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Psychotherapy - Evidence-Based Treatments for Depression

Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA

Psychotherapy is a talk therapy in which people work with trained professional therapists to discuss their problems and learn new skills. Psychotherapy can help people with depression to talk about their experiences and feel listened to. It can also help them to gain insight into and often some measure of control over the thinking processes that lead to depressed moods. They can explore past experiences and current stress.  They are able to learn coping skills that can help reduce the chance of developing future depressive episodes.

therapy sessionMany different professions train their members as psychotherapists. Psychotherapists may be:

  • psychologists
  • social workers
  • trained nurses
  • psychiatrists
  • counselors
  • psychoanalysts
  • professionals from other disciplines.

Each profession brings something different. Psychiatrists who offer psychotherapy are also able to prescribe medication.  Most other professional therapists must connect themselves with doctors who can prescribe for their patients when that is necessary. Psychologists have special training in mental health assessment as well as therapy. 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. Therapists may use many different approaches and techniques. The major schools of thought in current psychotherapy include psychodynamic, cognitive behavioral, family systems, and (to a lesser extent) humanistic schools. Each of these 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. They try to help individuals understand, express and control their feelings more effectively.  They work to transform negative thoughts, attitudes, behaviors and relationships for the better.

Evidence-Based Treatments

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. The behavioral approaches have always been scientifically based. However, most older forms of psychotherapy have not been subjected to thorough scientific tests to see how well they work.

The last twenty-five years or so has seen a growing interest in the development of evidence-based or empirically supported therapies (EBTs).  These 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 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.  This manual specifies the number of sessions to be offered, what to talk about and teach during those sessions, and what techniques are to be used 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. Evidence-based therapies are not designed to be open-ended or free form in nature. They are designed to achieve a specific goal. Patients generally appreciate the no-nonsense approach to treatment taken by many EBTs. However, 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.

Evidence-based therapies 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 and offer greater accountability). They are also liked 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. Both 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.