Therapy for Depression

I developed something of a specialization in depression back in the ‘90’s when I was a clinician in what was then the largest single-sight clinical trial funded by the National Institute of Mental Health. It was headed in Seattle by Neil Jacobson (sadly now deceased), at U.W. who compared the effectiveness of an antidepressant (Paxil) with a placebo medication and with two different psychotherapies. One therapy was cognitive-behavioral, which is well-proven.

The other therapy was a new kid on the block, behavioral activation. This therapy is usually a component in the early stages of cognitive therapy, and the idea is to help people with depression figure out how to start doing things that make them feel better. It is comparatively simple and “parsimonious” or efficient. I was one of the three Seattle therapists in this section of the study. It turns out that behavioral activation is at least as effective as cognitive therapy, more effective with those who are severely depressed, and it is more efficient. Also, patients with either therapy had lower rates of relapse than patients on medication. Try Googling “behavioral activation” and you’ll see that the method is getting a lot of attention now.

I tend to focus on how clients can start structuring their time and getting back to activities that are gratifying. I want them to start reconnecting as soon as possible with the sense that they can enjoy things and feel effective again. As a long-time family therapist, I was always interested in how we interact with our environment. We explore the inner world too of course…we just don’t want to set up camp there when we’re down.

When depressed, we tend to become ruminative. It is as if we apply the mind to a problem of the mind…which is like trying to extinguish a fire with fuel. Meanwhile, the depressive rumination is a way to avoid things we don’t want to do but which may make us feel better in the long run.

I also practice cognitive therapy, which means we examine the ways in which you make automatic distortions in your thinking. Events that are negative seem highly consequential, seem to be your fault, and seem to represent ongoing patterns. Positive events on the other hand seem to be temporary, insubstantial and lucky. We overestimate difficulties and underestimate strengths and resources. We make negative predictions and assumptions with insufficient information. We use our negative emotions to validate negative assumptions. You and I might practice identifying the ways in which you engage in these and other such distortions. I may have you practice, for example, listing the evidence in support of a negative belief and the evidence against it.

Often, I want to help those with depression connect with emotions. Ironically, depressed people, while sad, are not always good at experiencing or expressing sadness fully. Sometimes you have to swim in the river to reach the other side.

I have the view that we tend to flee from sadness, grief and pain, which really are fully wholesome emotions and unavoidable in any full life. For sure, some of us become too steeped but on the other hand don’t want to repress it.

Is medication recommended? Sure, it might be. I can work with you on how you take it, how you manage any side-effects, which antidepressants you might want to discuss with your doctor and so on. I also work with many people who come through depression counseling only.

For more, see the Depression and Medication categories in Ask the Therapist.

Questions? Call or email.

Tom Linde M.S.W.
PO Box 28186
Seattle, WA 981189
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