The National Institute of Mental Health reports that over 24 million adults are afflicted each year with symptoms that can be diagnosed as Major Depression or Dysthymic Disorder (what is often described as moderate or low level depression). Almost every therapist in private practice is familiar with these complaints, and research indicates that therapy is usually effective in reducing distress from these symptoms. Then you might ask: Why choose one therapist over another?
An important reason is that therapists use different models of therapy and think differently about how change occurs. Therapies that pathologize, that look for indications of illness, disease, and dysfunction, tend to find it. Once found, a lifetime can be invested in curing or resolving it. On the other hand, therapies that are strength-based and future-oriented—therapies that focus on how clients manage to function even under the weight of the complaints that bring them to therapy—tend to generate change that is both measurable and lasting.
When I see depressed clients, I usually assess with the client the possibility of using medication. If the client thinks it might be worth trying, I will refer him or her to a psychiatrist that I know and work closely with so that this person can then manage the medication. My client and I then get on with the work of identifying the concrete and measurable indicators that he or she is overcoming the depression that brought that person to my office in the first place. Richard Dreyfuss, as the psychiatrist in the wonderful movie, “What About Bob?” had it right when he talked about his book, Baby Steps.
For instance, a client told me that she was getting up an hour earlier during the week. She was less depressed and that “baby step” was one way she recognized (or perhaps created) the change.
When I provide therapy, it’s the attention to detail, to the small but meaningful changes, that result in lasting and successful outcomes.
I also work with clients to understand how past experiences can affect our neural pathways so that certain triggers in the present can cause our neurons to fire in a way that creates depressive symptoms. Another way of thinking about how therapy is effective in treating depression is to think about how conscious awareness allows a brain (that is, the neuronal pathways in the brain) to wire and fire in new and healthier patterns.