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Depression Talk Therapy, M.Glaser, MD., Chicago There are primarily two categories of treatment for depression and anxiety. They are talk therapy and medication treatment. There are other far less commonly used treatments. This section will discuss talk therapy for adults and children. Types of Talk Therapy: There are many different philosophies and techniques of talk therapy. Talk therapy refers to when a therapist and patient talk to each other to improve the patient's depression. In most accepted types of talk therapy, the patient usually does most of the talking but not all of the talking. Now a days, the most common type of talk therapy is cognitive therapy linked with behavior therapy. Other common therapy types are psycho-analytic (aka psychodynamic), interpersonal therapy, family therapy, play therapy. Cognitive and Behavioral Therapy: This is the most common therapeutic technique today for relieving depression and anxiety. People tend to think of things in patterns unique to that person. We call those patterns "cognitive schema". People who are depressed or nervous often utilize schema that perpetuates the depression. A simple and common schemata is when a person who is depressed feels that the hole that they are in is impossible to get out of and they will be stuck in this miserable spot forever. However, when looking at their dilemma in a different way with the help of a therapist, the problem doesn't look so insurmountable. Since a person developes their schema (way of looking at things) based on a lifetime of feelings, thoughts, and events, schema are not always easy to change. Cognitive therapy involves usually once a week therapy for 3 to 12 months. Some times cognitive and behavioral therapy is time limitted with a termination date, other times it is ongoing. During the treatment sessions, the patient usually talks about their thoughts and experiences and the therapist asks questions and provides feedback. Behavioral therapy utilizes specific directives by the therapist for the patient to follow. For children and teenagers this can be a behavior chart that lists rewards and less often punishments for targeted behaviors like completing homework and respecting authority. Adult behavior therapy establishes a step by step plan of action to accomplish a set of tasks, such as a plan to get a new job. Another example would be for a person with a fear to step by step challenge the fear and conquer it. Psycho-analytic therapy is the kind made popular by Hollywood. It involves the patient lying on a couch and looking away from the therapist. Doctors who practice this style of treatment should go for several years additional education at an approved institute or psychoanalysis. Sigmund Freud invented this type of treatment. Its basic premise is to uncover the unconscious motivations for our actions, thoughts and interpretations of events and relationships. This type of treatment requires treatment sessions several times a week for several years. In this type of treatment, the patient does 98% of the talking. The therapist will occasionally provide an interpretation of unconscious thoughts. Some have described this therapy as a patient sitting in a train describing to the therapist what he sees. Within psychoanalysis there are many separate theories such as Self Psychology (my personal favorite) and Reichian, and others. Ana Freud, Sigmund's daughter developed play therapy in order to adapt psychoanalysis for children. Here, the child plays independently and the therapist will interact with the child as the child sees fit. Like in psychoanalytic therapy for adults and teenagers, unconscious thoughts are brought to light. Psychoanalytic therapy has three primary modalities. 1st is catharsis: allowing the appropriate expression of emotion that has either been suppressed or misdirected. 2nd is understanding what baggage you bring to a relationship so as to get a better understanding of your own needs. 3rd is to advance past whatever developmental stage you are stuck in and improve your defense mechanisms. Psychodynamic therapy is psychoanalysis light: less frequent sessions, you face towards the therapist and sit in a chair instead of lying on a couch, and less "analysis of the transference". Transference refers to how the therapist usually comes to represent past relationships to the patient. |
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