There are pros—and cons—to treating depression and bipolar disorder with psychotherapy

Most people think of psychotherapy simply as counseling. In fact, the term psychotherapy is used to describe a variety of talk therapies that treat emotional, behavioral, personality, and psychiatric disorders. It involves a commitment to a series of appointments with a licensed mental health professional, enabling a relationship to form between the therapist and the individual. This relationship focuses on helping the person to cope with or avoid factors contributing to his or her condition, with the overall goals being personal development and self-understanding. Like any medical treatment, it has advantages and disadvantages.

Psychotherapy is commonly used to treat people with depression. It has proven effective in treating mild and moderate forms and can be combined with drug therapy to treat all degrees of depression.

Advantages of Psychotherapy for Depression and Bipolar Disorder

A major advantage over treatment with medication is that psychotherapy has few physiological side effects—an especially important consideration for older adults who are often taking more than one type of medication. In addition, it offers the possibility of effective treatment for those who have not responded to medications.

Disadvantages of Psychotherapy for Depression and Bipolar Disorder

A disadvantage is that psychotherapy typically takes longer than drug therapy to produce benefits that are noticeable to the person receiving treatment—six to eight weeks or longer for psychotherapy, compared with four to six weeks for medication. Also, psychotherapy alone is not effective in people with severe depression or bipolar disorder.

Depending on the severity of the depression and other factors specific to each individual, a therapist selects a combination of techniques from the range of psychotherapeutic approaches. Regardless of the particular approach, the essential foundation of all psychotherapy is the establishment of a trusting relationship with the therapist. This allows the patient to share confidences, life experiences, and problems. If psychotherapy alone leads to no improvement by six weeks, or if a person has only a partial or weak response by 12 weeks, medication should be strongly considered.

Although people with bipolar disorder should be on medication, they can also benefit from psychotherapy. Environmental factors such as stress may trigger episodes of mania or depression, and counseling can help a person identify and deal with these triggers. It can also help the person gain insight into his or her condition, confront the dysfunctional thinking often associated with bipolar disorder, and improve his or her ability to handle work, family, and financial challenges. Furthermore, counseling that involves the individual’s family can help to educate relatives about the disorder. A recent study found that people with bipolar disorder who combined psychotherapy and medication had a 94% recovery rate in an average time of 113 days, compared with 52% of those who took medication and had only a brief psychoeducational intervention.

Unfortunately, a person who is in an acute manic state would likely be unable to attend or benefit from therapy. For those with mania or severe depression who do not respond to drug treatments or psychotherapy, electroconvulsive therapy may be needed.

Publication Review By: Karen L. Swartz, M.D.

Published: 04 Mar 2011

Last Modified: 22 Jun 2011