Depression Counseling

Learn about the process of depression counseling ...

depression counseling

Everyone knows the image of the patient lying on the couch, the psychotherapist sitting with a pad of paper, taking notes, but letting the patient ramble on about his or her problems, nodding, saying therapeutic quips such as “Tell me more,” or “How do you feel about that?”

This psychodynamic approach based on Sigmund Freud’s theories and his psychoanalytic framework is still used today, but much less frequently than movies, books, and television shows would have us believe.

Depression counseling today looks much more like a strategy session, or coaching, or mentoring sessions. It’s a collaborative experience between patient and counselor, and it more than likely focuses on finding solutions to negative, distressful thoughts, and practicing more productive, healthy behaviors.

Solution-focused therapies

The commonly used psychotherapies supporting this patient-therapist collaboration are cognitive behavioral strategy (CBT), and interpersonal therapy (IPT), and in some cases solution-focused brief therapy (SFB). SFB was developed from brief strategic therapy, a therapy designed for working with group counseling situations, and with families. (also see article on Treatments for Depression.)

A large body of research shows that these highly focused, solution-oriented therapies provide effective outcomes when treating depression. More research explores these therapies than research investigating the effectiveness of psychodynamic therapies, or those that ask patients to freely associate, saying whatever comes into their minds.

Solution-oriented therapies are all designed to be relatively short, lasting from about 12 to 16 sessions. SFB takes even less time, with the goal of treating individuals or groups in about five sessions or less.

Psychodynamic therapy

In contrast, psychodynamic therapy seeks to uncover insights and awareness about past issues and problems, and it takes several months, or years. Many depression counselors use this analytic type of therapy to explore depressive symptoms in connection to childhood experiences and traumas, as with problematic parental relationships.

Unlike traditional psychoanalysis first developed by Freud, however, psychodynamic therapy has progressed and changed over many years. No longer are these psychoanalysts seen as passive, blank slates simply prodding loose the patient’s memories. Depression counseling using the psychodynamic approach also requires an active therapist. While psychodynamic counseling takes a different approach, it still requires that counselors act as coaches or mentors, helping the client with strategies and concrete steps to better manage depression.

And psychodynamic therapy is based on the belief that the counselor-patient relationship is essential for healing, and is actually a key aspect of any therapeutic intervention.

In a 2010 study published in the American Psychologist, a journal of the American Psychological Association, author Jonathan K. Shedler, PhD, acknowledged the largest body of scientific studies on the effectiveness of depression counseling investigates the more solution-focused frameworks like CBT, IPT, and SFB.

However, Shedler conducted eight meta-analyses, analyzing 160 studies of psychodynamic therapy used for depression and other mental health disorders, and for comparison, nine meta-analyses of other psychological interventions including medications.

His meta-analyses – or studies that examine other scientific studies – focused on the size of the effect of a particular treatment. And it measured the effects of the treatment nine or more months after the patient completed therapy.

His eight meta-analyses of psychodynamic therapy showed substantial treatment benefits, according to Shedler, benefits that exceeded the results of many other therapies and antidepressant medications. Even more significant were the effects of psychodynamic treatment after therapy had ended, showing continued and greater symptom improvement after several months.

Shedler, associate professor of psychiatry at the University of Colorado Denver School of Medicine, theorized that the positive outcome of continued improvement after the cessation of therapy shows that “psychodynamic psychotherapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended.”

Studies done to measure the efficacy of these types of psychodynamic therapies are typically harder to conduct because psychodynamic therapy doesn’t only treat symptoms of depression, but deeper changes as well, such as personality changes, which are much harder to empirically measure.

Talk therapy

Many psychologists and counselors acknowledge today that many of the psychological frameworks for treating depression and other mental health disorders share many similarities. Regardless of the psychological approach, for example, counselors from all psychological disciplines listen to their patients. They talk with them about their distress, internal and external depression triggers, and signs of a severe depressive episode. They set goals with their patients, and work with patients on strategies that will alleviate depression.

Treating a patient with one type of therapy over another depends to a large extent on the needs of the patient. And the type of therapeutic intervention depends on a patient’s history, genetics, gender, age, and socioeconomic and cultural factors. (See Signs of Depression in Preschool Children, Signs of Depression in School-Aged Children and Teens, Depression in Women, and Depression in Men.)

