Specific Psychotherapy Treatment Approaches to Depression - Coursework Example

To review specific psychotherpy tretment pproches, techniques nd outcomes relted to depression lthough theories bout the etiology, precipittion nd mintennce of depression differ from ech other, the tretment techniques predicted to be effective by the vrious models tend to converge. Tht is not to sy tht there re only few methods used. On the contrry, I shll list five theories ech of ech proposes specific techniques nd wys of tretment, usully grouped in some multifceted procedure, to cliniclly depressed ptients. Interpersonl Therpy Interpersonl therpy (IPT) is tretment tht focuses on the behviors nd socil interctions ptient hs with fmily nd friends. The primry gol of this therpy is to improve communiction skills nd increse self-esteem during short period of time. It usully lsts three to four months nd works well for depression cused by mourning, reltionship conflicts, mjor life events, nd socil isoltion. IPT is one of the short term therpies tht hve been proven to be effective for the tretment of depression. Short term usully involves up to 20 sessions (usully weekly meetings, 1 hour per session) nd mintins focus on 1-2 key issues tht seem to be most closely relted to the depression. Although depression my not be cused by interpersonl events, it usully hs n interpersonl component, tht is, it ffects reltionships nd roles in those reltionships. IPT ws developed to ddress these interpersonl issues. The precise focus of the therpy trgets interpersonl events (such s interpersonl disputes / conflicts, interpersonl role trnsitions, complicted grief tht goes beyond the norml berevement period) tht seem to be most importnt in the onset nd / or mintennce of the depression. Tretment Techniques IPT is time-limited therpy tht previews in totl 12-week tretment schedule (Mufson & Moreu, 1998). The gols of IPT re to identify interpersonl problem res with which the dolescent is struggling nd to focuse on how those problems re currently impcting their reltionships (Mufson & Moreu, 1998). There re three tretment phses identified s prt of the IPTmodel--initil, middle, nd termintion. Initil Phse occurs during sessions one through four. During this phse, the gols of IPT re to conduct complete dignostic ssessment nd explin tretment options, obtin complete history of current interpersonl reltionships, identify the interpersonl problem re(s) tht my hve precipitted the onset of the depression, discuss gols nd techniques of IPT tretment, nd contrct for tretment. The middle phse of IPT tretment consists of sessions five through eight nd it is during this time tht the mentl helth counselor nd client begin to directly work on the interpersonl problem res identified during the initil stges of tretment. The min gol of the middle phse of IPTtretment is to ssocite these interpersonl problem res to the depressive symptomology currently being experienced by the dolescent. Five interpersonl problem res re exmined during this time: grief, interpersonl role disputes, role trnsitions, interpersonl deficits, nd single-prent fmilies (Mufson & Moreu, 1999). The focus of these interpersonl problem res hs been modified from IPT to meet the developmentl needs nd issues of depressed dolescents. The termintion phse of IPT occurs between sessions nine through twelve (Mufson & Moreu, 1999). In this phse, dolescents re helped to individute from the mentl helth counselor nd to gin sense of efficcy for coping with future problems. During the termintion session, mentl helth counselors nd dolescents process wht hs occurred in counseling, discuss possible res tht could cuse future problems, nd explore problem-solving strtegies relted to those res. Cognitive-Behviorl Therpy Cognitive-behviourl therpy (CBT) is the ne mongst number of structured psychotherpies tht hd proved to be effective in the cute tretment of depression. CBT is generic term referring to therpies tht incorporte both behviorl interventions (direct ttempts to reduce dysfunctionl emotions nd behvior by ltering behvior) nd cognitive interventions (ttempts to reduce dysfunctionl emotions nd behvior by ltering individul pprisls nd thinking ptterns). Both types of intervention re bsed on the ssumption tht prior lerning is currently hving wrong outcomes, nd tht the gol of tretment is to decrese depression or unwnted behvior by undoing this lerning or by providing new, more dptive lerning experiences. (Brber, DeRubeis, 2001). The rtionle for the cognitive therpy given is tht depressed mood is rooted in self-evlution. People re tught how to become wre of thoughts which occurred between n event nd consequent ffective disturbnce, nd instructed to use lterntive self-sttements to cope with such situtions when they occurred. With therpist's help, list of positive self-sttements re constructed, nd people who re imposed to depression re instructed to red through the list before engging in high probbility behviour. The rtionle for the behviourl tretment is tht depression results from insufficient positive reinforcement. People re given help in identifying situtions which produced depressed mood, nd in lerning new lterntive ptterns of behviour. Role-ply, modelling nd homework ssignments to reherse new techniques re used, often with the im of promoting more ssertive, socilly skilled behviour. The combined tretment would hve mde