Psychosocial therapies include all the ‘talking therapies’. They can be very helpful for milder forms of depression. We can divide them into three major groups:
– cognitive behavioural
– short-term psychodynamic
In day-to-day practice, most therapists use a combination of many types of therapy. Both the therapist and you are active -exchanging observations, ideas, and feelings in a comfortable private place. You are free to talk about what you like, while the therapist listens and asks questions in order to understand the issues. The old stereotype of the bearded analyst staring and saying nothing, like someone out of a Punch cartoon, has essentially gone the way of the horse and buggy.
The different types of therapy have common characteristics. In the first stage of therapy, a respectful and empathic relationship, sometimes referred to as a ‘working alliance’, develops between you and the therapist. The therapist listens carefully to how you define and understand your difficulties, deciphering when the problems started, how they are affecting you now, what makes you feel better and what worse, and what sort of changes might help. How does this differ from what a good friend or partner can offer? For one thing, your choices don’t affect the therapist’s own life. For another, everything you tell the therapist is held in confidence. The therapist has no set ideas about what is best for you. He or she will do more than try to cheer you up. Both of you work on clarifying the problem, how you are affected by it, and how you can act in your best interests with minimum negative consequences for your relatives and friends.
The relief in having a safe place to talk to someone who is actively trying to understand and make sense of your experience, without judging you, can be healing in itself. When differences arise between you and the therapist, you can talk about the conflict openly, not sweep it under the table as you might in social situations. This flexibility helps you explore different viewpoints without always having to decide on a right or wrong answer. It is also very gratifying to be given someone’s complete attention and interest for an uninterrupted hour. Usually the sessions are once or twice a week for approximately twelve to twenty weeks.
It is useful to combine drug therapy with psychotherapy. Thoughts and feelings and chemical changes in the brain influence each other. When we change the way we think and feel, we change what is happening chemically in the brain. When we change the chemical balance in the brain with drugs, we change how we think and feel. That’s why drugs and psychotherapy can work together, reinforcing each other.
At some point, you may have to deal with sadness and anger over a permanent change in your life that you can’t control. Such adjustments can be very painful. Perhaps you have lost someone you love, or the future you had hoped for. Losses like this can leave anyone disappointed and angry, but if you are predisposed to develop depression, you may be convinced that the loss is entirely your fault, and that you are helpless and incapable of controlling what happens to you. If you are unable to get past this guilt and self-blame, you are very likely to become depressed. When you are able to voice your grief and rage without being silenced, your feelings are validated – they are accepted as reasonable and understandable. You can then eventually move past the loss, taking joy in life as it now is.
Early in treatment, your therapist should give you an explanation of what he or she sees happening to you and what can be done about it. This should be in clear language; if you don’t understand any of it, say so. The therapist will be aware of any embarrassment you feel about coming for help, and needs to be aware of your doubts about your treatment. You may have had bad experiences in the past with caregivers, such as parents, teachers, and doctors, that make you sceptical about receiving care. Even one bad experience can make you wary and uncomfortable.
Tyrell had once been assessed in a large auditorium with medical students watching. He had been humiliated and unable to say a coherent word. Later, the doctor asked his wife what it was like to live with someone who was so seriously ill. Needless to say, it took months before Tyrell overcame this experience and managed to see another therapist!
The therapist can only build up your sense of trust by being consistent and caring over time. In short-term therapy, you usually contract with a therapist to work on your difficulties for some ten to twelve weekly sessions of about an hour each. During that time you may discuss issues that are bothering you currently, what it is about you that makes these issues particularly disruptive, where those feelings originated, and how they might be altered. As you go through the therapy, you begin to notice that certain patterns recur between you and the people you interact with in the present, between you and your therapist, and between you and important people in your past. Once the patterns are identified, they can be modified. You may also come to understand how your family or other caregivers pass on to you the stresses or depressions they themselves are burdened by. Through understanding, you can use behaviours that work rather than behaviours from the past that hinder your present relationships.