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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


October 01, 2014

What Kind Of Treatment Is Available?
Different types of psychotherapy are needed to address a variety of needs.
InteliHealth Medical Content

Reviewed by the Faculty of Harvard Medical School

Just as no single drug is best suited to treat depression, there is no best form of talk therapy (psychotherapy). Different types of therapy address a variety of needs. Here are a few common types of therapy used to treat depression:

Choosing the right type of therapy depends on your goals. One important goal is relief from depression symptoms. To get relief, you need to pay attention to important influences on mood, such as losses you've experienced, attitudes you've developed, ways in which you interact with people who are important to you, as well as your view of yourself. This is why therapy may involve learning new skills, developing insight into your own history and experiences, and growing emotionally. 

The role of the therapist. Therapy is a joint effort. The therapist may have practical suggestions, but for the most part, you will work with the therapist to develop a sensible approach to your problems. To do this, you need to feel comfortable with your therapist. Note whether or not you and your therapist are a good match. No therapist is perfect, but a good working relationship is key. If you have the opportunity, you may want to interview more than one therapist before deciding whom to work with.
There are several qualities to keep in mind when trying to find a therapist:
  • Formal training and licensure in one of the mental-health professions
  • A style that balances professionalism and warmth
  • A sympathetic attitude combined with an ability to ask probing questions
  • Honest discussion of the advantages and limitations of the methods the therapist uses
  • Openness to answering your questions, whatever they may be
Theoretically, it is possible to be too comfortable with a therapist. Look for a therapist who will explain the plan for your therapy and sympathetically challenge you to address your problems.
Although some therapists limit their practices to one type of therapy (for example, cognitive behavior therapy), many professionals combine methods, depending on your needs. To some extent, all forms of therapy involve you understanding the roots of your problems and making changes in your thoughts, attitudes and behaviors. A mix of techniques is often the best approach.
Therapy can be a time-consuming process that can last from weeks to years. If after a few months you find no progress or relief, ask your therapist to reevaluate therapy with you or get a consultation with another therapist.

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Cognitive Behavior Therapy
Cognitive behavior therapy targets thoughts and behaviors that need to be changed. The therapist helps you understand the beliefs at the root of your behaviors. One concept the therapist works with is the possibility that you are depressed (in part) because you have an excess of self-critical and pessimistic thoughts. You may have these thoughts because you do not properly perceive events around you, so you automatically cast them in a negative light.
The therapist helps you to recognize what triggers certain thoughts and behaviors and then helps you to alter your routines through direction and action. You will learn to focus on the present more than on the past. And you may be encouraged to do homework. Behavior change is the primary goal, with internal change (how you feel or what you learn about yourself) as a byproduct of the outward behavioral change.

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Interpersonal Psychotherapy
Interpersonal psychotherapy is based on the belief that depression is caused by problems in important relationships. A therapist will teach you about the connection between interpersonal problems and depression. Depression may arise from the loss of a relationship, conflict in a relationship or changes that come from an important life event.
The number of sessions is usually limited, with therapy lasting several months. The therapist tends to focus on current events rather than past history. The goal is to solve the problems occurring in your relationships today. The therapist will guide you toward better interactions with others. As your relationships improve, so should your mood.

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Psychodynamic Psychotherapy
Psychodynamic psychotherapy (also called psychoanalytic psychotherapy, insight-oriented psychotherapy or exploratory psychotherapy) tries to help you be aware of the conflicts in your own mind that are at the root of your depression. The source of such conflicts can be early experiences with important figures (such as parents and siblings) or a lack of tools to handle life’s ups and downs.
A psychodynamic therapist may ask direct questions or try to help you get at your thoughts indirectly, by encouraging you to follow your thoughts wherever they take you. Your therapist may ask about formative family relationships. The therapist may also ask you to pay attention to the thoughts and feelings you have about himself or herself. This technique is unique to psychodynamic therapy. By understanding feelings you have about your therapist, you may learn about feelings that bubble up in other relationships.
Psychodynamic psychotherapy usually continues for months or years, because it is impossible to know how long it will take each individual to gain insight or resolve conflicts.
Psychodynamic psychotherapy versus psychoanalysis. Do not confuse psychodynamic therapy with psychoanalysis. Psychoanalysis involves three to five meetings per week and a great commitment to free association and open-ended exploration. Psychodynamic therapy, in contrast, is less time intensive and is meant to be more focused and restricted in its goals. With psychoanalysis, unlimited and open exploration is a primary goal, while symptoms of depression are rarely targeted. Thus, most people with depression are not likely to turn to psychoanalysis as a central part of their treatment, at least not initially.

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