it impossible to spend more thn hlf the time (on verge) on ech component. Despite this, the results of the six forty-minute sessions over four weeks showed cler superiority for the combined tretment over ech one lone, which in turn were superior to no tretment. The trend of these results ws still clerly visible on follow-up ssessment five weeks lter. (Med, 2002) In the end, CBT's pproch to deling with depression suggested tht rther thn to crete new memories, it should be rther ttempted to limit the ese with which these memories re ctivted by the current environment. One feture of depression is tht negtive mood chnges re elicited by wide rnge of stimuli. Ptients respond to mny reltively hrmless situtions s though these situtions contined enormous potentil for vrious psychologicl nd physicl threts. The therpist infers the content of these representtions by systemticlly gthering dt bout the situtions tht elicit nxiety or depression in person nd bout the person's rections to these situtions. Dt my be obtined from the ptient's own ccount, from the ccounts of fmily nd friends, nd by the therpist's own observtions of the ptient's behvior in the therpy sitution. Solution-Focused Therpy s it's nme suggests, the emphsis here is on finding solutions to current problems nd focusing on future wellness rther thn pst hurts. This is not to sy tht the pst is ignored but the min emphsis is on teching new skills nd keeping therpy brief nd focused. Solution focused therpy is problem-solving pproch to difficulties which concentrtes more on finding effective wys to meet chllenges rther thn nlysing ll the resons why you re in difficulties. It cn be pplied to wide rnge of problems nd chllenges. nd in the shortest possible time. During the process of depression tretment nd in ccordnce with solution-focused theory, dignosis nd lbeling of the disese re cornerstones of the therpy process. Determining custion nd gining insight s to why the disese hs occurred re centrl. It is ssumed tht if the disese cn be locted nd understood, it cn then be relesed (cthrsis) or removed through n ssortment of interventions (e.g., mediction, cognitive restructuring, behviorl modifiction). The cornerstone of solution-focused pproch is the vigilnt solicittion of exceptions to problemtic behvior. This is very consistent with the philosophy underlying competency-bsed models (dms & Nelson, 1995), but dds unique, specific strtegies for identifying client competencies. It is ssumed tht clients hve in fct ttempted to solve their conflict but hve been lrgely unsuccessful. Symptomtic behvior, therefore, is in prt mnifesttion of frustrted nd filed efforts to cope with dily life. However, it is lso ssumed tht they hve not lwys filed. Tht is, t lest on occsion, efforts hve proven successful. It is these moments, these smll successes or exceptions to the problem, to which solution-focused pproches devote their ttention. Solution-focused nd constructivist ssumptions, since they nticipte chnge, emphsize collbortion, nd cknowledge client competence, nturlly fcilitte rpport between clients nd professionls. For instnce, lthough brvdo my disguise their discourgement, clients often re indeed discourged by their too frequently filed ttempted solutions. Not surprisingly, mny of these individuls nd fmilies eventully become convinced they lck the resources to conquer conflict (Butler et l., 2003). This entrenched nd discourging view of themselves tends to obscure their wreness of their existing potentil solutions. In the end, solution-focused therpy is known to be n effective pproch to difficulties ssocited with emotions nd beliefs. When pplied to the problems of depression nd other stress-relted conditions it cn quickly bring tngible results. Psychodynmic Therpy Psychodynmic therpy is bsed on the ssumption tht person experiences depression s result of unresolved, generlly unconscious conflicts, often stemming from childhood. The gol of this type of therpy is for the ptient to understnd nd cope better with these feelings by re-experiencing them through tlking bout them. Psychodynmic therpy is dministered over period of three to four months, lthough it cn lst longer, even yers. The vlue of psychodynmic therpy of depression is tht it provides informtion nd specific exercises for depressed ptients who find they hve fllen into the depths. The tretment of depression ccording to current theory implies counsellors to: () provide ptients with new corrective experiences; (b) offer ptients direct feedbck; (c) induce in ptients the expecttion tht therpy will help them; (d) crete therpeutic reltionship; nd (e) provide ptients with repeted opportunities to test relity. Focusing more specificlly on depression, there re fctors which re effective in treting depression. First, this therpy hs n elborte, well-plnned rtionle which provide n initil structure tht guides ptients to the belief tht they cn control their own behviour nd thereby their own depression. Secondly, psychodynmic therpy which is effective provides trining in skills tht ptients cn use to feel more effective in solving problems in their life. Thirdly, psychodynmic therpy emphsizes the independent use of these skills by the ptient outside the therpy context, nd provide sufficient structure so tht the ptient cn ttin the independent use of them. Finlly, the theory encourges ptients to ttribute improvement in their mood to