TYPES OF THERAPY
by
©Stephen L. Bernhardt 1997-2000
I believe that of the over 200 differing types of mental health 'therapies' available there are two methods which are most effective when dealing with clinical depression. Those are the cognitive-behavioral model and medication. Further I believe that there is potential harm when drugs are used alone without the longer term benefits of the cognitive-beharioral model. The 'drug only' therapies are able to site many success stories, but the problems arise when the environmental, social, and cognitive aspects of depression are ignored. If you have found yourself in a drug only program I strongly urge you to supplement your treatment with a cognitive-behavioral self help program.
I have heard it said that 'the talking therapies don't work for me'. I would submit that there are three main reasons why the talking therapies are ineffective for some people. One, the therapy was not cognitive-behavioral based. There are many therapies which may help us deal with past issues and future aspirations, but depression is caused and also cured by the relationship and interaction of the conscious mind and the biological unconscious mind. Any therapy which is to be effective in reversing the depressive response must deal with our cognitions (how we think and what we think). Secondly, it may be that the first contact was with an inept or at least an ineffectual therapist. And third, the patient may have been either unable or unwilling to be an active participant in the therapeutic process.
Much of the initial effectiveness of any therapy (this includes drugs) is the placebo or a positive psychosomatic effect. If we believe that our chosen therapy has a chance of reversing the pain of depression, and that now there is a small glimmer of hope where before there was no hope, this many times gives us that needed 'jump start' which begins the road to healing. Medications have a distinct advantage where the placebo effect is concerned as the drug companies, the news media, and the government, all hype our 'miracle drugs' as being able to help eighty percent of those who seek therapy. Also after the four to six weeks, when the drug begins to take effect, the relief of the symptoms of depression can have a powerful placebo effect for someone who has been plagued with the pain of depression for years. For many this is all that is needed and the depression begins to lift. For others this is not enough as the environmental, social, and cognitive component of their depression continues to exert pressure on the ability of the drugs to relive the symptons of depression and we are forced to continually adjust dosages or change to that new and better 'miracle drug'.
For the cognitive therapies it is up to the therapist to instill in us the confidence that in the near future it is possible we will be free of the pain of depression. Although this placebo 'jump start' is more difficult for the cognitive therapist I would remind you that studies have shown that the cognitive therapies are as effective as the drug therapies without the unpleasant side effects many have when taking drugs. Also the cognitive therapies empower us with new life skills and an improved mind set which we are able to use for the rest of our lives. This affords us some insurance that the depression will not return at a later date.
I have two reasons for discussing therapies other than the cognitive-behavioral, rational emotive, and medication therapies. One, some of them are not effective in dealing with depression and you need to be aware of their drawbacks, and secondly some of the other listed therapies are effective, after depression is stabilized, with helping us improve life skills, coping skills and with controlling our emotions, they help us to grow and improve ourselves.
It has become increasingly apparent that of the "talking therapies" the cognitive approach is most effective when treating depression, that is the Cognitive- Behavioral and/or the Rational Emotive therapies. The cognitive approach acknowledges that we have control over our life and our emotions, and that it is possible for us to change what we think, how we think, our emotional response, and what we do or how we react to our environment. The past is important in that our past has much to do with who we are and how we act and react, but it is what we do and what we think in the present that is most important in shaping our future. We have within us the power to change maladaptive thoughts and behaviors in order for us to better cope with the stress of modern life. The competent and caring cognitive therapist will help us gain insight into the thoughts and behaviors which have caused this depressive response. They help us to begin to live our life more in control of our emotions. At best, the clinical depression will lift and we are able to resume our life, relatively depression free. At least, we will be able to function better than before, more in control of our emotions and our moods, with tools which will help us better manage our depressive responses. The cognitive approach is supplemented with drug therapy when needed. Medication may be needed if we are not strong enough when we first seek therapy to participate in a dialog with the therapist. They may also be needed, if for whatever reason, we refuse to participate in our own health and well being or when talking therapies, for some unknown reason are ineffective.
The "drug only" therapists believe we have little control over our life situation, that the environment does not for the most part cause depression, and that the depressive response is a genetic malfunction or chemical imbalance. They believe we are on the verge of discovering the genetic markers which are the cause of most depressions. They begrudgingly acknowledge some situational depressions may benefit from cognitive- behavioral therapies as an adjunct to their medications.
