A Guide to Psychotherapy for Depression
This reference guide is for people who want to learn more about depression and how psychotherapy can help to treat it. It will discuss what causes depression, how psychotherapy can help, some of the different therapies on offer and how to find a depression psychotherapist.
This guide can be useful to people who are considering whether psychotherapy might enable them to deal with depression. It may also be helpful to family members or friends of people suffering from depression and wanting to understand how psychotherapy might help.
This guide will address the following common questions regarding psychotherapy and depression:
What Causes Depression?
How is Depression Diagnosed?
How Effective Is Psychotherapy In Treating Depression?
What Are The Benefits Of Psychotherapy With Depression?
How Many Psychotherapy Sessions Are Needed To Treat Depression?
What Are The Different Types Of Psychotherapy For Depression?
When Can Psychotherapy Be Unhelpful With Depression?
How to Find a Depression Psychotherapist
According to the Office for National Statistics, mixed depression and anxiety is the most common mental health problem in Britain, affecting nearly one-fifth of adults. Depression carries with it a high cost in terms of relationship problems, family suffering and lost work productivity. Yet, depression is highly treatable.
Depression does not have one single cause. It can be developed for a number of different reasons, some include:
- Stressful life events. An upsetting incident such as a death in the family or the breakdown of a romantic relationship can lead people to depression. Job stress or financial woes are also common causes. Early life experiences can also play a role. People who try to deal with these issues on their own and shut themselves off from family and friends are especially vulnerable to developing depression.
- Personality and heredity. People who have certain personality traits are also susceptible to depression. Those who are excessively self-critical or have very low self-esteem are at particular risk. Moreover, if you have a family history of depression – such as a depressed parent or sibling – it is possible you could become depressed yourself. However, this is not a given, many people with such histories do not become depressed.
- Illness and aging. Any illness can trigger depression in certain individuals, especially if it has repercussions on your activity level or sex life. In particular, people with life-threatening or recurrent illnesses are prone to depression. Thyroid problems and head injuries can also lead to mood swings. In addition, aging can make some people feel depressed.
- Drug and Alcohol Use. People who turn to drugs or alcohol to deal with problems are more likely to end up even more depressed because these substances can bring on or worsen depression. Moreover, those who become addicted often experience family or work problems, which can also contribute to depression.
- Giving birth. Postnatal depression can be triggered by the emotional, physical and hormonal changes that accompany giving birth as well as the responsibility and challenges of caring for a baby and changes in the family structure.
Depression is normally diagnosed in three main categories:
- Mild Depression
- Moderate Depression
- Severe Depression
A standard formula is used to diagnose individuals experiencing depressive symptoms. To receive a formal diagnosis you would need to experience at least one of the two core symptoms shown below:
Core Symptoms of Depression
- A persistent low mood and/or feelings of sadness, with or without weepiness.
- Lack of motivation: defined by a marked lack of interest or pleasure in activities you may have previously enjoyed.
Related Symptoms of Depression
There are seven further related symptoms, each of which may or may not, be experienced alongside one or both of the two core symptoms, these include:
- Sleep problems
- Appetite changes
- Sluggish movements or agitation
- Difficulty in concentrating and day to day problem solving
- Feelings of guilt and/or worthless
- Thoughts of death or suicide
Mild Depression Diagnosis:
With a mild depression diagnosis, you would experience one of the above core symptoms and usually no more than four of the related symptoms. Your day to day functioning may feel like a struggle but you will still be able to cope and get by.
Moderate Depression Diagnosis:
With a moderate depression diagnosis you would experience both core symptoms as well as four or more related symptoms. Your daily work and social activities are likely to be affected as you may avoid or struggle with situations you used to feel able to manage. Your ability to concentrate and solve problems will also feel significantly impaired.
Severe depression Diagnosis
A diagnosis of severe depression will include both core symptoms and most if not all the related symptoms. Symptoms will markedly interfere with your day to day functioning, in that you will be unable to manage most day to day activities at all.
There is a wide body of scientific research which demonstrates that psychotherapy is a very effective treatment for depression. It helps alleviate symptoms, provides effective coping strategies and can enable you to prevent depressive bouts occurring or escalating in the future.
Historically, GP’s tended to prescribe medication to treat depression. Nowadays, psychotherapy (or counselling) is increasingly recommended as the first intervention, particularly when symptoms are mild to moderate. In cases of severe clinical depression, psychotherapy alone may not be sufficient. However, used in conjunction with other treatments, such as medication, it can play an important role in treatment success.
- You can learn specific strategies to relieve depressive symptoms
- It can help you identify current life triggers which can evoke or increase symptoms and show you how to address these
- It can help you understand how beliefs and behaviours learnt in the past can trigger or exacerbate bouts of depression and what you can do to change this
- You can learn how to address areas in your life that may contribute to or worsen depressive symptoms
- It can show you strategies for improving communication, self-confidence and overall wellbeing which can help prevent depression recurring in future
- If you are prescribed medication, you can use it to learn how to cope with the side effects of depression medication
- When you have developed coping strategies you feel confident you can rely on – it can support you in the process of reducing or ending the use of medication
Because every individual is different and often dealing with a unique set of circumstances, the number of therapy sessions needed to produce results can vary considerably. However, there are some common factors, which can influence the length of time it takes to establish and maintain recovery:
Common Factors Which Influence Progress in Therapy:
- Length of time the problem has been present
- Severity and duration of depressive episodes
- Self-confidence levels
- Social factors such as relationships and work
- Difficult painful childhood experiences
- The quality of the therapeutic relationship: This means, the more trust and confidence you have in your therapist, the better the results.