their own incresed skilfulness nd not tht of the therpist. There re number of teching techniques tht re used to implement the gols of current psychotherpy. Ther re s follows: teching self-monitoring of mood, teching self-evlution of behviourl chievement; mstery nd plesure techniques, teching self-monitoring of thoughts, teching how to find lterntive rtionl responses to negtive thoughts nd ssumptions, listing positive self-descriptions, nticiption trining, relxtion nd desensitiztion (for nxiety component nd initil insomni), role-plyin, nd others nticipted in ccordnce with prticulr sitution. On prctice, psychodynmic therpist usully tlk little while even sitting behind the ptient nd encourging him or her to spek out whtever comes into the mind. From time to time therpists my interpret wht the ptient hve sid or drw ttention to some spect of ptient thoughts. But there my be sessions where the therpist hrdly speks nd, if ptient is not in very tlktive mood either, some sessions cn be very quiet indeed. True psychodynmicists will not be worried by long silences - they my decide tht some importnt work hs been done in those quiet periods. This type of therpy seems dted to mny people, but it is still mjor prt of the therpeutic scene. It seems to benefit individuls who hve big issues with their psts nd who re prepred to ccept tht these issues hve coloured their whole lives. Most clients will be intelligent nd they'll tend to be fscinted by the intriccies of the humn mind. They will lso hve plenty of time nd money. Fmily Systems Therpy Depression is misery to experience nd difficult for therpist to cure. Ech cse is unique when one tkes into ccount the socil situtions nd the possible biologicl cuses. There re mny medictions to choose mong nd debte. Therpists cn hve different theories for the tlk therpies they do. Fmily therpy my be promising tretment for depression since it hs been linked in severl studies to fmily problems nd fmilies cn be in the session, or it cn be only n individul client depending on the theory. Typiclly, fmily system therpy hs been designted s the tretment of choice when the two re concomitnt-tht is, when mritl or fmily problems re intertwined with depression nd one or more fmily members re involved (Med, 2002). n exmple of this might be wife's depression tht is due in prt to her husbnd's infidelity. This issue is compounded by the fct tht the husbnd clims tht he hs stryed outside of the mrrige becuse his wife hs been unresponsive to him emotionlly nd hs shown no interest in sexul reltions. The reciprocl reltionship my render it difficult for therpist to discern which problem occurred first nd how ech ffects the other. Bech, Sndeen, nd O'Lery (2001) strongly suggested tht mritl disstisfction most often predtes depression. Mritl disstisfction is likely to led to n incresed risk of depression by reducing vilble support nd therefore contributing to the further liention nd isoltion of the depressed spouse. On the other hnd, Dvil (2001) proposed tht depression is most likely to predte mritl disstisfction with the depressive condition serving s n versive stimulus in the mritl reltionship. clinicin might legitimtely question which should be treted first, the dysfunction in the mritl reltionship or the depression. Even more confusing, clinicin might be chllenged by ptient to ddress the depression s wy to "distrct" tretment nd void deling with mritl or fmily issues. Like the two sides of coin, the pictures re seprte but inextricbly connected. Hence, they must be treted concomitntly. Couples therpy is lso supported in the professionl literture s the most efficcious mode of tretment for depression when it coexists with mritl problems (Bech, 2001). Bibliogrphy: 1. Brber JP, DeRubeis RJ. (2001). On second thought: where the ction is in cognitive therpy for depression. Cognitive Therapy, 13. 57-441. 2. Bech, S. R. H., Sndeen, E. E., & O'Lery, K. D. (2001). Depression in mrrige: model for etiology nd tretment. New York: Guilford Press, 81. 3. Butler G, Fennell M, Robson P, Gelder M. (2003). Comprison of behvior therpy nd cognitive behvior therpy in the tretment of generlized nxiety disorder. Clinical Psychology, 59, 75-167. 4. Dvil., J. (2001). Pths to unhppiness: The overlpping cuses of depression nd romntic dysfunction. Wshington, DC: Americn Psychologicl ssocition, 11, 12-15. 5. Med, D. E. (2002). Mritl distress, co-occurring depression nd mritl therpy: review Journl of Mritl nd Fmily Therpy, New York: Guilford Press, 28 (3), 299-314. 6. Moreu, D., Mufson, L., Weissmn, M. M., & Klermn, G. L. (1991). Interpersonl psychotherpy for dolescent depression: Description of modifiction nd preliminry ppliction. Journl of the mericn cdemy of Child nd dolescent Psychitry, 30, 642-651. 7. Mufson, L., & Moreu, D. (1998). Interpersonl psychotherpy for dolescent depression. In J. C. Mrkowitz (Ed.), Interpersonl psychotherpy (pp. 35-66). Wshington, DC: mericn Psychitric Press. 8. Mufson, L., Weissmn, M. M., Moreu, D., & Grfinkel, R. (1999). Efficcy of interpersonl psychotherpy for depressed dolescents. Archives of Generl Psychitry, 56, 573-579. 9. Nolen-Hoeksem, S. N., & Girgus, J. S. (1994). The emergence of gender differences in depression during dolescence. Psychologicl Bulletin, 115, 424-443. 10. Weissmn, M. M., & Mrkowitz, J. C. (2000). Interpersonl psychotherpy. Archives of Generl Psychitry, 51, 599-606. Read More