Counselling and Psychotherapy for Depression
Depression is a condition which affects many people in their lives. This article discusses some of the reasons why it happens and what can be done about it. My experience has been that there is no one standard "thing" called depression - every client who comes to me with depressive symptoms is unique, as are the causes of their problems. I therefore try to keep an open mind and adapt my treatment to the needs to the depressed person - the "one size fits all" approach does not seem to be very useful.
Depression is an extremely varied condition - in my work with sufferers the reasons for their depression can vary hugely, some of the typical causes including:
- being stressed for long periods of time (burnout)
- lack of sleep (exhaustion)
- grief due to bereavement and loss
- feelings of frustration and failure due to lack of achievement and success
- growing up in a family where one or more parents were themselves depressed
- major life changes (such as post-natal depression)
- breakdown of an important relationship
- work-related depression, such as redundancy or being in an unsatisfying job
- sexual difficulties
- medical conditions, such as thyroid deficiency and ME
- having been bullied, victimised or criticised
- past experiences of abuse
- suffering a trauma
- negative thought patterns and beliefs
- lack of meaning and purpose (mid-life crisis)
- social isolation and loneliness
- nutritional deficiencies
These causes can be grouped together into the general categories of medical and physical problems, emotional problems, problems of thinking and beliefs, life circumstances, past history and personality.
It is important to realise that the issues that caused the depression may not be the same as the factors that are maintaining depression, as shown in the diagram above. For example the loss of a job may cause someone to become depressed, but it may be a lack of purposeful activity (staying in bed, watching TV all day) that maintains the depression.
With such a wide range of possible causes, there is no simple "one size fits all" treatment for depression. Some possible options include:
As a counsellor and psychotherapist I encourage my clients to avoid antidepressants if possible, as they tend to mask feelings and make the work of therapy harder. However there are times when taking an antidepressant can be the best option, particularly when the feelings of depression are so strong that the sufferer feels suicidal or unable to function. Most people don't like the thought of being on medication long term, but combining it with counselling or psychotherapy can reduce the length of time it needs to be used.
These can help by exploring the underlying causes of depression and resolving them. Counselling tends to be more focussed on causes in the present, and psychotherapy looks more at the past, but there is considerable overlap in the way counsellors and psychotherapists work
CBT focuses on the negative and limiting thought patterns which underlie some forms of depression, and can offer exercises and techniques for changing these patterns and behaviours.
CBT was originally developed specifically to treat depression, and in recent years it has received considerable publicity about it's effectiveness in treating this disorder (for example the Layard Report). Despite this I am not convinced that CBT lives up to all that is claimed for it in treating depression. It certainly has a role to play, and for certain types of depression it may well be the most effective treatment, but in my clinical experience it does not have the monopoly of efficacy that it's supporters claim.
There are a wide range of complementary therapies which can address some of the physical causes of depression. Examples include reflexology, body massage, Yoga and nutritional therapy.
Where depression is linked to feelings of failure, lack of achievement, dissatisfaction with career and other life-related issues, then life coaching can provide a very practical way of turning things round. It does not attempt to look at causes in the past, but instead focusses on making changes in your present attitudes, beliefs and behaviour which will bring positive changes in your life.
Where depression comes from a mid-life crisis, accompanied by feelings of loss of meaning and purpose, then this can be addressed by therapies such as psychosynthesis. Psychosynthesis includes many of the techniques of counselling, psychotherapy, CBT and life coaching, but adds another dimension which can be described as spiritual or transpersonal.