Various types of psychotherapy can help treat depression and bipolar disorder. Here, we describe the most common types of therapy: interpersonal therapy, psychodynamic therapy, supportive therapy, behavioral therapy, cognitive therapy and group therapy. These may be helpful to patients with depression, bipolar or a range of other mental health struggles.
Also known as crisis intervention, interpersonal therapy is most effective when depression results from a major life event, such as the death of a spouse, the loss of a job, divorce, or another difficult life transition. Because the depressive symptoms stem from an immediate problem, the goal is to help the person cope with the stressor by improving self-awareness, resolving emotional conflicts, and possibly making some behavioral changes. Interpersonal therapy can be extremely effective at helping individuals restore balance to their lives.
This form of psychotherapy focuses on an individual's past experiences in an attempt to understand present-day conflicts and feelings about recent life changes, such as retirement or grief. This therapy attempts to treat the "whole person" rather than just the symptoms of depression. A crucial component of the therapy is transference—the transfer of feelings about important childhood figures from the patient onto the therapist, who then works to help the patient resolve residual past conflicts. This therapy can be effective in helping a person overcome destructive personality patterns.
Supportive therapy teaches individuals about their illness, with the idea that a better understanding of the mood disorder will enable the person to set more realistic and tangible goals. In supportive therapy, the person is encouraged to focus on current challenges and relationships and develop strategies for dealing with them. The therapy is goal oriented, and the individual works with the therapist to set goals. The person's family members or close friends may be included in counseling or education sessions.
This type of therapy is based on the premise that depressed people have learned destructive patterns of thinking and acting, and these patterns cause and/or prolong their depression. Counseling is provided to improve social skills, problem solving, and self-control and to change how a person reacts to problems. Behavioral therapy emphasizes step-by-step improvements in behavior and is most often effective when the problem is clearly defined. Although less studied in the treatment of depression, behavioral therapy has been useful in relieving some types of anxiety states, such as obsessive-compulsive disorder and phobias.
The aim of cognitive therapy is to reverse a person's destructive and exaggerated belief that his or her weaknesses and inadequacies doom him or her to future failure. The therapist not only encourages the individual to recognize that these views are distorted —by listing positive attributes or past and present successes, for example —but also attempts to bolster confidence by demonstrating that the person can successfully complete increasingly challenging "assignments." The treatment generally requires a series of sessions over several months. It is often combined with behavioral therapy, known as cognitive-behavioral therapy (CBT). A recent review of 25 studies found that people undergoing CBT for generalized anxiety disorder were significantly more likely to have reduced anxiety at the end of treatment than those receiving no treatment.
The psychoanalytic theory of depression derives from the Freudian concept that altered mood develops because of anger directed toward oneself. The theory asserts that curing depression requires exposing the cause of the anger and confronting it in a constructive and realistic manner. The patient meets with the therapist three to five times a week in a stream-of-consciousness, free-associative atmosphere that involves minimal feedback from the therapist. Because classic psychoanalysis requires years of treatment, it is not suitable for managing acute depression. It is used infrequently in its classic form today, although aspects of the Freudian approach have survived under psychodynamic therapy.
In this method, a small group of people with similar problems meet regularly to discuss their troubles under the guidance of a therapist. Participants can share personal feelings, experiences, and solutions in a supportive atmosphere. The resulting interaction often reduces feelings of isolation and can heighten awareness and understanding of personal problems. It is useful for people who benefit from feedback from peers.
Finding a Therapist
If you think you have depression or bipolar disorder, you do not necessarily have to see a psychiatrist. Many people with mood disorders are treated by their primary care physician, who can identify other medical conditions that could be responsible for the symptoms. If the diagnosis does turn out to be a mood disorder, your primary care physician can initiate drug therapy, coordinate care from other specialists, or both.
Many kinds of mental health professionals are available —psychiatrists, psychologists, psychiatric nurses, and social workers. Which therapist is best for you? That depends on several factors, including how severe your symptoms are and the cost of treatment. No matter what type of therapy you select, keep in mind that it may take some time and research to find the right therapist. A family physician will be able to provide some recommendations, but other resources are available as well. Local medical societies, university medical centers, and national mental health organizations may be able to provide assistance. Also check community mental health clinics, local schools, and religious organizations, which sometimes offer inexpensive or even free counseling programs.
Compatibility is extremely important, and it may take more than one referral to find a comfortable counseling relationship. It is also important to ask about a therapist's education and professional licenses, either before making an appointment or during the first visit. You can get a sense of a therapist by describing your condition and asking the therapist how he or she would treat it. Reputable practitioners will not object to requests for information about their background and will understand your desire to interview other therapists.