Source Books:
Rational emotive therapy is not a passive therapy, it allows the client to take responsibility for and control of, their own future. It is not based on historical events as is the traditional Freudian psychoanalysis, it is not mystical or spiritual as with Jung's analytical psychology or as with the Eastern religion influence. Rational emotive therapy is an action-oriented, directive, short term therapy which uses cognitive and behavioral techniques. The therapist helps the client gain insight into maladaptive and dysfunctional behaviors and thoughts which have caused the client stress and put them at odds with their environment. This insight helps the client focus on the present, not the past, and emphasis is placed on what the client can do in the here and now in order to make the future less stressful.
Although the therapist may feel the need to be somewhat confrontive and persuasive, one should never be made to feel that they are less of a person because they are depressed and have certain irrational thoughts and behaviors. It is not a matter of right or wrong as far as our beliefs are concerned, it is a matter of those thoughts and actions which cause our unconscious mind to deploy the depressive response in reaction to undue stress. We should be able (with the help of our therapist) to change our irrational thoughts and behaviors and cause ourselves less stress, yet continue the integrity of our basic belief system. That is true, unless we have allowed the depressive response free reign of our mind to the point that we have begun to believe we need do harm to ourselves or to others.
The depressed person feels the need to explore the emotions they are experiencing, yet it is the over emphasis and dwelling on the negative emotions which causes the stress that in turn causes the depressive response. Some therapies emphasize the exploration of emotional issues to the point that the negative emotions are reinforced and there are no actions implemented in order to begin the process of stopping the negative emotions. The depressive response will continue and the negative emotions will intensify. The cognitive therapies help us reverse this cycle, even though our depressed mind would have us do otherwise. Once the depression has lifted we can then begin to explore more fully our emotions and possibly our past emotional response if we feel the need, from a more rational and controlled perspective.
You will find if you investigate the referral listings of cognitive and rational emotive sanctioned therapists, that there are relatively few listed, especially if you live in a rural area. Most of us will end using either psychologists or masters level therapists whose training is more generalized in a number of differing therapeutic styles. You will more than likely hear the term 'the eclectic approach', which means that your therapist will use that approach or combination of therapies which will best fit your particular needs. Of course this requires that the therapist is able to determine your needs and that they then know which therapy is best for you. As there is no truly 'eclectic' therapy (it would have to incorporate all that is effective for you of the 100's of theraputic models designed throughout the years) I would not recommend any 'eclectic' therapy for depression which does not begin with the cognitive approach.
Why am I so adamant that cognitive therapy is best for depression? What I know is that the depressive response is a function of the relationship and interaction of the conscious and the biological unconscious minds. In order to reverse the depressive response, that which is stressful to the unconscious mind must not be reinforced. I have found the cognitive-behavioral and the rational emotive therapies come close to meeting that criteria.
Books:
INTERPERSONAL THERAPY
This therapy concentrates on interpersonal relationships with our peers, co-workers,
friends and family members. I think it is encouraging that an eclectic hybrid of
this therapy seems to be emerging, e.g. cognitive/interpersonal therapy which sounds
promising, especially where teens are concerned. I will take a closer look.
Books:
FAMILY THERAPY
Certainly the family dynamic is extremely important when dealing with teen eating disorders,
abuse, marital problems, and adolescent depression. I think the bad press that family
therapy has received regarding its effectiveness with depression is the result of a failure
to include one-on-one cognitive therapy with the depressed individual in addition to the
family counseling. This would probably need to be a team counseling effort, especially if
more than one member of the family were depressed.-- My opinion.
SHORT TERM PSYCHOTHERAPY
In response to increased costs of mental health care, managed health care providers profit
motivated insistence on shorter term therapy, and competition from drug therapies, there is
emerging a number of short term psychotherapies. I have no way of evaluating these new
therapies and as of yet neither does the mental health community. It may well be that some
extremely beneficial short term psychotherapy may emerge from this social experiment, God
knows it is long overdue. But, mental health care professionals have never been reticent
about using us (depressed people) as guinea pigs in their quest for the one true, fix all,
theraputic model. If I were in need of therapy at this time, I would hold off on using
any of these new therapies until there comes to the surface one which is effective against
depression.
© 1997-2007 steveb@frii.com
WebRings
Home-Index |
Understanding Suicidal Thoughts
Emotional Thought Stopping |
Tempering the Mania
Finding Help for Depression |
Social Comment
Theory |
Links |
Awards
Help-a-Friend
Self-Help