Treatment length for Mild to Moderate Depression or Bouts of Depression
Psychotherapy demonstrates high success rates as a treatment with mild to moderate depression. As a general rule, for mild to moderate depression anything ranging from 6–12 or 24 sessions can produce good results. When the influencing factors accompanying the moderate depression are more extreme, some people find more than 24 sessions would be required to tackle issues, embed new strategies and feel equipped to maintain lasting changing.
Treatment Length for Severe Clinical Depression
In cases of severe clinical depression, psychotherapy alone is often not sufficient. However, used in conjunction with other treatments, such as medication, it can play an important role in treatment success. In severe cases more than 24 sessions and sometimes more than one session a week, could be required, in order to develop the ability to manage symptoms.
Treatment Length with Different Therapuetic Approaches
Some of the more modern therapies such as CBT, solution focussed therapy and integrative therapy (an approach that integrates a range of therapies – depending on the training and interest of the practitioner) view change as possible within a fewer number of sessions than older traditional therapies such as analytic and psychodynamic approaches, which have historically held the view that change takes a long time, often many years. However, there are now newer forms of psychodynamic therapy that do work within a shorter frame of 10 sessions.
There is a considerable range of psychotherapy approaches which have demonstrated success in treating depression. Below is a selection of some of the most common ones in use today.
Integrative Psychotherapy for Depression
Nowadays, many therapists are trained in more than one psychotherapy approach. This is commonly known as integrative psychotherapy. Integrative therapists can draw on a range of theories and techniques, which can help tackle depression symptoms from a range of different angles. The most common therapies they will be trained in are: psychodynamic , person centred and CBT (see more about these below). An experienced integrative therapist should be able to work effectively within a brief time frame and also have the skills to help you tackle more long-standing symptoms of depression.
Cognitive Behavioural Therapy – CBT
Cognitive behaviour therapy (CBT) has become more widely known in recent years as the government’s recommended treatment for anxiety and depression on the NHS. It demonstrates good success rates in treating mild to moderate depression. CBT provides some excellent exercises and tools that can help you understand depression cycles and symptoms and help you devise strategies to address them effectively. Homework assignments are agreed upon with your therapist so you can develop your skills outside of the therapy, using specific exercises to address areas of difficulty. However, the government have discovered that CBT is not always the best treatment for every individual and other therapies are needed to bridge this gap.
Interpersonal Therapy – IPT
Interpersonal Therapy is a relatively new therapy provided by the NHS to address the fact that CBT is not suitable for treating all cases of depression. In essence, IPT shares many similarities to most other forms of psychotherapy such as integrative, psychodynamic and humanistic, which have been in existence for many years and also show good evidence of effectiveness with depression.
Psychodynamic psychotherapy is one of the oldest of the modern therapies. It concentrates on the subconscious processes that guide a person’s present behaviour. It helps people understand the influence that their past has on their current emotional state as well as their actions and helps them deal with unresolved conflicts. This type of therapy also gives people better ways to deal with challenging situations. In addition to depression, it can also help with addictions, anxiety, and eating disorders.
Humanistic psychotherapy is a client-centred psychotherapy that includes all facets of the human existence, making it a “whole person” approach to problems. It has a strong focus on the here and now, and it focuses on the way personal responsibility is connected to self-empowerment. It treats depression as a chance for you to grow and develop your full potential. There is a wide range of therapies that fall under the humanistic therapy banner which include: person centred psychotherapy, transactional analysis, existential psychotherapy and gestalt psychotherapy.
A trusting relationship with your psychotherapist is the key to feeling better. If you do not feel comfortable sharing confidences after about two to three sessions, you might want to find a therapist who is a better match.
Whilst it is true that therapy can be challenging at times, this is simply because you are dealing with issues which have made you feel depressed. Therefore, touching upon these is bound to bring up feelings. However, you should not be feeling overwhelmed, over-exposed or really confused. A well matched depression psychotherapist will support you to explore important issues, at a pace that you feel in control of. You should feel safe, understood and contained and that you are growing and learning through the difficult patches. Some psychotherapists adopt an explorative approach that “opens things up” too much, too soon and in such cases clients report feeling overexposed or “too vulnerable” or “confused”. If this is occurring, let your therapist know and if things don’t improve you may benefit more from seeking a different therapist who is more skilled in helping you feel in control of the pace, so you can learn and improve.
It is also important to keep in mind that some people who suffer from severe depression or bipolar disorder might not see benefits from psychotherapy alone. In these cases, a combined approach of psychotherapy and medication may be more beneficial.
Private depression psychotherapists can be found on google and through directories including those of the main clinical governing bodies noted below. You can also ask family members or friends for recommendations.
On the NHS a general practitioner, social worker, or other health professional can refer you to a psychotherapist and you can self refer via the Increasing Access to Psychological Therapies (IAPT) Scheme. You can also access psychotherapy for depression in the charity sector, the largest mental health charity in the UK is MIND and they have branches in different boroughs of London and throughout the UK, many of which offer psychotherapy.