Which Kind of Therapy is the Best?

The best therapy is determined by the situation of the individual depressed patient. A review of the most common types of therapy will shed light on the unique values of each.

• Psychodynamic Therapy and Psychoanalysis: The goal of psychoanalysis is to help patients recover repressed memories or feelings that might be affecting their mental health in the present. Modern day psychoanalysis is an in depth, frequently-scheduled form of therapy that is meant to inspire insight that will help the patient's situation. Psychodynamic therapy works towards same goals as psychoanalysis but is less frequent, perhaps once a week. The advantage of this therapy is that it is helpful in people with deeply ingrained habits or personality defects that they wish or need to change, a concept that easily applies to depression. Another variation of this is client-centered therapy, which is inspired by the humanistic theories of Freud's protege Carl Jung. Client-centered therapy attempts the same personality improvements but is characterized by a empathetic therapist rather than an objective therapist.                                     
•  Interpersonal Therapy: Interpersonal therapy focuses on identifying issues in the interpersonal relationships of the patient. Rather than examining the past and attempting to solve personality issues, this type of therapy attempts to help the patient find solutions for the relationship problems most detrimental to them in the present. This can be useful in cases of marital, parental, and workplace issues. Real time solutions to social problems can assist patients in coping with depression.

Shown Above: An Example of Irrational Negative Thought

• Cognitive Therapy: The aim of cognitive therapy is to alter the thought process of the patient when confronted with situations that could upset him or her. This type of therapy is based on the concept that negative thoughts produce negative moods, and therefore, depression. The ideal candidate for cognitive therapy is a patient with low self-esteem and self-defeating or even irrationally negative thoughts. Cognitive therapy both attempts to raise self esteem and equip patients with long term coping solutions for negative thought.                                                  
• Behavior Therapy: Behavior therapy is exactly what is sounds like: an attempt to help the patient alter his or her behavior in ways that will eliminate destructive behaviors and replace them with more constructive behaviors. The patient sees a therapist and tells that therapist about his or her routines. The therapist will suggest things that the patient can start doing that may improve his or her mood. Other methods of behavioral change include role-playing and reward-based behavior modification.

These methods are not alone and are often combined, most famously in cognitive-behavioral therapy. Each approach has it's own advantages and all of them are accepted as possible paths to overcoming depression. I cannot stress enough that there is no one cause of depression. Just as antidepressants can only treat one aspect of the disorder and do not work equally for everyone, the same is true of each of these therapies. It strikes me that the successful depression treatment plan is most likely to be a custom fit. The small child who has conflicts with his new stepmother may be at risk on a medication but may improve after interpersonal therapy. The overworked college student with no self confidence and diminished motivation may be best off trying antidepressants while also attending cognitive-behavioral therapy. The battered wife who continually returns to her abusive husband and is extremely depressed may need a proper antidepressant and a good bit of psychodynamic soul-searching. One thing that is certain about all of these therapies is that, they give the depressed patient a support system when he or she may not have anyone else. Therapy gives a patient with major depressive disorder someone to talk to about his or her feelings and even the effects of his or her medication. Perhaps, it is not too much to demand such attention from not just our psychologists but also our psychiatrists. Why aren't the people prescribing the medicine monitoring and assisting the psychological improvement of their patients on a regular basis? I don't mean to claim that there are not psychiatrists who are highly involved in their patient's progress. However, if you were to ask the next person you see after reading this blog post, I would be willing to bet that they would be more likely to predict a fifteen-minute interview followed by a prescription and a follow-up appointment in a month from a psychiatrist than a weekly or bi-weekly psychiatrist involvement. Is the disconnect between administering medicine and therapy a simple necessity of specialization or a problem that requires reform or an overestimated anomaly brought to the conscious of the public by a few bad psychiatrists among many better ones? I will examine these questions and their direct connection to the effectiveness of antidepressant treatment for depression in my next post.

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