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

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

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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