THERAPY
/ COUNSELING
There
are many types of mental health professionals, including
psychologists, psychiatrists, social workers, and counselors.
All may work as therapists, though different professions
emphasize different aspects of mental health services. The
words "therapist" and "counselor" do not have legal meanings.
In most states anyone can use these terms. In addition to
clinical psychologists there are many fine counselors and
therapists who have degrees in counseling, clinical social
work, and related mental health fields. Check for credentials
and memberships in professional organizations. Many specialize
in certain areas, such as family therapy, sexual problems,
or eating disorders. If you plan to see a mental health
professional, take these steps first:
- get
a referral from someone you trust
- interview
the therapist
- ask
about fees, insurance, and the plan for treatment
The
National Mental Health Association at (800) 969-6642 can
help answer questions. If you are not satisfied with your
first mental health professional, do not give up on counseling
or therapy. Try someone else.
Who
can counsel me?
Psychiatrists are medical doctors who have earned
the M.D. or D.O. degree and have had both the full medical
training in human diseases and completed a three year (or
longer) psychiatric residency. They usually work by providing
medication and psychotherapy.
Psychologists
have earned a Ph.D. in clinical psychology. They cannot
prescribe medications, but they are experienced in psychological
theory and interventions, such as cognitive behavioral and
psychotherapy discussed below.
Social
workers are people with a degree called the master's
in social work. They often work with doctors to coordinate
the family education and support for a patient with a medical
illness. They are trained to help people work out difficult
feelings and situations, and can provide resources in the
community.
School
and work counselors are often psychologists or social
workers by training, however it is up to you to determine
the training of the particular counselor who you are interested
in speaking with.
People
may also find it helpful to speak with people who are not
trained in psychology per se, such as members of the clergy,
artists, teachers, friends and family members. While they
may not be able to treat the depression, it is better to
discuss your feelings with somebody rather than nobody at
all. Clergy and teachers, in particular, should be aware
of counseling resources available for you.
Click
here for more information on the credentialing process
of therapists.
Research
has shown that therapies based on discussions with a mental
health provider can be just as effective in improving depression
as medications in many people. Using both counseling and
medication has been shown to be most effective in the treatment
of depression, though many people with mild to moderate
depression may do well with counseling alone. Commonly used
forms of psychotherapy are cognitive, behavioral, and interpersonal
therapies. Cognitive
therapies challenge the negative thought patterns that accompany
depressed moods and teach techniques to think more positively.
Behavior therapies concentrate on changing patterns of behavior
that can help manage your symptoms better. Interpersonal
therapies help you examine your relationships with others,
and how they impact on the mood disorder.
Counseling
& Therapy Techniques
Cognitive & Behavioral Theory: Certain forms of depression
are best understood from a psychological standpoint. The
persistent negative thinking and feelings of depression
can be understood as the result of experiences that have
profoundly affected the mind's development, such as childhood
traumas or relationships with parents. Behavioral psychology
proposes one form of depression may be due to 'learned helplessness'
which is when a person or animal is punished no matter what
they do. You can imagine that if a child were punished for
no apparent reason they would conclude that their every
action was deemed wrong and begin to doubt and hate themselves.
Cognitive
behavioral therapy attempts to identify, confront, and change
patterns of negative thinking. Such patterns are often so
entrenched in the minds of depressed people they may not
realize there are even other ways of thinking. Negative
patterns may include: jumping to conclusions, over-generalizations
("I failed at this, I'll fail at everything"), mental filtering
("she liked my gift, but I ruined our relationship because
I left the price sticker on it"), discounting the positive
("he doesn't know what he's talking about, I'm not really
that good"), all-or-nothing ("Either I get an A+ or I am
worthless"), and personalizing blame ("it's my fault she
got lost on her way here even though I wasn't the one who
gave her directions").
Dr.
David Burns, the founder of cognitive behavioral therapy,
found that there are some strategies that may help you escape
such negative thinking. Six strategies include: (1) What
would you say to a friend who was in your place? (2) Examine
the evidence: is the situation truly as you describe it?
Do you really have no social network, or have you just not
called some of your friends or have they been really busy?
(3) Experiment: perhaps you feel you are selfish, but contemplate
unselfish acts you do, such as helping friends or doing
community service. (4) Look for partial successes: instead
of seeing things as partial failures, appreciate the successful
aspects of what you have achieved. (5) Define your terms.
If you call yourself mean, selfish, or blind, stop right
away and force yourself to define what you mean by that.
How are you 'mean'? Does it correspond to how the dictionary
defines it? (6) Solve the problem. A previous resident of
your house still has the keys and comes in at all times?
Change the locks.
Seven
steps to more positive thinking include: (1) Write your
feelings out with pen and paper. (2) Identify exactly what
is bothering you. (3) Identify what are your negative emotions.
(4) Identify negative thoughts that accompany those emotions.
(5) Identify how you have distorted things and substitute
rational responses. (6) Reconsider the conclusions you have
jumped to. (7) Plan corrective action.
More
information on cognitive behavioral therapy can be found
from the NIH Depression Awareness, Recognition, and Treatment
(D/ART) Program and The Feeling Good Handbook by David D.
Burns, MD More detailed information about cognitive behavioral
therapy can be found here.
Psychotherapy:
Psychotherapy involves a psychological approach to addressing
depression. Discussions with a mental health care provider
explore the possible causes and effects of depression in
terms of family relationships, childhood, dreams, work,
social situation, and other medical or psychological problems.
Therapists may employ role-playing, hypnosis, behavioral,
art, dance, music, movement, animals, exercise, diet, meditation
or whatever may be appropriate to help people learn about
and deal with depression.
The
word 'psychotherapy' refers to a broad range of psychological
intervention that may include everything from cognitive
behavioral therapy, discussed earlier, to traditional psychoanalysis.
Psychoanalysis is based on the tradition established by
Freud (pictured) in which patients use free association
and dream discussion to explore self-destructive thinking,
which the therapist then comments upon and gives advice.
While psychoanalysis remains controversial, psychodynamic
therapy involves the therapist discussing ideas actively
with the patient. It may feel like a normal conversation
to the patient, but in fact the therapist uses his or her
extensive knowledge of psychological processes to help the
patient understand and deal with depression. Therapists
can always tailor therapy to the needs and ideas of a patient:
religious texts, literature or poetry might be helpful for
one patient, while walking through the woods or making a
sculpture might be more helpful for another. In all these
cases, a skilled therapist can use these interventions to
help a patient learn more about who they are and how they
can help herself.
Therapists
may integrate the theories and practices of certain psychiatrists
and teachers. Some important psychiatrists who have introduced
helpful therapeutic thinking include: Jung, Erikson,
and Maslow.
Psychotherapy has been shown to be quite effective. One
recent study using PET scanners (which record overall brain
metabolism) showed that brain scans of depressed people
who have been treated with medications are comparable with
those of depressed people who have undergone intensive psychotherapy
for a similar amount of time. In other words, psychotherapy
is able to cause changes in the brain in a similar fashion
as if the person had taken medication.
