Today’s post is directed at those who are depressed and are contemplating or already receiving treatment from a mental health professional such as a psychologist. I want to share with you some suggestions about how you can optimize the effectiveness of treatment for depression. These suggestions are based on both published research and from my experience as a psychotherapist and as someone who has had personal experience with depression. Most of these suggestions hold true not only for the treatment of depression but for the treatment of any psychological problem.
Depression is complex in its origin and no one therapeutic strategy works for everyone
My first suggestion is that you understand that there is no single way to treat depression. As discussed in a previous post, depression is very complex in its causation and manifestations: one must consider genes, environment, and the interactions between these factors. Since each one of these factors is unique for each individual, each person’s depression is different in its causation, in the way it manifests itself, and correspondingly in the way or ways it can be alleviated. Hence there is no single miracle “cure” for depression that works for everyone.
Also there is no evidence that a depressed individual can be helped by just one particular therapy. In other words there may be several kinds of treatment approaches that can be useful to any one individual suffering from depression. Perhaps specific combinations e.g. meditation and exercise might work better than other combinations e.g. cognitive and emotion focussed therapy. Sounds complicated but please remember that extensive research has provided a variety of effective (evidence-based) kinds of treatment for depression, so there is lots of hope that psychological treatment will help you to recover from depression.
Many times clients come to me having read about certain approaches e.g. cognitive behavioural therapy and indicate their preference. I will generally follow the client’s wishes because that is the best way to assure the client is motivated to do the therapeutic work that is required for recovery. Also there is much research that one of the most important factors increasing effectiveness of psychotherapy is that a positive relationship develops between the client and the therapist; having the client choose the kind of therapy is a good first step in establishing this important relationship.
In most cases however the client has no preference about the kind of therapy as long as they get better. In such cases, I generally use a blended approach in which I help the client using whatever approach I feel on the basis of a thorough assessment is the best for that particular client at that particular phase of treatment. For example, if in the first visit I find the client is so severely depressed that they cannot summon the mental energy required to get active in their recovery program, I will refer them to a psychiatrist for an independent assessment and likely medication. I have found this to be a very effective way of helping even those with severe depression.
My personal experience with depression; what helped me most
My second suggestion for improving the effectiveness of therapy for depression is to try incorporating the three A’s of awareness, acceptance and action into your recovery from depression. This suggestion is based on my own personal experience and so may not apply to you. After I wrote a first draft of this post, I remembered that I too, for much of my life, had suffered from a chronic mild level of depression. My recovery from depression was strongly influenced by my experience with twelve step recovery groups such as Alanon which emphasizes the three A’s.
Awareness (understanding) came for me decades ago in Toronto, Canada, when a friend struggling with her own depression “dragged” me to a workshop by John Bradshaw. Bradshaw is one of the pioneers of the codependency movement and arguably its most successful public educator. Codependency which is now called developmental trauma or complex PTSD deals with the effects of childhood abuse, trauma, or neglect on adult functioning and one of the most frequent symptoms of codependency is chronic depression.
Bradshaw conducted a series of guided visualizations of childhood experiences. Being a typical reserved Canadian, I was flabbergasted at the groundswell of grief and sadness exhibited by the thousand or so people at this workshop. I was too inhibited to join in but nevertheless the experience lead me to realize that my depression had started in childhood due to the early traumatic events: being separated from my father when my mother and I fled from Scotland to Canada months before the outbreak of WWII. It was an amazing discovery and prompted me to read much more about codependency and depression and start my own recovery program.
The second A is Acceptance which means emotionally working through one’s issues. I can state unhesitatingly that getting into a self help group of individuals with similar issues was a pivotal experience in my recovery. I experienced acceptance and positive regard from the other group members. This acceptance and positive regard gradually became internalized as self-compassion a critical component of recovery.
The third A is action. As well as individual psychotherapy, early in my recovery I attended a “Survivors” workshop at the Meadows, organized by Pia Mellody. This “action” which involved a considerable investment of time and money was a pivotal step in my recovery and has improved the quality of my life immeasurably. Another action I do daily is to practice yoga and exercise, mindfulness meditation, and good nutrition in order to maintain my recovery.
Practice the HOW attitude
A final suggestion arises from HOW which is an acronym common in twelve step groups. In therapy, strive to have the HOW attitude i.e. honesty, open-mindedness, and willingness. Strive to be honest with yourself and with your psychotherapist. Also if your psychotherapist suggests homework assignments, be open-minded when considering them and if you find them reasonable then become willing to carry them out. The HOW attitude will help you make the most of your treatment program.
Summary
- There is no general treatment for depression that works for everyone and even for one person there is no one “correct” treatment; each person follows a different recovery path. The important thing is to develop a recovery program that works for you.
- Depression is a frequent symptom of developmental trauma (codependency). The three A’s are an effective general approach to treatment and recovery.
- Recovery depends upon you becoming actively involved in your treatment program and striving for an attitude of honest, open-mindedness, and willingness.
I hope that these three suggestions make sense to you and that they help you make the most effective use of the valuable time, effort and money that you invest in your treatment for depression.
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