Just yesterday, a friend told me how her family doctor prescribed her mother antidepressants for twenty years. She was outraged that he never encouraged her to get counseling as well. She believes her mom could be happier if encouraged to grieve the untimely death of her husband and directed to build a bigger support system.
Last week, a new client came in for help with anxiety, and her doctor told her she must see a psychiatrist—not a psychologist or family therapist. This was the GP’s advice in spite of the fact that the woman complained about the controlling behavior of her husband. Unfortunately, far too many psychiatrists now prescribe medication (usually anti-depressants but sometimes addictive drugs like Xanax) rather than doing psychotherapy or even suggesting it.
This is no small question since one in six people will experience depression at some time during their life. Study after study has shown that psychotherapy helps people–and not just for depression. Given that therapy is available in many forms—and that low-cost or sliding fee scale options are available in most communities across America—why are doctors still not prescribing it as the first line of attack for depression and anxiety?
One answer can be found by following the money. Intense marketing strategies on the part of drug companies sell every new drug therapy as the quick and easy fix–while only mentioning in fine print the negative side effects that typically coincide with any drug. In the blog I wrote about anxiety, I received numerous heartfelt comments from readers who became addicted to prescription meds being taken just as their doctor prescribed.
Perhaps there are so many different forms of therapy out there these days that doctors are unfamiliar with and therefore hesitant to make referrals. While it is broadly accepted that psychotherapy can help people with depression, the question of which type of psychotherapy works best for most patients has remained controversial.
That’s why a research team, led by Jurgen Barth at the University of Bern in Switzerland, decided to shed new light on this question. Barth and his team analyzed results from 198 published studies involving over 15,000 patients, one of the largest examinations on the effectiveness of seven different types of therapy. The authors compared each of the therapies described below with each other and with a control group.
Interpersonal Psychotherapy: This short-term model (6-20 sessions) focuses on the client’s interpersonal issues, patterns of interaction with family and friends, and has the goal of reducing specific symptoms, improving interpersonal skills, and helping increase social support for the client.
Behavioral Activation: This approach focuses on helping the client increase positive interactions between themselves and the environment, bringing increased awareness of positive activities and interactions.
Cognitive Behavioral Therapy: This kind of treatment uncovers the patient’s negative beliefs about self and others, then teaches how these beliefs impact on behavior in order to facilitate symptom resolution.
Problem Solving Therapy: This model explores the nature of the client’s problems that contribute to the depression. The client examines multiple solutions for each problem, and then selects, implements, and evaluates the best solution.
Psychodynamic Therapy: This paradigm focuses on how unresolved conflicts and issues from the past have a negative impact on the patient’s current situation. Through insight and exploration of old patterns, the client develops new healthier ways of relating.
Social Skills Therapy: This highly educational process teaches people the skills needed to build and maintain healthy relationships.
Supportive Counseling: This less directive model encourages the client to talk about their life experiences and emotions. The therapist then offers active listening and empathy without suggesting solutions or teaching new skills.
These seven treatments for depression in the study were not exhaustive of all the possible treatments now available–such as spiritual counseling, acupuncture, exercise, yoga and meditation (the list goes on)–but are each commonly practiced forms of talking therapy. The study found evidence that all seven interventions achieved moderate to large effects on alleviating depression when compared to no treatment at all.
They also found that the therapies worked equally well for different patient groups, from young to old, from post-partum mothers to single men. The only significant difference was that interpersonal therapy was somewhat more beneficial than supportive counseling. They also found that in larger studies, the cognitive-behavioral, interpersonal, and problem-solving models were more effective than the other three but by a very small margin. Other research on the effectiveness of therapy indicates that experienced clinicians include interventions at all the levels mentioned above (thoughts, feelings, behaviors; providing insight, encouragement and support) no matter what theoretical model they say they follow.
If you are one of the many for whom medication is a life-saver, stay on your meds AND make sure that some form of counseling is part of your program. When looking for the right therapist, think about what strategy might be best for you. Just because a certain type of therapy has a track record of success doesn’t mean it fits your particular needs or cultural beliefs.Discuss different forms of non-drug therapy with your doctor or friends or check out on-line resources such as those offered here at PsychCentral.
Some people prefer practical hands-on approaches; others merely want a good sounding board. The bottom line: the new standard of care should always include therapy if the depression or anxiety is serious enough to merit taking medication. Find whatever approach feels right for you. Then make a beeline for it.
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Last reviewed: 10 Jun 2013