What type of Psychotherapy?

In the past two decades, several specific therapies developed to address the symptoms and associated features of depression have produced benefits superior to those provided by nonspecific psychotherapies, as demonstrated by results of outcome studies. These approaches tend to be structured (in some cases, being presented in a "treatment manual" format), directive, time-limited, and focused on identified target symptoms and on current rather than long-past issues. Moreover, they de-emphasize personality, character, and early-life relationships. None of these approaches prescribe therapy "by the book." Rather, each assumes a base of general clinical and therapeutic training and experience on the part of the therapist, a positive patient-therapist alliance, and use of nonspecific elements of empathy, nonpossessive warmth, concern, and optimism regarding the patient's capacity to apply personal resources to his or her own benefit.

Specific Psychotherapeutic Approaches

Four specific psychotherapeutic approaches have demonstrated benefits or "value-added" effects. Often, experienced psychotherapists combine these various depression-specific techniques in individual psychotherapy for depressed patients. Although the integrated-eclectic approach used clinically by many "master therapists" does not afford the same clarity that outcome research programs do, it frequently adds the benefit of clinical wisdom and expertise, which represents the practitioner side of the scientist-practitioner model.

Cognitive-Behavioral Therapy^2,3

The goals of cognitive-behavioral therapy are to alleviate depressive symptoms and prevent their recurrence by helping patients (1) identify, test, and reshape negative cognitions about themselves, the world, and the future, (2) develop new and more flexible cognitive patterns or schema that are alternatives to depressogenic ways of viewing life experiences, and (3) rehearse new cognitive and behavioral responses.

Interpersonal Psychotherapy^4-7

In interpersonal therapy, depression is defined as a disorder that happens to the patient and requires treatment. The patient can then assume the "sick role" with little concern for assigning blame to self or significant others.

Interpersonal therapy focuses on improving current social function in four problem areas:

1. Grief reaction to "exit events," losses, and bereavement, which is treated by facilitating grief work and encouraging the patient to compensate for losses by engaging in other relationships
2. Interpersonal role disputes and conflicts with significant others, which are treated by strategies for resolving disputes or facilitating the process of ending negative relationships
3. Role transitions and changes that add stress and threaten self-esteem, which are treated by helping the patient develop a sense of mastery in new roles
4. Interpersonal deficits reflected in the patient's history and current circumstances involving inadequate or unsatisfying relationships, which are treated by strategies to reduce social isolation by building the social skills and opportunities needed to develop and maintain supportive relationships

Behavioral Therapies

Behavioral approaches to treating depression include social learning therapy, self-control therapy, social skills training, and multimodal therapies. All these therapies make use of the following techniques:

• Self-monitoring and self-evaluation of mood and activity
• Scheduled increases in levels of general, social, and pleasurable activity and behavioral productivity
• Decrease in or management of aversive events
• Development of self-reinforcement patterns
• Cognitive skills training to modify self-statements and attributions and to improve cognitive self-control, problem-solving and decision-making skills, and time management
• Relaxation and mental imagery training to encourage active stress management by development of positive coping and mastery images
• Assertiveness training, improvement of communication skills, and role play to enhance social skills and interpersonal effectiveness

Short-term Dynamic and Psychoanalytic Therapies

These therapies are not narrowly focused on symptoms of depression, and their efficacy rates are somewhat less definite than those achieved with symptom-specific therapies. They tend to organize brief interventions around the selection of a specific dynamic focus (usually an interpersonal problem) with links to core conflicts that often originated earlier in life. The current conflict is used as a focus, or "microcosm," for addressing negative patterns in the patient's life.