Notably, Shedler referenced what he believes to be a common thread among all therapies in his study, stating that when other therapies prove effective, they include elements of psychodynamic therapy.

“When you look past therapy ‘brand names’ and look at what the effective therapists are actually doing, it turns out they are doing what psychodynamic therapists have always done—facilitating self-exploration, examining emotional blind spots, understanding relationship patterns.”

The type of therapy that takes place during depression counseling also depends on the therapist or counselor. In many cases, the counselor uses an integrated approach of two or more therapeutic frameworks depending on the patient. (See article Depression Counselor.)

Also some depression counselors will specifically call themselves CBT therapists, IPT therapists, or psychodynamic therapists. Training for these modalities is specific, requiring an in-depth knowledge of theory, practice, and ongoing research that takes place using the particular framework’s therapeutic interventions. But in all traditions and frameworks, depression counseling or psychotherapy is referred to as talk therapy since the discussion that takes place between the counselor and patients is integral to healing and a positive outcome.

In addition to the type of psychological framework, depression counseling also takes one of the following formats:

  • Individual counseling. Depression counseling takes place only between the patient and the therapist.
  • Group counseling. Depression counseling involves two or more patients at the same time. Patients share problems, stories and experiences, learning from each other, and helping each other through difficulties.
  • Marital or relationship counseling. Depression counseling is focused on a patient and his or her spouse or partner, helping individuals understand the depressive symptoms exhibited by a significant other. Often, specific ways that the couple interact, communicate, and react to each other affect the relationship in addition to the depressed patient’s ability to heal and successfully manage symptoms.
  • Family counseling. Similar to depression counseling for relationships, depression counseling for families teaches family members how to cope with a family member’s depression. It also focuses on teaching family members how to help a depressed individual, sorting through healthy behaviors and those that enable depressive behaviors.

Depression counseling and medication

For cases of severe depression, medication in the form of antidepressants is often required. When a patient must take medication, depression counseling still focuses on long-term strategies for overcoming depression.

Many recent studies have contributed to a growing body of research that suggests the combination of psychotherapy or counseling along with an antidepressant has extremely positive outcomes.

Yet mental health practitioners still advise patients to do the hard work required during depression counseling to achieve the longest lasting results, and prevent more severe and frequent depressive episode relapses. (see the article Medications for Depression)

If you want to help individuals overcome depression, living less stressful and more enjoyable lives, consider a career in depression counseling. To work in this field, usually a master’s degree or PhD is required in a counseling specialty.

Contact schools offering degree programs in mental health counseling to learn more.

Male Postpartum Depression

Much is known and a lot of research exists on postpartum depression in women, so depression counseling for women after the birth of child is not uncommon or unexpected. However a new type of postpartum depression counseling is now gaining momentum, that known as depression counseling for men after a partner or spouse gives birth.

Evolutionary biologists don’t find this phenomenon strange at all. They note that men's testosterone levels go down, and estrogen levels rise during pregnancy and early in the postpartum period. This, research suggests, might be a major reason for male postpartum depression.

These scientists credit hormonal changes as nature’s way of keeping men close to mother, baby, and home, after the birth.

According to the website postpartummen.com, research attributes other possible causes for male postpartum depression as well. These reasons include the lack of sleep experienced with a newborn, a personal history of depression, and poor relationships with the spouse, in-laws, or the male’s own parents.

Other reasons for male depression include feeling mounting stress over becoming a father, lack of social support, economic problems, and the feeling of being excluded from the mother-baby relationship.

But the greatest risk factor for male depression after the birth of a child regard’s the partner’s depressive state. If a woman has postpartum depression, the man is also likely to have the disorder. In fact, half of men with partners suffering from postpartum depression also are depressed themselves.

The website has another name for male postpartum depression, calling it Paternal Postnatal Depression, or PPND. And it recommends finding a mental heath practitioner who specializes in treating men for mental health disorders.

Men are often reluctant to get help for any mental health disorder let alone something that seems so related to a woman’s disorder. But research shows that left untreated, PPND has damaging consequences on the relationship with the mother, and the child’s emotional and behavioral development.