatry. That training includes some limited training in both psychology and psychotherapy. Psychiatrists work in different ways but only psychiatrists can prescribe medications.
Psychologists are university-trained, and the term psychology usually refers to Cognitive Behavioural Therapy and the scientist-practitioner model. Psychology is based on research, and research determines general trends or ways that people are the same. Therefore, psychology is a one-size-fits-all method. Its usual focus is trying to change the way we think and behave.
The training for Psychotherapy is different and the practice operates in a different way. One difference is that psychotherapy trainees are required to have therapy for themselves. This is essential for working with people with mental/emotional issues to be safe and effective. Psychotherapy practice is based on individual difference and focuses on each person’s way of experiencing their world and themselves in it. We pay particular attention to feelings and to each patient’s history and how that affects their present situation. We also focus upon the dynamics of interpersonal relationships, on family of origin experiences and on recurring patterns. Psychodynamic Psychotherapy makes use of the professional relationship that has been shown as a primary agent of healing and of change; it is specifically a personal development process.
What is depression? What are the signs and symptoms?
Depression manifests differently for different people but it must be one of the worst feelings there is. Depression is characterized by feeling helpless, hopeless, futile, bleak toward the present and future, numb, immobilized, it often feels very dark, oppressive, there can be self-pity, despair and a generally negative feeling and outlook. It can be hard to get out of bed in the morning or into first gear to do anything and also feel like “what’s the point?” It is a most horrible mental state and can be very hard to shake, especially once entrenched.
How is it diagnosed?
The need to diagnose is more important for psychiatry and practices that have to answer to insurance companies. As psychotherapy is more concerned with experience, then the focus is on how a patient feels. Patients may well be depressed one day and not the next or depression may set in for years. The experience of depression is powerfully evident and usually presents no mystery as to whether or not it is there. I don’t use scales or questionnaires because they don’t take into account essential variables, personal differences or properly consider how the way we feel changes over time.
How can psychotherapy help in the management/treatment of depression?
While the experience of depression differs, there are some predictable themes. Depression is usually about loss, and a need to grieve a loss, come to terms with it and adjust. It can also be about anger that is turned against oneself. And I find that depression is often a consequence of disappointment or more specifically, of disillusionment. For example, a person has always believed they will be rich or recognized for their work, or marry Prince Charming or become a famous actor, or rock star.
One day they realize that their life is not turning out that way, possibly quite a long way from that dream—and depression follows. So, a loss can be the loss of a hope or a dream or a belief that we were attached to, or it can be a more tangible loss—for example, when I first came to Australia in 1990 some of my first patients here had lost their farms, substantial properties that had been in the family for generations due to debt and high interest rates. And this was devastatingly depressing.
Psychotherapy then helps people work through the feelings involved, come to terms with what has happened or hasn’t happened and adjust to life as it is. Psychotherapy can be longer-term and go into greater depth and detail than other practices.
It is very important to understand that to blame depression on a biochemical imbalance in the brain and only treat it with meds is to miss the underlying reasons for depression, or the underlying psychology that leaves a person susceptible to depression. If that remains untreated, then patients will be at risk of depression recurring down the track. And psychotherapy has been shown by controlled studies to be the most effective method for treating depression, for reducing its severity, its duration and its likelihood of recurring.
With a major depressive episode, psychotherapy can be used in conjunction with medication and this is a common approach.
Many patients have either been completely cured of depression or find that it happens less often or not as intense or overwhelming for the benefit of psychotherapy. Especially when it has been worked-through and given time.