Depression can be co-morbid with other conditions which complicate its treatment, but for straightforward mild cases it can usually be treated in 12 therapeutic hours of counselling, or less, depending on the severity at the outset, the speed with which you respond and the kind of treatment you are offered.
Treatment by the NHS
The NHS tries to match treatment methods to your needs by assessing the severity of your condition. They call this approach the Stepped Care Model. Treatment begins at step two for mild depression, intensifying to step three for moderate to severe, with step four reserved for treatment-resistant forms, or if you are at risk of harm. Waiting lists for treatment are often six to 12 months; in some areas, they are closed altogether with patients signposted to the voluntary sector. As many people recover from depression without help in four to six months, the waiting list is like a pyramid with a great many waiting at the bottom, reducing in stages as it nears the top where many fewer receive treatment.
Individual therapy at step two and step three is usually restricted to six, sometimes 12 sessions, after which you will be discharged whether you feel ready or not. Considerable beneficial change often occurs in the first eight to 12 sessions of treatment, which is rational for this treatment plan. You should also be aware that demand is high and if you can’t attend your appointment, even for good reasons, often your therapy will be prematurely terminated.
For mild depression, you may be offered computerised CBT, either at a centre or by accessing a site on the internet. Or you may be given leaflets and access to books on how to help yourself overcome the effects of mild depression broadly based on CBT principles.
What kinds of therapy are available?
CBT teaches you that how you think and how you behave when you are depressed influence the way you feel, and together these components feed one another in a vicious spiral that maintains and deepens your depression. To break the cycle you need to change your behaviours and ways of thinking. The treatment educates you to challenge negative automatic thoughts by substituting positive alternative thoughts and change your behaviour from doing things that feed and nurture your depressed feelings, to doing things that weaken its grip and promote your sense of well-being.
Counselling for depression practitioners facilitate your understanding of your condition and what may be causing it, in an environment where you experience unconditional acceptance, empathic understanding, and the undivided attention of your counsellor, who is fully present in the relationship. In this safe environment, you can look at memories that you had previously suppressed and discover your own solutions to the difficulties you face that best suit your individual needs.
Psychodynamic and dynamic interpersonal therapy are the present day descendants of the psychoanalytic therapy Sigmund Freud described over 100 years ago. The former tries to discover internal conflicts in your unconscious mind which directly or indirectly cause your low mood, whereas the latter tries to help you find a link between your interaction with other people and your low mood, in the belief that if your relationships improve, your stress will lower and your emotions will become more buoyant.
Behavioural activation therapists rely on the belief that there is a relationship between actions and emotions. Depressed people often employ ineffective methods of coping with their mood which have the effect of deepening their distress – the use of alcohol or drugs provides temporary respite but makes you feel worse when the effect has worn off; avoiding difficult situations, thoughts and feelings, such as not going out so you don’t meet people who might ask why you’re not at work, not opening letters for fear of the content, makes you want to isolate even more; and rumination—continually thinking about aspects of life that upset you, does not make you feel better but makes you even more upset. Alternative more adaptive ways of coping are suggested, and these might include mindfulness, doing things that take your mind away from your troubles and other activities intended to increase your sense of wellbeing.
EMDR, a relatively new form of psychotherapy which has successfully helped many victims of Posttraumatic Stress Disorder (PTSD), is now showing promise as a treatment for depression.
Triggers appear to play a major role in both conditions. They activate badly processed memories of frightening, humiliating, or shameful events which became stuck – stranded in the wrong part of the brain. When triggered, the thoughts, beliefs (about yourself), emotions and bodily experiences associated with the originating event flood back with the same force as if it was happening all over again, in the present. Events which seem dissimilar to that which caused the original harm can trigger the unprocessed memory network and you re-experience that original shame, humiliation or powerlessness, struggling to hold onto the last vestiges of your integrity, confidence and self-esteem as if it was happening now!
EMDR treatment reprocesses the memory, removing the emotions, beliefs and sensations and turning it into a historical narrative, which can be recalled as the archaic record of bygone times. If it works as suggested, it will ‘cure’ your depression, preventing future episodes, because memories no longer exist in the original form that can be triggered.
What are the advantages of private therapy?
- You do not have a long wait for your first appointment.
- You can select your therapist – even try a few before deciding on which one you would like to work with. Having the right therapist is of paramount importance for a speedy return to health. The strength of your connection with your therapist can be even more important, a predictor of a positive outcome to therapy, than even their credentials or the kind of therapy on offer… If your gut instinct tells you it isn’t working, try another therapist.
- You can choose the treatment modality you think would best suit you.