Psychotherapy - Evidence-Based Treatments for Major Depression
Psychotherapy is a talk therapy in which people work with trained professional therapists to discuss their problems and learn new skills. Psychotherapy can help depressed individuals to talk about their experiences and feel listened to, gain insight into (and often some measure of control over) the thinking processes that lead to depressed moods, explore the contribution of past experiences to present day distress, and learn practical coping skills that can help decrease the likelihood of developing future depressive episodes.
As mentioned previously, many different professions train their members as psychotherapists. Psychotherapists may be psychologists, social workers, trained nurses, psychiatrists, counselors, psychoanalysts, or even professionals from other disciplines. Each profession brings something different to the psychotherapy table. Psychiatrists who offer psychotherapy are also able to prescribe medication, unlike most other professional therapists who compensate by aligning themselves with doctors who can prescribe for their patients when that is necessary. Psychologists have special training in mental health assessment as well as psychotherapy. Social workers can also offer mental health assessment (although not as broadly or comprehensively as psychologists) and treatment as well as link people to community and institutional resources.
There isn't one type of psychotherapy; there are many. Psychotherapy is not a unified field. Accordingly, psychotherapists may employ any of a number of different approaches and techniques. The major schools of thought that dominate current psychotherapy thinking include psychodynamic, cognitive-behavioral, family systems, and (to a lesser extent) humanistic schools. Each of these schools has a unique perspective on what causes people to have mental problems and how best to fix those problems. However, all types of psychotherapy aim to teach individuals about their depression, help individuals understand, express and control their feelings more effectively, and transform negative thoughts, attitudes, behaviors and relationships for the better.
Historically, psychotherapy was not an evidence-driven field. Therapists trained in a particular school or approach to mental health and learned from practical experience what worked and what did not. With the exception of the behavioral approaches, which have always been scientifically based, most older forms of psychotherapy have not been subjected to rigorous scientific tests to see how well they work.
Thankfully, the last twenty-five years or so has seen a growing interest in the development of evidence-based or empirically supported therapies (EBTs). EBTs are standardized psychotherapy treatments that have been subjected to scientific clinical studies and which have shown substantial evidence of efficacy. The term "efficacy" is a tricky term. It refers to how well an intervention helps people recover during a clinical study. Efficacy is not quite the same thing as "effectiveness" which refers to how well a therapy works under real world conditions. Unfortunately, true effectiveness is much harder to study than efficacy. Though they are not perfect therapies by any means, modern empirically based therapies represent the state of the art and the best that the therapy professions currently have to offer patients. If you are depressed and have the opportunity to receive an evidence-based form of psychotherapy that has been specifically designed to help you overcome your depression, you should feel very comfortable deciding to participate in that therapy.
Psychotherapies that fit the definition of "empirically supported" meet several different criteria. These therapies have a specified focus (e.g., they target depression), are intended for a defined treatment population (e.g., African American women between the ages of 20 and 50), and follow a well-defined treatment protocol. Typically, clinicians follow a treatment manual, which specifies the number of sessions to be offered, what to talk about and teach during those sessions, and what techniques are to be employed during those sessions.
Evidence-based therapies are highly structured for a reason; they aim to teach specific skills to specific patients who will benefit from them. EBTs are not designed to be open-ended or free-form in nature but rather to achieve a specific aim. Patients generally appreciate the no-nonsense approach to treatment taken by many EBTs, but some will benefit from a more traditional open-ended and free-form mode of therapy. It is quite alright to follow a more structured EBT therapy with a more traditional supportive psychotherapy, or to participate in both EBT and supportive forms of therapy at the same time if these options prove helpful or useful to patients.
EBTs are increasingly becoming a gold standard for mental health care for a few different reasons. Health care companies like EBTs because they have scientific data that support their use (therefore offering greater accountability) and also because they are short-term in nature. Health insurance and managed care companies are interested in having clinicians be able to justify the number of treatment sessions necessary to treat particular disorders and EBTs offer a science-based way to do just that. Many patients like the shortness and focus of EBTs as well.
Cognitive Behavioral Therapy and Interpersonal Therapy are two EBT psychotherapies, which have documented success in treating groups of people with depression in clinical trials. As with medication therapy, not all people with depression will be helped by evidence-based therapies. Keeping this in mind, we conclude our discussion of psychotherapy and depression with brief introductions to other varieties of psychotherapy that can also be helpful.